Evaluation of an online journal club–style course on evidence-based surgery for trainees of the College of Surgeons of East, Central and Southern Africa

  • James J. Aird
  • Victor Animasahun
  • Tara Harrop
  • Brian Cameron
  • Andrew Howard
  • Pankaj Jani
Keywords: evidence-based medicine, online learning, postgraduate surgical training, Africa


Background: Evidence-based surgical practice is key to optimizing patient care. Surgeons need critical appraisal skills to apply the best evidence, so formal training in evidence-based surgery (EBS) is increasingly a part of postgraduate surgical education. Surgeons in Africa must apply research to their unique patient populations, local practices, and limited healthcare resources. To meet this need, partners in Canada and the United Kingdom collaborated with the College of Surgeons of East, Central and Southern Africa
(COSECSA) to offer the Surgery in Africa Journal Club (SIAJC) as an online course for COSECSA trainees. We evaluated the participation, satisfaction, and knowledge gained by SIAJC participants over its initial 2 years.

Methods: Knowledge was measured by comparing precourse with postcourse test scores using validated multiple-choice questions. Scores were compared using a paired-samples t-test. Trainees gave anonymous feedback on the course, and responses were grouped into themes and analysed.

Results: After exclusions, there were 282 postgraduate surgical trainees who completed the SIAJC precourse test in 2015 and 2016. Postcourse tests were completed by 95 of these 282 trainees (33.7%). EBS knowledge increased significantly, with a mean postcourse test score of 20±5.28 out of 30, vs 15±3.62 out of 30 on the precourse test (t=−10.1, df=110, P<0.001). Trainees reported enthusiasm for the course, improved knowledge of best practices, empowerment to make better clinical decisions, and concerns that EBS would be expensive or conflict with local expert opinion. For some participants, poor Internet access was a barrier to
accessing course materials.

Conclusions: The SIAJC effectively taught EBS-related material, but the course had a high attrition rate and has been difficult to sustain because of its dependence on external faculty. A blended model using course materials for local face-to-face journal clubs led by local EBS champions may be the best long-term model to improve EBS skills and practice in the COSECSA region.

Original Research