The effect of the Dar es Salaam neurosurgery training course on self-reported neurosurgical knowledge and confidence

Abstract

Introduction: The Muhimbili Orthopaedic Institute in collaboration with Weill Cornell Medicine organises an annual neurosurgery training course in Dar es Salaam, Tanzania. The course teaches theory and practical skills in neurotrauma, neurosurgery, and neurointensive care to attendees from across Tanzania and East Africa. This is the only neurosurgical course in Tanzania, where there are few neurosurgeons and limited access to neurosurgical care and equipment.

Research question: To investigate the change in self-reported knowledge and confidence in neurosurgical topics amongst the 2022 course attendees.

Material and methods: Course participants completed pre and post course questionnaires about their background and self-rated their knowledge and confidence in neurosurgical topics on a five point scale from one (poor) to five (excellent). Responses after the course were compared with those before the course.

Results: Four hundred and seventy participants registered for the course, of whom 395(84%) practiced in Tanzania. Experience ranged from students and newly qualified professionals to nurses with more than 10 years of experience and specialist doctors. Both doctors and nurses reported improved knowledge and confidence across all neurosurgical topics following the course. Topics with lower self-ratings prior to the course showed greater improvement. These included neurovascular, neuro-oncology, and minimally invasive spine surgery topics. Suggestions for improvement were mostly related to logistics and course delivery rather than content.

Discussion and conclusion: The course reached a wide range of health care professionals in the region and improved neurosurgical knowledge, which should benefit patient care in this underserved region.

Keywords: East Africa; Education; Neurosurgery; Tanzania; Traumatic brain injury; Traumatic spinal cord injury.

Fig. 1

Flow Diagram of Respondents Number of participants completing the questionnaires and reasons for exclusions. Duplicate entries for the same person were removed. For the pre and post course comparison only those completing both pre and post course questionnaires were included. There was one nurse and 8 doctors who completed the post-course questionnaire without completing the pre-course questionnaire.

Fig. 2

Map of Attendees The current hospital of work for participants from the East Africa region is plotted. Number of participants from each location is represented by the size of the point (see key). Participants attending from outside this region are not shown.

Fig. 3

Self-reported knowledge and confidence on neurosurgical topics of doctors attending the course Doctors rated themselves on a scale from 1 (poor, shown in light green) to 5 (excellent) shown in dark green, see key). Pre-course results are shown on the left and post-course results on the right. Each row of graphs represents a topic, with the skills in that topic listed on the x axis. There were 144 responses for each question, scaled to 100%. The skills assessed reflect the course topics. The skill of ‘Basic Principles’ was only assessed for lumbar minimally invasive surgery (MIS), and the skill of ‘Perform Surgery’ was not assessed for management of intracranial aneurysms. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 4

Self reported knowledge and confidence in research skills Doctors were asked to rate their research skills before and after the course. The ratings were from 1 (poor, shown in light green) to 5 (excellent, shown in dark green, see key). There were 144 respondents for each question, and the data is scaled so each bar represents 100%. Skills assessed are shown along the x axis. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 5

Self-reported knowledge and confidence on neurosurgical topics of nurses attending the course Nurses rated themselves on a scale from 1 (poor, shown in light purple) to 5 (excellent) shown in dark purple, see key). Pre-course results are shown on the left and post-course results on the right. Each row of graphs represents a topic, with the skills in that topic listed on the x axis. There were 45 responses for each question. The skills assessed reflect the course topics. Some topics had more than one question per skill, and some skills were not asked about in some topics. Responses are scaled to represent 100% of answers for each topic in each skill. Pituitary adenomas, posterior fossa tumours, and other generic brain tumour questions were all assigned to the brain tumour topic. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 6

Assessment of Course Education Level by Profession All participants were asked to assess whether the level of the course was too basic, satisfactory, or too advanced. Responses split by profession are shown in the bar chart. All participants completing the post course questionnaires were included regardless of whether the pre course questionnaire was completed (n ​= ​198).