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Saving sight in West Africa through skills development

21 March 2014

Dr Rosalind Duhs reports on her trip to Abuja, Nigeria, where she helped design a curriculum for local eye surgeons


Millions of people in West Africa are blind due to treatable conditions. The problem is that there are too few doctors with the skills to restore their sight. However, a project is underway that will see local consultants take part in a series of sub-specialism training courses.

My involvement began in autumn 2012 when I attended the first partnership meeting between the West African College of Surgeons and Moorfields. My job was to help with curriculum design – a role that has since led to a visit to Abuja, the capital of Nigeria.

Nigeria is resource-rich and potentially an economic powerhouse, but there’s a huge gap between some relatively prosperous city-dwellers and the poor without access to healthcare. One UK consultant eye surgeon described the painful process of triage, selecting patients for treatment in a packed waiting room. Many had walked for days to reach the eye clinic, funding their care with money scraped together by the whole village.

Practice over theory

During my trip the need to plan carefully and effectively was palpable. We started with a run-through of the latest UK surgical education approaches to help inform our curriculum design. We also concentrated on what was most essential – how to help learners become proficient at the core operations most needed in the region.

It was a complex task. We couldn’t be sure about the baseline skills of the eye specialists who would take part in the courses, so the first step was to work out how to evaluate their experience. Logbooks of cases, multiple choice questions and discussion with learners would be a starting-point.

The great advantage was that learner groups would be small so there would be scope for one-to-one supervision. Two-week intensive face-to-face courses could also be enriched through pre- and post-module distance learning, so precious time in clinic could focus on hands-on practical learning.

At first, assessment was geared towards testing factual knowledge, but we quickly established that proficiency at diagnosis and hands-on treatment were most important. We therefore employed the simple notion of ‘learn by watching and doing’ and ‘assess by watching the doing’. Mini clinical evaluation exercises, objective structured assessment of technical skills (OSATS), direct observation of procedural skills (DOPS) and discussion of videos of treatment seemed good options.

UCL Arena goes global

The West Africa sub-specialism skills development course is one of the earliest examples of UCL Arena. Set to be officially launched at the 2014 UCL Teaching and Learning Conference, UCL Arena is a new scheme designed to enable staff to gain recognition for their teaching and support of learning and develop fresh approaches to education with colleagues.

UCL staff can register for the conference to learn more about the scheme.

Cultural difference

West African and UK colleagues knew each other well and were open about cultural difference. The notion of 360° feedback, given to all the consultants in the UK group, appeared strange to non-UK participants. The focus on active learning, peer learning and providing learners with the opportunity to evaluate the learning experience were also new, but readily adopted.

The status and authority of the West African group – senior consultants and professors – was high. The advantages of flatter hierarchies in healthcare teams and between learner and teacher are considerable but it takes time to achieve them.

The three-day meeting was productive and each of the five sub-specialty teams left with a syllabus for their initial modules. So what’s next?

Our aim is to launch the first two-week face-to-face modules in West Africa in 2014-15. We’re also keen to share our work more widely and to set up resources for online learning. We have a space on UCLeXtend so we’ll be working with E-Learning Environments to prepare a rich set of learning opportunities for this important target group.

Further information