Understanding the Need for Simulation-Based Endourology Training for East, Central, and Southern Africa Urology Residents: A Cross-Sectional Survey Study

Abstract Background Limited access to advanced endourology training in East, Central, and Southern Africa constrains residents’ ability to build confidence and competence in minimally invasive procedures. Simulation based education offers a way to practice core skills outside the operating room, especially where case volumes, equipment, and faculty time are limited. We seek to describe exposure and confidence across core endourology procedures among urology residents in East, Central, and Southern Africa, and to assess perceived need and demand for simulation-based training. Methods We conducted a nineteen-question, descriptive, cross sectional, web-based survey of urology residents in College of Surgeons of East, Central and Southern Africa (COSECSA) and national training programs. The survey collected demographic characteristics, self-reported exposure to seven core endourology procedures, confidence in performing each procedure, and views about simulation-based training and non-technical surgical skills. Responses were recorded on five-point Likert scales. For each procedure, we calculated mean exposure and confidence scores and derived a difference score to describe training gaps. The difference between exposure and confidence scores was used to quantify procedural training gaps. Open-ended responses were analyzed thematically to identify key training gaps and preferences for curriculum design. Results Seventy-nine residents completed the survey. Most respondents were male with a mean age of 32.9 years. Residents came from eight African countries, primarily Ethiopia, Zambia, and Uganda, and were most often in their third to fifth year of training. Exposure was highest for cystoscopy and ureteric (JJ) stent insertion and removal, with corresponding confidence scores that were slightly lower. In contrast, ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) had lower confidence scores despite moderate exposure, producing the largest exposure/confidence gaps. Three-quarters of respondents reported no previous simulation experience, while 97 percent expressed interest in structured endourology simulation courses. Conclusions Among COSECSA urology residents, exposure to core endourology procedures does not consistently translate into confidence, especially for URS and PCNL. Most residents have never participated in simulation but strongly support the introduction of structured courses. A regional, simulation-based curriculum that prioritizes procedures with the largest exposure/confidence gaps could help strengthen endourology training and expand access to safe minimally invasive care.