Optimal Resources for Children's Surgery 2: Updates on Training and Education Recommendations

OBJECTIVE: The practice of pediatric surgery, and surgery in general, in low- and middle-income countries (LMICs) presents multiple challenges. Beyond limitations in physical and human resources, there is a great disparity in the quality and accessibility of training programs in LMICs. In response to input from high-income countries (HICs) and a desire to standardize training, regional associations have formed with the aim of facilitating knowledge sharing and enhancing surgical education around the world. Despite this, no clear guidelines exist regarding the types of initial training programs and Continuing Professional Development (CPD) needed at various levels of health care delivery. METHODS: We performed a PRISMA literature review to identify the types of training programs needed at the health center, first-level hospital, second-level hospital, third-level hospital, and national children's referral hospital. We then used an iterative Delphi like approach to identify and rank specific educational needs by hospital level. Participation was open to all GICS V conference attendees held in Manila Philippines February 2024. This represents 441 participants from 50 countries (79% low to middle income countries). Final recommendations were made based on greater than 75% agreement by respondents and reviewed by the GICS OReCS 2 core working group. RESULTS: There was agreement among respondents that some education program should be offered at every facility level. For health centers and first-level hospitals, programs were limited to initial training and continuing education for community health workers and nurses. General medical provider training should start at the first-level hospital, whereas medical schools should be at the third-level and national children's referral hospital. Specialty training for medical and surgical specialties was recommended only at the third-level and national children's referral hospital. CONCLUSION: Providing safe and high-quality surgical care for children requires a standardized approach to training not only for surgeons but also for all members of the care team. While the Optimal Resources for Children's Surgery update does not seek to dictate how the training is administered, it does provide a framework for fostering local training programs and creating a skilled workforce at standards mirroring those in HICs.