Developing countries have a significant burden of eye disease that is compounded by severe shortages of specialised skills, presenting a critical global ophthalmology challenge. Many ophthalmologists may seek to pursue specialised training upon completion of their postgraduate studies. Much of these structured fellowship opportunities are not available regionally, leaving ophthalmologists in Africa mostly needing to travel abroad for this training.
Hospital-based training initiatives help to address this critical unmet need for subspecialty training, by combining clinical exposure with hands-on, mentored practice. These initiatives not only provide mentees and trainees with opportunities to enhance their skills and gain confidence, but they also enable sustainable capacity development and ultimately help to strengthen healthcare systems. Localised hospital-based trainings ease the economic and social burden of distance-based training, which increases the mentees satisfaction of learning. These direct skills transfer initiatives are complemented and well supported by platform-based training initiatives, such as the numerous lectures and courses offered through Cybersight.
Though hospital-based trainings may seem to be easier to conduct than travelling to a well-equipped centre far from home, they do come with their challenges. A significant financial investment from partner organisations is critical for the successful implementation of these initiatives. The buy-in of local hospital and institutional leadership and staff is crucial, as these initiatives run within these facilities, utilising available local resources. Receptivity and buy-in of the patient population for this training initiative is necessary. A planning and implementation partner is instrumental to provide skills, resource and administrative support. Lastly, hospitals require base infrastructure, equipment and consumables to host specialised training.
Case study
The majority of ophthalmologists in Africa are trained in adult glaucoma management during their residency. This leaves a gap in paediatric glaucoma, a rare and complex disease entity. This vulnerable group of patients deserve focused care for their lifelong disease management. Training situated under the domain of glaucoma ensures development of highly specialised skills and equity of these expertise.
"Tell me and I forget, teach me and I may remember, involve me and I learn" – Benjamin Franklin
In September 2024, Orbis (International) Zambia organised a hospital-based training initiative for paediatric glaucoma at the University Teaching Hospital (UTH) Lusaka. This training aimed to broaden the surgical options available for paediatric glaucoma care in Zambia and Malawi, through the introduction of new surgical techniques. Ophthalmologists Phyllis Moonga (Zambia) and Chinsisi Nyirenda (Malawi), who have both completed glaucoma fellowships, were mentees of this initiative. Nombuso Mathe, an experienced adult and paediatric glaucoma specialist from South Africa and member of the volunteer faculty of Orbis International, was the mentor in this initiative, which spurred regional skills transfer.
Figure 1: Dr Mathe explaining to Dr Nyirenda.
The week-long initiative entailed the outpatient assessment of pre-screened patients from across different regions in Zambia. Objectives of the training included comprehensive assessment of a paediatric glaucoma patient, understanding the different spectrums of paediatric glaucoma diseases, as well as an approach to decision-making in treatment options. An array of surgical procedures was scheduled which included goniotomy, trabeculotomy, bleb revision and insertion of a newer glaucoma drainage device (Paul’s Implant). The week’s programme also included didactic lectures and discussions on glaucoma for the ophthalmology residents at UTH Lusaka.
Figure 2: Dr Moonga observing Dr Mathe operate.
During the hands-on teaching in theatre, Dr Mathe demonstrated the different surgical procedures. Drs Moonga and Nyirenda were both given the opportunity to observe, and under instruction, perform the different surgeries. Postoperative assessments were conducted by the team and detailed treatment plans were discussed. Both mentees, through the support of Orbis Zambia, were provided with sufficient consumables and equipment to continue providing some the newly introduced surgical techniques beyond the initiative. The initiative was expanded to include ongoing remote mentoring of both mentees and continued clinical support by Dr Mathe. A year later, both mentees have strengthened their surgical skills and are operating independently.
Figure 3: Dr Nyirenda sharing her experiences to Dr Mathe.
Discussion
Hospital-based training allows trainees to translate theoretical knowledge into practical skills through supervised, direct patient management. This experience also fosters clinical competence, professional growth and regional collaboration in the management of the paediatric glaucoma patient. Exposure to rare and complex cases such as paediatric glaucoma enriches the mentees learning experience, enhances diagnostic accuracy and broadens clinical judgement and skills. Supervised learning with continuous feedback helps mentees recognise and address mistakes and encourages the adoption of best practices. Peer mentorship, particularly amongst female specialists, supports professional and personal development and encourages a shared goal towards combating childhood blindness in the region.
The success of hospital-based training initiatives relies on a multidisciplinary approach to patient care, involving administrators, nurses, pharmacists, technicians, residents and specialists. This promotes good communication skills and respect for different healthcare roles.
Most clinicians in Sub-Saharan Africa face similar challenges such as resource constraints, poor access to care and low patient follow-up rates. Regional skills transfer through the training enables a shared space of discussion and strategising around some of these challenges and helps bridge the gap between evidence-based medicine and contextualised daily practice. By training within hospitals that serve local communities, healthcare professionals contribute directly to service delivery by increasing workforce capacity.
Conclusion
Hospital-based training with peer mentorship remains an indispensable component of medical education. They equip healthcare professionals with practical skills, critical thinking abilities and decision-making strategies needed to provide safe and effective patient care. As health systems worldwide strive for excellence, strengthening hospital-based training models will ensure the development of a competent, confident and compassionate healthcare workforce, as well as sustainability of the services offered to the communities.
Declaration of competing interests: None declared.
