World Journal of Surgery

, Volume 43, Issue 1, pp 75–86 | Cite as

Increasing and Retaining African Surgeons Working in Rural Hospitals: An Analysis of PAACS Surgeons with Twenty-Year Program Follow-Up

  • Caleb Van EssenEmail author
  • Bruce C. Steffes
  • Keir Thelander
  • Beryl Akinyi
  • Hsin-Fang Li
  • Margaret J. Tarpley
Original Scientific Report



African surgical workforce needs are significant, with largest disparities existing in rural settings. Pan-African Academy of Christian Surgeons (PAACS), a primarily rural-based general surgery training program, has published successes in producing rural African surgeons; however, long-term follow-up data are unreported. The goal of our study was to define characteristics of PAACS alumni surgeons working in rural hospitals, documenting successes and illuminating strategies for trainee recruitment and retention.


PAACS’ twenty-year surgery residency database was reviewed for 12 programs throughout Africa regarding trainee demographics and graduate outcomes. Characteristics of PAACS’ graduate surgeons were further analyzed with a 42-question survey.


Among active PAACS graduates, 100% practice in Africa and 79% within their home country. PAACS graduates had 51% short-term and 35% long-term (beyond 5 years) rural retention rate (less than 50,000 population).


Our study shows that PAACS general surgery training program has a high retention rate of African surgeons in rural settings compared to all programs reported to date, highlighting a multifaceted, rural-focused approach that could be emulated by surgical training programs worldwide.



We appreciate PAACS and AIC Kijabe staff: Evelyn Mbugua, MD, Steve Doane, MD, Thomas Robey, MD and Carol Mwangi, acquiring data and performing survey. COSECSA data by Deirdre Mangaoang–RCSI/COSECSA Collaboration Program. Statistical support was made possible by James M. Scanlan, Providence Health and Services, USA and graphics from Kalie Wolfinger.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Caleb Van Essen
    • 1
    Email author
  • Bruce C. Steffes
    • 2
  • Keir Thelander
    • 3
  • Beryl Akinyi
    • 4
  • Hsin-Fang Li
    • 5
  • Margaret J. Tarpley
    • 6
  1. 1.General Surgery Residency ProgramSwedish Medical CenterSeattleUSA
  2. 2.Pan-African Academy of Christian SurgeonsLindenUSA
  3. 3.Pan-African Academy of Christian SurgeonsStrongsvilleUSA
  4. 4.AIC Kijabe HospitalKijabeKenya
  5. 5.Medical Data Research CenterProvidence Health and ServicesPortlandUSA
  6. 6.Department of SurgeryVanderbilt UniversityNashvilleUSA

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