Strengths and limitations
hernia, inguinal hernia
RECRUITMENT
This study has several strengths. The internal validity is high due to the rigorous oversight of the primary investigator (TA). It was implemented in a rural district hospital, where most hernia surgeries takes place in Sierra Leone; therefore, its results would be generalizable to other similar hospitals [The results of this study provide evidence of the feasibility and safety of training non-specialist surgical providers in a procedure that is much needed in the context of the human resource crisis of low-income countries such as Sierra Leone. A limitation of this study is the fact that the trainees had pre-training knowledge and experience on how to perform tissue inguinal hernia repairs. Recruitment of MDs was challenging due to their limited number and the fact that they are often the only surgical-skilled doctor at their hospital, and therefore not easily able to take time away from their jobs.