Citizenship and Social Responsibility in Surgery: A Review

Social Determinants of Health and Preoperative Care

Preoperative care exists as part of perioperative continuum during which anesthesiologists and surgeons optimize patients for surgery. These multispecialty efforts are important, particularly for patients with complex medical histories and those requiring major surgery. Preoperative care improves planning and determines the clinical pathway and discharge disposition. The role of nonmedical social factors in the preoperative planning is not well described in anesthesiology. Research to improve outcomes based on social factors is not well described for anesthesiologists but could be instrumental in decreasing disparities and advancing health equity in surgical patients.

Moral courage, job-esteem, and social responsibility in disaster relief nurses

BACKGROUND

Social responsibility can motivate disaster relief nurses to devote themselves to safeguarding rights and interests of people when facing challenges that threaten public health. However, few studies focused on the relationship of moral courage, job-esteem, and social responsibility among disaster relief nurses.

OBJECTIVE

To explore the influence of moral courage and job-esteem on the social responsibility in disaster relief nurses and clarify the relationship model between them.

METHODS

A cross-sectional study was conducted among 716 disaster relief nurses from 14 hospitals in central China through an online survey, including moral courage scale, job-esteem scale, and social responsibility questionnaire. The data were analyzed by Pearson's correlation, and the mechanism of the effect of moral courage and job-esteem on social responsibility was completed.

ETHICAL CONSIDERATIONS

This study was approved by the Medical Ethics Committee of the Second Xiangya Hospital of Central South University (Approval Number: 2019016).

RESULTS

Disaster relief nurses' moral courage positively impacted social responsibility (r = 0.677, p < 0.01), and moral courage could affect social responsibility through the mediating role of job-esteem.

CONCLUSION

Job-esteem mediated between moral courage and social responsibility among disaster relief nurses. Nursing managers regular assessment of nurses' moral courage and interventions such as meetings and workshops can reduce moral distress, foster morally courageous behavior, enhance job-esteem, and improve social responsibility performance among disaster relief nurses.

Advocacy Curricula in Graduate Medical Education: an Updated Systematic Review from 2017 to 2022

BACKGROUND

Advocacy is an integral component of a physician's professional responsibilities, yet efforts to teach advocacy skills in a systematic and comprehensive manner have been inconsistent and challenging. There is currently no consensus on the tools and content that should be included in advocacy curricula for graduate medical trainees.

OBJECTIVE

To conduct a systematic review of recently published GME advocacy curricula and delineate foundational concepts and topics in advocacy education that are pertinent to trainees across specialties and career paths.

METHODS

We conducted an updated systematic review based off Howell et al. (J Gen Intern Med 34(11):2592-2601, 2019) to identify articles published between September 2017 and March 2022 that described GME advocacy curricula developed in the USA and Canada. Searches of grey literature were used to find citations potentially missed by the search strategy. Articles were independently reviewed by two authors to identify those meeting our inclusion and exclusion criteria; a third author resolved discrepancies. Three reviewers used a web-based interface to extract curricular details from the final selection of articles. Two reviewers conducted a detailed analysis of recurring themes in curricular design and implementation.

RESULTS

Of 867 articles reviewed, 26 articles, describing 31 unique curricula, met inclusion and exclusion criteria. The majority (84%) represented Internal Medicine, Family Medicine, Pediatrics, and Psychiatry programs. The most common learning methods included experiential learning, didactics, and project-based work. Most covered community partnerships (58%) and legislative advocacy (58%) as advocacy tools and social determinants of health (58%) as an educational topic. Evaluation results were inconsistently reported. Analysis of recurring themes showed that advocacy curricula benefit from an overarching culture supportive of advocacy education and should ideally be learner-centric, educator-friendly, and action-oriented.

DISCUSSION

Combining core features of advocacy curricula identified in prior publications with our findings, we propose an integrative framework to guide design and implementation of advocacy curricula for GME trainees. Additional research is needed to build expert consensus and ultimately develop model curricula for disseminated use.

Editorial Commentary: Understanding the Gap in Clinical Outcomes After Rotator Cuff Repair Based on the Influence of Social Determinants of Health

There is growing recognition and understanding of the important role that social determinants of health and access to care play in surgical outcomes, particularly in the field of orthopaedic surgery and sports medicine. Factors including race, ethnicity, education, income, insurance status, social class, and sex have been identified as important contributors to outcomes after orthopaedic procedures, including rotator cuff repair. Disadvantaged or marginalized patients have been shown to attend fewer office visits and physical therapy sessions, are more likely to present with advanced stages of disease, have delayed surgical interventions, and have poorer patient-reported outcomes after surgery. Virtual visits and telemedicine have the great ability to improve access to medical professionals for disadvantaged patients who have poor access to transportation. However, reliance on telehealth has the potential to worsen access to care for patients with limited access to technology or language barriers. Disadvantaged populations, including those with noncommercial health care insurance, show decreased use of telemedicine.

Is it about time to develop social surgery?

The need for social surgery is nowadays more dire than ever, due to the exponential increase of the driving factors of surgical diseases in modern societies. During the last decades, high rates of urbanization have been linked to increased incidence of colon, liver, pancreas cancer and appendicitis.⁹ Sedentary lifestyle and obesity have translated into higher orthopedic surgical volumes.¹⁰ Climate change has jeopardized surgical supply chains, influenced surgery and pregnancy complications and increased the risk for massive trauma in the context of natural disaster.¹¹ Finally, the COVID-19 pandemic has put a strain on surgical care and training, prolonged surgical waiting lists, hindered operable non - communicable diseases' (NCDs) screening and early diagnosis.¹² Even though innovation in surgery has made big leaps in personalizing surgical planning, advancing minimally invasive approaches and improving surgical outcomes, the risk of losing the race to the mounting drivers of surgical morbidity is significant. This sets a reminder of the hippocratic doctrine of prevention over treatment, in the sense that preventing surgical disease and their complications can safeguard the access of those with non - preventable disease to better surgical care.

Social responsibility and subjective well-being of volunteers for COVID-19: The mediating role of job involvement

Aim

Our study aimed to investigate the effect of social responsibility on the subjective well-being of volunteers for COVID-19 and to examine the mediating role of job involvement in this relationship.

Background

Nowadays, more and more people join volunteer service activities. As we all know, volunteer work contributes to society without any return. Volunteers often have a strong sense of social responsibility and reap subjective well-being in their dedication. Although research shows that social responsibility will drive them to participate in volunteer work actively, it is less clear whether job involvement will impact their subjective well-being.

Methods

The data were collected in the precaution zone in Shanghai, China, from April to May 2022. A sample of 302 volunteers for COVID-19 completed the social responsibility scale, subjective well-being scale and job involvement scale in the form of an electronic questionnaire on their mobile phones. A structural equation model was adopted to verify the research hypotheses.

Results

Social responsibility was significantly and positively related to volunteers’ subjective well-being and job involvement (p &lt; 0.05). Job involvement fully mediates the relationship between volunteers’ social responsibility and subjective well-being.

Conclusion

Social responsibility is critical to predicting volunteers’ subjective well-being. Job involvement plays an intervening mechanism in explaining how social responsibility promotes volunteers’ subjective well-being.