title: Implementation of a low-cost laparoscopic skills curriculum in a third-world setting.
abstract: BACKGROUND
  Training outside the operating room has become a mainstay of surgical education. Laparoscopic training often takes place in a simulation setting. Advanced laparoscopic procedures are now commonplace, even in third-world countries with minimal hospital resources. We sought to implement a low-cost laparoscopic skills curriculum in a general surgery residency program in East Africa.
  
  
  METHODS
  The laparoscopic skills curriculum created and validated at the University of Kentucky was presented to the 10 general surgery residents at Tenwek Hospital. The curriculum and all materials were purchased for approximately $50 (USD). The residents in Kenya had access to laparoscopic trainer boxes and personal laptops to perform the simulations. Residents were timed on their performance at the initiation of the project and after 3 weeks of practice.
  
  
  RESULTS
  Residents were tested on 3 separate tasks (cannulation drill, peg board, and rope pass). At the initiation of the project, residents were unable to complete the 3 tasks chosen for timing without a critical error (i.e., dropping a peg out of view). After 3 weeks of independent practice, residents were able to successfully complete the tasks, nearing the time limits established in the curriculum manual. Additional practice and testing sessions are scheduled for the remainder of the year.
  
  
  CONCLUSIONS
  Implementation of a low-cost laparoscopic skills curriculum in a third-world setting is feasible. This approach offers much-needed exposure and opportunities for residents with extremely limited resources and promises to be a vital aspect of the growing surgical residency training in third-world settings.
authors.affiliation: Department of General Surgery, University of Kentucky, Lexington, Kentucky. Electronic address: Kristin.long@uky.edu.
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Long
authors.affiliation: Department of Surgery, Tenwek Hospital, Bomet, Kenya.
authors.forename: Carol
authors.initials: C
authors.lastname: Spears
authors.affiliation: Department of General Surgery, University of Kentucky, Lexington, Kentucky.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Kenady
authors.affiliation: Department of General Surgery, University of Kentucky, Lexington, Kentucky.
authors.forename: John Scott
authors.initials: JS
authors.lastname: Roth
mesh_terms: D003479:Curriculum; D003906:Developing Countries; D004503:Education, Medical, Graduate / Q000191:economics*; D006801:Humans; D007396:Internship and Residency; D007630:Kenya; D010535:Laparoscopy / Q000193:education*
keywords: Africa; Interpersonal and Communication Skills; Medical Knowledge; Practice-Based Learning and Improvement; Systems-Based Practice; curriculum; international; laparoscopic; resident; surgical education