Training the trainers: The fundamental basis for guaranteeing the evolution of academic surgery in third world countries

Abstract

Dear Editor We read with great interest the article by Vlachou et al. [1] titled “The development and evaluation of “Training the trainer” curriculum for surgical residents: Feasibility study”, where the authors conducted an experimental study with the objective of designing a curriculum for residents to include the domains of pre-operative preparation, technical teaching and subsequent feedback. It was evidenced that this curriculum was well perceived, with improvements in technical errors and promotion of skills in the three domains, and maintaining these results in the medium term. We thank Vlachou et al. [1] for providing us with such valuable evidences. However, we consider it necessary to emphasize that to train the trainers according to the objectives of global surgery, it is necessary to involve residents and trainers in academic surgery and its pillars, especially in third world countries. With passage of time and emergence of difficulties in global health, medicine has been reformed to become more efficient and safer [2]. To counteract barriers in different regions of the world, programs cannot be designed to direct clinicians only to clinical practice, but also to involve in technical and scientific developments [3,4]. From this, academic medicine is born. Now, one such discipline that makes up this evolution is academic surgery, which has quickly made its mark with high production of evidence-based surgery [5]. Academic surgery focuses primarily on training surgeons with excellent surgical and non-surgical skills. Non-surgical skills include development of professionalism, research, teaching and evaluation skills, as well as healthy lifestyles for surgeons [5,6]. However, most available evidence and published studies came from high-income countries, although many tools can easily be replicated in third world countries [7,8], including mentoring, development of interest groups in surgery, creation of student scientific societies, fellowships in surgical research, among others [2–5]. In this way, it can be guaranteed that medical students with an interest in surgery, residents and specialists would be trained in research skills to produce evidences on surgical knowledge, techniques and treatment outcomes [2]. Several authors including Jayaram [6] and Lee [7] argued on the imperative need to design an academic curriculum based on hot topics of global surgery so that such an approach can lead to equitable production of knowledge to allow expansion of treatment outcomes to be obtained in different health systems [6,7]. At present, there is no convergence on acceptance of competencies in global academic surgery. Specialized knowledge networks are heterogeneous and access to quality services and education in surgery is deficient, particularly affecting third world countries [6]. We propose the priority of development in academic surgery in third world countries should focus on funding which allows development of quality, research training, promotion of professionalism and mentoring, and massive dissemination of evidence available in each region (Fig. 1).Fig. 1.: Proposed points to be developed to promote academic surgery in low- and middle-income countries [5]. Source: authors. Created with BioRender.As stated by Fitzgerald T [8], development of global surgery is the responsibility of an individual surgeon. Training of trainers and future trainers should go beyond their clinical practices, and to focus on surgical education on students and other professionals, quality research and scientific publications, and solving problems related to professionalism (doctor-patient interaction, interaction between colleagues, interaction between professors and students, racism, harassment, inequity, among others) [9,10]. Training the trainers could be a solution to accelerate growth of global academic surgery, promote leadership and enable healthy lifestyles for students, residents and specialists, and reduce gaps in surgeons’ comprehensive knowledge between their beliefs and the evidence [9,10]. This training should be focused primarily on academic surgery and all its components, but not to exclude development of technical skills [11]. This is a call for the design and massive dissemination of programs on academic surgery for early surgical training of medical students with an interest in surgery, residents and trainee surgeons to accomplish the objectives of global surgery in the short-, medium- and long-term, and to excel in academic surgery in a definite way in third world countries. Ethical approval It is not necessary. Sources of funding None. Author contribution All authors equally contributed to the analysis and writing of the manuscript. Provenance and peer review Not commissioned, internally peer-reviewed. Research registration Unique Identifying number (UIN) 1. Name of the registry: Not applicable. 2. Unique Identifying number or registration ID: Not applicable. 3. Hyperlink to your specific registration (must be publicly accessible and will be checked): Not applicable. Guarantor Ivan David Lozada-Martinez, Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia. Email: [email protected]. Declaration of competing interest None.