title: A novel approach for needs assessment to build global orthopedic surgical capacity in a low-income country.
abstract: OBJECTIVE
  Visiting surgical teams are a vital aspect of capacity-building continuing medical education (CME) in low-income countries like Haiti. Imperfect understanding of the genuine needs of local surgeons limit CME initiatives. Previous paper-based needs assessment efforts have been unsuccessful because of low response rates. We explored using an electronic audience response system (ARS) during a Haitian CME conference to improve the response rates and better assess needs.
  
  
  METHODS
  Data were prospectively collected using an ARS from 78 conference participants (57 Haitian and 21 foreign) about current and desired knowledge of 7 topic and 8 skill areas using a 5-point Likert scale presented in English and in French. The response rates using ARS vs a similar paper survey were compared using a 2-sample test of proportions. The current and desired knowledge levels were compared using paired t tests. Analysis of variance and post hoc unpaired t tests were used to compare between demographic groups.
  
  
  RESULTS
  The response rates were significantly greater for ARS vs a paper survey (87.7 vs 63.2%, p = 0.002). The 4 areas of least self-confidence for Haitians were pelvic and articular injury, joint dislocation, and osteomyelitis. The 4 skills of least self-confidence for Haitians were arthroscopy, open reduction and internal fixation-plate, external fixation, and fasciotomy. Haitians desired improvements in knowledge and management of articular, diaphyseal, and pelvic injury, joint dislocation, and osteomyelitis to a greater extent than foreigners (p < 0.05). Participants who previously attended the conference on open fractures felt more knowledgeable about open fractures as a topic (p < 0.05), but not in its management.
  
  
  CONCLUSIONS
  We are the first to show that an ARS improves response rates to allow for better characterization of surgeon needs in the developing world. We also demonstrate the importance of skill building paired with topic area teaching. Lastly, we show how a CME conference is an effective tool to build surgical capacity and increase confidence level.
authors.affiliation: Harvard Medical School, Boston, Massachusetts. Electronic address: abhiram_bhashyam@hms.harvard.edu.
authors.forename: Abhiram R
authors.initials: AR
authors.lastname: Bhashyam
authors.affiliation: Program in Global Surgery and Social Change, Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Jacky
authors.initials: J
authors.lastname: Fils
authors.affiliation: Harvard Medical School, Boston, Massachusetts.
authors.forename: Jim
authors.initials: J
authors.lastname: Lowell
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Program in Global Surgery and Social Change, Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: John G
authors.initials: JG
authors.lastname: Meara
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts.
authors.forename: George S M
authors.initials: GS
authors.lastname: Dyer
mesh_terms: D005260:Female; D014943:Global Health; D006205:Haiti; D006301:Health Services Needs and Demand / Q000639:trends*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D020380:Needs Assessment; D009985:Orthopedics / Q000193:education*; D010820:Physicians; D011203:Poverty; D011446:Prospective Studies; D011795:Surveys and Questionnaires
keywords: Medical Knowledge; Practice-Based Learning and Improvement; Systems-Based Practice; continuing medical education; education technology; global health; orthopedic surgery; professional development