Evolving paradigms of surgical education in Africa : historical contexts and outcomes
This thesis explores the historical background and evolution of surgical education in Africa and the shift towards an African-based postgraduate education by using specific case studies about a collegiate-based education under the College of Surgeons of East Central and Southern Africa (COSECSA) and a university-based surgical education in Ethiopia. It examines the change from extracontinental to intra-continental training models, assessing their impact on graduate retention, educational quality, and assessment methods. The thesis starts by exploring the determinants of surgical training in Africa, highlighting the impact of colonialism and the “brain drain” phenomenon by utilizing two of my publications. It then outlines the establishment of Africa's leading surgical colleges and provides a case analysis of the College of Surgeons of East, Central, and Southern Africa (COSECSA). My key publications evaluate COSECSA's training impact on graduate retention, countering the "brain drain" myth and identifying retention factors for COSECSA-trained surgeons. Two additional papers are used to examine COSECSA’s quality assurance framework and innovative assessment methods, including the ENTRUST platform for evaluating clinical decision-making and the several factors that influenced exam performance among COSECSA trainees. The thesis also includes an exploration of various innovations in education such as the integration of electronic surgical logbooks and the variations in operative case volume. My two papers demonstrate the effectiveness of such innovative approaches in competency-based learning in the region and offer practical recommendations for improving surgical training in Africa and similar contexts. Finally, the thesis provides an analysis of Addis Ababa University’s general surgery residency program, based on four publications. This allows for scrutiny of its structure, educational strategies, outcomes, assessment tools, and role in addressing Ethiopia's surgical workforce needs. Textual narrative analysis and critical interpretive synthesis reveal central themes across these works, showcasing the colonial legacies influencing African surgical training structures.
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