NOTSS-VRC (Variable ReSource Contexts)

Although NOTSS was initially developed, piloted, and implemented in high-income countries, its principles are wholly relevant to variable-resource contexts.  As surgical capacity and workforce continue to grow in low- and middle-income countries (LMICs), strategies to improve surgical education and surgical care are increasingly important worldwide. 

The original NOTSS system was initially piloted in Rwanda in 2013.  This pilot exposed a need to create a system which was more specific to contexts with variable resources.  Therefore, a novel, contextually-adapted version of NOTSS, NOTSS-VRC: Variable-Resource Contexts, was created to better address the challenges faced in Rwanda and other LMICs. 

This system was developed in Rwanda over 2013-2016 by surgeons at the University of Rwanda, in partnership with colleagues at the Center for Surgery and Public Health at the Brigham and Women’s Hospital and Harvard Medical School.  Through a rigorous process of interviews and iterations of teaching videos based on common challenges identified in Rwanda, this NOTSS system serves as a practical guide to surgeons practicing in variable-resource contexts. 

The NOTSS-VRC system focuses specifically on the skills that any surgeon must possess in order to perform well in variable-resource contexts. It is widely applicable to surgeons regardless of whether they have trained in this type of setting, or are experiencing it for the first time.

Filming NOTSS-VRC video scenarios in Kigali, Rwanda

Filming NOTSS-VRC video scenarios in Kigali, Rwanda

Research Team

John Scott, MD, MPH (Surgery, Brigham & Women's Hospital/ Harvard Medical School)

Robert Riviello, MD, MPH (Surgery, Brigham & Women's Hospital/ Harvard Medical School)

Georges Ntakiyiruta, MD (Surgery, University of Rwanda)

Yihan Lin, MD, MPH (Surgery, University of Colorado)

Steven Yule, PhD (Brigham & Women's Hospital/ Harvard Medical School)