Disparities in Investment: Trauma Training vs. Minimally Invasive Surgery Training in Low- and Middle-Income Countries—A Scoping Review

Disparities in Investment: Trauma Training vs. Minimally Invasive Surgery Training in Low- and Middle-Income Countries—A Scoping Review

Tressa Parker, Jill Nelson, Ana Reyes, Julie Valenzuela
University of Miami, Miami, United States

Objective:
Trauma remains a leading cause of morbidity and mortality in low- and middle-income countries (LMICs), yet formal training is limited. Comparatively, minimally invasive surgery (MIS) training is structured with documented outcomes. This study reviews training in trauma and MIS across LMICs, focusing on methodologies, skill acquisition, duration, and limitations.

Methods:
Separate literature searches were conducted in PubMed, SCOPUS, and EMBASE for trauma and MIS training using terms such as “trauma,” “minimally invasive surgery,” and “low- and middle-income country.” Eligible studies involved physician or surgical training. Titles and abstracts were screened independently, followed by full-text review.

Results:
Trauma training search yielded 565 results; 91 from 45 countries met inclusion. Most programs were short-term (<1 week; n=36) with 23% incorporating Point of Care Ultrasound (POCUS), 23% Advanced Trauma Life Support (ATLS), and 11% Primary Trauma Care (PTC). Median duration was 3 days. Training focused on resuscitation, injury management, and emergency surgery, with improved provider confidence (n=41) and test performance (n=25). MIS training search yielded 507 results; 61 from 29 countries met inclusion. Training involved simulation, didactics, and mentorship, with a median duration of 3 months. Focus areas were cholecystectomy (n=22), appendectomy (n=16), OB/GYN procedures (n=14), and diagnostic laparoscopies (n=11), showing improved skills (n=15) and reduced operative times (n=6). Cost and limited resources were limitations in both domains.

Conclusion:
Despite trauma’s burden in LMIC, trauma training lags behind MIS training in both program structure, duration, and long-term outcomes. Greater investment in trauma training is essential for improvement of trauma care in LMICs.

Keywords: Trauma training, emergency education, medical education, minimally invasive surgery training, laparoscopic surgery training, training disparities, trauma, low income country, middle income country, training disparity, education disparity