General surgery education: a systematic review of training worldwide

Surgical care is an essential component of health management worldwide. As the prevalence of injuries and non-communicable diseases increases, the provision of effective surgical care will become an increasingly important priority to reduce death and disability. To assess the ability of health systems to meet current surgical needs, we did a review of surgical training programmes worldwide.

We searched Medline, EMBASE, and the Global Health Library databases with the search terms "surgical training" and "surgeon training" for abstracts and citations in all languages published between Jan 1, 1998, and Dec 31, 2013, describing a national general surgery training system. We extracted the following data: a brief description of the programme, years of training required, year after medical school graduation when training begins, name of national oversight organisation(s), in-country opportunities for subspecialty training, and whether programmes self-identified as being similar to or affected by the surgical education system in the USA or the UK.

We identified 5229 abstracts (3888 from Medline, 971 from EMBASE, and 726 from the Global Health Library databases). 228 (4·4%) articles underwent full text review. 60 articles were included for data extraction. We identified descriptions of general surgery training programmes in 52 countries. Data from an additional 17 countries represented by a regional college of surgeons were also recorded. Training duration ranged from 2-8 years (median total training, 6 years; median surgical training, 5 years), and lasted on average 6 years after medical school graduation. 19 countries self-identified as being similar to or affected by the US or UK training model. Many low-income and middle-income countries (LMICs) are working to expand access to surgical care through programmes, often focusing on training non-physician clinicians. Programmes in high-income countries have also undergone substantial reforms, affected by evolving practice environments, trainee preferences, and training bottlenecks.

General surgery training programmes are often responsive to national health care needs. We show a global trend towards standardisation of curricula and competency-based training. Countries expanding or developing their programmes show benefit from association or partnership with larger surgical organisations and academic institutions, but there are questions of sustainability. Both LMICs and high-income countries stand to benefit from coordinating development of global training standards and educational exchanges. Although more research is needed to understand the role of surgical education in meeting the demand for surgical care, it is clear that a cross-nationally coordinated strategy will be important to address the burden of surgical disease.

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