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Costa CDDS, Silva GG, Santos ERD, Engel AMRPVTDC, Costa ACDS, da Silva TM, da Conceição WH, Cristóvão H, Lima ARDA, Brienze VM, Bizotto TSG, Oliani AH, André JC. Surgical Residents' Perception of Feedback on Their Education: Protocol for a Scoping Review. JMIR Res Protoc 2024; 13:e56727. [PMID: 39158942 PMCID: PMC11369536 DOI: 10.2196/56727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/22/2024] [Accepted: 07/11/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Feedback is an essential tool for learning and improving performance in any sphere of education, including training of resident physicians. The learner's perception of the feedback they receive is extremely relevant to their learning progress, which must aim at providing qualified care for patients. Studies pertinent to the matter differ substantially with respect to methodology, population, context, and objective, which makes it even more difficult to achieve a clear understanding of the topic. A scoping review on this theme will unequivocally enhance and organize what is already known. OBJECTIVE The aim of this study is to identify and map out data from studies that report surgical residents' perception of the feedback received during their education. METHODS The review will consider studies on the feedback perception of resident physicians of any surgical specialty and age group, attending any year of residency, regardless of the type of feedback given and the way the perceptions were measured. Primary studies published in English, Spanish, and Portuguese since 2017 will be considered. The search will be carried out in 6 databases and reference lists will also be searched for additional studies. Duplicates will be removed, and 2 independent reviewers will screen the selected studies' titles, abstracts, and full texts. Data extraction will be performed through a tool developed by the researchers. Descriptive statistics and qualitative analysis (content analysis) will be used to analyze the data. A summary of the results will be presented in the form of diagrams, narratives, and tables. RESULTS The findings of this scoping review were submitted to an indexed journal in July 2024, currently awaiting reviewer approval. The search was executed on March 15, 2024, and resulted in 588 articles. After the exclusion of the duplicate articles and those that did not meet the eligibility criteria as well as the inclusion of articles through a manual search, 13 articles were included in the review. CONCLUSIONS Conducting a scoping review is the best way to map what is known about a subject. By focusing on the feedback perception more than the feedback itself, the results of this study will surely contribute to gaining a deeper understanding of how to proceed to enhance internal feedback and surgical residents' learning progress. TRIAL REGISTRATION Open Science Framework yexb; https://osf.io/yexkb. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/56727.
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Affiliation(s)
- Carlos Dario da Silva Costa
- Center for Studies and Development of Health Education, Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Gabriela Gouvea Silva
- Center for Studies and Development of Health Education, Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Emerson Roberto Dos Santos
- Center for Studies and Development of Health Education, Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | | | - Ana Caroline Dos Santos Costa
- Center for Studies and Development of Health Education, Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Taisa Morete da Silva
- Center for Studies and Development of Health Education, Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Washington Henrique da Conceição
- Center for Studies and Development of Health Education, Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Helena Cristóvão
- Center for Studies and Development of Health Education, Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Alba Regina de Abreu Lima
- Center for Studies and Development of Health Education, Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Vânia Ms Brienze
- Center for Studies and Development of Health Education, Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Thaís Santana Gastardelo Bizotto
- Center for Studies and Development of Health Education, Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Antonio Hélio Oliani
- Center for Studies and Development of Health Education, Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
- University Hospital Center Cova da Beira, University of Beira Interior, Covilhã, Portugal
| | - Júlio César André
- Center for Studies and Development of Health Education, Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
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Deininger C, Wichlas F, Necchi M, Deluca A, Deininger S, Trieb K, Tempfer H, Kriechbaumer L, Traweger A. Enhancing Cranio-Maxillofacial Fracture Care in Low- and Middle-Income Countries: A Systematic Review. J Clin Med 2024; 13:2437. [PMID: 38673709 PMCID: PMC11050981 DOI: 10.3390/jcm13082437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Cranio-maxillofacial (CMF) injuries represent a significant challenge in low- and middle-income countries (LMICs), exacerbated by inadequate infrastructure, resources, and training. This systematic review aims to evaluate the current strategies and solutions proposed in the literature to improve CMF fracture care in LMICs, focusing on education, patient transfer, and off-label solutions. Methods: A comprehensive literature search was conducted using PubMed/Medline from January 2000 to June 2023. Studies were selected based on the Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA). Solutions were categorized into three main areas: education (digital and on-site teaching, fellowships abroad), patient transfer to specialized clinics, and off-label/non-operative solutions. Results: Twenty-three articles were included in the review, revealing a consensus on the necessity for enhanced education and training for local surgeons as the cornerstone for sustainable improvements in CMF care in LMICs. Digital platforms and on-site teaching were identified as key methods for delivering educational content. Furthermore, patient transfer to specialized national clinics and innovative off-label techniques were discussed as immediate solutions to provide quality care despite resource constraints. Conclusions: Effective CMF fracture care in LMICs requires a multifaceted approach, prioritizing the education and training of local healthcare professionals, facilitated patient transfer to specialized centers, and the adoption of off-label solutions to leverage available resources. Collaborative efforts between international organizations, local healthcare providers, and educational institutions are essential to implement these solutions effectively and improve patient outcomes in LMICs.
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Affiliation(s)
- Christian Deininger
- University Clinic for Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (F.W.); (K.T.); (L.K.)
| | - Florian Wichlas
- University Clinic for Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (F.W.); (K.T.); (L.K.)
| | - Marco Necchi
- Department of Surgery and Orthopaedics, Hospital Sterzing, Margarethenstraße 24, 39049 Sterzing, Italy;
| | - Amelie Deluca
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (A.D.); (H.T.); (A.T.)
| | - Susanne Deininger
- Department of Urology and Andrology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria;
| | - Klemens Trieb
- University Clinic for Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (F.W.); (K.T.); (L.K.)
- Department for Orthopaedics and Traumatology, Center for Clinical Medicine, Faculty of Medicine and Dentistry, Danube Private University, 3500 Krems, Austria
| | - Herbert Tempfer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (A.D.); (H.T.); (A.T.)
| | - Lukas Kriechbaumer
- University Clinic for Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (F.W.); (K.T.); (L.K.)
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (A.D.); (H.T.); (A.T.)
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3
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Garoufalia Z, Bellato V, Cunha MF, Avellaneda N, Dudi-Venkata NN, Gallardo C, Meyer J, Zaffaroni G, Christensen P, Aytac E, Brady RRW, Pellino G. A narrative on diversity, equity, and inclusion in surgery: insights from the European Society of Coloproctology and identification of points for action. Updates Surg 2024; 76:529-537. [PMID: 38280108 PMCID: PMC10995079 DOI: 10.1007/s13304-023-01685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 01/29/2024]
Abstract
The focus of the 2022 European Society of Coloproctology (ESCP) annual campaign was diversity, equity, and inclusion (DEI) in surgery. The ESCP "Operation Equal Access" campaign sought to interview key-opinion leaders and trainees, to raise awareness on inequalities, inform the community of the status of the topic, and to identify future areas for improvement. The ESCP Social Media Working Group interviewed experts who have made significant contributions to DEI in colorectal surgery and were acknowledged opinion leaders in the field. The interviews focused on their career, professional life, experiences, and opportunities during their training, and their views on DEI in colorectal surgery. DEI principles, education, and values need further promotion to reduce and address bias within the profession and overall improve the experience of minority community including health professionals and patients. International Societies are working to facilitate training opportunities and overcome DEI, and networking have contributed to that. Collaborations between societies will be pivotal to contribute to offering research and leadership opportunities equally. Access to advanced workshops including cadaveric training and simulation can be consistently promoted and provided globally via societies through telemonitoring. Involving patients in research should be encouraged, as it brings the perspective of a living experience.
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Affiliation(s)
- Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
| | - Vittoria Bellato
- ESCP Social Media Committee Co-Chair, ESCP, Portsmouth, United Kingdom
- Minimally Invasive Surgery Unit, Università di Tor Vergata, Rome, Italy
- Gastroenterology Surgery Department, San Raffaele Hospital, Milan, Italy
| | - Miguel F Cunha
- ESCP Social Media Committee Co-Chair, ESCP, Portsmouth, United Kingdom
- Surgical Department, Algarve University Hospital, Portimão, Portugal
| | - Nicolas Avellaneda
- Nueva Proctologia, Buenos Aires, Argentina
- CEMIC, Buenos Aires, Argentina
- Danish Cancer Society National Research Centre for Survivorship and Late Side Effect to Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Nagendra N Dudi-Venkata
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Cristián Gallardo
- Servicio de Coloproctologia, Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
- Medical School, University of Geneva, Rue Michel-Servet 1, 1205, Genève, Switzerland
| | | | - Peter Christensen
- Danish Cancer Society National Research Centre for Survivorship and Late Side Effect to Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Erman Aytac
- Department of Surgery, School of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, Instanbul, Turkey
- Incoming ESCP Communication Committee Chair, ESCP, Portsmouth, United Kingdom
| | - Richard R W Brady
- Newcastle Centre for Bowel Disease Research Group, Newcastle Upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Queen Victoria Road, Newcastle Upon Tyne, United Kingdom
- ESCP Communication Committee Chair, ESCP, Portsmouth, United Kingdom
| | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain.
- Department of Advanced Medical and Surgical Sciences, Universitá Degli Studi Della Campania "Luigi Vanvitelli, Naples, Italy.
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4
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Binda CJ, Adams J, Livergant R, Lam S, Panchendrabose K, Joharifard S, Haji F, Joos E. Defining a Framework and Evaluation Metrics for Sustainable Global Surgical Partnerships: A Modified Delphi Study. Ann Surg 2024; 279:549-553. [PMID: 37539584 PMCID: PMC10829902 DOI: 10.1097/sla.0000000000006058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
OBJECTIVE The aim of this study was to use expert consensus to build a concrete and realistic framework and checklist to evaluate sustainability in global surgery partnerships (GSPs). BACKGROUND Partnerships between high-resourced and low-resourced settings are often created to address the burden of unmet surgical need. Reflecting on the negative, unintended consequences of asymmetrical partnerships, global surgery community members have proposed frameworks and best practices to promote sustainable engagement between partners, though these frameworks lack consensus. This project proposes a cohesive, consensus-driven framework with accompanying evaluation metrics to guide sustainability in GSPs. METHODS A modified Delphi technique with purposive sampling was used to build consensus on the definitions and associated evaluation metrics of previously proposed pillars (Stakeholder Engagement, Multidisciplinary Collaboration, Context-Relevant Education and Training, Bilateral Authorship, Multisource Funding, Outcome Measurement) of sustainable GSPs. RESULTS Fifty global surgery experts from 34 countries with a median of 9.5 years of experience in the field of global surgery participated in 3 Delphi rounds. Consensus was achieved on the identity, definitions, and a 47-item checklist for the evaluation of the 6 pillars of sustainability in GSPs. In all, 29% of items achieved consensus in the first round, whereas 100% achieved consensus in the second and third rounds. CONCLUSIONS We present the first framework for building sustainable GSPs using the input of experts from all World Health Organization regions. We hope this tool will help the global surgery community to find noncolonial solutions to addressing the gap in access to quality surgical care in low-resource settings.
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Affiliation(s)
- Catherine J. Binda
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jayd Adams
- Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rachel Livergant
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sheila Lam
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Shahrzad Joharifard
- Department of Surgery, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Faizal Haji
- Department of Surgery, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Emilie Joos
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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5
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Alvares LTDEA, Rangel AG, Campos LN, Viana SW, Kim AWS, Sampaio NZ, Ferreira R, Silva JB, Mooney DP, Camargo CP. Expanding Global Surgery Education in Brazil: Perspectives after the 35th Brazilian Surgical Congress. Rev Col Bras Cir 2024; 51:e20243667. [PMID: 38324886 PMCID: PMC10826473 DOI: 10.1590/0100-6991e-20243667-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/15/2023] [Indexed: 02/09/2024] Open
Abstract
The 35th Brazilian Congress of Surgery marked a turning point for surgical education in the country. For the first time, the Brazilian College of Surgeons included Global Surgery on the main congressional agenda, providing a unique opportunity to rethink how surgical skills are taught from a public health perspective. This discussion prompts us to consider why and how Global Surgery education should be expanded in Brazil. Although Brazilian researchers and institutions have contributed to the fields expansion since 2015, Global Surgery education initiatives are still incipient in our country. Relying on successful strategies can be a starting point to promote the area among national surgical practitioners. In this editorial, we discuss potential strategies to expand Global Surgery education opportunities and propose a series of recommendations at the national level.
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Affiliation(s)
| | - Ayla Gerk Rangel
- - Harvard Medical School, Program in Global Surgery and Social Change - Boston - Massachusetts - Estados Unidos
| | | | | | | | | | - Roseanne Ferreira
- - McMaster University, Department of Health Research Methods, Evidence and, Impact - Hamilton - Ontario - Canadá
| | | | - David P Mooney
- - Boston Children's Hospital - Boston - Massachusetts - Estados Unidos
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Attebery JE, Nuwas E, Mayegga E, Rabiel H, Massaga FA, Elahi C, Barranco FD, Lawton MT, Hall O, Ellegala DB. Global Neurosurgery: A Retrospective Cohort Study to Compare the Effectiveness of Two Training Methods in Resource-Poor Settings. Neurosurgery 2024; 94:263-270. [PMID: 37665218 DOI: 10.1227/neu.0000000000002652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/22/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Many low- and middle-income countries are experiencing profound health care workforce shortages. Surgical subspecialists generally practice in large urban centers but are in high demand in rural areas. These subspecialists must be trained through sustainable programs to address this disparity. We quantitatively compared the relative effectiveness of 2 unique training models to advance neurosurgical skills in resource-poor settings where formally trained neurosurgeons are unavailable. METHODS Neurosurgical procedure data were collected from 2 hospitals in Tanzania (Haydom Lutheran Hospital [HLH] and Bugando Medical Centre [BMC]), where 2 distinct training models ("Train Forward" and "Back-to-Back," respectively) were incorporated between 2005 and 2012. RESULTS The most common procedures performed were ventriculoperitoneal shunt (BMC: 559, HLH: 72), spina bifida repair (BMC: 187, HLH: 54), craniotomy (BMC: 61, HLH: 19), bone elevation (BMC: 42, HLH: 32), and craniotomy and evacuation (BMC: 18, HLH: 34). The number of annual procedures at BMC increased from 148 in 2008 to 357 in 2012; at HLH, they increased from 18 in 2005 to 80 in 2010. Postoperative complications over time decreased or did not significantly change at both sites as the diversity of procedures increased. CONCLUSION The Train Forward and Back-to-Back training models were associated with increased surgical volume and complexity without increased complications. However, only the Train Forward model resulted in local, autonomous training of surgical subspecialists after completion of the initial training period. Incorporating the Train Forward method into existing training programs in low- and middle-income countries may provide unique benefits over historic training practices.
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Affiliation(s)
- Jonah E Attebery
- Barrow Global, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , Arizona , USA
- Division of Critical Care, Department of Pediatrics, University of Colorado School of Medicine, Aurora , Colorado , USA
| | | | | | - Happiness Rabiel
- Department of Neurosurgery, Kilimanjaro Christian Medical Centre, Moshi , Tanzania
| | | | - Cyrus Elahi
- Barrow Global, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , Arizona , USA
| | - F David Barranco
- Barrow Global, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , Arizona , USA
| | - Michael T Lawton
- Barrow Global, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , Arizona , USA
| | - Osborne Hall
- Barrow Global, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , Arizona , USA
| | - Dilantha B Ellegala
- Barrow Global, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , Arizona , USA
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Qin R, Alayande B, Okolo I, Khanyola J, Jumbam DT, Koea J, Boatin AA, Lugobe HM, Bump J. Colonisation and its aftermath: reimagining global surgery. BMJ Glob Health 2024; 9:e014173. [PMID: 38176746 PMCID: PMC10773343 DOI: 10.1136/bmjgh-2023-014173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/24/2023] [Indexed: 01/06/2024] Open
Abstract
Coloniality in global health manifests as systemic inequalities, not based on merit, that benefit one group at the expense of another. Global surgery seeks to advance equity by inserting surgery into the global health agenda; however, it inherits the biases in global health. As a diverse group of global surgery practitioners, we aimed to examine inequities in global surgery. Using a structured, iterative, group Delphi consensus-building process drawing on the literature and our lived experiences, we identified five categories of non-merit inequalities in global surgery. These include Western epistemology, geographies of inequity, unequal participation, resource extraction, and asymmetric power and control. We observed that global surgery is dominated by Western biomedicine, characterised by the lack of interprofessional and interspecialty collaboration, incorporation of Indigenous medical systems, and social, cultural, and environmental contexts. Global surgery is Western-centric and exclusive, with a unidirectional flow of personnel from the Global North to the Global South. There is unequal participation by location (Global South), gender (female), specialty (obstetrics and anaesthesia) and profession ('non-specialists', non-clinicians, patients and communities). Benefits, such as funding, authorship and education, mostly flow towards the Global North. Institutions in the Global North have disproportionate control over priority setting, knowledge production, funding and standards creation. This naturalises inequities and masks upstream resource extraction. Guided by these five categories, we concluded that shifting global surgery towards equity entails building inclusive, pluralist, polycentric models of surgical care by providers who represent the community, with resource controlled and governance driven by communities in each setting.
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Affiliation(s)
- Rennie Qin
- Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Barnabas Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Gasabo, Rwanda
- Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Isioma Okolo
- Department of Obstetrics and Gynaecology, NHS Slothian, Edinburgh, UK
| | - Judy Khanyola
- Center for Nursing and Midwifery, University of Global Health Equity, Kigali, Gasabo, Rwanda
| | - Desmond Tanko Jumbam
- Department of Health Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | - Jonathan Koea
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Adeline A Boatin
- Department of Obstetrics & Gynecology and Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Henry Mark Lugobe
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology Faculty of Medicine, Mbarara, Uganda
| | - Jesse Bump
- Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway
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Kebede MA, Tor DSG, Aklilu T, Petros A, Ifeanyichi M, Aderaw E, Bognini MS, Singh D, Emodi R, Hargest R, Friebel R. Identifying critical gaps in research to advance global surgery by 2030: a systematic mapping review. BMC Health Serv Res 2023; 23:946. [PMID: 37667225 PMCID: PMC10478287 DOI: 10.1186/s12913-023-09973-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/26/2023] [Indexed: 09/06/2023] Open
Abstract
Progress on surgical system strengthening has been slow due to a disconnect between evidence generation and the information required for effective policymaking. This systematic mapping review sought to assess critical research gaps in the field of global surgery guided by the World Health Organisation Health Systems building block framework, analysis of authorship and funding patterns, and an exploration of emerging research partnership networks. Literature was systematically mapped to identify, screen, and synthesize results of publications in the global surgery field between 2015 and March 2022. We searched four databases and included literature published in seven languages. A social network analysis determined the network attributes of research institutions and their transient relationships in shaping the global surgery research agenda. We identified 2,298 relevant studies out of 92,720 unique articles searched. Research output increased from 453 in 2015-16 to 552 in 2021-22, largely due to literature on Covid-19 impacts on surgery. Sub-Saharan Africa (792/2298) and South Asia (331/2298) were the most studied regions, although high-income countries represented a disproportionate number of first (42%) and last (43%) authors. Service delivery received the most attention, including the surgical burden and quality and safety of services, followed by capacity-building efforts in low- and middle-income countries. Critical research in economics and financing, essential infrastructure and supplies, and surgical leadership necessary to guide policy decisions at the country level were lacking. Global surgical systems remain largely under-researched. Knowledge diffusion requires an emphasis on developing sustainable research partnerships and capacity across low- and middle-income countries. A renewed focus must be given to equipping countries with tools for effective decision-making to enhance investments in high-quality surgical services.
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Affiliation(s)
- Meskerem Aleka Kebede
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London, WC2A 2AE, UK.
| | - Deng Simon Garang Tor
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London, WC2A 2AE, UK
| | | | - Adane Petros
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Martilord Ifeanyichi
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London, WC2A 2AE, UK
| | - Ezekiel Aderaw
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Maeve Sophia Bognini
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London, WC2A 2AE, UK
| | - Darshita Singh
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London, WC2A 2AE, UK
| | - Rosemary Emodi
- Royal College of Surgeons of England, Global Affairs, 38-43 Lincoln's Inn Fields, London, UK
| | - Rachel Hargest
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London, WC2A 2AE, UK
- Royal College of Surgeons of England, Global Affairs, 38-43 Lincoln's Inn Fields, London, UK
- School of Medicine, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - Rocco Friebel
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London, WC2A 2AE, UK
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Alayande BT, Hughes Z, Fitzgerald TN, Riviello R, Bekele A, Rice HE. With equity in mind: Evaluating an interactive hybrid global surgery course for cross-site interdisciplinary learners. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001778. [PMID: 37141197 PMCID: PMC10159197 DOI: 10.1371/journal.pgph.0001778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
There is limited understanding of the role of transcultural, cross-site educational partnerships for global surgery training between high- and low- or middle-income country (LMIC) institutions. We describe the development, delivery, and appraisal of a hybrid, synchronous, semester-long Global Surgical Care course by global health collaborators from widely different contexts, and evaluate the equity of the collaboration. The course was collaboratively modified by surgical educators and public health professionals with emphasis on collaboration ethics. Faculty from high-income and LMICs were paired to deliver lectures. To collaborate internationally, students and faculty participated either onsite or online. Perceptions and knowledge gained were quantitatively evaluated through participant and faculty cross-sectional surveys, using Likert scales, prioritization rankings, and free text responses analysed qualitatively. Equity was assessed using the Fair Trade Learning rubric and additional probes. Thirty-five learners from six institutions participated. Teams produced mock National, Surgical, Obstetric, and Anaesthesia Plans (NSOAPs) for selected LMICs, and reported a 9% to 65% increase in self-reported global health competencies following the course. Online learners had favourable perceptions of learning, but experienced connectivity challenges. Barriers to effective group work included time differences and logistics of communication for dispersed team members. Individuals taking the course for academic credit scored significantly higher than other learners in peer assessments of participation (8.56±1.53 versus 5.03±3.14; p<0.001). Using the Fair Trade Rubric, 60% of equity indicators were ideal, and no respondents perceived neo-colonialism in the partnership. Blended, synchronous, interdisciplinary global surgery courses based on "North-South" partnerships with a focus on equity in design and delivery are feasible but require careful and deliberate planning to minimize epistemic injustice. Such programs should address surgical systems strengthening, and not create dependency. Equity in such engagements should be evaluated and monitored in an ongoing fashion to stimulate discussion and continuous improvement.
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Affiliation(s)
- Barnabas Tobi Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Zoe Hughes
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Tamara N Fitzgerald
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke University School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Robert Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke University School of Medicine, Duke University, Durham, North Carolina, United States of America
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