Locally Led, Globally Impactful: A Simulation-Based Laparoscopic Skills Curriculum for Surgeons and Trainees in Ethiopia

Abstract Purpose Access to laparoscopic surgery is severely limited across much of sub-Saharan Africa, where formal training infrastructure is scarce and most programs depend on visiting foreign faculty. We evaluated whether a short, locally led, simulation-based laparoscopic curriculum delivered entirely by in-country faculty and resources could improve the laparoscopic knowledge and technical skills of practicing surgeons and surgical trainees in Ethiopia. Methods Thirty surgical trainees (14 general or pediatric surgeons; 16 general surgery or urology residents) with no prior formal laparoscopic instruction were selected for a blended curriculum: six weeks of asynchronous online modules based on the Fundamentals of Laparoscopic Surgery (FLS) framework, followed by a five-day intensive hands-on workshop using both locally fabricated and imported validated box trainers. Three FLS tasks (peg transfer, circle cutting, and intracorporeal suturing) were timed before and after training; a nine-domain Global Rating Scale (GRS; maximum 45) and a 20-item multiple-choice knowledge test were also administered. Paired-samples t-tests, McNemar tests, Pearson correlation, and linear regression were used; effect sizes were estimated using Cohen’s d or Hedges’ g. Results Twenty-eight of the 30 participants completed both assessments and were analyzed. All task completion times decreased significantly: peg transfer from 5.51 to 2.47 minutes, circle cutting from 5.74 to 3.17 minutes, and suturing from 10.95 to 3.71 minutes (all p < 0.001; effect sizes 0.94–1.26). GRS scores rose from 17.8 to 30.1 (+ 12.3 points; p < 0.001; d = 1.49), with 27 of 28 participants (96%) improving. Knowledge scores rose modestly, from 13.5 to 15.5 out of 20 (mean gain 2.0). Both surgeons and residents improved significantly in technical skill (p = 0.001 and p < 0.001, respectively). Baseline knowledge predicted baseline skill (r = 0.49; R² = 0.24; p < 0.01) but not post-training skill (r = − 0.03; p = 0.87). Conclusions A brief, intensive, locally led blended curriculum produced large and consistent improvements in laparoscopic skills in a low-resource setting. Hands-on practice neutralized the baseline knowledge–skill relationship, functioning as an equalizer across learners regardless of prior theoretical preparation. These findings support locally owned, replicable models of surgical capacity building as a sustainable strategy to expand minimally invasive surgery in the Global South.