A Theoretical Framework for Decolonising Surgical Education in Sub-Saharan Africa: Critical Evidence from Nigerian Postgraduate Medical Training

Surgical education in sub-Saharan Africa is organised around curricula, assessment tools, and training philosophies largely inherited from British and North American medical education traditions, which were designed for healthcare contexts that differ fundamentally from the high-volume, resource-constrained surgical environments in which Nigerian surgeons practice. The conceptual and practical consequences of this structural misalignment for surgical competence, health system strengthening, and epistemic justice have not been theoretically examined. This study develops a theoretical framework for decolonising surgical education in sub-Saharan Africa using critical evidence from Nigerian postgraduate training. A critical constructivist methodology is applied through three sequential phases: Phase 1 comprises an epistemological discourse analysis of Nigerian and West African surgical examination content, textbooks, and training logs, examining the proportion of content grounded in Nigerian epidemiology, disease ecology, and resource context. Phase 2 applies Freire-informed Participatory Action Research with 60 surgical residents, 30 trainers, and 10 postgraduate medical college curriculum officers across six geopolitical zones, generating co-produced alternatives to current training elements. Phase 3 develops and pilots an adapted contextually grounded surgical competency module at two institutions. Decolonial Theory, Freire's Pedagogy of the Oppressed, and Critical Medical Education Theory provide the multi-theoretical framework. Original contributions include the Contextualised African Surgical Education Framework, a decolonially grounded model for curriculum reform. Findings will be submitted to the National Postgraduate Medical College of Nigeria and WACS. Keywords: surgical education, decolonisation, postgraduate training, Nigeria, critical pedagogy.