{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:44:11Z","timestamp":1791960251585,"version":"4.3.4"},"reference-count":20,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,9,6]],"date-time":"2017-09-06T00:00:00Z","timestamp":1504656000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2017,9,6]],"date-time":"2017-09-06T00:00:00Z","timestamp":1504656000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The unmet burden of surgical disease represents a major global health concern, and a lack of trained providers is a critical component of the inadequacy of surgical care worldwide. Competency\u2010based training has been advanced in high\u2010income countries, improving technical skills and decreasing training time, but it is poorly understood how this model might be applied to low\u2010 and middle\u2010income countries. We describe the development of a competency\u2010based program to accelerate specialty training of in\u2010country providers in cleft surgery techniques.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The program was designed and piloted among eight trainees at five international cleft lip and palate surgical mission sites in Latin America and Africa. A competency\u2010based evaluation form, designed for the program, was utilized to grade general technical and procedure\u2010specific competencies, and pre\u2010 and post\u2010training scores were analyzed using a paired <jats:italic>t<\/jats:italic> test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Trainees demonstrated improvement in average procedure\u2010specific competency scores for both lip repairs (60.4\u201371.0%, <jats:italic>p<\/jats:italic> &lt; 0.01) and palate (50.6\u201366.0%, <jats:italic>p<\/jats:italic> &lt; 0.01). General technical competency scores also improved (63.6\u201372.0%, <jats:italic>p<\/jats:italic> &lt; 0.01). Among the procedural competencies assessed, surgical markings showed the greatest improvement (19.0 and 22.8% for lip and palate, respectively), followed by nasal floor\/mucosal approximation (15.0%) and hard palate dissection (17.1%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Surgical delivery models in LMICs are varied, and trade\u2010offs often exist between goals of case throughput, quality and training. Pilot program results show that procedure\u2010specific and general technical competencies can be improved over a relatively short time and demonstrate the feasibility of incorporating such a training program into surgical outreach missions.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-017-4205-2","type":"journal-article","created":{"date-parts":[[2017,9,7]],"date-time":"2017-09-07T01:13:47Z","timestamp":1504746827000},"page":"646-651","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Competency\u2010Based Education in Low Resource Settings: Development of a Novel Surgical Training Program"],"prefix":"10.1002","volume":"42","author":[{"given":"Meghan","family":"McCullough","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Keck School of Medicine University of Southern California 1200\u00a0N. State Street 90033 Los Angeles CA USA"},{"name":"Division of Plastic and Reconstructive Surgery Children\u2019s Hospital of Los Angeles Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Campbell","sequence":"additional","affiliation":[{"name":"Division of Education Operation Smile Virginia Beach VA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armando","family":"Siu","sequence":"additional","affiliation":[{"name":"McGregor Comprehensive Cleft Center Operacion Sonrisa Nicaragua Colonia Bolonia, Managua Nicaragua"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Libby","family":"Durnwald","sequence":"additional","affiliation":[{"name":"Division of Education Operation Smile Virginia Beach VA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubha","family":"Kumar","sequence":"additional","affiliation":[{"name":"Institute for Global Health University of Southern California Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"William P.","family":"Magee","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Keck School of Medicine University of Southern California 1200\u00a0N. State Street 90033 Los Angeles CA USA"},{"name":"Division of Plastic and Reconstructive Surgery Children\u2019s Hospital of Los Angeles Los Angeles CA USA"},{"name":"Division of Plastic Surgery Shriner\u2019s Hospital Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Swanson","sequence":"additional","affiliation":[{"name":"Division of Education Operation Smile Virginia Beach VA USA"},{"name":"McGregor Comprehensive Cleft Center Operacion Sonrisa Nicaragua Colonia Bolonia, Managua Nicaragua"},{"name":"Division of Plastic Surgery Shriner\u2019s Hospital Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,9,6]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2015.02.009"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010014\u20102516\u20100"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(15)60091\u20105"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214\u2010109X(14)70349\u20103"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00001888\u2010200012000\u201000009"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.M.00314"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002\u20109610(05)80843\u20108"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20102001\u201014964"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.3109\/0142159X.2010.500704"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00001888\u2010200205000\u201000003"},{"key":"e_1_2_10_12_2","volume-title":"Annual report: creating an accountable graduate medical education program","author":"The Josiah Macy Jr. Foundation","year":"2011"},{"key":"e_1_2_10_13_2","volume-title":"Graduate medical education that meets the nation\u2019s health needs","author":"Institute of Medicine","year":"2014"},{"key":"e_1_2_10_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002407"},{"key":"e_1_2_10_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000939"},{"key":"e_1_2_10_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102929.2006.02528.x"},{"key":"e_1_2_10_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12909\u2010015\u20100286\u20105"},{"key":"e_1_2_10_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.7115"},{"key":"e_1_2_10_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2014.11.030"},{"key":"e_1_2_10_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsurg.2014.08.006"},{"key":"e_1_2_10_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0b013e3182869faf"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00268-017-4205-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-017-4205-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-017-4205-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-017-4205-2","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T16:29:21Z","timestamp":1703608161000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-017-4205-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9,6]]},"references-count":20,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018,3]]}},"alternative-id":["10.1007\/s00268-017-4205-2"],"URL":"https:\/\/doi.org\/10.1007\/s00268-017-4205-2","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9,6]]},"assertion":[{"value":"6 September 2017","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with Ethical Standards"}},{"value":"All authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}