Title : Mapping pediatric general surgery training in low and middle income countries: A scoping review
Abstract:
Children in low- and middle-income countries experience a substantial disparity in access to essential pediatric surgical care. Estimates suggest that up to 85 percent of children will require at least one surgical intervention before the age of 15. However, the availability of trained pediatric surgeons remains critically limited. In sub Saharan Africa, approximately 100 pediatric surgeons currently serve more than 300 million children, and this number is expected to approach 500 million by 2050. These demographic projections underscore an urgent need to strengthen the pediatric surgical workforce. Building capacity requires not only expansion of training programs but also a clear understanding of which educational models are effective, contextually feasible, and scalable within resource constrained settings.
Purpose: The objective of this scoping review is to map the existing literature describing pediatric general surgery training in low- and middle-income countries and to identify the barriers, facilitators, and educational strategies reported in the global literature. By synthesizing these findings, the review aims to highlight approaches that can support the development of equitable and sustainable pediatric surgical training programs, both internationally and within underserved regions of high-income countries.
Methods: A scoping review methodology was applied, incorporating seven electronic databases and grey literature sources. A total of 6,213 records were identified. After sequential screening of titles, abstracts, and full texts, 50 studies were included. Data extraction focused on training modalities, instructional approaches, evaluation methods, contextual barriers, and enabling factors. Studies were examined across geographic regions and classified by the structure and reported outcomes of the training initiatives.
Results: The educational initiatives identified in the literature demonstrated considerable variation in structure and delivery. Examples included low bandwidth videoconferencing initiatives used for case-based instruction in South Africa, DVD based seminar programs implemented across East and Central Africa, simulation-based modules introduced in Kenya and Nigeria, regional training hubs developed in Tanzania, and the early adoption of competency based pediatric surgery curricula in Pakistan and India. Many programs reported high acceptability, perceived gains in trainee knowledge and confidence, and strengthened collaboration. However, objective assessments of skill acquisition and long-term clinical outcomes were seldom reported. Significant barriers included limited faculty availability, lack of infrastructure, insufficient access to simulation equipment, absence of standardized curricula, and competing clinical responsibilities. Facilitators included blended and asynchronous learning models, regional and international partnerships, structured mentorship, and institutional support for protected teaching time.
Conclusion: The findings of this review demonstrate that context specific and adaptable educational models can meaningfully contribute to the development of pediatric surgical capacity in low resource environments. Strengthening the global pediatric surgical workforce may require standardized evaluation frameworks, regionally coordinated training networks, and investment in sustainable and flexible learning infrastructures. Lessons derived from these international initiatives may also inform strategies for improving pediatric surgical access in remote and underserved areas of Canada and other high-income countries.
