Initial Qualitative Needs Assessment of Surgical Resident Case Logging in Low- and Middle-Income Countries Across Pan-African Training Programs

Background: Despite proven efficacy of case logging systems to track volume, breadth, and progression of surgical experiences, they can be burdensome in low- and middle-income countries (LMICs). In this study, we evaluate the current use of the Pan-African Academy of Christian Surgeons (PAACS) case log system. This study is the first to examine the challenges of surgical case logging from the perspective of trainees and faculty in LMICs. Methods: We used a multi-method qualitative design consisting of focus groups, individual interviews, and a survey. 44 people participated in either focus groups or one-on-one interviews representing 11 PAACS training programs. One focus group consisted of 23 faculty members while the other consisted of 13 residents. Eight individual interviews were conducted at two hospitals. Everyone who participated in the study was asked to complete a 26-item survey. Results: Necessary case log entry fields based on majority agreement between residents and faculty during focus groups and interviews included: procedure, date, post-operative diagnosis, patient identifier, sex, age, degree of supervision, and outcome. Three parameters were unanimously deemed “non-negotiable” for a future case log system in the LMIC context: mobile compatibility, offline data collection, and adherence to the residency accreditation governing body. Survey results revealed over 70% of surgical residents and faculty felt the current logging system should be restructured or completely replaced. Conclusions: This study highlights LMIC-specific barriers as described by PAACS surgical residents and faculty- including intermittent internet accessibility, reliability, and cumbersomeness that must be mitigated in the next generation of case-logging systems.