title: Surgical simulation in Africa: the feasibility and impact of a 3-day fundamentals of laparoscopic surgery course.
abstract: BACKGROUND
  The use of laparoscopy in resource-restricted countries has increased in recent years. Although simulation is now considered an important adjunct to operating-room-based training for learning laparoscopic skills, there is very little literature assessing the use of simulation in resource-restricted countries. The purpose of this study was to determine the feasibility and impact of a 3-day Fundamentals of Laparoscopic Surgery (FLS) course in Botswana, Africa.
  
  
  METHODS
  A total of 20 surgeons and trainees participated in a 3-day FLS course. A pretest FLS score was obtained for each subject, followed by 2 days of practice with feedback. A final FLS posttest score was then obtained. Participants also watched the FLS instructional CD-ROM and took the written test on day 3.
  
  
  RESULTS
  Mean posttest scores were significantly higher than pretest scores for each FLS task and for the total normalized FLS simulator score (285 +/- 94 versus 132 +/- 92, p < 0.001). The mean score on the written test was 242 (116). In total, only two surgeons achieved a passing score on both the cognitive and skills assessment required to obtain FLS certification.
  
  
  CONCLUSIONS
  To our knowledge, this is the first time the FLS program has been taught in Africa. We have shown that giving the FLS course in a resource-restricted country is feasible and resulted in a significant improvement in FLS technical skills after 3 days. Most surgeons, however, still did not reach FLS passing scores, indicating that more than 3 days will be required in future courses to help surgeons obtain FLS certification.
authors.affiliation: Department of Surgery, Toronto Western Hospital - University Health Network, 8th Floor, Main Pavilion, Rm 325, M5T 2S8, Toronto, ON, Canada. allan.okrainec@uhn.on.ca
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
authors.forename: Lloyd
authors.initials: L
authors.lastname: Smith
authors.forename: Georges
authors.initials: G
authors.lastname: Azzie