A thematic review of the use of electronic logbooks for surgical assessment in sub-Saharan Africa
Introduction
Dubbed the ‘neglected step-child of global health’,1 conditions amenable to surgical treatment account for as much as 30% of the global burden of disease2 and kill more people each year than HIV/AIDS, tuberculosis, and malaria combined.3 Despite this, there remain substantial deficits in the surgical workforce in low and middle income (LMIC) regions, particularly in sub–Saharan Africa. Whilst almost half of the world's population live in low resource settings, these same regions are home to only 19% of the global surgical workforce, with further disparities present between rural and urban areas.4,5
The 2015 Lancet Commission6 identified training and education of the surgical workforce as one of the key indicators of measuring universal access to safe, affordable surgical and anaesthesia care, and set a minimum target of securing at least 20 surgical, anaesthetics, and obstetric physicians per 100,000 population in every country across the world by 2030. Investing in the expansion of national surgical training programmes in LMICs is recognised as an essential step in addressing these workforce shortages.7 Moreover, ensuring that these surgical training programmes provide high quality training, including adequate operative experience, is of crucial importance in meeting these goals. This is particularly important in sub-Saharan African settings, where trained specialist surgeons play an important role in the clinical governance of health systems which rely heavily on the work of non-physician clinical providers.8
Surgical training programmes in high income countries rely on data recorded in trainee logbooks as a key indicator for both individual trainee progression and the quality of surgical training programmes.9 Increasingly, electronic online logbooks (eLogbooks) are being deployed as these allow real time review of trends and data mining to analyse both trainee progression and training programme performance.10 Indeed, there has been a recent proliferation of apps and websites on which eLogbooks are hosted.11,12 However, eLogbooks have only recently been adopted throughout the Global South and analysis of their use has been limited.
In this review, we analyse the literature relating to the use of electronic logbooks (eLogbooks) for assessment within surgical training schemes in sub-Saharan Africa, with a view to identifying the learning to date and areas for future research.
Section snippets
Methods
With the assistance of a subject librarian, we carried out a comprehensive search of the literature on the use of eLogbooks for surgical training in sub-Saharan Africa using PubMed and Google Scholar in June 2021. We used keywords and Medical Subject Headings (MeSH) terms: logbook, electronic logbook, surgery, assessment, low- and middle-income countries (LMICs), sub-Saharan Africa, in varying combinations. References from those studies identified were searched manually for additional relevant
Results
Whilst there are multiple papers highlighting the use of surgical eLogbooks in high-income countries, we identified only three papers which discussed their use in LMICs,13, 14, 15 all of which were based in sub-Saharan Africa. Two of the papers analysed the use of the eLogbook at The College of Surgeons of East, Central and Southern Africa (COSECSA),14,15 whilst the other paper was based on research carried out into the eLogbook in use at the Pan-African Academy of Christian Surgeons (PAACS).13
Discussion
Most surgical training programmes around the world still use a modified model of graduated experience under close supervision originally described by Halsted in 1904.16 Students are exposed to repetitive opportunities to treat surgical patients under close supervision, before progressing on to increased levels of independent work in the later years of training. Surgical experience is considered an important indicator of trainee progression.17 Indeed, studies in multiple sub-specialties
Conclusions
Robust data to demonstrate trainee progression and the quality of surgical training programmes are of crucial importance in ensuring that surgical training programmes can rapidly scale up to rapidly deliver large numbers of well-trained surgical providers to address the unmet patient need in LMICs in the next decade. The limited data on the use of well designed, centralised electronic surgical logbooks indicate that this tool may play an important role in providing key data to underpin these
Declaration of competing interest
None.
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