Original Investigation
Pacific Coast Surgical Association
November 2015

A Consortium Approach to Surgical Education in a Developing CountryEducational Needs Assessment

Author Affiliations
  • 1Department of Surgery, Oregon Health & Science University, Portland
  • 2Department of Surgery, University of California, San Francisco
  • 3Department of Public Health, University of California, Berkeley
  • 4Alliance for Global Clinical Training, San Francisco, California
  • 5Hofmann Healthcare Group, Moraga, California
  • 6Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Surg. 2015;150(11):1074-1078. doi:10.1001/jamasurg.2015.2205

Importance  Surgical disease is a global health priority, and improving surgical care requires local capacity building. Single-institution partnerships and surgical missions are logistically limited. The Alliance for Global Clinical Training (hereafter the Alliance) is a consortium of US surgical departments that aims to provide continuous educational support at the Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (MUHAS). To our knowledge, the Alliance is the first multi-institutional international surgical collaboration to be described in the literature.

Objective  To assess if the Alliance is effectively responding to the educational needs of MUHAS and Muhimbili National Hospital surgeons.

Design, Setting, and Participants  During an initial 13-month program (July 1, 2013, to August 31, 2014), faculty and resident teams from 3 US academic surgical programs rotated at MUHAS as physicians and teachers for 1 month each. To assess the value of the project, we administered anonymous surveys.

Main Outcomes and Measures  Anonymous surveys were analyzed on a 5-point Likert-type scale. Free-text answers were analyzed for common themes.

Results  During the study period, Alliance members were present at MUHAS for 8 months (1 month each). At the conclusion of the first year of collaboration, 15 MUHAS faculty and 22 MUHAS residents completed the survey. The following 6 areas of educational needs were identified: formal didactics, increased clinical mentorship, longer-term Alliance presence, equitable distribution of teaching time, improved coordination and language skills, and reciprocal exchange rotations at US hospitals. The MUHAS faculty and residents agreed that Alliance members contributed to improved patient care and resident education.

Conclusions and Relevance  A multi-institutional international surgical partnership is possible and leads to perceived improvements in patient care and resident learning. Alliance surgeons must continue to focus on training Tanzanian surgeons. Improving the volunteer surgeons’ Swahili-language skills would be an asset. Future efforts should provide more teaching coverage, equitably distribute educational support among all MUHAS surgeons, and collaboratively develop a formal surgical curriculum.