The Impact of Colonialism on Surgical Training Structures In Africa Part 2: Surveying Current and Past Trainees

Authors

Nqobile Thango, Department of Neurosurgery, University of Cape Town, Cape Town, South Africa; Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
Andrea L. Klein, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA; Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA.
Beverly Cheserem, Department of Neurosurgery, Aga Khan University Hospital, Nairobi, Kenya.
Muhammad Raji Mahmud, Department of Neurosurgery, Ahmadu Bello University, Zaria, Kaduna, Nigeria.
Abebe Bekele, Department of Surgery, University of Global Health Equity, Kigali, Rwanda.
Efosa Ohonba, Department of Neurosurgery, University of Cape Town, Cape Town, South Africa.
Gloria Shani Kabare, Department of Neurosurgery, Aga Khan University Hospital, Nairobi, Kenya.
Saidu Abdulkarim Umar, Department of Neurosurgery, Ahmadu Bello University, Zaria, Kaduna, Nigeria.
Jules Iradukunda, Department of Surgery, University of Global Health Equity, Kigali, Rwanda.
Gail L. Rosseau, Department of Neurosurgery, The George Washington University, Washington, District of Columbia, USA; Barrow Neurological Institute, Phoenix, Arizona, USA. Electronic address: gailrosseaumd@gmail.com.

Document Type

Article

Abstract

BACKGROUND: As a result of gradual independence from colonial rule over the course of the past century, Africa has developed and evolved 3 primary surgical training structures: an extracontinental colonial model, an intracontinental college-based model, and several smaller national or local models. There is consistent evidence of international brain drain of surgical trainees and an unequal continental distribution of surgeons; however there has not, to date, been an evaluation of the impact colonialism on the evolution of surgical training on the continent. This study aims to identify the etiologies and consequences of this segmentation of surgical training in Africa. METHODS: This is a cross-sectional survey of the experience and perspectives of surgical training by current African trainees and graduates. RESULTS: A surgeon's region of residence was found to have a statistically significant positive association with that of a surgeon's training structure (P <0.001). A surgeon's professional college or structure of residency has a significantly positive association with desire to complete subspecialty training (P = 0.008). College and structure of residency also are statistically significantly associated with successful completion of subspecialty training (P < 0.001). CONCLUSIONS: These findings provide evidence to support the concept that the segmentation of surgical training structures in Africa, which is the direct result of prior colonization, has affected the distribution of trainees and specialists across the continent and the globe. This maldistribution of African surgical trainees directly impacts patient care, as the surgeon-patient ratios in many African countries are insufficient. These inequities should be acknowledged addressed and rectified to ensure that patients in Africa receive timely and appropriate surgical care.

Medical Subject Headings

Colonialism; Humans; Africa; Cross-Sectional Studies; Internship and Residency; Surveys and Questionnaires; Surgeons (education); Neurosurgery (education)

Publication Date

5-1-2024

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

185

First Page

e299

Last Page

e303

PubMed ID

38244680

Digital Object Identifier (DOI)

10.1016/j.wneu.2023.11.146

Recommended Citation

Thango, Nqobile; Klein, Andrea L.; Cheserem, Beverly; Mahmud, Muhammad Raji; Bekele, Abebe; Ohonba, Efosa; Kabare, Gloria Shani; Umar, Saidu Abdulkarim; Iradukunda, Jules; and Rosseau, Gail L., "The Impact of Colonialism on Surgical Training Structures In Africa Part 2: Surveying Current and Past Trainees" (2024). Neurosurgery. 2047.
https://scholar.barrowneuro.org/neurosurgery/2047