{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T17:25:05Z","timestamp":1787851505660,"version":"build-2784847793"},"reference-count":42,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100008894","name":"Stryker","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008894","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Operation Smile Canada"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate a competency-based cleft surgery training pathway designed to expand local surgical capacity in low- and middle-income countries (LMICs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective observational study of cleft surgery training outcomes between July 2022 and September 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Operation Smile cleft surgery programs and partner hospitals in LMICs, with integrated virtual education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients\/Participants<\/jats:title>\n                    <jats:p>Twenty trainee cleft surgeons from 11 countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>A competency-based training pathway combining virtual education and mentored operative experience, with assessment using a validated surgical competency tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Changes in self-reported surgical confidence and educator-rated surgical competency<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Trainee cleft surgeons participated in 1168 cleft lip and palate repairs, including 862 primary procedures. Confidence improved significantly for all primary procedures (unilateral cleft lip (UCL)\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.001; bilateral cleft lip\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001; cleft palate\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001), with greatest gains in cleft palate repair. Educator-rated competency increased by 46% for UCL, 56% for bilateral cleft lip, and 71% for cleft palate repair. By September 2024, 3 surgeons had completed the pathway; by April 2025, 8 had completed training, with others progressing toward certification.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Competency-based cleft surgery training in LMICs, delivered through partnerships between non-governmental organizations and local health systems, improves surgical confidence and competence while maintaining local workforce integration. Combining high-volume operative experience with structured education offers a scalable model to expand workforce capacity and support sustainable, locally led cleft care. Long-term success depends on developing systems capable of sustaining training and service delivery independently.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656261475423","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:09:41Z","timestamp":1787584181000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Expanding Cleft Surgical Workforce Capacity in Low- and Middle-Income Countries Through Competency-Based Training"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0091-7578","authenticated-orcid":false,"given":"Daniel","family":"Bradley","sequence":"first","affiliation":[{"name":"Operation Smile, 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