Background Countries in Sub-Saharan Africa lack adequate surgical workforces to achieve safe and affordable care for their populations. The Global Surgery movement highlights the urgent need to address this situation. Interventions include not only financial, material and infrastructural support, but also collaborative information flow to support surgical training. In 2015, an electronic logbook was launched for surgical trainees across Sub-Saharan Africa.Objectives To assess the integration and context sustainability of surgical e-logbooks in Sub-Saharan Africa. Methods In January 2019, a survey analysis of surgical trainees was employed using quantitative and qualitative methods. Participants (active trainees and recent fellows) completed an anonymous internet-based questionnaire evaluating end-user feedback, perceptions and self-reported compliance. Multi-point Likert Scale measures and freetext thematic analysis were used. Results 358 (68.19%) eligible individuals across 21 Sub-Saharan countries and seven surgical specialties voluntarily participated. The e-resource demonstrated integration into local curricula with the majority of users maintaining activity and reporting moderate-high compliance. Context appropriateness measures were high with 203 (69.76%) deeming it convenient to use. The principle obstacle to compliance was internet connectivity (74, 25.96%), while behavioural factors including supervisor engagement were implicated. The e-logbook demonstrated future sustainability with the majority (243, 78.14%) of participants intent on maintaining usage beyond completion of surgical training. Conclusions We describe the successful integration and sustainability of electronic surgical logbooks for trainees across Sub-Saharan Africa. However context-appropriate resources are essential for Low-and Middle-Income Countries. Internet connectivity may hinder the achievement of several Global Surgery objectives in Sub-Saharan Africa.

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Objective: We describe a structured approach to developing a standardized curriculum for surgical trainees in East, Central, and Southern Africa (ECSA). Summary Background Data: Surgical education is essential to closing the surgical access gap in ECSA. Given its importance for surgical education, the development of a standardized curriculum was deemed necessary. Methods: We utilized Kern's 6-step approach to curriculum development to design an online, modular, flipped-classroom surgical curriculum. Steps included global and targeted needs assessments, determination of goals and objectives, the establishment of educational strategies, implementation, and evaluation. Results: Global needs assessment identified the development of a standardized curriculum as an essential next step in the growth of surgical education programs in ECSA. Targeted needs assessment of stakeholders found medical knowledge challenges, regulatory requirements, language variance, content gaps, expense and availability of resources, faculty numbers, and content delivery method to be factors to inform curriculum design. Goals emerged to increase uniformity and consistency in training, create contextually relevant material, incorporate best educational practices, reduce faculty burden, and ease content delivery and updates. Educational strategies centered on developing an online, flipped-classroom, modular curriculum emphasizing textual simplicity, multimedia components, and incorporation of active learning strategies. The implementation process involved establishing thematic topics and subtopics, the content of which was authored by regional surgeon educators and edited by content experts. Evaluation was performed by recording participation, soliciting user feedback, and evaluating scores on a certification examination. Conclusions: We present the systematic design of a large-scale, context-relevant, data-driven surgical curriculum for the ECSA region.

scale curriculum development project, there are several important contributors. All authors have given final approval of the version to be submitted. A.S.P. made substantial contributions to the conception and design of this study, the collection, analysis, and interpretation of data, and to writing the manuscript. B.C.S. made substantial contributions to the acquisition of data related to the examination scores and assessment of module-and non-module-related questions and has critically revised the manuscript. K.H. made substantial contributions to the conception and design this study, specifically relating to the acquisition of user feedback. She was instrumental in the analysis and interpretation of data and has critically revised the manuscript. D.M. and N.B. made substantial contributions to the acquisition of data relating to trainee engagement and tracking of learner participation and have critically revised the manuscript. M.M. and A.B., as membersObjective: We aimed to determine the impact of a standardized curriculum on learning outcomes for surgical trainees in East, Central, and Southern Africa (ECSA). Background: As surgical education expands throughout ECSA, there is a recognized need for a standardized curriculum. We previously described the design of a novel, large-scale, flipped-classroom, surgical curriculum for trainees in ECSA. Methods: In January 2020, the first year of curricular content for trainees of the College of Surgeons of ECSA was released, containing 11 monthly thematic topics, each with 2 to 5 weekly modular subtopics. We aimed to evaluate 3 outcomes utilizing data sources incorporated into the curriculum structure. Learner engagement was assessed by the number of trainees completing curriculum topics. User experience was evaluated using quantitative and qualitative feedback responses to embedded surveys for each content week. Curriculum impact on trainee examination performance was assessed by comparing certification examination scores stratified by the number of curricular topics each trainee completed. Results: Two hundred seventy-one trainees (96%) in 17 countries accessed at least 1 weekly module. Trainees completed a median of 9 topics (interquartile range: 6-10). The feedback survey response rate was 92% (5742/6233). Quantitative and qualitative responses were positive in overall module value (93.7% + 2.6%), amount of learning experienced (97.9% + 1.4%), confidence in achieving learning objectives (97.1% + 2.4%), and ease of use of the module (77.6% + 5.98%). Topic-related certification examination performance improved significantly with increased completion of thematic topics. Conclusions: A standardized surgical curriculum in ECSA demonstrated excellent trainee usage, positive feedback, and improved examination scores.

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