A NEW SURGICAL SKILLS CENTER IN MBARARA

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Tina Mirembe, Dr. Mark Varavares, and Emmanuel Opolot with one of the newly-installed stations.

This past September saw the arrival of the core of a modern surgical skills lab at Mbarara University of Science and Technology (MUST) in Uganda. Simulated surgical skills training has been widely recognized as a vital part of modern surgical training and has been made a compulsory part of surgical education in many parts of the world. Surgical skills training has been shown to improve operating room performance for surgical trainees and lead to increased patient safety, decreased operating room time, and decreased surgical complications. In academic medical centers where operating room time is restricted due to resource management, simulated surgical skills training is especially necessary to compensate for limited surgical exposure.

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Dr. Doreen Nakku, Dr. Mack Cheney (OGSH), Dr. Brian Westerberg, Emmanuel Opolot, Tina Mirembe, and Dennis Lukaya (MUST) discuss infrastructure changes to the surgical skills lab space.

The lab, originally part of the Temporal Bone Dissection Lab at Massachusetts Eye and Ear, includes four stations equipped with Zeiss microscopes with foot pedal control units and vacuum system and a teaching station with endoscopy camera and flat panel monitor. Warehoused and refurbished by IMEC, a non-profit specializing in responsible medical equipment donation, the stations were shipped in coordination with MUST administration and faculty, including Vice Chancellor Celestino Obua, Dean Samuel Maling, Dr. Doreen Nakku (ENT), and Dennis Lukaya (MUST Public Relations). MUST funded the shipping and installation costs for the stations and will coordinate future training courses. Dr. Nakku and Dr. John Onyango (Ophthalmology) will partner in coordinating use of the lab and exploring its potential as a host for multidisciplinary regional training courses.  The first temporal bone course is set to be taught by Dr. Brian Westerberg, an otologist at UBC, and will be attended by ENT residents from MUST and Makerere University (Kampala, Uganda).

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The teaching station in its new home at Mbarara University and Referral Hospital Eye Centre=

During the week of September 28th, teams from both the Mass Eye and Ear (OGSH) and the Canadian ENT group were onsite to oversee the installation of the surgical skills center, lead academic modules for ENT residents and faculty on head and neck surgery and rhinology, and support MUST ENT faculty running a clinical officers’ training course. Tina Mirembe, a biomedical engineer based in Vancouver, who has been active with the School of Biomedical Sciences at Makerere University, and Emmanuel Opolot, a graduate of the program, were instrumental to the project’s success. Both engineers were onsite to unpack and install the stations, troubleshoot equipment issues, and provide invaluable expertise and guidance in transitioning the lab to its new space, including the necessary power and plumbing infrastructure needs. The surgical skills lab is now hosted in the Mbarara University and Referral Hospital Eye Center, next to the CAMTech (Consortium for Affordable Medical Technology) facility.

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Biomedical engineers Tina Mirembe (Vancouver) and Emmanuel Opolot (Mulago National Referral Hospital) install the teaching station.

Medtronic is currently in discussions with MUST and the OGSH on how to partner with the skills lab through both their philanthropic and emerging markets arms. The East Africa Regional Office for Medtronic is actively engaged in supporting and encouraging regional surgical skills development in their core medical device areas, leading to a fortunate meeting of interests. This partnership has the potential to bolster the surgical skills center’s impact as a hub for multi-disciplinary skills training for the region.  While the new surgical skills lab originally served as a Temporal Bone Dissection Laboratory, in its new incarnation it will support training for a variety of surgical subspecialties including ophthalmology, neurosurgery, orthopedics, and plastics.

Access to Temporal Bone Dissection Courses is a prerequisite for any surgeon performing modern specialized ear surgery. The number of Temporal Bone Courses offered in East Africa is severely limited, and the addition of such a resource to Mbarara has the potential to increase ENT training opportunities for not only Mbarara, but for much of Central and Eastern Africa. As with the Temporal Bone Lab located at the University of Nairobi, the Mbarara Regional Temporal Bone Lab is set to offer courses taught by visiting and local faculty to interested ENT Faculty, private physicians, and MMeds/trainees from other programs. Diversifying and advancing surgical services offered and taught by MUST and the other ENT postgraduate training programs in the region requires embracing new methods of surgical training and reinforcement.


 

In 2013, the Office of Global Surgery and Health (OGSH) at Mass Eye and Ear and MUST entered into an academic partnership to augment the ENT MMed (post-graduate) program. Over the past two years, five Mass Eye and Ear faculty teams have visited MUST to teach on a variety of subspecialty topics, including laryngology, rhinology, and head and neck surgery, with another faculty visit coming next month. In addition to the OGSH, the Dr. Brian Westerberg (UBC) leads a team of Canadian ENT surgeons that has also begun a partnership with MUST, focusing on otology training, education, and outreach.   Between these two groups, there are approximately 4 onsite faculty rotations at MUST annually in addition to distance learning, research mentorship, data collection (OGSH funds outcomes research for inpatients and outpatients), testing assessments (both programs utilize a uniform system of oral, skill-based, and written exams to evaluate intervention impact and assess retention), and resident exchanges. The goals for this collaboration are to support the development of the MUST Department of Otolaryngology as a premier center for modern ENT training led by Ugandan subspecialty faculty and, through capacity-building, demonstrate an impact on improved patient outcomes and surgical access.

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