title: Centralized, capacity-building training of Lichtenstein hernioplasty in Brazil.
abstract: BACKGROUND
  In Brazil, access to healthcare varies widely by community. Options for repair of surgically correctable conditions, such as inguinal hernias, are limited. A training program was instituted to expand access to Lichtenstein hernioplasty.
  
  
  METHODS
  Between September, 2014 and September, 2015, 3 orders of training series took place in São Paulo, Brazil. Participating surgeons received training and assessments from expert trainers using the Operative Performance Rating Scale (OPRS). Those who completed training successfully were invited to become trainers. OPRS scores were compared between training series. Outcomes were documented up to 6 months post-training.
  
  
  RESULTS
  The 3 orders of training series resulted in 45 surgeons trained and 213 hernias repaired. Eleven trainees subsequently became trainers. Mean post-training OPRS scores were 4.4 (scale of 5) and did not vary significantly between training series. The overall complication rate was 4.7%, with no hernia recurrences or reoperations at 6 months.
  
  
  CONCLUSIONS
  Competency-based training generates a regional network of surgeons proficient in Lichtenstein hernioplasty. Each training session progressively expands patient access to high quality operations in underserved communities in Brazil.
authors.affiliation: David Geffen School of Medicine of UCLA, Los Angeles, CA, USA.
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Moore
authors.affiliation: David Geffen School of Medicine of UCLA, Los Angeles, CA, USA.
authors.forename: Néha
authors.initials: N
authors.lastname: Datta
authors.affiliation: David Geffen School of Medicine of UCLA, Los Angeles, CA, USA. Electronic address: jwagner@mednet.ucla.edu.
authors.forename: Justin P
authors.initials: JP
authors.lastname: Wagner
authors.affiliation: Creighton University School of Medicine, Omaha, NE, USA.
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Schroeder
authors.affiliation: Wilhelmsburg Hospital, Gross-Sand, Hamburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Reinpold
authors.affiliation: School of Medical Sciences of Santa Casa de São Paulo, São Paulo, Brazil.
authors.forename: Maurice Y
authors.initials: MY
authors.lastname: Franciss
authors.affiliation: School of Medical Sciences of Santa Casa de São Paulo, São Paulo, Brazil.
authors.forename: Rodrigo A
authors.initials: RA
authors.lastname: Silva
authors.affiliation: David Geffen School of Medicine of UCLA, Los Angeles, CA, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Chen
authors.affiliation: Creighton University School of Medicine, Omaha, NE, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Filipi
authors.affiliation: School of Medical Sciences of Santa Casa de São Paulo, São Paulo, Brazil.
authors.forename: Sergio
authors.initials: S
authors.lastname: Roll
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D003162:Competency-Based Education / Q000458:organization & administration*; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility; D006552:Hernia, Inguinal / Q000601:surgery; D059685:Herniorrhaphy / Q000193:education* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Brazil; Inguinal hernia; Lichtenstein hernioplasty; Surgical education