Provision of online surgery masters programmes and funded scholarships to support the academic and professional development of surgical trainees and improve surgical education globally, especially in world’s poorest countries.

Overall goals

(1) To deliver high quality online masters programmes that complement the traditional acquisition of clinical knowledge by the surgical trainee

(2) To support the academic and professional development of surgical trainees in their training.

(3) To provide funded scholarships in support of surgical trainees in low and middle income countries

Key UK Colleagues and Partners

The Royal College of Surgeons of Edinburgh

International Partners

International partners include College of Surgeons of Eastern, Central and Southern Africa (COSECSA); Royal Australian College of Surgeons (RACS).

Sustainable development goals

• SDG 3 - Good health and well-being
• SDG 4 - Quality education
• SDG 5 - Gender equality
• SDG 8 - Decent work and economic growth
• SDG 10 - Reduced inequalities

Funding source

Our work is funded through student fees with surplus income being channelled into bursaries and full scholarship funding for training surgeons based in low and middle income countries. Additional external scholarship funding has come from Commonwealth Commission Scholarships, Ethicon (Johnson and Johnson), eoSurgical Scholarship, Physicians for Peace and the National Institute for Health Research.

Project origin

The University of Edinburgh and the Royal College of Surgeons of Edinburgh (RCSEd) first collaborated in 2006 to develop part-time online Master’s programmes to support the surgical trainee in their academic and professional development on a background of the changes in surgical training which reduced clinical exposure in the workplace.

Evidence of need

Surgery provides the best solution to many diseases, with over 300 million surgical procedures required annually worldwide. Unfortunately, less than half the world’s population have access to safe, affordable and timely surgical care. Major changes in surgical training in the last decade have involved reduced working hours, which limit the exposure to common surgical conditions and operations that would have formed part of traditional training for surgical trainees. In low resource settings there may also be a lack of structured training to augment in-the-work-place experience.

The apparent lack of teaching provision of knowledge and consistent educational support for the trainee resulted in a greater than expected demand for access to our online master’s programmes. In low and middle-income countries, these specifically augment in-the-workplace training without the trainees having to leave their country. The initial launch of the MSc in Surgical Sciences to support early years training was followed by a demand for additional advanced online ChM Masters programmes in General Surgery, Trauma & Orthopaedics, Urology and Vascular & Endovascular Surgery. Most recently, a MSc programme in Patient Safety and Clinical Human Factors has been developed. These programmes have now extended their reach to a global audience including trainees from LMICs. However, although the performance of LMIC students on these programmes remains very high and the level of applications from sub-Saharan Africa are increasing year on year, only very few applications are converted to enrollment because of limited scholarship funding.

Project areas

Health and Education

Project activities

Our MSc Surgical Sciences emerged as the fastest recruiting postgraduate course at our university when launched in 2007. Enrollment figures (1252 students) since its launch indicate a growing popularity, with uptake from 8 countries in 2007 (25% from LMICs), to 56 countries to date (39% from LMICs). In the last 11 years, 1873 trainees (23% female) in 75 countries have registered for the programmes while some 600 students are currently enrolled. The number of students from low middle-income countries (LMICs) on our MSc Surgical Science programme has also increased, from 8 students from 4 LMICs in 2007 to 207 students from 24 LMICs over the subsequent ten years.

Of the 207 students enrolled from developing countries, 63 are currently on the MSc in Surgical Sciences programme, 99 have completed the full masters stage, 9 at Certificate level and 16 students at Diploma level with an overall successful pass rate of 86%. For the more advanced ChM programmes, 109 of the 223 students from LMICs that have enrolled since 2011 are currently in programme, while 75 (66%) students have now completed the full ChM award.

Our students achieve higher success rates (~15%) in their professional examinations (MRCS & FRCS) in the United Kingdom. Success rate of LMIC Students on our MSc and ChM programmes is no different from the entire cohort.

Our programmes have enabled increase in surgical practice capacity globally and especially in LMICs, where trainees continue to practice in their own country, thus, combating loss of regional workforce. Feedback from LMIC students suggests that case-based scenarios in the Surgical Sciences programme can improve patient safety by providing a way to apply knowledge virtually, before practice. Our programmes have extensive international collaboration and have facilitated philanthropic activity in Africa, offering a sustainable means of providing outreach support to surgical trainees in less privileged countries.

Our scholarships have extended educational opportunities globally to both male and female trainee surgeons in LMICs. In Malawi, for example, our programmes have provided full scholarship funding to 31 trainees (59% female) such that there are now more supported trainees than qualified, independently practising, general surgeons.

The strong publication record of our graduates (89 published articles to date from 467 students) is evidence of the value of our programmes to academic development. Our programmes show that Scottish Health Care professionals can contribute to global citizenship remotely as programme and module leaders as well as tutors and dissertation supervisors.

In recognition of the quality of our programmes, the University of Edinburgh in 2010, gave the Chancellor’s Award for Teaching, and the 2010 national eLearning Awards for Best Online Learning Programme (Education), to its director (Professor James Garden). The growing suite of online learning surgical educational programmes has continued to recruit strongly and was awarded the Queen’s Anniversary Prize for Higher and Further Education in 2013.

Changes

To enhance the success of surgical trainees at their own professional examinations and as indicated by student feedback, this has been achieved.

To support and equip trainee surgeons in their professional activities and to improve surgical patient care, safety and access. While it is difficult to measure specific impact of our programmes on patients, experience in Malawi has shown that trainee surgeons can be academically and professionally supported without significant loss of the surgical workforce in their country.

To ensure strong LMIC trainee engagement and prevent a high student dropout rate by continuing to support trainee surgeons from LMICs with full scholarship funding.

To continue to contribute to the academic development of trainees and scientific knowledge

To continue to promote gender equality among surgical trainees.

To re-shape the landscape of postgraduate surgical education, and ultimately improve patient care, as today’s surgical trainees are tomorrow’s surgeons.

Next steps

To secure additional funding to widen access to masters programmes in LMICs

To establish an annual capacity building retreat in sub-Saharan Africa from 2019 to support the professional and leadership development of the trainee surgeon with partners, (including Commonwealth Commission Scholarship, College of Surgeons of Central, Eastern and Southern Africa, Johnson & Johnson)

To understand where there is an increasing need for online educational support in LMICs

To establish the precise role of a new online MSc in Patient Safety and Clinical Human Factors in supporting all healthcare professionals in LMICs

To develop individual modules for continuing professional development that might widen access to quality educational resource.

Challenges

The performance of LMIC students on our programmes remains very high but the level of applications from sub-Saharan Africa has increased year on year. A small proportion of applications are converted to enrollment because of limited scholarship funding.

Feedback from some of our graduates especially from LMICs suggests the need for a platform for continuing engagement of our graduates after graduation.

While our students can flexibly exit the MSc Surgical Sciences programme after completing one year to obtain a Certificate award or two years to obtain a Diploma Award and three years to obtain a full MSc award, our ChM programmes have not provided for such flexibility until recently. A student on any of our ChM programmes must complete the full two-years to obtain a ChM award.

Mitigating challenges

There is an increasing need for online educational support in LMICs. Additional funding is required to widen access to these programmes in LMICs

We have established an annual capacity building retreat in sub-Saharan Africa to support the professional development of the trainee surgeon with partners.

We have created a virtual platform for continued engagement of our graduates on completion of their studies and are looking to recruit those who have performed well as future tutors.

Develop individual modules for continuing professional development

Our ChM programmes now offer the flexibility of obtaining a Diploma award after the completion of one year

Partnership principles

• strategic
• harmonised
• effective
• respectful
• organised
• responsible
• flexible

Project gains

• leadership
• teamwork
• awareness
• academic
• resilience