Developing sustainable Emergency Urology Simulation Training in sub-Saharan Africa

Simulation-based education (SBE) is widely adopted in high-income countries to enhance surgical training, but opportunities remain limited in low- and middle-income countries (LMICs). Emergency Urology Simulation Training (EUST) was developed to address knowledge and skill gaps in managing urological emergencies in sub-Saharan Africa.

EUST courses were delivered in Ethiopia, Uganda and Malawi using a single-day format combining pre-course online learning, didactic teaching with hands-on simulation. Locally, sourced animal tissue models were employed to replicate ureteric, bladder, renal, scrotal and penile injury repairs. Pre- and post-course assessments included multiple-choice questions (MCQs) and confidence surveys. Post-course composite scores were compared across sites using the Kruskal-Wallis test. Faculty feedback evaluated preparedness and sustainability.

A total of 46 participants completed EUST across four sites, baseline knowledge was low (mean pre-course MCQ scores: 8.0-10.75/15). Post-course scores improved (10.63-12.72/15), with knowledge gains of 15%-32%. Confidence in managing rare emergencies, such as penile fracture and ureteric reimplantation, increased universally; 100% of delegates recommended integrating EUST into national training curricula. Faculty anxiety about SBE delivery decreased post-training, and senior trainees transitioned well into faculty roles, supporting ongoing sustainability. Cost-effectiveness was achieved by using animal tissue and donated instruments, reducing reliance on expensive synthetic models.

EUST is an affordable, scalable and effective model for surgical education in LMICs. The 'See one, run one' approach enables replication across both specialty and international boundaries and fosters sustainable local faculty development. EUST demonstrates a significant positive educational impact and offers a sustainable programme for improving emergency urology care in resource-limited settings. Partnering with COSECSA facilitates a reduction in UK faculty requirement long-term.