Writing in the journal Global Surgical Education, a team describes the implementation and evaluation of a year-long research curriculum developed collaboratively between the American College of Surgeons Health Outreach Program for Equity, known as ACS-H.O.P.E., and the University Teaching Hospital in Lusaka, Zambia. In an accompanying invited commentary, Brian M. Carter of The Ohio State University Wexner Medical Center frames the work as an important contribution to the literature on research capacity building and a potentially replicable model for bidirectional partnerships in global surgery education. The program’s significance lies less in any single result than in the design principles it demonstrates and the honest accounting of where it fell short.

Zambia is an instructive setting. The country pioneered a National Surgical, Obstetric, and Anesthesia Plan, or NSOAP, one of a new generation of national strategies that translate the global surgery agenda into domestic policy. Zambia’s plan explicitly identified research capacity as a core pillar, recognizing that durable gains in surgical care must be driven by data produced in-country and by researchers trained on the ground. Yet the training pipeline has lagged behind the ambition. A recent needs assessment of surgeons across the College of Surgeons of Eastern, Central and Southern Africa region identified faculty development and structured educational content as the areas of greatest perceived need, while surveys of Nigerian surgical trainees and trainers have found mentorship and research training inadequate, with both groups calling for formalized mentorship programs.

The Lusaka curriculum was built to answer those gaps, and its architecture reflects hard-won lessons about what international educational programs can and cannot do. The course ran for twelve months and followed a hybrid virtual-asynchronous format: live sessions delivered over video were paired with recorded lectures that participants could access on their own schedule. That flexibility is not a cosmetic feature. Clinical demands and time zone differences have historically limited participation in international programs, and the pandemic-era shift toward virtual learning has only recently produced evidence that such modalities can work when thoughtfully implemented. In the Zambian program, 80 percent of participants reported using the recorded lectures when they could not attend live sessions, a figure that underscores how asynchronous material can keep a cohort engaged through the interruptions of surgical training.

Equally important is how the curriculum was conceived in the first place. Rather than importing a syllabus designed abroad, the organizers grounded the program in a formal needs assessment and developed it iteratively through binational collaboration. The global surgical education literature has consistently emphasized that successful training partnerships require local leadership, bidirectional knowledge exchange, and alignment with locally identified priorities. The program embodied those principles concretely: a research champion based at the University Teaching Hospital anchored the effort locally, and faculty from the hospital’s School of Public Health led biostatistics instruction. The distinction matters because the history of global health partnerships is littered with programs that collapsed the moment external funding or enthusiasm moved on. Capacity that resides entirely in visiting experts is not capacity at all.

The longitudinal structure also departs from the short-course model that dominates much of international medical education. Research capacity building is increasingly understood as a staged process requiring sustained engagement rather than a discrete training event, and the twelve-month arc allowed progressive skill building from foundational concepts to applied competencies. The evaluation, however, measured confidence rather than scholarly output, and the authors were careful to frame their results accordingly: confidence gains are early-phase indicators in a capacity-building framework, and they must eventually be followed by objective measures of productivity such as abstracts, manuscripts, and grants.

Perhaps the most instructive finding in the report is a negative one. While participants improved across most domains, biostatistics confidence did not improve significantly. The authors acknowledged this limitation transparently and described in detail the modifications they made in response, an iterative quality improvement approach that Carter highlights as essential to educational program development. The result also resonates with broader challenges in research training. Biostatistics is a procedural skill that requires hands-on practice with real datasets, iterative feedback, and sufficient instructional time, elements that are easily constrained by asynchronous delivery and the competing demands of clinical service. The program’s response, adding a dedicated four-day biostatistics workshop, incorporating case-based exercises, and strengthening collaboration with local biostatistics faculty, represents an evidence-informed attempt to close the gap, and future reports on whether those changes work will be valuable to the field.

Mentorship proved equally stubborn. Thirty percent of participants gained a mentor through the program, but 30 percent remained without mentorship at curriculum completion, and participants rated the accessibility of mentorship only three out of five. These numbers align with a wider literature identifying mentorship as both critically important and persistently difficult to deliver in low- and middle-income settings. Effective mentorship in global surgery requires attention to cultural context, clear expectations for mentor-mentee engagement, and protected time for both parties, none of which emerges spontaneously from a video link. The program used a website-based mentorship request form, an innovative mechanism that nonetheless may have been insufficient to overcome time zone differences, competing clinical demands, and the inherent difficulty of establishing relationships virtually. Carter suggests that future iterations might consider more structured mentor-mentee matching, defined expectations for meeting frequency, and integration of mentorship into the curriculum itself rather than treating it as an adjunct. The underlying argument is blunt: if research curricula are to mature, structured mentorship must be treated not as an optional add-on but as core infrastructure.

The study’s limitations are those typical of a feasibility study of a novel educational intervention. The sample was small, just ten participants, the outcomes relied on self-reported confidence, and selection bias is a plausible concern. None of this diminishes the contribution, but it does underscore the importance of subsequent evaluation phases. The field, Carter argues, would benefit from longitudinal follow-up examining objective outcomes: abstracts submitted, manuscripts published, grants obtained, and ultimately whether participants become research mentors themselves, completing the capacity-building cycle. That last measure is the decisive one. The ultimate test of a global surgery education partnership is not how long outside collaborators remain indispensable, but whether the partnership strengthens local capacity enough that leadership, mentorship, and scholarship increasingly reside within the host institution. The authors indicate that objective outcome measures have been incorporated into subsequent iterations of the curriculum, and publishing that data will be essential.

For institutions contemplating similar partnerships, the Zambian experience distills into three practical lessons. Hybrid virtual-asynchronous models can deliver research training across geographic and temporal barriers, but complex skills like biostatistics may demand more intensive, hands-on approaches. Local leadership and institutional embedding are non-negotiable for sustainability. And mentorship, the element most often left to chance, is the hardest to implement well and deserves dedicated design attention. What makes the report notable, beyond its results, is its candor: successes and failures are reported with equal precision, exemplifying the scholarly rigor the field will need as it develops evidence-based approaches to global surgery education. As Carter concludes, the work is a reminder that global surgical education is most valuable when it creates agency, not just access. In a world where five billion people are waiting for safe surgery, the fastest route to them may run through classrooms in Lusaka rather than operating theaters in Washington or London.

Subject of Research: Research capacity building in global surgery education through a binational partnership in Zambia

Article Title: Building research capacity through partnership: a model for sustainable global surgery education

Article References: Carter, B. M. (2026). Building research capacity through partnership: a model for sustainable global surgery education. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 143. https://doi.org/10.1007/s44186-026-00547-x

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00547-x

Keywords: global surgery, research capacity building, surgical education, Zambia, mentorship, biostatistics training, LMICs, NSOAP, hybrid learning, curriculum design, ACS-H.O.P.E, partnership