Open AccessPolicy options for surgical mentoring: Lessons from Zambia based on stakeholder consultation and systems science
Author(s) -
Henk Broekhuizen,
Martilord Ifeanyichi,
Mweene Cheelo,
Grace Drury,
Chiara Pittalis,
E.A.J.A. Rouwette,
Michael Mbambiko,
John Kachimba,
Ruairı́ Brugha,
Jakub Gajewski,
Leon Bijlmakers
Publication year - 2021
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0257597
Subject(s) - stakeholder , citizen journalism , construct (python library) , pairwise comparison , medical education , district hospital , medicine , psychology , public relations , political science , computer science , family medicine , developmental psychology , law , programming language
Background Supervision by surgical specialists is beneficial because they can impart skills to district hospital-level surgical teams. The SURG-Africa project in Zambia comprises a mentoring trial in selected districts, involving two provincial-level mentoring teams. The aim of this paper is to explore policy options for embedding such surgical mentoring in existing policy structures through a participatory modeling approach. Methods Four group model building workshops were held, two each in district and central hospitals. Participants worked in a variety of institutions and had clinical and/or administrative backgrounds. Two independent reviewers compared the causal loop diagrams (CLDs) that resulted from these workshops in a pairwise fashion to construct an integrated CLD. Graph theory was used to analyze the integrated CLD, and dynamic system behavior was explored using the Method to Analyse Relations between Variables using Enriched Loops (MARVEL) method. Results The establishment of a provincial mentoring faculty, in collaboration with key stakeholders, would be a necessary step to coordinate and sustain surgical mentoring and to monitor district-level surgical performance. Quarterly surgical mentoring reviews at the provincial level are recommended to evaluate and, if needed, adapt mentoring. District hospital administrators need to closely monitor mentee motivation. Conclusions Surgical mentoring can play a key role in scaling up district-level surgery but its implementation is complex and requires designated provincial level coordination and regular contact with relevant stakeholders.