Ugandan physician attitudes towards a potential, local trauma fellowship program

Alan Zambeli-Ljepović; Treasure Ibingira; Caroline Stephens; Rachel Koch; Marissa A Boeck; Doruk Ozgediz; Martha Namugga

doi:10.1186/s12893-025-02953-2

Ugandan physician attitudes towards a potential, local trauma fellowship program

BMC Surg. 2025 Jul 1;25(1):251. doi: 10.1186/s12893-025-02953-2.

Authors

Alan Zambeli-Ljepović¹, Treasure Ibingira², Caroline Stephens¹, Rachel Koch¹, Marissa A Boeck^{1

3}, Doruk Ozgediz^{1

3}, Martha Namugga⁴

Affiliations

¹ Department of Surgery, University of California San Francisco, 513 Parnassus Ave, Suite S-321, San Francisco, CA, 94143-0470, USA.
² Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
³ Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, 550 16 th St, 3rd Floor, Box 1224, San Francisco, CA, 94158, USA.
⁴ Department of Surgery, Mulago National Referral Hospital, Mulago Hill, P.O. Box 7051, Kampala, Uganda. kasujjammn@gmail.com.

Abstract

Introduction: In low-income countries, clinicians trained through a context-specific trauma surgery fellowship program (TFP) can help reduce injury-related mortality to levels closer to those observed in higher-resource settings. Successful implementation, however, hinges on buy-in from local clinicians. We assessed clinician support for a potential TFP in Uganda, considering perceived need, curricular recommendations, barriers, and motivating factors.

Methods: After cognitive interviews with experts and questionnaire pilot testing, we cross-sectionally surveyed Ugandan consultants (general surgeons and procedural specialists involved in trauma care) and surgical residents at a tertiary, national referral hospital. Respondent percentages were calculated for multiple-choice answers, and we performed thematic analysis of free-text responses using a primarily inductive approach.

Results: Among 46 faculty (from 13 specialties) and 42 resident respondents, 86% supported a Ugandan TFP. Respondents recommended incorporating emergency general surgery (66%), critical care (84%), and international rotations (76%) into the curriculum. Severe resource and structural deficiencies (82%) and concern about governmental support for post-training employment and compensation (66%) were leading perceived barriers to TFP implementation. Most faculty felt a TFP would improve patient outcomes (93%), overall trainee education (77%), and clinical efficiency (68%). Free-text responses were consistent with survey themes, indicating acute awareness of current trauma system inadequacies and conviction that a TFP would reduce injury-related mortality.

Conclusions: Ugandan clinicians who care for injured patients view a TFP as crucial to improving injury-related outcomes, despite known barriers. TFP implementation should incorporate curricular recommendations from this survey and address widespread concerns about financial and infrastructural support from the national government and local institutions.

Keywords: Fellowship; Global surgery; Injury; Low income; Low resource; Surgery; Survey; Training; Trauma; Uganda.

MeSH terms

Adult
Attitude of Health Personnel*
Cross-Sectional Studies
Fellowships and Scholarships*
Female
Humans
Internship and Residency
Male
Surveys and Questionnaires
Traumatology* / education
Uganda

Abstract

MeSH terms

Grants and funding