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

Nqobile Thango, Andrea L. Klein, Beverly Cheserem, Muhammad Raji Mahmud, Abebe Bekele, Efosa Ohonba, Gloria Shani Kabare, Saidu Abdulkarim Umar, Jules Iradukunda, Gail L. Rosseau

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
JournalWorld Neurosurgery
Publication statusAccepted/In press - 2024


  • Africa
  • Colonialism
  • Global neurosurgery
  • Global surgery


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