Addressing the severe shortage of health care providers in Ethiopia: bench model teaching of technical skills

Abstract

There is a severe shortage of health care workers in Ethiopia. This situation must be addressed by the efficient training of mass cohorts of students. This study aimed to demonstrate that bench model training is a feasible approach to teaching surgical skills in Ethiopia. A pre-test, simulation-based training intervention and post-test design was used. Two objective structured assessments of technical skills (OSATS) and a bench-top simulation training session were administered at the Black Lion Hospital, Addis Ababa, Ethiopia. Participants included 19 surgical residents who volunteered as trainees. Five surgical faculty members and one senior resident from the Black Lion Hospital, as well as two faculty members from the University of Toronto, participated as trainers and evaluators. The intervention consisted of OSATS tests comprising four stations, covering knot tying, closure of skin laceration, elliptical excision and bowel anastomosis. Tests were separated by 2-hour practice sessions. Main outcome measures included previously validated instruments comprising global rating scales (GRS) and skill-specific checklists (SSC). The measures showed no improvement on knot tying (GRS: P = 0.14; SSC: P = 0.7), marginal improvement on closure of laceration (GRS: P = 0.48; SSC: P = 0.003), and improvements on excision (GRS: P = 0.012; SSC: P = 0.003) and bowel anastomosis (GRS: P < 0.001; SSC: P < 0.001). The bench models and scoring schemes developed in Toronto, Canada were directly applicable in Addis Ababa, Ethiopia. This approach may prove a feasible, safe and cost-effective method for training a multitude of health care professionals in technical skills and may help to address the human resources deficit in Africa.