Aims There are many challenges in delivering an orthopaedic training programme in Sierra Leone, West Africa, including human resource and equipment constraints. We provide a reflective analysis of adaptive strategies to overcome these.

Methods An orthopaedic surgical training course was delivered in preparation for a clinical trial in Connaught Hospital, Freetown, Sierra Leone. The trial examines the implementation of Ilizarov frame fixation for tibia fractures in adults.

Results Whilst it is possible to deliver a high-quality course in Sierra Leone, a significant amount of prior planning and preparation, including adaptive and contingency strategies, is required to achieve the desired outcome.

Conclusions With the Royal Navy increasing its global reach, including deployment of new aircraft carriers, there are increasing opportunities to deliver medical training in low and middle-income countries in both the military and civilian sector. We believe this article may be useful for service and civilian practitioners intending to deliver education and training around the world.