Around the world, millions of people are unable to receive the surgical care they need. Each year, at least 160 million necessary operations do not happen, most in low- and middle-income countries. Workforce shortages are one reason. Growing the workforce takes experienced surgeons to teach, and they are few.
Addressing this challenge requires more than increasing the number of healthcare workers entering the profession. It requires new approaches to education that enable learners to acquire and refine procedural skills independently, efficiently and at scale, regardless of where they are based.
Through a unique collaboration between the Intuitive Foundation, RCSI Institute of Global Surgery, the RCSI SIM Centre for Simulation Education and Research and its Department of Surgical Affairs, RCSI is helping to transform how procedural skills are taught globally through leadership of the Surgical Education Learners Forum (SELF).
SELF is a global community of practice, supported by Intuitive Foundation, that brings together clinicians, educators, technologists and institutions from around the world to develop innovative approaches to procedural skills training. Its focus is simple but ambitious: creating self-directed training modules that combine simulator-based practice with integrated feedback and assessment that can be used by learners anywhere.
Traditional surgical skills training has long relied on apprenticeship models, specialist facilities and access to experienced instructors. While highly effective, these approaches can be difficult to scale, particularly in settings where educational resources are limited, and healthcare needs are growing rapidly.
Scalable solutions
SELF seeks to overcome these barriers by enabling learners to take greater ownership of their skills development through self-directed practice and assessment. The initiative supports the creation of simulation-based training tools that can be produced using affordable, locally available materials, making them practical and sustainable in resource-constrained environments.
These innovations demonstrate that effective simulation-based education does not always require expensive technology. By focusing on accessibility, reproducibility and local relevance, educators can create meaningful learning experiences that support skill acquisition while reducing dependence on specialist infrastructure.
RCSI's leadership in this area builds on its longstanding commitment to strengthening surgical systems and supporting healthcare workforce development globally. Through involvement in the Global Surgery Training Challenge mentorship programme, RCSI has supported multidisciplinary teams in low-resource settings to develop, implement and evaluate locally relevant surgical education initiatives.
This work has provided valuable insights into the educational challenges facing healthcare institutions in different contexts and has informed the development of practical, scalable solutions.
High-quality training
Today, RCSI continues to support educators and institutions through mentorship, faculty development and international collaboration. At the centre of these efforts is the SELF Community of Practice, which has grown to more than 260 members worldwide.
The network provides a platform for sharing expertise, showcasing innovations and fostering collaboration between individuals and organisations working to improve procedural skills education.
By connecting educators and healthcare professionals across geographic and disciplinary boundaries, SELF is helping to create a global movement focused on expanding access to high-quality procedural skills training.
Rather than developing solutions in isolation, members work together to identify educational priorities, share successful approaches and build resources that can be adapted and used in diverse settings around the world.
One example of SELF's impact can be seen at Gaston Berger University in Saint-Louis, Senegal, where surgical residents used SELF modules and low-cost simulation training to develop laparoscopic appendectomy skills that would otherwise have required training opportunities abroad.
Participants built their own laparoscopic box trainers using affordable, locally available materials and completed a structured programme combining online learning, simulation practice and supervised clinical experience. Ten residents completed the programme with a 100% certification rate. Following certification, participants performed laparoscopic appendectomies under supervision before progressing to independent practice.
The programme demonstrates how low-cost, scalable training models can expand access to advanced surgical skills in resource-constrained settings while reducing reliance on expensive infrastructure or overseas training opportunities.
Shaping a new future
A major milestone for the collaboration has been the development of an evidence-informed framework for self-directed procedural skills training. Through a series of international collaborations and peer-reviewed publications, SELF participants have established practical recommendations for designing, implementing, assessing and scaling simulation-based training programmes.
The framework addresses key questions facing educators: which procedures should be prioritised, how low-cost simulators can be designed effectively, how learners can assess their own performance and how successful models can be scaled to reach larger numbers of learners. Collectively, this work provides a roadmap for institutions seeking to strengthen procedural skills training while using resources efficiently.
The significance of this work extends beyond education. By enabling more healthcare professionals to access effective skills training, particularly in resource-constrained settings, SELF contributes to broader efforts to strengthen health systems and improve access to safe surgical care.
Better training leads to more confident practitioners, stronger healthcare workforces and ultimately better outcomes for patients.
As demand for surgical care continues to grow globally, innovative, and scalable approaches to skills education will become increasingly important. Through leadership, collaboration and a commitment to practical innovation, RCSI is helping to shape a future in which high-quality procedural skills training is within reach of every learner, regardless of geography or resources.
Research outputs
The SELF framework has been advanced through a series of peer-reviewed publications providing guidance for educators, institutions and policymakers seeking to expand access to procedural skills training.
- A Scalable Model for Global Procedural Skills Training: Introduction to SELF (2026) – Introduces SELF as a global community of practice and outlines a scalable approach to self-directed procedural skills training.
- Where to Begin? Prioritising Procedures for Surgical Skills Training Development (2026) – Establishes a framework for identifying the highest-priority procedures for simulation-based training development.
- Best Practices for Designing Effective Procedural Skills Training in Resource-Constrained Settings (2026) – Provides recommendations on simulator design, fidelity and the development of open-access educational resources.
- Self-Administered Skills Assessment Using Simulation Modules for Procedural Competency (2026) – Sets out guidance for integrating self-assessment and formative feedback into simulation-based learning.
- Scaling SELF Simulation Training (2026) – Explores pathways for adoption, evidence generation and large-scale implementation of training programmes.
RCSI is committed to achieving a better and more sustainable future through the UN Sustainable Development Goals.
