title: The effect of a new surgery residency program on case volume and case complexity in a sub-Saharan African hospital.
abstract: BACKGROUND
  Improved access to surgical care could prevent a significant burden of disease and disability-adjusted life years, and workforce shortages are the biggest obstacle to surgical care. To address this shortage, a 5-year surgical residency program was established at Kamuzu Central Hospital (KCH) in July 2009. As the residency enters its fourth year, we hypothesized that the initiation of a general surgical residency program would result in an increase in the overall case volume and complexity at KCH.
  
  
  METHODS
  We conducted a retrospective analysis of operated cases at KCH during the 3 years before and the third year after the implementation of the KCH surgical residency program, from July 2006 to July 2009 and the calendar year 2012, respectively.
  
  
  RESULTS
  During the 3 years before the initiation of the surgical residency, an average of 2317 operations were performed per year, whereas in 2012, 2773 operations were performed, representing a 20% increase. Before residency, an average of 1191 major operations per year were performed, and in 2012, 1501 major operations were performed, representing a 26% increase.
  
  
  CONCLUSIONS
  Our study demonstrates that operative case volume and complexity increase following the initiation of a surgical residency program in a sub-Saharan tertiary hospital. We believe that by building on established partnerships and emphasizing education, research, and clinical care, we can start to tackle the issues of surgical access and care.
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Claire
authors.initials: C
authors.lastname: Kendig
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Anna
authors.initials: A
authors.lastname: Tyson
authors.affiliation: Haukeland University Hospital, Bergen, Norway.
authors.forename: Sven
authors.initials: S
authors.lastname: Young
authors.affiliation: Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
authors.forename: Charles
authors.initials: C
authors.lastname: Mabedi
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Bruce
authors.initials: B
authors.lastname: Cairns
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, North Carolina; Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi. Electronic address: anthchar@med.unc.edu.
authors.forename: Anthony
authors.initials: A
authors.lastname: Charles
mesh_terms: D017954:Africa South of the Sahara; D013502:General Surgery / Q000193:education*; D007396:Internship and Residency; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D016526:Workload
keywords: Global Health; Global Surgery; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; Surgical Education in Sub Saharan Africa; Surgical Workforce; Systems-Based Practice and Professionalism