Learning Skills During Surgical Camps

By Dr. J. Gnanaraj and Dr. A. Awojobi

Training in surgical skills involves learning, understanding, practicing and repetition. At most of the places where young surgeons train, the number of patients available is insufficient for the trainees to repeat the surgical procedures many times within a short period of time. The repetitions help in fine tuning the skills, while correcting any mistakes, if any occur, with close supervision. The earlier the repletion is carried out, the better it is for learning.

We present how surgical camps could be used for training in surgery, especially for minimally invasive surgery. The training consists of an initial online course, followed by training in simulators and then finally hands-on training during surgical camps.

Methods

Two online courses are available through the Karunya University: one for Gasless or Lift Laparoscopic surgeries and the other for Minimally Invasive Surgery for rural surgeons. The courses are not time-bound and could be done whenever it is convenient.

Practical skills like depth perception, hand-eye co-ordination, etc., are taught using trainer boxes (1). The following training methods are used:

1. Laparoscopic suturing: Two gauze pieces are held close together and tight. Suturing is practiced using ordinary sewing thread.
2. Tying of knots: This is practiced using pieces of gauze and an adapted lift apparatus.
3. Excising the appendix: The fingers of an examination glove are used for simulating the appendix.
4. Simulation of dissection using Velcro pieces stuck to dome, etc.

Hands-on training under strict supervision is then offered during the surgical camps (2).

Results

Data from 2003 to 2014 from a mission hospital in Northeast India and a charitable Non-Governmental Organization entered into Hospital Management software were analyzed. During this period there were 116 surgical camps at 29 different rural hospitals. About 23 junior surgeons either accompanied the team or were at the local hospital to learn. Most of them did not do the online course, as this was started only recently, and only 4 had enrolled for the course. The surgical camps were typically for 3 to 4 days at a place, and most of the time was combined with another place.
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