A. Chichom-Mefire1, G. N. Keith1, P. Fokam1, D. S. Nsagha1, M. Ngowe-Ngowe1 1Faculty of Health Sciences, University of Buea,Department Of Surgery,Buea, Cameroon
Introduction: Surgery plays an important role in provision and support of primary health care services. The World Health Organization recommends that basic surgical care be administered at the district level. Due to limited availability of qualified surgeons, general practitioners need to be competent in a number of practical surgical skills in order to reduce the number of referrals for emergency and selected elective surgical procedures. Curriculum of medical schools in low and middle-income countries must be designed accordingly. The aim of this study was to report the level of exposure of final year medical students to practical surgical skills.
Methods:
A descriptive cross-sectional study was carried out in the four state owned medical schools in Cameroon. The target population was final year medical students who have completed all clinical rotations. All final year medical students were approached.
A structured self-administered questionnaire was proposed to these students in order to assess their exposure to basic surgical skills and selected surgical procedures. Self-confidence in performing basic surgical skills (BSS) was assessed using a Likert scale. Adequate exposure for a given surgical procedure was defined as at least one of the following: (1) observing the procedure five or more times and participating as fist assistant at least four times and performing it at least once under supervision. (2) Observing the procedure five times and participating as first assistant at least five times. Data analysis was performed using EPI INFO version 7.2 and statistical significance was set at P < 0.05.
Results:
Of the 347 final year medical students approached, 304 returned filled questionnaires giving a response rate of 87.6%. Male to female ratio was 5:4 and females were significantly younger than males (P < 0.001). Their comfort in basic surgical skills ranged from 25% (manual surgical node tying) to 86% (surgical scrubbing). Adequate exposure to selected surgical procedures was 87% for perineal tear repair after vaginal delivery, 81% for caesarean section and incision and drainage of an abscess, 73% for cast immobilisation of a limb fracture, 55% for hernia repair and 53% for appendectomy. It was as low as 3% for bowel resection and anastomosis. The choice to perform extra-curricular activity for skills improvement was significantly associated with adequate exposure (P < 0.05).
Conclusion:
Overall, the performance rate of practical surgical skills by final year medical students in medical schools in Cameroon is poor. However, the majority of students are likely to be able to perform a sizeable number of surgical procedures by the end of their training. There is need to reinforce the training and assessment to ensure that medical students who do not master basic clinical skills and are not adequately exposed to common procedures are given an opportunity to be exposed before graduation.