Global reach, equity, and learning outcomes of a digital surgical education platform: a RE-AIM implementation-effectiveness evaluation of SURGhub

Healthcare providers in resource-constrained settings face persistent barriers to continuing professional development. Digital platforms may offer scalable approaches to surgical education, but evidence on implementation, equity, and learning outcomes at a global scale is limited. We evaluated the reach, implementation, equity, and learning outcomes of the United Nations Global Surgery Learning Hub (SURGhub) using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework.

We conducted a cross-sectional evaluation of 112 SURGhub courses delivered between June 2023 and July 2025, alongside an uncontrolled paired analysis of learner knowledge acquisition. We analysed prospectively collected content provider, aggregated learner, and anonymised individual-level data to assess intervention outputs, reach, country-level uptake, implementation feasibility and acceptability, and changes in assessment scores.

SURGhub recorded 32,014 course enrolments from learners practising in 195 countries. The weighted mean progression and completion rates were 29.0% and 23.1%, respectively. Completion rates decreased from 34.0% among courses with shorter mean enrolment-to-completion intervals to 13.8% among those with longer intervals. Acceptability was high among course completers who responded to the survey, with a mean score of 4.57 on a five-point scale. A linear mixed-effects model including a random intercept for course estimated a mean increase in assessment score of 33.4 percentage points (95% confidence interval = 29.8-37.1) across 1,928 paired learner-course observations from 33 courses. Course-level mean increases ranged from 15.3 to 54.4 percentage points. Content providers were concentrated in high-income countries, while learners enrolled from both high-income and low- and middle-income settings, indicating broad geographic access along a geographic concentration of content production.

SURGhub achieved global reach and high acceptability, demonstrating the potential of low-bandwidth, open-access digital platforms to deliver surgical education at scale. Completion should be interpreted alongside other engagement metrics, particularly for longer modular courses. Future research should assess long-term knowledge retention, clinical impact, multilingual content expansion, and participation by stakeholders from low- and middle-income countries.