Interesting survey of sub-saharan ECSA training institutions was publushed by the London School of Hygiene and Tropical Medicine… Trabeculectomy remains difficult to master during ophthalmology resudency in Sub-Saharan Africa (ECSA Region). The majority master MSICS cataract surgeries. Phaco numbers remains close to zero, as it is mainly irrelevant skill for the majority of areas in the region: expensive, barely better as MSICS.
Wellcome Open Res. 2019 Nov 27;4:187. doi: 10.12688/wellcomeopenres.15580.1. eCollection 2019.
Survey of ophthalmologists-in-training in Eastern, Central and Southern Africa: A regional focus on ophthalmic surgical education.
Dean W1,2, Gichuhi S3, Buchan J1, Matende I4, Graham R5, Kim M6, Arunga S1, Makupa W7, Cook C2, Visser L8, Burton M1,9.
1. International Centre for Eye Health (ICEH), Clinical Research Department Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E7HT, UK.
2. Department of Ophthalmology, University of Cape Town, Cape Town, South Africa.
3. Department of Ophthalmology, University of Nairobi, Nairobi, Kenya.
4. College of Ophthalmology of Eastern Central & Southern Africa, Nairobi, Kenya.
5. International Agency for the Prevention of Blindness, Durban, South Africa.
6. Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
7. Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
8. Department of Ophthalmology, University of KwaZulu-Natal, Durban, South Africa.
9. Moorfields Eye Hospital NHS Foundation Trust, London, UK.
Background: There are 2.7 ophthalmologists per million population in sub-Saharan Africa, and a need to train more. We sought to analyse current surgical training practice and experience of ophthalmologists to inform planning of training in Eastern, Central and Southern Africa. Methods: This was a cross-sectional survey. Potential participants included all current trainee and recent graduate ophthalmologists in the Eastern, Central and Southern African region. A link to a web-based questionnaire was sent to all heads of eye departments and training programme directors of ophthalmology training institutions in Eastern, Central and Southern Africa, who forwarded to all their trainees and recent graduates. Main outcome measures were quantitative and qualitative survey responses. Results: Responses were obtained from 124 (52%) trainees in the region. Overall level of satisfaction with ophthalmology training programmes was rated as ‘somewhat satisfied’ or ‘very satisfied’ by 72%. Most frequent intended career choice was general ophthalmology, with >75% planning to work in their home country post-graduation. A quarter stated a desire to mainly work in private practice. Only 28% of junior (first and second year) trainees felt surgically confident in manual small incision cataract surgery (SICS); this increased to 84% among senior trainees and recent graduates. The median number of cataract surgeries performed by junior trainees was zero. 57% of senior trainees were confident in performing an anterior vitrectomy. Only 29% of senior trainees and 64% of recent graduates were confident in trabeculectomy. The mean number of cataract procedures performed by senior trainees was 84 SICS (median 58) and 101 phacoemulsification (median 0). Conclusion: Satisfaction with post-graduate ophthalmology training in the region was fair. Most junior trainees experience limited cataract surgical training in the first two years. Focused efforts on certain aspects of surgical education should be made to ensure adequate opportunities are offered earlier on in ophthalmology training.