Surgical competency upon completion of obstetric fistula training
“Competency” refers to a trainee’s ability to perform obstetric fistula (OF) surgical repair according to a set standard. Formal standards/requirements for qualifying as a competent provider (in this case, doctor) are established by the ministry of health (MOH) in each country program. Critical steps are identified in clinical skills check lists and providers must perform all of these steps correctly, completely and consistently to be deemed competent (EngenderHealth, 2008).
This indicator is calculated as:
(Number of trainees demonstrating surgical competence upon completion of OF training / Total number of trainees observed and/or tested) x 100
Training records. Data can be disaggregated by sex, type of staff (e.g. nurse, doctor, midwife), type of facility (public, private, non-governmental, community-based), and by district and urban rural location.
Observation at various stages during and after the training event; knowledge pre and post-test forms, along with clinical skills check lists. The Fistula Care project has a Fistula Services Facilitative Supervision and Medical Monitoring form for training follow-up (EngenderHealth, 2008).
This output indicator measures what doctors can actually do in the workplace as a result of the training. It emphasizes progress in mastery of specified knowledge, attitude, and skills related to OF repair.
Surgical competency of OF is based on three levels. At the skills acquisition level, doctors receive knowledge and skills to diagnose, classify fistula, and refer, but are not yet competent to perform fistula surgery. At the competence level, trainees learn how to diagnose, classify, and perform actual fistula surgery. Because fistulas vary greatly in complexity and difficulty of repair, a gradual increase in length of training is required for skill and surgical efficiency, starting with simple cases and then progressing to moderate then high complexity cases. At the proficiency level, doctors must be able to do most of the high complexity fistula cases safely, efficiently, and in correct sequence for key steps, and deal with unexpected complications during surgery (EngenderHealth, 2008). It should take at least three months to gain competency in the standard management of OF, 12 months in their advanced management, and 24 months in their expert management.
The International Federation of Gynecologists and Obstetricians (FIGO) co-ordinated the production of a training manual, the Global Competency-Based Fistula Surgery Training Manual, aimed at healthcare providers from low- and middle-income countries involved in the prevention and management of OF. Because there is now a standardized training curriculum that articulates what fistula surgical training should be, both trainer and trainee performance can be objectively evaluated and surgical competence assessed. The manual was pilot tested in several centers in 2011 and is currently being rolled out (FIGO, UNFPA, 2011).
Because formal standards and scores required for qualifying as a competent provider are established in each country program, there may be some variation among field programs, with requirements for qualifying as competent being about 85% on “must know content” knowledge assessments and in clinical practice, in addition to performing all critical steps competently.
training, obstetric fistula (OF), quality, knowledge, safe motherhood (SM)
EngenderHealth, 2008, Fistula Care Training Strategy. http://www.fistulacare.org/pages/pdf/Training/FistulaTrainingStrategyEngenderHealthFistulaCare070708formatted.pdf
EngenderHealth, 2008, Fistula Services Facilitative Supervision and Medical Monitoring for Training Sites and Training Follow-up. http://www.fistulacare.org/pages/pdf/Training/FistulaSupervisionandMonitoringforTrainingsiteandtrainingfollowupApril08formatted.pdf
FIGO, UNFPA, 2011. Global Competency-Based Fistula Surgery Training Manual.