Artificial Intelligence for Surgical Trainees: A Tool for Equity, Efficiency, and Evolution in East, Central, and Southern Africa

Artificial Intelligence (AI) is poised to transform surgical education and clinical care, presenting unprecedented opportunities to enhance training efficiency, optimize learning, and improve patient outcomes. As surgical training programs in East, Central, and Southern Africa (ECSA) continue to evolve, AI has the potential to address persistent challenges in simulation-based learning, operative case volume assessment, curriculum development, and feedback mechanisms. However, much like autonomy in the operating room, the effectiveness of AI depends not solely on its presence but on the individual user, how it is supervised and integrated into the training process. When appropriately overseen, AI enhances rather than replaces human judgment.¹

Operative case volume is a critical determinant of surgical competency. A review of operative case volumes across multiple training centers in Africa revealed that while trainees frequently meet or exceed requirements in general procedures, deficiencies persist in specialized areas such as endoscopy and laparoscopic surgery.² AI-driven analytics could play a transformative role by tracking and evaluating case volumes in real time, evaluating preset competency milestones, identifying gaps in exposure, and facilitating targeted skill development. Machine learning models could further predict trends in operative training, enabling institutions to proactively address deficiencies and adapt curricula accordingly. By integrating AI into surgical log tracking, training programs could become more individualized, ensuring consistency in trainee experiences and providing crucial information to trainers.

Simulation-based training has proven to be an effective means of skill acquisition, particularly where direct surgical experience is constrained. A multinational survey on surgical simulation in the ECSA region underscored its value in skill development while highlighting significant barriers, including limited access to simulation tools, financial constraints, and maintenance challenges.³ AI-driven simulators could help overcome these obstacles by providing real-time adaptive feedback, refining technique acquisition, and personalizing training experiences. By leveraging machine learning algorithms, these systems can identify procedural errors and suggest corrective actions, accelerating proficiency development.⁴

COSECSA has been an innovative leader in digital learning, demonstrating the effectiveness of online, modular curricula.⁵ Incorporating instruction on the responsible use of AI into surgical training should be a forward-thinking goal. AI-enhanced educational tools, including adaptive learning platforms and automated assessments, could further refine these models. By tailoring content delivery to individual learning trajectories and identifying specific knowledge gaps, AI could optimize educational outcomes while reducing faculty burden. AI-assisted literature review tools, such as OpenEvidence, have already improved access to high-quality scientific literature, streamlining research synthesis and enhancing evidence-based learning. In regions where access to academic resources is often constrained, these innovations could help level the playing field, ensuring that surgeons in resource-limited settings have access to the same knowledge base as their counterparts in high-income countries. With appropriate guardrails to ensure accurate and relevant content, surgical trainees could interact with generative AI platforms in a safe learning environment and ask questions while being free of judgement.

Trainee autonomy and structured feedback are fundamental to developing surgical competence. Studies examining the relationship between autonomy and surgical outcomes suggest that increased responsibility, when appropriately supervised, does not compromise patient safety.⁶ The use of smartphone-based platforms for intraoperative feedback has been shown to enhance trainee learning and improve communication with supervisors. AI-powered systems could further improve this process by offering real-time, objective assessments of technical performance, highlighting areas for improvement, and personalizing feedback based on procedural data. However, as with any tool, AI’s effectiveness depends on its application. Standardization of surgical procedures is a key element for utility of AI across diverse settings. In addition, poorly designed AI systems may reinforce biases or provide misleading assessments, underscoring the need for ongoing oversight and refinement.

Algorithmic bias remains a concern in AI-driven surgical education. Many AI models rely on datasets and publications derived from high-income countries, producing outputs that may not be applicable to the patient populations and healthcare systems of the ECSA region. Addressing this gap requires generating high-quality, region-specific data to develop AI tools that are both effective and equitable. The East and Central African Journal of Surgery (ECAJS) has an essential role in this process, providing a platform to build the regional evidence base. By publishing studies that are relevant to surgical education within the ECSA context, ECAJS can contribute to the development of AI models that align with local training needs and clinical realities. For instance, in the latest issue of the ECAJS, Volume 30 issue 1 (2025), the journal features two case reports, one from Ethiopia⁷ and another from Namibia,⁸ alongside two original research articles from Sudan⁹ and Zambia.¹⁰ Despite AI’s potential, several challenges must be addressed to ensure its responsible implementation in surgical education. Data privacy concerns, ethical considerations, and substantial investment in infrastructure, faculty training, and policy development are critical factors. AI should be deployed as a tool to augment human expertise rather than displace it, ensuring that surgical judgment and decision-making remain central to training. Just as no amount of simulation or operative experience can replace the mentorship of a skilled surgeon, AI should be seen as an adjunct that enhances, rather than dictates, surgical education.

Lastly, it would be incomplete to talk about the role of AI in surgical training and education without making a note on its role in surgical research, a very foundational component which surgical training is built on. As we take in the reality of how integrated AI is in our day-to-day activities, we also need to appreciate that we live in an era where the use of AI in research is progressively becoming more and more inevitable. From its use by researchers in the conceptualization, conduct and analysis of research, to its utility in simplifying the technical aspects of the peer review process for editors and reviewers, AI’s footprint is evident in each step of the research process.¹¹ Its vast use in research has prompted technology firms to heavily invest to the tunes of millions of dollars in purchasing subscriptions from academic publishers to avail peer-reviewed journal content for the training of AI models.¹² While AI definitely has a role in enhancing surgical research output, caution needs to be taken, especially for open-source models to avoid ethical breaches, loss of confidentiality and minimize errors that would otherwise compromise on the quality of surgical care. As surgical trainees play a crucial role in furthering evidence-based practice as early career researchers, it is important that they are well equipped and trained in the proper and ethical use of AI in their research activities. Several guidelines exist on the permitted use of AI for authors, reviewers, editors and publishers.^13,14

As surgical training evolves globally, AI will inevitably play an increasing role in education and practice. The challenge now is not whether AI will be integrated but how effectively it will be implemented to create lasting, equitable improvements in education and patient care. With thoughtful implementation, AI could revolutionize surgical education in the ECSA region, enhancing training efficiency and improving patient outcomes while ensuring that the next generation of surgeons is equipped with the skills necessary to meet the demands of modern surgical practice.