A mixed-methods study of engagement drivers within a laparoscopic surgical education platform

Abstract Introduction Open-source, web-based educational platforms offer critical opportunities for surgical skill acquisition, particularly in resource-limited settings. However, sustaining user engagement beyond initial exposure is a persistent challenge that may require structured support. This study evaluated the impact of supportive strategies on engagement with a simulation-based laparoscopic training platform, which was piloted across the United States and 10 countries in Africa. Methods In this mixed-methods study, we analyzed participant engagement across six educational modules, each comprising (1) a case scenario and (2) psychomotor video upload. Retention was defined by module initiation and module completion. We evaluated participant demographics, program characteristics (program requirements, pilot site designation, pre-assembled simulation kits), and exposure to in-person teaching courses. Semi-structured qualitative interviews with stakeholders were conducted, and thematic analysis was performed to understand the barriers and facilitators to sustained platform engagement. Results Of the 306 participants using the platform, 80% (245/306) stopped after initiating 1 module, while 20% (61/306) initiated more than one module. 76% (233/306) of participants were supported by at least one form of structured support (12 pilot sites, 3 teaching courses, 2 programs with formal requirements). Of the 107 participants who completed at least one module, 69% (74/107) stopped after completing 1 module, while 31% (33/107) completed more than one modulewith completion primarily occurring at pilot sites (94%; 31/33) that featured surgeon champions and pre-assembled box trainers. Interviews revealed that sustained engagement was influenced by self-efficacy, institutional and social opportunity created by surgeon champions, and structured support. Conclusion Although open-access platforms rely on intrinsic motivation, program requirements and supportive infrastructure can enhance sustained engagement. Dedicated in-person courses not only improve participant retention but also may facilitate spillover effects.