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

Document Type

Journal Article

Publication Date



World neurosurgery




Africa; colonialism; global neurosurgery; global surgery


BACKGROUND: As a result of gradual independence from colonial rule over the course of the past century, Africa has developed and evolved three 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 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). CONCLUSION: 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 in sufficient. These inequities should be acknowledged addressed and rectified to ensure that patients in Africa receive timely and appropriate surgical care.


Neurological Surgery