What Makes a Confident Surgeon? A survey on Surgical Trainee perspectives from Kenya, China, and Mali

Introduction: Surgical training effectiveness varies significantly worldwide. Understanding the key determinants of trainee confidence and career preference across diverse healthcare systems is crucial for optimizing educational strategies. This study examines surgical training from trainees' self-reported perspectives across Kenya, Mali, and China to identify common factors associated challenges and potential solutions. Methods: An anonymous 38-item questionnaire incorporating multiple response formats was distributed online to surgical trainees and professionals across Kenya, China, and Mali (n=274) between December 2023 and March 2024. The survey assessed demographics, training duration, working patterns, operative experience, assessment methods, perceived pre-operative mastery, and confidence/preference regarding surgery. Data were analysed using descriptive statistics, univariate tests, binary logistic regression (for confidence), and mixed-effects logistic regression (for preference, accounting for country). This study adheres to CHERRIES guidelines. Results: Analysis of 274 respondents revealed notable variations in professional composition and working patterns across countries. Only 28.8% reported confidence in performing gastrointestinal surgery independently after training. Multivariate analysis demonstrated that making a specialty decision (OR=2.00, p=0.035), experience as primary surgeon (OR=3.07, p=0.009), assessment during training (OR=2.86, p=0.011), and pre-operative mastery (OR=3.43, p<0.001) were key predictors of surgical confidence. Country-specific factors included professional status in Kenya, pre-operative mastery in China, and practical examinations in Mali. Regarding surgical preference, weekly participation in operations (OR=1.94, p=0.031), understanding procedures beforehand (OR=2.13, p=0.013), and effective team communication (OR=2.15, p=0.030) were significant factors. Conclusion : This multinational survey reveals that surgical training effectiveness is primarily determined by quality factors (pre-operative preparation, hands-on experience, and formal assessment) rather than training duration. Implementation of structured learning approaches emphasizing these elements could substantially improve surgical education, regardless of resource availability or regional differences