American College of Surgeons Member Involvement in Global Surgery: Results from the 2015 Operation Giving Back Survey

Health professionals' involvement in volunteering their professional skills: a scoping review

Background

Volunteering positively affects overall health of both volunteers and recipients through social interaction, support and physical activity. Health professionals' volunteering has considerable potential to improve health outcomes in communities.

Objectives

This study aimed to summarize published scientific literature regarding volunteering by health professionals.

Method

Medine, Embase, Scopus, PsycINFO and CINAHLdatabases were searched to identify eligible studies published between 2010 and 2023. Data on study methods and findings were extracted and synthesized.

Results

Of the 144 eligible studies, 80 (56%) used quantitative methods, 46 (32%) used qualitative, 18 (12%) used mixed methods and 8 (6%) were interventional. Doctors (74 studies, 51%) and nurses (n = 40, 28%) were the professions with most reports of volunteering. Half the studies were from USA (n = 77, 53%), followed by UK (n = 19, 13%), Canada (n = 12, 8%), and Australia/New Zealand (n = 11, 8%). International volunteering in low-to-middle-income countries was reported in 64 studies (44%). Providing service and training were the dominant types of activities (n = 90, 62.5%), with health promotion reported in only 4 studies (3%). Studies reported positive impact from volunteering, both professionally and personally. Time and family commitments were the main barriers. Enablers, barriers and impact were summarized in a socio-ecological map.

Conclusion

Health professionals volunteer in diverse activities and report multifaceted benefits. Studies of volunteering interventions could enable new, sustainable approaches to health promotion.

Global cardiothoracic surgery: A survey of trainees' interests and barriers

Background

More than 5 billion people lack access to surgical care, disproportionately in low- and middle-income countries. The emerging literature demonstrates high interest in global surgery across specialties; however, participation in global cardiothoracic surgical care remains low. To date, there has been no research quantifying the attitudes of cardiothoracic surgeons about global surgery. Our study aimed to acquire a broader understanding of cardiothoracic surgical trainees' interest in global surgery to address barriers and promote cardiac healthcare worldwide.

Methods

An online survey was sent to all North American cardiothoracic surgical residents via the Thoracic Surgery Residents Association email listserv. The survey was designed in the REDCap database and administered twice, in 2021 and 2022. Data were analyzed by descriptive and chi-square analysis using Stata.

Results

Seventy-three cardiothoracic surgical trainees responded to our survey, of whom 95.3% considered increasing cardiothoracic surgical access to be important, and 67.2% identified this as a future career priority. Most respondents (82.8%) would participate in global surgery if opportunities were available through their home institution. Lack of opportunities (70.0%) and finances (66.7%) were the primary barriers to participation. Respondents identified funding (85%) and institutional support (83.3%) as the most significant incentives to increase involvement.

Conclusions

There is strong interest in global surgery among cardiothoracic trainees; however, involvement remains low. A consensus among the North American cardiothoracic surgical community is needed to address barriers to global volunteerism within surgical residency and improve access to cardiac surgery worldwide.

The American College of Surgeons as an advocate for global surgery awareness

The American College of Surgeons (ACS), founded in 1913, is the one of the oldest surgical professional organizations in the United States. Originally founded to foster surgical professional excellence and collaboration among surgeons in North America, the ACS has now expanded to over 80,000 members worldwide with programs delivering a rich portfolio of professional services in the domains of surgical education, clinical surgery and global surgery, surgical quality and leadership, surgical research, member services. ACS international programs initially focused on international professional exchange and hosting of young surgeons from around the world in US based surgical centers to develop scholarly and clinical collaborations. Over the last 20 years, with the founding of the ACS-Operation Giving Back (OGB) Program, the ACS has broadened its international perspective to support surgical care in emerging nations and to develop collaborative programs with host institutions in emerging nations to support surgical care capacity growth through on site partnerships, and educational and policy initiatives. To that end, in recent years, OGB has developed global surgical programs in the COSECSA region of sub-Saharan Africa creating opportunities to participate in Global Surgical Training Hubs. After developing a pilot hub project in Hawassa, Ethiopia, OGB is now in the process of scaling up two additional sites. In this manuscript, we will describe ACS's rich history of activities promoting international surgical collaboration and scholarship and discuss the process of creating the global surgical training hub model in Hawassa.

Academic Global Surgery Curricula: Current Status and a Call for a More Equitable Approach

INTRODUCTION

We aimed to search the literature for global surgical curricula, assess if published resources align with existing competency frameworks in global health and surgical education, and determine if there is consensus around a fundamental set of competencies for the developing field of academic global surgery.

METHODS

We reviewed SciVerse SCOPUS, PubMed, African Medicus Index, African Journals Online (AJOL), SciELO, Latin American and Caribbean Health Sciences Literature (LILACS) and Bioline for manuscripts on global surgery curricula and evaluated the results using existing competency frameworks in global health and surgical education from Consortium of the Universities for Global Health (CUGH) and Accreditation Council for Graduate Medical Education (ACGME) professional competencies.

RESULTS

Our search generated 250 publications, of which 18 were eligible: (1) a total of 10 reported existing competency-based curricula that were concurrent with international experiences, (2) two reported existing pre-departure competency-based curricula, (3) six proposed theoretical competency-based curricula for future global surgery education. All, but one, were based in high-income countries (HICs) and focused on the needs of HIC trainees. None met all 17 competencies, none cited the CUGH competency on "Health Equity and Social Justice" and only one mentioned "Social and Environmental Determinants of Health." Only 22% (n = 4) were available as open-access.

CONCLUSION

Currently, there is no universally accepted set of competencies on the fundamentals of academic global surgery. Existing literature are predominantly by and for HIC institutions and trainees. Current frameworks are inadequate for this emerging academic field. The field needs competencies with explicit input from LMIC experts to ensure creation of educational resources that are accessible and relevant to trainees from around the world.

Pediatric Urology and International Medical Volunteerism: Where Are We? Where Are We Going?

OBJECTIVE

To determine the current landscape of international medical volunteerism (IMV) in pediatric urology.

METHODS

A questionnaire regarding IMV participation was distributed to Societies for Pediatric Urology members (SPU), pediatric urology fellows (PUFs), and pediatric urology fellowship program directors (PDs). Questions related to IMV interest, experience, and perceived barriers, as well as the importance of trainee participation.

RESULTS

98 of 733 SPU members queried responded; 62/98 (63%) having volunteered. There was no difference in gender, age, or years in practice between volunteers and non-volunteers (P >.05). Non-volunteers were generally interested in participating (26/36; 72%), with lack of time and knowledge of opportunities cited as limitations. 27/46 PUFs and 16/27 PDs submitted responses. 10/27 (37%) of PUFs have participated in IMV. The main perceived barrier to their participation was lack of protected time off. While 2 PUFs (7%) stated IMV was a mandatory component of fellowship, 11/27 (41%) of PUFs vs 2/16 (13%) of PDs believe IMV should be part of the curriculum (P = .11). PUFs and PDs similarly ranked importance of trainee IMV participation on Likert scale (median 73 vs 70, P = 0.67). Volunteering SPU respondents ranked trainee participation higher than non-volunteers (median 80 vs 50, P = 0.0004).

CONCLUSION

While pediatric urology IMV opportunities exist, disseminating this information to interested parties and lack of time are barriers to participation. Amongst SPU members, there is a divide in attitudes regarding the importance of trainee participation. Trainees, however, strongly support IMV participation.

Exploring the knowledge and attitudes of Cameroonian medical students towards global surgery: A web-based survey

Introduction

Global surgery is a growing field studying the determinants of safe and affordable surgical care and advocating to gain the global health community's attention. In Cameroon, little is known about the level of knowledge and attitudes of students. Our survey aimed to describe the knowledge and attitudes of Cameroonian medical students towards global surgery.

Materials and methods

We performed an anonymous online survey of final-year Cameroonian medical students. Mann-Whitney U test and Spearman correlation analysis were used for bivariate analysis, and the alpha value was set at 0.05. Odds ratios and their 95% confidence intervals were calculated.

Results

204 respondents with a mean age of 24.7 years (±2.0) participated in this study. 58.3% were male, 41.6% had previously heard or read about global surgery, 36.3% had taken part in a global surgery study, and 10.8% had attended a global surgery event. Mercy Ships was well known (46.5%), and most students believed that surgical interventions were more costly than medical treatments (75.0%). The mean score of the global surgery evaluation was 47.4% (±29.6%), and being able to recognize more global surgery organizations was correlated with having assumed multiple roles during global surgery studies (p = 0.008) and identifying more global surgery indicators (p = 0.04). Workforce, infrastructure, and funding were highlighted as the top priorities for the development of global surgery in Cameroon.

Conclusion

Medical students are conscious of the importance of surgical care. They lack the opportunities to nurture their interest and should be taught global surgery concepts and skills.

Global health, global surgery and mass casualties: II. Mass casualty centre resources, equipment and implementation

Trauma/stroke centres optimise acute 24/7/365 surgical/critical care in high-income countries (HICs). Concepts from low-income and middle-income countries (LMICs) offer additional cost-effective healthcare strategies for limited-resource settings when combined with the trauma/stroke centre concept. Mass casualty centres (MCCs) integrate resources for both routine and emergency care-from prevention to acute care to rehabilitation. Integration of the various healthcare systems-governmental, non-governmental and military-is key to avoid both duplication and gaps. With input from LMIC and HIC personnel of various backgrounds-trauma and subspecialty surgery, nursing, information technology and telemedicine, and healthcare administration-creative solutions to the challenges of expanding care (both daily and disaster) are developed. MCCs are evolving initially in Chile and Pakistan. Technologies for cost-effective healthcare in LMICs include smartphone apps (enhance prehospital care) to electronic data collection and analysis (quality improvement) to telemedicine and drones/robots (support of remote regions and resource optimisation during both daily care and disasters) to resilient, mobile medical/surgical facilities (eg, battery-operated CT scanners). The co-ordination of personnel (within LMICs, and between LMICs and HICs) and the integration of cost-effective advanced technology are features of MCCs. Providing quality, cost-effective care 24/7/365 to the 5 billion who lack it presently makes MCCs an appealing means to achieve the healthcare-related United Nations Sustainable Development Goals for 2030.

International surgery: How to be involved while maintaining a surgical practice

BACKGROUND

Surgeons can find it challenging to sustain their global involvement while maintaining a clinical practice. This study gathered advice from surgeons with global surgical experience on how to do so successfully.

METHODS

Using a qualitative approach with thematic analysis, 14 semi-structured interviews were conducted with surgeons from different specialties involved in varying international projects.

RESULTS

Early involvement is important to set up expectations for one's practice, and makes anticipated costs more manageable. The type of practice does not limit amount of participation, but maintaining a broader skill set can be beneficial. Hiring locums can help defray costs for community surgeons, and good collegial support is important for academic surgeons. Family support is important to maintain involvement.

CONCLUSIONS

Surgeons from diverse clinical practices are able to participate in international surgery. Early involvement sets up expectations and allows one to build their practice and lives around their international work instead of the other way around.