THE CANADIAN NETWORK FOR INTERNATIONAL SURGERY
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Mission Statement
The Canadian Network for International Surgery is committed to empowering low-income countries to create an environment where the risk from injuries is minimal and that all people receive adequate healthcare. CNIS believes in sharing knowledge, expertise and experience to promote lasting and sustainable improvements in health and safety in the developing world.
About This Cause
The Canadian Network for International Surgery (CNIS), established in 1995, is now in its 25th year of operations. It has been addressing the unmet surgical and obstetrical needs in Sub Saharan Africa through educational strategies. As a result of the work supported by Donner Canadian, the Canadian International Development Agency, other family foundations and individual donors, more than 50,000 African Health Professionals have received clinical skills training and tens of thousands school children have been taught non-violent conflict resolution. Currently, the health needs in Sub Saharan Africa are larger than before and the educational needs are even larger. The CNIS educational programs have and continue to address critical thinking, patient management and technical skills. To have successful programs and to address the increased needs CNIS has always been innovative. CNIS introduced structured clinical training to Africa using quiz questions, case studies linked to technical training with simulation in the laboratory, and supervision in the operating room. In 1995, these teaching methods were iconoclastic; now they are the evidence-based standard. To accomplish the training of tens of thousands, we developed 12 structured courses to teach surgical skills from the community to the district hospital level; this was highly successful. The medical schools and clinical teaching colleges have expanded massively throughout Africa. This is a good thing but it includes some important challenges. Our structured training courses include 12 or 24 learners at a time for courses that last from days to weeks. When there are classes of 400 students, CNIS courses which supplement regular training would have to be conducted continuously throughout the year. To address these numbers we have commenced a new innovation with digital education. This was initially restricted to thinking, knowledge and management skills CNIS is now testing remote and digital means for technical training. The learners complete interactive quiz questions and case studies through the digital training but now we are also supplementing technical training with video instruction and to respond with video recordings demonstrating skills acquisition. With the COVID 19 pandemic we have also developed strategies to teach remotely. Our teaching objectives remain constant but our methods and strategies have changed to include both the digital and remote teaching strategies which we have developed in the last 5 years. In 2017 we evaluated KTS App training and found the results were at equal to traditional training. The Kampala Trauma Score (KTS training) was very popular among learners under 40 years old and unpopular with the older learners. Digital learning, once it has been developed and posted, is highly efficient, as many can learn even without the direct presence of an instructor. The downside of digital learning is that the initial costs in terms of content expert contribution and technical developer time is high, however, once published online, it can be propagated at no cost. Initially CNIS was dependent on contracting development support but has now established in-house capabilities for Learning Management Systems and Video recording for skills training. This has allowed us to control costs. We still use some outside assistance but limit this to specific needs and expect that we will continue to augment our in-house development activities. The advantages of digital education includes large numbers of learners, easy monitoring of learning, and self-direction, meaning a reduced requirement for instructor travel and accurate calculations for digitized clinical protocols. CNIS activities for 26 years have been to teach thinking, management and technical clinical skills to health care professionals. Success is based on keeping the content current, expanding target learners and using methods that are efficient, and evaluation of results.