JBJS - 2026-04-13 - Journal Article
A Novel Hybrid Training Model for Open Fracture Management in Rwanda.
Kadiyala S, Powis E, Mirahmadi A, Mercado C, Yu S, Velichala SR, Colannino A, Hung I, Bikoroti JB, Kubwimana O, Dusingizimana LR, Alayande BT, Ingabire JCA, Byiringiro JC, Rodriguez EK, Agarwal-Harding KJ
Topics
Key Takeaway
A hybrid open fracture management course in Rwanda increased self-reported confidence from 3.83 to 4.69 out of 5 (p<0.001) among 160 learners, with 96.5% reporting anticipated practice change.
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Summary
This study developed and evaluated a hybrid (in-person + live-streamed) open fracture management course for surgical trainees and practicing surgeons in Rwanda. The single-session workshop combined virtual pre-course content, didactics, case discussions, and hands-on external fixation and NPWT skills training. Among 84 survey respondents, confidence scores rose from 3.83 to 4.69/5 (p<0.001), satisfaction averaged 4.6/5, and 96.4% reported improved knowledge.
Key Limitation
No objective assessment of knowledge acquisition or clinical skill retention was performed, and no follow-up data confirm whether self-reported practice change translated into measurable improvements in patient care or adherence to open fracture management benchmarks.
Original Abstract
➢ Open fractures are a critical global health challenge that disproportionately affect individuals in low- and middle-income countries (LMICs), primarily due to road traffic collisions. Surgical management of open fractures is 1 of the 3 essential bellwether procedures identified by The Lancet Commission on Global Surgery.➢ We developed and evaluated a novel hybrid course on open fracture management for surgical trainees and practicing surgeons in Rwanda, combining a self-directed, virtual, pre-course curriculum with a live, in-person workshop in Kigali in June 2025 that was simultaneously live-streamed for virtual attendees. Prerecorded multilingual lectures (English and French) and curated peer-reviewed articles provided foundational knowledge in advance and prepared learners for in-person didactics, case discussions, and skills training.➢ The in-person workshop included didactic sessions and discussions of local clinical cases from Rwanda related to open fracture management and other orthopaedic emergencies, along with hands-on practice in fracture external fixation and negative pressure wound therapy using affordable devices designed for resource-constrained practice.➢ The workshop engaged 160 active learners (37 in-person, 123 virtual) and demonstrated high overall satisfaction among 84 survey respondents, with an average rating of 4.6 out of 5.➢ Self-reported confidence in managing open fractures increased substantially following the course, from a mean rating of 3.83 to 4.69 on a 5-point scale (p < 0.001). Most survey respondents reported that the course moderately or significantly improved their knowledge (96.4%) and would change their clinical practice (96.5%).➢ Participant feedback highlighted opportunities for improvement, including extending the workshop duration to increase hands-on time, expanding the content on complex soft-tissue management, and improving the engagement of remote learners through mechanisms such as the provision of low-cost external fixation models for at-home practice.➢ Future directions include integrating the course into medical student and general practitioner education in Rwanda, adapting it for major surgical conferences regionally and internationally, and continuing to prioritize hands-on training modules. Iterative refinement of the course is planned on the basis of participant feedback.