Participants and data collection

Eligible individuals for inclusion were all current ophthalmology trainees and recently qualified ophthalmologists (≤3 years since training completed), at any of the ophthalmology training institutions within the Eastern, Central and Southern Africa sub-regions ( Table 1). These doctors have synonymous titles in different sub-regions: trainee, registrar, or resident. For this study, the term ‘trainee’ is used.

A link to the web-based questionnaire was sent to all heads of eye departments and training programme directors of ophthalmology training institutions in the Eastern, Central and Southern Africa region, who forwarded to their trainees and recent graduates in September 2017. Three reminders were sent over a six-month period to those that had not completed the survey. The survey was also publicized via the International Agency for the Prevention of Blindness (IAPB) quarterly Africa Newsletter ¹⁵.

For closed questions, possible responses were on a five-point ordinal Likert scale: very satisfied, somewhat satisfied, neutral, somewhat dissatisfied, and very dissatisfied (see Extended data). Discrete numerical data was used for further quantitative questions. Free text responses were allowed for open questions. These were collated, and manual coding used before manual thematic analysis.

The total number of current ophthalmology trainees and ophthalmologists who completed training within the last three years was estimated at 240. To encourage attainment of responses, incentive strategies were employed. Participants were invited to enter a lottery for an iPad. Offering non-monetary incentives has been shown to increase survey responses by one half ¹⁷.