Bridging the divide in vascular surgery

A pioneering course in Kenya teaches the principles of vascular assessment and operating

The first Fundamentals in Vascular Surgery course ran for two days at the Nairobi Surgical Skills Centre last October

The first Fundamentals in Vascular Surgery course ran for two days at the Nairobi Surgical Skills Centre last October

Access to vascular surgery remains limited across many sub-Saharan African (SSA) and other low-income countries1,2. There is a rising profile of vascular disease burden driven by the growing prevalence of diabetes and obesity3,6, with trauma cases also requiring vascular surgery skills and interventions2,5,7.

Peripheral arterial disease is estimated to be of equal or higher prevalence in lower- and middle-income countries (LMIC) compared with high-income countries1,5. Many patients present late with advanced-stage disease, such as non-healing ulcers or gangrene.

There is an urgent need to expand the capacity to recognise and manage vascular diseases across SSA. In Kenya, vascular care is provided mainly by cardiothoracic or general surgeons. The limited availability of formal vascular surgery training is a significant barrier in LMIC1,8,9. 

Collaborative training initiatives can play an essential part in strengthening the local capacity for vascular surgery in these countries. In response, we designed and implemented the inaugural Fundamentals in Vascular Surgery course in Kenya, held over two days last October. This course is the first step in establishing a low-cost, sustainable vascular training programme.

This course was aimed at trainees and junior consultants and taught the principles of vascular assessment and operating. It also provided coaching in performing operations necessary for life or limb-saving surgery in the case of foot sepsis or vascular trauma.

The course was run at Nairobi Surgical Skills Centre (NSSC) in collaboration with the Surgical Society of Kenya (SSK). It began with interactive talks describing the techniques to be taught during the practical sessions. The remainder of the course was in the cadaveric laboratory where delegates practised the operation techniques for minor and major amputations, femoral and brachial artery access, long saphenous vein harvest and ligation, and external iliac artery exposure and control. These fundamental techniques provide safe options to manage a wide range of emergency vascular presentations and were selected by the local surgeons as the principal procedures to teach during a fundamentals course.

Overall feedback summary

The course was over-subscribed, with 28 participants attending. Feedback was positive, with all delegates responding that the course met their expectations, was relevant to their practice and they would recommend the course to a colleague (see chart). Several surgeons have also reported successful implementation of their new knowledge into clinical care since attending the course.

The course will run again this year along with a further Advanced Vascular Surgery Skills course. A faculty development scheme is also being introduced, with a view to increasing local faculty potential and providing leadership opportunities.

The Fundamentals in Vascular Surgery course is a step towards bridging the gap in vascular surgery training in SSA. It has built a robust foundation for addressing the growing burden of vascular diseases in the region. With close collaboration between SSK, RCSEd, industry partners and faculty, it is hoped this will offer a long-term, sustainable supplement to clinical vascular training, with local experts encouraged to engage in faculty roles.

The course has the potential to expand its reach and attract participants from across Africa, fostering regional collaboration through partnerships with organisations such as COSECSA. 

Acknowledgements 

We thank the NSSC team for its expertise and organisation in preparing and delivering the course. We also extend our gratitude to our industry partners and sponsors: Lariox, Pyramid Pharma, Prota, Ottobock, Surgipharm and Proximie.

References: 

  1. General Medical Council. The state of medical education and practice in the UK: Workplace experiences 2024 [Internet]. London: GMC; 2023 Nov [cited 2024 Aug 19]. Available from: https://www.gmc-uk.org/-/media/documents/somep-workplace-report-2024-full-report_pdf-107930713.pdf
  2. General Medical Council. Specialty, associate specialist and locally employed doctors workplace experiences survey: initial findings report. London: GMC; [no date].
  3. Carty E, Page M. “I brought that up in my appraisal ... And my consultant said no.” Structure and agency in specialty and associate specialist (SAS) doctors’ experiences of appraisal. Health Expect. 2021 May;21(3):E252–6.
  4. General Medical Council. Reference tables about the register of medical practitioners 2023 [Internet]. London: GMC; [no date] [cited 2024 Aug 19]. Available from: https://www.gmc-uk.org/-/media/documents/reference-tables-about-the-register-of-medical-practitioners-2023_xlsx-103845475
  5. General Medical Council. Spotlight on SAS doctors and LE doctors: analysis of Barometer survey 2022 results. Working paper 13 [Internet]. London: GMC; 2023 Oct [cited 2024 Aug 19].
  6. General Medical Council. Specialty, associate specialist and locally employed doctors workplace experiences survey: initial findings report [Internet]. London: GMC; 2020 Jan [cited 2024 Aug 19]. Available from: https://www.gmc-uk.org/-/media/documents/sas-and-le-doctors-survey-initial-findings-report-060120_pdf-81152021.pdf
  7. BMA Scotland. Recognition, support and development: A charter for SAS doctors and dentists in Scotland [Internet]. Edinburgh: BMA; 2024 [cited 2024 Aug 20]. Available from: https://www.bma.org.uk/media/fujppn5z/bma-scotland_sas-charter_may2024.pdf
  8. The Society for Cardiothoracic Surgery. SAC & Training Programme [Internet]. [place unknown]: SCTS; [cited 2024 Aug 20]. Available from: https://scts.org/professionals/education/career_groups/ntn_trainees/sac_training_programme.aspx
  9. The Society for Cardiothoracic Surgery. Hospitals [Internet]. [place unknown]: SCTS; [cited 2024 Aug 23]. Available from: https://scts.org/patients/hospitals/
  10. The Society for Cardiothoracic Surgery. Find a Consultant [Internet]. [place unknown]: SCTS; [cited 2024 Aug 23]. Available from: https://scts.org/patients/consultants/
  11. BMA. New Scottish SAS contracts [Internet]. London: BMA; 2024 [cited 2024 Aug 20]. Available from:https://www.bma.org.uk/pay-and-contracts/contracts/sas-doctor-contract/new-scottish-sas-contracts

Access to vascular surgery remains limited across many sub-Saharan African (SSA) and other low-income countries1,2. There is a rising profile of vascular disease burden driven by the growing prevalence of diabetes and obesity3,6, with trauma cases also requiring vascular surgery skills and interventions2,5,7.

Peripheral arterial disease is estimated to be of equal or higher prevalence in lower- and middle-income countries (LMIC) compared with high-income countries1,5. Many patients present late with advanced-stage disease, such as non-healing ulcers or gangrene.

There is an urgent need to expand the capacity to recognise and manage vascular diseases across SSA. In Kenya, vascular care is provided mainly by cardiothoracic or general surgeons. The limited availability of formal vascular surgery training is a significant barrier in LMIC1,8,9. 

Collaborative training initiatives can play an essential part in strengthening the local capacity for vascular surgery in these countries. In response, we designed and implemented the inaugural Fundamentals in Vascular Surgery course in Kenya, held over two days last October. This course is the first step in establishing a low-cost, sustainable vascular training programme.

This course was aimed at trainees and junior consultants and taught the principles of vascular assessment and operating. It also provided coaching in performing operations necessary for life or limb-saving surgery in the case of foot sepsis or vascular trauma.

The course was run at Nairobi Surgical Skills Centre (NSSC) in collaboration with the Surgical Society of Kenya (SSK). It began with interactive talks describing the techniques to be taught during the practical sessions. The remainder of the course was in the cadaveric laboratory where delegates practised the operation techniques for minor and major amputations, femoral and brachial artery access, long saphenous vein harvest and ligation, and external iliac artery exposure and control. These fundamental techniques provide safe options to manage a wide range of emergency vascular presentations and were selected by the local surgeons as the principal procedures to teach during a fundamentals course.

Overall feedback summary

The course was over-subscribed, with 28 participants attending. Feedback was positive, with all delegates responding that the course met their expectations, was relevant to their practice and they would recommend the course to a colleague (see chart). Several surgeons have also reported successful implementation of their new knowledge into clinical care since attending the course.

The course will run again this year along with a further Advanced Vascular Surgery Skills course. A faculty development scheme is also being introduced, with a view to increasing local faculty potential and providing leadership opportunities.

The Fundamentals in Vascular Surgery course is a step towards bridging the gap in vascular surgery training in SSA. It has built a robust foundation for addressing the growing burden of vascular diseases in the region. With close collaboration between SSK, RCSEd, industry partners and faculty, it is hoped this will offer a long-term, sustainable supplement to clinical vascular training, with local experts encouraged to engage in faculty roles.

The course has the potential to expand its reach and attract participants from across Africa, fostering regional collaboration through partnerships with organisations such as COSECSA. 

Acknowledgements 

We thank the NSSC team for its expertise and organisation in preparing and delivering the course. We also extend our gratitude to our industry partners and sponsors: Lariox, Pyramid Pharma, Prota, Ottobock, Surgipharm and Proximie.

References: 

  1. General Medical Council. The state of medical education and practice in the UK: Workplace experiences 2024 [Internet]. London: GMC; 2023 Nov [cited 2024 Aug 19]. Available from: https://www.gmc-uk.org/-/media/documents/somep-workplace-report-2024-full-report_pdf-107930713.pdf
  2. General Medical Council. Specialty, associate specialist and locally employed doctors workplace experiences survey: initial findings report. London: GMC; [no date].
  3. Carty E, Page M. “I brought that up in my appraisal ... And my consultant said no.” Structure and agency in specialty and associate specialist (SAS) doctors’ experiences of appraisal. Health Expect. 2021 May;21(3):E252–6.
  4. General Medical Council. Reference tables about the register of medical practitioners 2023 [Internet]. London: GMC; [no date] [cited 2024 Aug 19]. Available from: https://www.gmc-uk.org/-/media/documents/reference-tables-about-the-register-of-medical-practitioners-2023_xlsx-103845475
  5. General Medical Council. Spotlight on SAS doctors and LE doctors: analysis of Barometer survey 2022 results. Working paper 13 [Internet]. London: GMC; 2023 Oct [cited 2024 Aug 19].
  6. General Medical Council. Specialty, associate specialist and locally employed doctors workplace experiences survey: initial findings report [Internet]. London: GMC; 2020 Jan [cited 2024 Aug 19]. Available from: https://www.gmc-uk.org/-/media/documents/sas-and-le-doctors-survey-initial-findings-report-060120_pdf-81152021.pdf
  7. BMA Scotland. Recognition, support and development: A charter for SAS doctors and dentists in Scotland [Internet]. Edinburgh: BMA; 2024 [cited 2024 Aug 20]. Available from: https://www.bma.org.uk/media/fujppn5z/bma-scotland_sas-charter_may2024.pdf
  8. The Society for Cardiothoracic Surgery. SAC & Training Programme [Internet]. [place unknown]: SCTS; [cited 2024 Aug 20]. Available from: https://scts.org/professionals/education/career_groups/ntn_trainees/sac_training_programme.aspx
  9. The Society for Cardiothoracic Surgery. Hospitals [Internet]. [place unknown]: SCTS; [cited 2024 Aug 23]. Available from: https://scts.org/patients/hospitals/
  10. The Society for Cardiothoracic Surgery. Find a Consultant [Internet]. [place unknown]: SCTS; [cited 2024 Aug 23]. Available from: https://scts.org/patients/consultants/
  11. BMA. New Scottish SAS contracts [Internet]. London: BMA; 2024 [cited 2024 Aug 20]. Available from:https://www.bma.org.uk/pay-and-contracts/contracts/sas-doctor-contract/new-scottish-sas-contracts

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