title: Efficacy of Surgical Simulation Training in a Low-Income Country.
abstract: Simulation training has evolved as an important component of postgraduate surgical education and has shown to be effective in teaching procedural skills. Despite potential benefits to low- and middle-income countries (LMIC), simulation training is predominately used in high-income settings. This study evaluates the effectiveness of simulation training in one LMIC (Rwanda).
  
  
  
  Twenty-six postgraduate surgical trainees at the University of Rwanda (Kigali, Rwanda) and Dalhousie University (Halifax, Canada) participated in the study. Participants attended one 3-hour simulation session using a high-fidelity, tissue-based model simulating the creation of an end ileostomy. Each participant was anonymously recorded completing the assigned task at three time points: prior to, immediately following, and 90 days following the simulation training. A single blinded expert reviewer assessed the performance using the Objective Structured Assessment of Technical Skill (OSATS) instrument.
  
  
  
  The mean OSATS score improvement for participants who completed all the assessments was 6.1 points [95 % Confidence Interval (CI) 2.2-9.9, p = 0.005]. Improvement was sustained over a 90-day period with a mean improvement of 4.1 points between the first and third attempts (95 % CI 0.3-7.9, p = 0.038). Simulation training was effective in both study sites, though most gains occurred with junior-level learners, with a mean improvement of 8.3 points (95 % CI 5.1-11.6, p < 0.001). Significant improvements were not identified for senior-level learners.
  
  
  
  This study supports the benefit for simulation in surgical training in LMICs. Skill improvements were limited to junior-level trainees. This work provides justification for investment in simulation-based curricula in Rwanda and potentially other LMICs.
authors.affiliation: Department of Surgery, Division of General Surgery, Dalhousie University, Room 8-821, 1276 South Park Street, Halifax, NS, B3H2Y9, Canada. gtansley@dal.ca.
authors.forename: Gavin
authors.initials: G
authors.lastname: Tansley
authors.affiliation: Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Bailey
authors.affiliation: Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: Yuqi
authors.initials: Y
authors.lastname: Gu
authors.affiliation: Department of Surgery, Division of General Surgery, Dalhousie University, Room 8-821, 1276 South Park Street, Halifax, NS, B3H2Y9, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Murray
authors.affiliation: Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Livingston
authors.affiliation: Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda.
authors.forename: Ntakiyiruta
authors.initials: N
authors.lastname: Georges
authors.affiliation: Department of Surgery, Division of General Surgery, Dalhousie University, Room 8-821, 1276 South Park Street, Halifax, NS, B3H2Y9, Canada.
authors.forename: Marius
authors.initials: M
authors.lastname: Hoogerboord
mesh_terms: D002170:Canada; D002983:Clinical Competence; D003479:Curriculum / Q000592:standards*; D019049:Developed Countries; D003906:Developing Countries; D004503:Education, Medical, Graduate / Q000592:standards*; D004521:Educational Measurement; D013502:General Surgery / Q000193:education*; D006801:Humans; D007081:Ileostomy / Q000193:education*; D007396:Internship and Residency / Q000379:methods / Q000592:standards*; D011203:Poverty; D012432:Rwanda; D000066908:Simulation Training / Q000592:standards*; D012959:Socioeconomic Factors