Transforming Surgical Training: The Evolution of the COSECSA eLogbook Through a Theory of Change Framework

INTRODUCTION: Surgical training logbooks are vital for tracking trainee experience and training quality. As the College of Surgeons of East, Central and Southern Africa (COSECSA) expanded across 24 countries, its paper-based system outgrew the capacity of paper logbooks. In partnership with the Royal College of Surgeons in Ireland, COSECSA developed an electronic logbook (eLogbook) to enhance data collection, trainee monitoring, and quality assessment. This study reviews its evolution using a theory of change framework to inform future surgical training needs in sub-Saharan Africa and beyond. METHODS: We applied a retrospective theory of change (ToC) framework to analyze the development, implementation, and impact of the COSECSA eLogbook. Data sources included archived project records, eLogbook data, and published articles utilizing logbook data. Descriptive summaries were generated to analyze the logged surgical procedures. RESULTS: Phased rollout began in 2015 with full adoption in 2017. By the end of 2025, 1806 trainees had logged 712,118 procedures. The eLogbook facilitated training standardization across multiple countries and improved monitoring. Studies utilizing logbook data have identified disparities in procedural exposure, training gaps, and speciality-specific challenges. The logbook also supported quality assurance and program improvement. DISCUSSION: Key challenges include limited internet access, necessitating offline functionality, and initial resistance to digital adoption mitigated through training and iterative refinements. Lessons from COSECSA informed the development of a similar logbook for the College of Anesthesiologists in East, Central, and Southern Africa (CANECSA). CONCLUSION: The COSECSA eLogbook has revolutionized surgical training documentation, enabling data-driven evaluation and standardization across programs. It showcases how digital tools and long-term international collaboration can strengthen surgical education in low-resource settings.