Background
The shortage of reconstructive surgeons in low- and middle-income countries (LMICs) is a major barrier to addressing the global burden of surgical disease. This challenge is exacerbated by limited access to specialized training programs and educational resources. Although general surgery capacity in LMICs has grown in recent years, reconstructive surgery, which is essential for treating congenital anomalies, trauma, burns, and oncologic conditions, remains underrepresented.
Sub-Saharan Africa has the most acute shortage of reconstructive surgeons. To put this in perspective, the U.S. has one reconstructive surgeon for every 50,000 people. Sub-Saharan Africa has only 1 reconstructive surgeon per 10 million people. ReSurge International has partnered with the College of Surgeons of Eastern, Central, and Southern Africa (COSECSA), the largest surgical training institution in the region, to develop a set of online reconstructive surgery learning modules.
Introducing the first-ever COSECSA plastic and reconstructive surgery online curriculum
Jointly produced by ReSurge International, the Royal College of Surgeons in Ireland (RCSI) Institute of Global Surgery, and the College of Surgeons of East, Central, and Southern Africa (COSECSA), we’re excited to introduce the first-ever COSECSA plastic and reconstructive surgery online curriculum. We wrote about the impact and utilization of the first few years of this modular curriculum, which was published in the Journal of Plastic, Reconstructive, and Aesthetic Surgery. It was authored by experts in the field — notably several ReSurge surgical and organizational leaders, including Dr. James Chang, Dr. Godfrey Muguti, Dharshan Sivaraj, Dr. Meewon Olivia Park, Dr. Rose Alenyo, Natalie Meyers, MPH, Niraj Bachheta, and Dr. Lawrence Cai.
The curriculum was designed to complement in-person learning by providing structured, accessible content that covers the scope of plastic and reconstructive surgery. This project was initiated at the request of COSECSA leadership, and all modules were reviewed, edited, and approved by COSECSA faculty, who also contributed local clinical cases.
Research Methods
The online curriculum comprises 26 modules, each of which includes a pre-test, video lectures, reference slides, local case scenarios, and a post-test. Engagement metrics (module interactions and page views) and test scores were tracked over time. User satisfaction was assessed via feedback surveys, and knowledge improvement was gauged by comparing pre- and post-test scores. A discussion forum moderated by COSECSA faculty was also integrated to encourage peer collaboration. All learning modules are asynchronous, and trainees may engage at their own pace. A suggested three-year sequence was provided to guide learners through the modules.
Early Outcomes
A total of 103 surgical trainees participated in the curriculum since its launch, with 68 individuals still actively enrolled at the time of analysis. Platform engagement has increased over time, with more than 29,000 cumulative module interactions and 45,000 cumulative page views recorded by month 30. The post-test scores improved significantly compared to pre-test scores across all modules. This online curriculum was associated with trainee engagement, improved knowledge, and positive user feedback, supporting its feasibility and usefulness as an educational resource in this setting.
Why this matters
As a founder of the global surgery movement, and one of the first organizations to move away from the fly-in model in the 1990s, ReSurge international has continued to advocate for and practice the “train-the-trainer model” because it presents a more sustainable and scalable way to deliver long-term access to reconstructive surgical care in low and middle-income countries by training a new generation of local reconstructive surgeons.
This curriculum represents a useful resource to supplement the training of more plastic and reconstructive surgeons while taking into account the educational needs of low-resource settings. Training plastic and reconstructive surgeons through surgical education creates a substantial ripple effect. For example, a prior ReSurge study found that just one surgeon in a low-income country can treat 10,000 patients in their career, and if they become a full-time surgeon-trainer, they can transform over 400,000 lives in their lifetime by their succeeding trainees — creating a substantial multiplier effect across generations.
