22. Paradigms for Plastic Surgery Training Programs in sub-Saharan Africa

Abstract

Background: Sub-Saharan Africa (SSA) is one of the world’s geographic regions with the greatest need for expanded plastic surgery training and infrastructure to address its burden of surgical disease. The present study reviews the educational structure and existing training programs in Plastic and Reconstructive Surgery (PRS) throughout SSA to provide transparency as to the educational paradigms and help identify where unmet needs are the greatest. Methods: The respective websites of the College of Surgeons of East, Central, and Southern Africa (COSECSA), the West African College of Surgeons (WACS), and the Colleges of Medicine of South Africa (CMSA) were reviewed by the authors. Additionally, anecdotal evidence informed by authors who have trained or are currently members of these colleges was utilized when available website information was lacking. Results: After completing medical school and a governmentally sponsored internship, COSECSA, including 19 countries, requires 2 years of general surgery training prior to 3 years of PRS. There are currently 13 accredited programs in COSECSA to train PRS trainees, with 5 graduates completing their training in 2020. CMSA similarly requires 2 years of general surgery and 3 years of PRS training at one of the 8 accredited programs in South Africa. WACS, including 14 countries, requires 2.5-3 years of general surgery in addition to 3 years of PRS. There are 32 accredited programs, 29 in Nigeria and 3 in Ghana, approved for 116 resident positions. In April 2022, 5 WACS trainees passed their exams to become board certified plastic surgeons. The ratio of PRS-accredited programs to the number of countries in each region is demonstrated. Conclusion: The requirements for plastic surgery training in SSA are fairly consistent throughout the region. However, COSECSA, which includes the largest number of African countries, has less than 1/3 the ratio of accredited programs per country compared to any other region in SSA. Increased transparency and collaboration between SSA and other African regions will help each of these programs continue to expand to meet their surgical needs.