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Negash S, Starr N, Mesfin S, G Weiser T, Negussie TM. A novel global safe surgery mentorship program using a multidisciplinary team approach. World J Surg 2024. [PMID: 38813996 DOI: 10.1002/wjs.12216] [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: 02/22/2024] [Accepted: 05/07/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The global surgery movement aims to provide equitable surgical care in low- and middle-income countries (LMICs) and attempts to address a wide range of issues around the lack of access and poor-quality. In response, the Lifebox McCaskey Safe Surgery Fellowship was established in Ethiopia to train a multidisciplinary team of healthcare professionals. We conducted this study to evaluate the outcome of this training program. METHODS A qualitative study was conducted to evaluate the implementations and outcomes of the first three cohorts of the McCaskey Fellowship. Interviews with fellows, mentors, and program staff reveal valuable insights into the program's strengths and challenges. RESULTS Key findings include positive feedback on the program's curriculum highlighting its multidisciplinary nature. Challenges were noted in maintaining schedules, communication with healthcare facilities, and budget constraints, suggesting the need for improved program management. The fellowship's impact was evident in altering participants' perceptions of teamwork and enhancing their research and leadership skills. Fellows initiated quality improvement projects impacting surgical practices positively. However, challenges, such as hospital resistance and the COVID-19 pandemic, affected program implementation. CONCLUSION Despite various challenges, the program's unique approach combining multidisciplinary training and local mentorship proves promising. It fosters a culture of teamwork, equips participants with essential skills, and encourages fellows to become advocates for safe surgery. As surgical quality champions emerge from this fellowship, there is optimism for lasting positive impacts on surgical care in LMICs.
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Affiliation(s)
- Samuel Negash
- Menelik II Hospital, Addis Ababa, Ethiopia
- Lifebox Foundation, Addis Ababa, Ethiopia
| | - Nichole Starr
- Lifebox Foundation, Addis Ababa, Ethiopia
- University of California San Francisco, San Francisco, California, USA
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Brown K, Flores MJ, Haonga B, Chokotho LC, O'Marr JM, Rodarte P, Shearer D, Morshed S. Best Practices for Developing International Academic Partnerships in Orthopaedics. J Bone Joint Surg Am 2024; 106:924-930. [PMID: 37851955 DOI: 10.2106/jbjs.23.00626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
ABSTRACT Traumatic and nontraumatic orthopaedic conditions are major contributors to global morbidity and account for the majority of life-years lived with disability worldwide. Additionally, the burden of musculoskeletal injuries has increased substantially over the past 3 decades. Unfortunately, in low and middle-income countries (LMICs), access to orthopaedic care is limited, leading to a disproportionate burden of disease. The Lancet Commission on Global Surgery has emphasized the urgent need for unified international commitment and research collaboration to achieve universal access to safe and affordable surgical care. However, conducting high-quality orthopaedic research in LMICs remains challenging as a result of disparities in training, access to resources, infrastructure, and equipment availability. Partnerships between high-income countries (HICs) and LMICs have emerged in recent decades as an effective approach to combatting some of these challenges. These partnerships aim to bridge the gaps by facilitating collaborative research and knowledge exchange. The establishment of successful partnerships requires a collaborative and reciprocal approach that starts with a clear understanding of mutual research aims and the availability of resources. Despite the potential benefits, various factors can make establishing such partnerships difficult. However, these partnerships can have a substantial impact in delivering quality orthopaedic education and research training, thus improving access to care in resource-limited environments. This paper represents the collaborative effort of multiple international academic orthopaedic surgeons with extensive experience in HIC-LMIC partnerships. Our aims were to outline the best practices for conducting orthopaedic research within these relationships and to provide guidance for future successful collaborations.
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Affiliation(s)
- Kelsey Brown
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, California
| | - Michael J Flores
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, California
| | - Billy Haonga
- Muhimbili Orthopedic Institute, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Jamieson M O'Marr
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, California
| | - Patricia Rodarte
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, California
| | - David Shearer
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, California
| | - Saam Morshed
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, California
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Flores MJ, Brown KE, MacKechnie MC, O’Marr JM, Rodarte P, Shearer DW. An Analysis of Participant Preferences Regarding Virtual Versus In-person Format of Orthopaedic Surgery Educational Materials in Low- and Middle-Income Countries. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00003. [PMID: 38437056 PMCID: PMC10906641 DOI: 10.5435/jaaosglobal-d-23-00134] [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: 07/09/2023] [Revised: 12/21/2023] [Accepted: 01/16/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION The University of California, San Francisco Institute for Global Orthopaedics and Traumatology Surgical Management and Reconstructive Training (SMART) course has instructed orthopaedic surgeons from low-resource countries on soft-tissue reconstruction. Before the COVID-19 pandemic, the course was conducted in-person; however, it was transitioned to a virtual format during the pandemic. The aim of this study was to determine participant preferences regarding a virtual or in-person SMART course format. METHODS Survey data were collected via e-mail after each SMART course using RedCap or Qualtrics. Statistical analyses were conducted using Stata. RESULTS There were 247 survey respondents from 44 countries representing all world regions, with Africa (125, 51%) the most represented. Of those who attended both an in-person and virtual course, most (82%) preferred the in-person format. In addition, all measured course outcomes were significantly better for participants attending the in-person course. The most common reason for not attending an in-person course was the cost of travel (38, 51%). DISCUSSION This study demonstrated a preference toward in-person learning for the SMART course. In addition, those surgeons participating in the in-person course endorsed increased positive outcomes from the course. Increased emphasis should be placed on in-person surgical skills training for low-resource surgeons.
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Affiliation(s)
- Michael J. Flores
- From the Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Kelsey E. Brown
- From the Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Madeline C. MacKechnie
- From the Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Jamieson M. O’Marr
- From the Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Patricia Rodarte
- From the Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - David W. Shearer
- From the Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
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Brown KE, Flores MJ, MacKechnie MC, Rodarte P, O'Marr J, Shearer DW, Toogood P. Novel e-learning platform for orthopaedic training in LMICs: A descriptive review of the IGOT portal. Surg Open Sci 2023; 13:24-26. [PMID: 37351189 PMCID: PMC10282557 DOI: 10.1016/j.sopen.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/08/2023] [Indexed: 06/24/2023] Open
Abstract
Background While e-learning has been written about extensively within the context of orthopaedics in the United States, there are few articles describing e-learning initiatives geared towards low-and middle-income countries (LMICs). The Institute for Global Orthopaedics and Traumatology (IGOT) at the University of California, San Francisco (UCSF) developed the IGOT Learning Portal to meet this need. Methods The IGOT Learning Portal was designed to address knowledge gaps in patient care by increasing access to high-quality orthopaedic education for surgeons and trainees worldwide. It offers 10 distinct, asynchronous courses, which are divided into a modular format. Course enrollment is free and accessible to any surgeon or trainee with a web-browsing capable device and internet connection. Results There are more than 2700 registered users and 300 active learners enrolled in IGOT Learning Portal courses. The Surgical Management and Reconstructive Training (SMART) program is the most commonly taken course. Learners represent 32 different countries across six continents. The IGOT portal also has surgical videos available on YouTube. The IGOT Portal YouTube channel has over 2000 subscribers and over 143,000 total views. Conclusions The IGOT Learning Portal is an innovative approach to address the global disparity in orthopaedic trauma care by improving access to high-quality surgical education for surgeons and trainees both in the US and internationally. The development of an interactive online forum may be a beneficial addition to the Portal. Future directions include assessing content retention, participant interaction, and expanding existing content to other orthopaedic subspecialties.
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Affiliation(s)
| | | | | | | | | | | | - Paul Toogood
- Corresponding author at: 2550 23rd Street, San Francisco, CA 94110, USA.
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Mitchell J, Zeineddin A, Kearse L, Downton KD, Kushner AL, Gupta S. Surgical Training for Civilian Surgeons Interested in Humanitarian Surgery: A Scoping Review. J Surg Res 2023; 283:282-287. [PMID: 36423477 DOI: 10.1016/j.jss.2022.10.068] [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: 03/01/2022] [Revised: 08/04/2022] [Accepted: 10/18/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Humanitarian surgery is essential to surgical care in limited resource settings. The difficulties associated with resource constraints necessitate special training for civilian surgeons to provide care in these situations. Specific training or curricula for humanitarian surgeons are not well described in the literature. This scoping review summarizes the existing literature and identifies areas for potential improvement. METHODS A review of articles describing established courses for civilian surgeons interested in humanitarian surgery, as well as those describing training of civilian surgeons in conflict zones, was performed. A total of 4808 abstracts were screened by two independent reviewers, and 257 abstracts were selected for full-text review. Articles describing prehospital care and military experience were excluded from the full-text review. RESULTS Of the eight relevant full texts, 10 established courses for civilian surgeons were identified. Cadaver-based teaching combined with didactics were the most common course themes. Courses provided technical education focused on the management of trauma and burns as well as emergencies in orthopedics, neurosurgery, obstetrics, and gynecology. Other courses were in specialty surgery, mainly orthopedics. Two fellowship programs were identified, and these provide a different model for training humanitarian surgeons. CONCLUSIONS Humanitarian surgery is often practiced in austere environments, and civilian surgeons must be adequately trained to first do no harm. Current programs include cadaver-based courses focused on enhancing trauma surgery and surgical subspecialty skills, with adjunctive didactics covering resource allocation in austere environments. Fellowships programs may serve as an avenue to provide a more standardized education and a reliable pipeline of global surgeons.
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Affiliation(s)
- Jonathan Mitchell
- Howard University College of Medicine, Department of Surgery, Washington, District of Columbia; Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, Maryland.
| | - Ahmad Zeineddin
- Howard University College of Medicine, Department of Surgery, Washington, District of Columbia
| | - LaDonna Kearse
- Stanford University, Department of Surgery, Palo Alto, California
| | - Katherine D Downton
- Health Sciences and Human Services Library, University of Maryland, Baltimore, Maryland
| | | | - Shailvi Gupta
- Surgeons OverSeas, New York, New York; R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland
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MacKechnie MC, Albright PD, Garabano G, Bidolegui F, Pereira S, Pesciallo CA, Miclau T. Open tibial shaft fracture management in Argentina: an evaluation of treatment standards in diverse resource settings. OTA Int 2022; 5:e209. [PMID: 36425094 PMCID: PMC9580262 DOI: 10.1097/oi9.0000000000000209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/20/2022] [Indexed: 06/16/2023]
Abstract
Background Argentina is a country with varying access to orthopedic surgical care. The Argentine Association of Trauma and Orthopedics (AATO) "Interior Committee" was developed to address potential regional differences and promote standardization of orthopedic trauma care. The paper assesses the level of national standardization of the management of open tibia fractures across 9 provinces in Argentina. Methods Utilizing a matched-comparison group design, management of these injuries were assessed and compared between 3 groups: an "AATO Exterior Committee" consisting of surgeons that practice in Buenos Aires, and 2 "Interior Committees," comprising surgeons that practice in outlying provinces, 1 of which is affiliated with the AATO, and 1 that is not affiliated with the AATO. The study was conducted in 2 phases: phase 1 assessed open tibia fracture management characteristics, and phase 2 evaluated the management of soft-tissue wound coverage following open fractures. Results Soft-tissue coverage procedures for Gustilo Anderson Type IIIB fractures were more commonly performed by orthopedic surgeons in Interior Committees than the AATO Exterior Committee. Greater rates of definitive wound coverage within 7 days post-injury were reported in both Interior Committees compared to the Exterior Committee. Plastic surgeons were reported as more available to those in the AATO Exterior Committee group than in the AATO Interior Committees. Conclusion While treatment patterns were evident among groups, differences were identified in the management and timing of soft-tissue coverage in Gustilo Anderson Type IIIB fractures between the Exterior Committee and both Interior Committees. Future targeted educational and surgical hands-on training opportunities that emphasize challenges faced in resource-limited settings may improve the management of open tibia fractures in Argentina.
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Affiliation(s)
- Madeline C MacKechnie
- Institute for Global Orthopaedics and Traumatology, Orthopaedic Trauma Institute, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Patrick D Albright
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | | | | | | | | | - Theodore Miclau
- Institute for Global Orthopaedics and Traumatology, Orthopaedic Trauma Institute, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA
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Blair JA, Puneky GA, Dickerson TE, Faith HD, Davis JM. Posttraumatic Soft Tissue Coverage of the Lower Leg for the Orthopedic Surgeon. Orthop Clin North Am 2022; 53:297-310. [PMID: 35725038 DOI: 10.1016/j.ocl.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Soft tissue reconstructive techniques are powerful tools for the orthopedic surgeon caring for lower extremity trauma. This article seeks to inform orthopedic surgeons about useful techniques for skin closure, secondary wound closure techniques, and rotational flaps of the lower leg. Split thickness skin grafting, piecrusting, and the use of negative pressure wound therapy for skin closure, as well as rotational gastrocnemius, soleus, and reverse sural artery flaps are discussed with emphasis on techniques for the nonvascular and nonmicrovascular orthopedic surgeon.
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Affiliation(s)
- James A Blair
- Department of Orthopedic Surgery, Medical College of Georgia at Augusta University, 1120 15th St., BA 3300, Augusta, GA 30912, USA.
| | - George A Puneky
- Department of Orthopedic Surgery, Medical College of Georgia at Augusta University, 1120 15th St., BA 3300, Augusta, GA 30912, USA
| | - Thomas E Dickerson
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - Hayden D Faith
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - Jana M Davis
- Department of Orthopedic Surgery, Medical College of Georgia at Augusta University, 1120 15th St., BA 3300, Augusta, GA 30912, USA. https://twitter.com/janadavisMD
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Management of soft-tissue coverage of open tibia fractures in Latin America: Techniques, timing, and resources. Injury 2022; 53:1422-1429. [PMID: 35101259 DOI: 10.1016/j.injury.2022.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE This study examined soft-tissue coverage techniques of open tibia fractures, described soft-tissue treatment patterns across income groups, and determined resource accessibility and availability in Latin America. METHODS A 36-question survey was distributed to orthopaedic surgeons in Latin America through two networks: national orthopaedic societies and the Asociación de Cirujanos Traumatólogos de las Américas (ACTUAR). Demographic information was collected, and responses were stratified by income groups: high-income countries (HICs) and middle-income countries (MICs). RESULTS The survey was completed by 469 orthopaedic surgeons, representing 19 countries in Latin America (2 HICs and 17 MICs). Most respondents were male (89%), completed residency training (96%), and were fellowship-trained (71%). Only 44% of the respondents had received soft-tissue training. Respondents (77%) reported a strong interest in attending a soft-tissue training course. Plastic surgeons were more commonly the primary providers for Gustilo Anderson (GA) Type IIIB injuries in HICs than in MICs (100% vs. 47%, p<0.01) and plastic surgeons were more available (<24 h of patient presentation to the hospital) in HICs than MICs (63% vs. 26%, p = 0.05), demonstrating statistically significant differences. In addition, respondents in HICs performed free flaps more commonly than in MICs for proximal third (55% vs. 10%, p<0.01), middle third (36% vs. 9%, p = 0.02), and distal third (55% vs. 10%, p<0.01) lower extremity wounds. Negative Pressure Wound Therapy (NPWT or Wound VAC) was the only resource available to more than half of the respondents. Though not statistically significant, surgeons reported having more access to plastic surgeons at their institutions in HICs than MICs (91% vs. 62%, p = 0.12) and performed microsurgical flaps more commonly at their respective institutions (73% vs. 42%, p = 0.06). CONCLUSIONS The study demonstrated that most orthopaedic surgeons in Latin America have received no soft-tissue training, HICs and MICs have differences in access to plastic surgeons and expectations for flap type and timing to definitive coverage, and most respondents had limited access to necessary soft-tissue surgical resources. Further investigation into differences in the clinical outcomes related to soft-tissue coverage methods and protocols can provide additional insight into the importance of timing and access to specialists.
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Theroux L, Steere M, Katz E, Jewell R, Gardner A. A Goat Cadaver as a Cost-effective Resource for Teaching Emergency Medicine Procedures in Kijabe, Kenya. Pediatr Emerg Care 2022; 38:e1097-e1103. [PMID: 34225331 DOI: 10.1097/pec.0000000000002486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A pediatric emergency medicine and critical care fellowship was recently developed in Kenya through the University of Nairobi/Kenyatta National Hospital and AIC Kijabe Hospital. As part of this training, a week-long trauma and emergency medicine course was developed with emphasis on trauma and emergency medicine procedures. Given limited resources, we developed a course with simulation of procedures centered around utilization of a goat cadaver. OBJECTIVE The aim of the study was to describe fellow and faculty experiences and perspectives when using a goat cadaver to teach emergency medicine procedures by simulation in Kijabe, Kenya. METHODS A 5-day course was given to 2 fellows with a variety of didactics and simulations after which fellows completed a questionnaire to rate their satisfaction with the content and teaching effectiveness. RESULTS The course was rated very highly, with an average content satisfaction score of 4.5 5 and average teaching effectiveness score of 4.4 of 5. Qualitative faculty feedback was positive, with specific learnings allowing ongoing adaptation of this model. CONCLUSIONS A goat cadaver is a cost-effective resource not often considered that can be adequately used to teach several emergency medicine skills by simulation.
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Affiliation(s)
- Lindly Theroux
- From the Wake Forest University School of Medicine, Winston-Salem, NC
| | | | - Eric Katz
- From the Wake Forest University School of Medicine, Winston-Salem, NC
| | - Rebekah Jewell
- From the Wake Forest University School of Medicine, Winston-Salem, NC
| | - Alison Gardner
- From the Wake Forest University School of Medicine, Winston-Salem, NC
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Global Surgery Education and Training Programmes-a Scoping Review and Taxonomy. Indian J Surg 2021; 84:193-206. [PMID: 34456525 PMCID: PMC8386150 DOI: 10.1007/s12262-021-03081-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/15/2021] [Indexed: 10/30/2022] Open
Abstract
Global surgery is an emerging field of study and practice, aiming to respond to the worldwide unmet need for surgical care. As a relatively new concept, it is not clear that there is a common understanding of what constitutes "global surgery education and training". This study examines the forms that global surgery education and training programmes and interventions take in practice, and proposes a classification scheme for such activities. A scoping review of published journal articles and internet websites was performed according to the PRISMA Extension for Scoping Review guidelines. PubMed MEDLINE, EMBASE and Google were searched for sources that described global surgery education and training programme. Only sources that explicitly referenced a named education programme, were surgical in nature, were international in nature, were self-described as "global surgery" and presented new information were included. Three hundred twenty-seven records were identified and 67 were ultimately included in the review. "Global surgery education and training" interventions described in the literature most commonly involved both a High-Income Country (HIC) institution and a Low- and Middle-Income Country (LMIC) institution. The literature suggests that significant current effort is directed towards academic global surgery programmes in HIC institutions and HIC surgical trainee placements in LMICs. Four categories and ten subcategories of global surgery education and training were identified. This paper provides a framework from which to study global surgery education and training. A clearer understanding of the forms that such interventions take may allow for more strategic decision making by actors in this field.
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Qi X, He R, Wen B, Li Q, Wu H. Design and evaluation of a simulated wound management course for postgraduate year one surgery residents. PeerJ 2021; 9:e11104. [PMID: 33954032 PMCID: PMC8052975 DOI: 10.7717/peerj.11104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background It is vital to cover wound management knowledge and operations in the early stages of resident training. With this in mind, a simulated wound management course for postgraduate year one surgery residents (PGY1s) was designed and its effectiveness was evaluated. Methods A retrospective quasi-experimental method was used. PGY1s in 2014 constituted the control group, and PGY1s in 2015 and 2016 constituted the intervention group. The course given to the control group comprised didactic teaching followed by deliberate practice plus immediate personalized feedback. The newly designed course given to the intervention group was reconstructed and disassembled into four components according to the simulation-based mastery learning model, which were baseline test, interactive learning, basic skills practice, and reflective learning. The same performance assessments were used in the control and intervention group, including process measurement and outcome measurement. Results The process measurement showed that the intervention group’s scores were significantly higher in the “dissociation of subcutaneous tissue” and “quality of suturing and knots”. The outcome measurement showed that the accuracy of debridement was greatly improved and both key and total suture numbers were significantly higher in the intervention group. Conclusions Simulation-based mastery learning was incorporated into our proposed course framework, promoting the learning outcome of PGY1s. It has the potential to be adapted for other surgical training sites for residents in China.
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Affiliation(s)
- Xin Qi
- Plastic Surgery and Burn, Peking University First Hospital, Beijing, China
| | - Rui He
- Plastic Surgery and Burn, Peking University First Hospital, Beijing, China
| | - Bing Wen
- Plastic Surgery and Burn, Peking University First Hospital, Beijing, China
| | - Qiang Li
- Plastic Surgery and Burn, Peking University First Hospital, Beijing, China
| | - Hongbin Wu
- Institute of Medical Education/National Centre for Health Professions Education Development, Peking University, Beijing, China
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Expeditionary Plastic Surgery: Reconstruction Pearls for the Non-plastic Surgeon Managing Injured Host Nationals. CURRENT TRAUMA REPORTS 2021. [DOI: 10.1007/s40719-021-00212-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Holler JT, MacKechnie MC, Albright PD, Morshed S, Shearer DW, Terry MJ. The Impact of Inadequate Soft-tissue Coverage following Severe Open Tibia Fractures in Tanzania. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3272. [PMID: 33425587 PMCID: PMC7787316 DOI: 10.1097/gox.0000000000003272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/01/2020] [Indexed: 12/31/2022]
Abstract
Managing lower extremity fractures complicated by large soft-tissue defects is challenging for surgeons in low- and middle-income countries, and long-term quality of life (QOL) for these patients is unclear. METHODS We examined QOL, surgical complications, and longitudinal outcomes in 10 patients with Gustilo-Anderson Classification Type IIIB open tibia fractures seen at an orthopedic institute in Tanzania, from December 2015 to March 2017. Patients completed follow-up at 2-, 6-, 12-, 26-, and 52-week time points, and returned for qualitative interviews at 2.5 years. The primary outcome was QOL, as measured using EuroQoL-5D scores and qualitative semi-structured interview responses. The secondary outcome was rate of complication, as defined by reoperation for deep infection or nonunion. RESULTS Ten patients enrolled in the study and 7 completed 1-year follow-up. All fractures were caused by road traffic accidents and treated by external fixation. No patients received initial soft-tissue (flap) coverage of the wound. All patients developed an infected nonunion. No patients returned to work at 6 weeks, 3 months, or 6 months. EQ-5D index scores at 1 year were poor (0.71 ± 0.09). Interview themes included ongoing medical complications, loss of employment, reduced income, and difficulty with activities of daily living. CONCLUSIONS Patients in low- and middle-income countries with IIIB open tibia fractures not treated with appropriate soft-tissue coverage experience poor QOL, high complication rates, and severe socioeconomic effects as a result of their injuries. These findings illustrate the need for resources and training to build capacity for extremity soft-tissue reconstruction in LMICs.
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Affiliation(s)
- Jordan T. Holler
- From the UCSF School of Medicine, University of California, San Francisco, Calif
| | - Madeline C. MacKechnie
- Institute for Global Orthopedics and Traumatology, Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, San Francisco, Calif
| | - Patrick D. Albright
- Department of Orthopaedic Surgery, University of Minnesota – Medical School, Minneapolis, Minn
| | - Saam Morshed
- Institute for Global Orthopedics and Traumatology, Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, San Francisco, Calif
| | - David W. Shearer
- Institute for Global Orthopedics and Traumatology, Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, San Francisco, Calif
| | - Michael J. Terry
- Division of Plastic and Reconstructive Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, Calif
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Knowledge deficits and barriers to performing soft-tissue coverage procedures: An analysis of participants in an orthopaedic surgical skills training course in Mexico. OTA Int 2019; 2:e044. [PMID: 33937672 PMCID: PMC7997122 DOI: 10.1097/oi9.0000000000000044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 09/12/2019] [Indexed: 01/10/2023]
Abstract
Background: An increasing number of traumatic injuries in low- and low-middle-income countries (LICs/LMICs) have coexisting injuries requiring soft-tissue coverage (flaps). Yet, there is a lack of subspecialty care and flap training in Latin America. This study assesses the effectiveness of a surgical skills training course in improving rotational and free flap knowledge and identifies barriers to performing these types of flaps. Methods: Participants attending a surgical skills training course in Guadalajara, Mexico completed a pre/postcourse flaps knowledge survey consisting of 15 questions from the plastic surgery in-training examination and also completed a 7-point Likert survey regarding perceived barriers to performing flaps at their institution. Results: Of the course participants, 17 (44.7%) completed the precourse knowledge survey, 24 (63.2%) completed the postcourse survey, and 37 (97.4%) completed the barriers survey. Scores improved from pre- to postcourse knowledge surveys (39.6% to 53.6%, P = .005). Plastic surgery subsection scores also improved (39.0% to 60.4%, P = .003). Twenty-five percent of attendees received prior flap training and had plastic surgeons available to perform flaps. Few participants (38.9%) reported flap procedures being commonly completed at their hospitals. Participants stating that flaps were uncommon in their hospital reported more institutional barriers and less access to dermatomes. These participants also reported lack of operating room and surgical personnel availability. Conclusion: A surgical skills training course may be useful in improving knowledge of soft-tissue coverage procedures. There are also modifiable physician and institutional barriers that can improve the ability to perform rotational and free flaps as identified by the course participants.
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Barriers to Performing Soft Tissue Reconstruction Procedures among Orthopedic Surgeons in Low- and Middle-income Countries: Results of a Surgical Skills Training Course. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2420. [PMID: 31772876 PMCID: PMC6846298 DOI: 10.1097/gox.0000000000002420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/09/2019] [Indexed: 02/07/2023]
Abstract
Appropriate management of soft tissue injury associated with orthopedic trauma is challenging in low- and middle-income countries (LMICs) due to the lack of available reconstructive surgeons. The Surgical Management and Reconstructive Training (SMART) course teaches orthopedic surgeons reconstructive techniques aimed at improving soft tissue management. This study aims to identify additional barriers to implementing these techniques for surgeons in LMICs who have attended SMART courses.
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Practical Guide to Delivering Surgical Skills Courses in a Low-Income Country: Knowledge Gained From a Surgical Education Partnership in Haiti. J Orthop Trauma 2018; 32 Suppl 7:S18-S20. [PMID: 30247394 DOI: 10.1097/bot.0000000000001289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Routine surgical skills training is known to advance a surgeon's technical proficiency. However, orthopaedic providers in low-income countries have limited access to skills training programs. International academic partnerships can augment locally available orthopaedic education, improving the quality of and capacity to deliver orthopaedic care in low-income countries. The objective of this study is to provide a practical guide to delivering an orthopaedic skills training course in a low-resource setting. The information provided is based on the experiences of the authors, along with specific feedback from previous course participants in Haiti.
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Can a 2-Day Course Teach Orthopaedic Surgeons Rotational Flap Procedures? An Evaluation of Data From the Nepal SMART Course Over 2 years. J Orthop Trauma 2018; 32 Suppl 7:S38-S42. [PMID: 30247399 DOI: 10.1097/bot.0000000000001298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Traumatic lower extremity injuries requiring multidisciplinary treatment pose a challenge in low- and middle-income countries, where access to specialists may be limited. The surgical management and reconstructive training (SMART) course teaches orthopaedic surgeons muscle and fasciocutaneous flap procedures to address this scarcity. The purpose of this study is to assess the effectiveness of the SMART course in improving competency and comfort in performing common lower extremity flap procedures among participants. METHODS Sixty-four orthopaedic surgeons from different regions of Nepal and Bhutan participated in the Nepal SMART course in 2016 and 2017. A competency test-consisting of questions from US in-training plastic and orthopaedic surgery examinations-was administered to attendees before and after the course. Thirty-two participants from 2016 were asked to rate their comfort level in performing flap procedures both pre- and postcourse. RESULTS Overall competency test scores, as well as scores in the plastic surgery section, increased significantly after the course (P < 0.01). The precourse competency test scores were higher in 2016 compared with 2017 (P = 0.02). There was a higher increase in overall competency test scores after the course in 2016 compared with 2017 (P = 0.03). The procedure comfort levels reported by attendees increased for all flaps (P < 0.01). CONCLUSIONS These results demonstrate the ability of the SMART course to improve the competency and comfort levels of orthopaedic surgeons in performing common lower extremity flap procedures. Despite the differences in years in practice and previous experience in performing flaps, the course yielded significantly better results in 2017 compared with 2016, showing that the implementation of the course has been improving.
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