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Scott EM, Enumah ZO, Mehta K, Kontchou NA, Davis RW. Practical and Ethical Guidelines for the Involvement of Trainees in Global Surgery: Consensus Statement and Recommendations from the Resident and Associate Society of the American College of Surgeons Global Surgery Work Group. J Am Coll Surg 2023; 237:885-892. [PMID: 37702398 DOI: 10.1097/xcs.0000000000000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND The guidelines provided by US professional surgical organizations for involvement of trainees in global surgery are limited. The aim of this consensus statement is to provide surgical trainees with official recommendations from the Resident and Associate Society of the American College of Surgeons Global Surgery Work Group (GSWG) regarding professional, practical, and ethical guidelines for participation in global surgery endeavors. STUDY DESIGN A task force was created within the GSWG to review and define the scope of involvement of trainees in global surgery, and a consensus process was undertaken for the group at large to approve a set of proposed guidelines. RESULTS The list of practical and ethical guidelines for the engagement of trainees in global surgery covering the themes of preparedness, reciprocity and collaboration, ethical considerations, and sustainability was approved with consensus from the GSWG. CONCLUSIONS This consensus statement from the Resident and Associate Society of the American College of Surgeons GSWG outlines the official recommendations for guidelines for involvement of trainees in global surgery, with an aim to support equitable, sustainable collaborations that center on improving access to safe, timely, and affordable surgical care for the global community at large. Future processes seek to involve representation and perspectives from a larger body of low- to middle-income country surgical trainees.
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Affiliation(s)
- Erin M Scott
- From the Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA (Scott)
| | - Zachary O Enumah
- From the Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA (Scott)
| | - Kajal Mehta
- From the Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA (Scott)
| | - Nelly-Ange Kontchou
- From the Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA (Scott)
| | - Rachel W Davis
- From the Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA (Scott)
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Miller P, Laverde R, Thompson A, Park P, Ozgediz D, Boeck MA. COVID-19, Racial Injustice, and Medical Student Engagement With Global Health: A Single-Institution Survey. J Surg Res 2023; 283:833-838. [PMID: 36915010 PMCID: PMC9663756 DOI: 10.1016/j.jss.2022.11.020] [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: 03/09/2022] [Revised: 11/02/2022] [Accepted: 11/06/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION United States medical schools continue to respond to student interest in global health (GH) and the evolution of the field through strengthening related curricula. The COVID-19 pandemic and superimposed racial justice movements exposed chasms in the US healthcare system. We sought to explore the possible relationship between the pandemic, US racial justice movements, and medical student interest in GH to inform future academic offerings that best meet student needs. METHODS A novel, mixed-methods 30-question Qualtrics survey was disseminated twice (May-August 2021) through email and social media to all current students. Data underwent descriptive and thematic analysis. RESULTS Twenty students who self-identified as interested in GH responded to the survey. Most (N = 13, 65%) were in preclinical training, and half were women (N = 10, 50%). Five (25%) selected GH definitions with paternalistic undertones, 11 (55%) defined GH as noncontingent on geography, and 12 (60%) said the pandemic and US racial justice movement altered their definitions to include themes of equity and racial justice. Eighteen (90%) became interested in GH before medical school through primarily volunteering (N = 8, 40%). Twelve (60%) students plan to incorporate GH into their careers. CONCLUSIONS Our survey showed most respondents entered medical school with GH interest. Nearly all endorsed a changed perspective since enrollment, with a paradigm shift toward equity and racial justice. Shifts were potentially accelerated by the global pandemic, which uncovered disparities at home and abroad. These results highlight the importance of faculty and curricula that address global needs and how this might critically impact medical students.
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Affiliation(s)
- Phoebe Miller
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Ruth Laverde
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Avery Thompson
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Paul Park
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Doruk Ozgediz
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Marissa A Boeck
- Department of Surgery, University of California, San Francisco, San Francisco, California.
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Bhatia MB, Darkwa L, Simon C, Li HW, Allison H, Joplin TS, Meade ZS, Keung C, McDow AD. Uncovering the Overlap of Global and Domestic Rural Surgery for Medical Trainees. J Surg Res 2022; 279:442-452. [PMID: 35841813 PMCID: PMC9404475 DOI: 10.1016/j.jss.2022.06.041] [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: 03/01/2022] [Revised: 06/01/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022]
Abstract
Introduction Medical trainees who participate in global rotations demonstrate improved cultural sensitivity, increased involvement in humanitarian efforts, and ability to adapt to limited resources. The global coronavirus pandemic halted global rotations for medical trainees. Domestic rural surgery (DRS) may offer a unique alternative. We aimed to understand medical students’ perceptions of the similarities and differences between global surgery and DRS and how students’ priorities impact career choices. Methods An electronic survey was administered at eleven medical training institutions in Indiana, Illinois, and Michigan in spring 2021. Mixed methods analysis was performed for students who reported an interest in global surgery. Quantitative analysis was completed using Stata 16.1. Results Of the 697 medical student respondents, 202 were interested in global surgery. Of those, only 18.3% were also interested in DRS. Students interested in DRS had more rural exposures. Rural exposures associated with DRS interest were pre-clinical courses (P = 0.002), clinical rotations (P = 0.045), and rural health interest groups (P < 0.001). Students interested in DRS and those unsure were less likely to prioritize careers involving teaching or research, program prestige, perceived career advancement, and well-equipped facilities. The students who were unsure were willing to utilize DRS exposures. Conclusions Students interested in global surgery express a desire to practice in low-resource settings. Increased DRS exposures may help students to understand the overlap between global surgery and DRS when it comes to working with limited resources, achieving work-life balance and practice location.
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Affiliation(s)
- Manisha B Bhatia
- Indiana University, Department of Surgery, Indianapolis, Indiana.
| | - Louis Darkwa
- University of Illinois Chicago, School of Medicine, Chicago, Illinois
| | - Chad Simon
- University of Illinois Chicago, School of Medicine, Chicago, Illinois
| | - Helen W Li
- Washington University School of Medicine in St. Louis, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Hannah Allison
- Indiana University, Department of Surgery, Indianapolis, Indiana
| | | | | | - Connie Keung
- Indiana University, Department of Surgery, Indianapolis, Indiana
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PASCULLI A, REGA D, DEPAOLI F, MAZZARI A, MENICONI RL, GUAITOLI E. Experiences of Italian surgical residents in low-income countries: an analysis from the Italian Polyspecialistic Society of Young Surgeons (SPIGC). Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.21.05281-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bale AG, Sifri ZC. Does Global Surgery Interest Influence the Choice of Surgical Residency Program? JOURNAL OF SURGICAL EDUCATION 2021; 78:e137-e144. [PMID: 34548262 DOI: 10.1016/j.jsurg.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/05/2021] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Medical students actively seek global health opportunities. Surgical residents also show great enthusiasm for international missions, rotations and global surgery. Unfortunately, only 18% to 34% of all surgery residency programs offer such international opportunities. We surveyed fourth year medical students applying for surgery residency to determine if international surgery opportunities offered by a program would influence their match rank list. DESIGN A 20 question survey was given to interviewees at our surgery residency program. Survey was optional and anonymous. We queried prior volunteerism, interest in global surgery and importance of international opportunities offered during residency. SETTING Hackensack University Medical Center, Hackensack New Jersey PARTICIPANTS: All candidates interviewing for general surgery residency at Hackensack University Medical Center from October 2019 to January 2020. RESULTS A total of 97 fourth year medical students interviewed, with a 66% response rate to the survey. Mean age was 27 years. 92% of students had volunteered during college and/or medical school. 41% of students had volunteered internationally. Majority of students were interested in a surgery residency program offering international opportunity. 78% of students planned to volunteer internationally after residency, and two-thirds planned to include global surgery in future career. Half of the students reported they would rank a residency program higher if it offered an international opportunity. Students who were immigrants were significantly more likely to rank a program higher in the match if an international opportunity was offered, compared to students born in the US (p < 0.05). CONCLUSIONS There is great interest in global surgery and international volunteer opportunities amongst fourth year medical students who apply for surgery residency. The majority of applicants have prior volunteer experience either locally or abroad. Majority of students plan to volunteer internationally after residency and are interested in academic global surgery careers. Students will rank surgery residency programs that offer international opportunities higher in the match.
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Affiliation(s)
- Asha G Bale
- Department of Surgery, Hackensack University Medical Center, Hackensack, New Jersey.
| | - Ziad C Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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Lundy P, Miller C, Woodrow S. Current US neurosurgical resident involvement, interest, and barriers in global neurosurgery. Neurosurg Focus 2021; 48:E16. [PMID: 32114552 DOI: 10.3171/2019.12.focus19808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE It is estimated that nearly 47 million preventable deaths occur annually due the current worldwide deficit in surgical care; subsequently, the World Health Organization resolved unanimously to endorse a decree to address this deficit. Neurosurgeons from industrialized nations can help address the needs of underserved regions. Exposure during training is critical for young neurosurgeons to gain experience in international work and to cultivate career-long interest. Here, the authors explore the opinions of current residents and interest in global neurosurgery as well as the current state of international involvement, opportunities, and barriers in North American residency training. METHODS An internet-based questionnaire was developed using the authors' university's REDCap database and distributed to neurosurgical residents from US ACGME (Accreditation Council for Graduate Medical Education)-approved programs. Questions focused on the resident's program's involvement and logistics regarding international rotations and the resident's interest level in pursuing these opportunities. RESULTS A 15% response rate was obtained from a broad range of training locations. Twenty-nine percent of respondents reported that their residency program offered elective training opportunities in developing countries, and 7.6% reported having participated in these programs. This cohort unanimously felt that the international rotation was a beneficial experience and agreed that they would do it again. Of those who had not participated, 81.3% reported interest or strong interest in international rotations. CONCLUSIONS The authors' results indicate that, despite a high level of desire for involvement in international rotations, there is limited opportunity for residents to become involved. Barriers such as funding and rotation approval were recognized. It is the authors' hope that governing organizations and residency programs will work to break down these barriers and help establish rotations for trainees to learn abroad and begin to join the cause of meeting global surgical needs. To meet overarching international neurosurgical needs, neurosurgeons of the future must be trained in global neurosurgery.
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Riccardi J, Padmanaban V, Padberg FT, Shapiro ME, Sifri ZC. A Pilot Study of Surgical Trainee Participation in Humanitarian Surgeries. J Surg Res 2021; 262:175-180. [PMID: 33588294 DOI: 10.1016/j.jss.2020.11.055] [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: 06/29/2020] [Revised: 10/03/2020] [Accepted: 11/01/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The impact of general surgery resident participation on operative case time and postoperative complications has been broadly studied in the United States. Although surgical trainee involvement in international humanitarian surgical care is escalating, there is limited information as to how this participation affects care rendered. This study examines the impact of trainee involvement on case length and immediate postoperative complications with regard to operations in low- and middle-income settings. METHODS A retrospective chart review was conducted of humanitarian surgeries completed during annual short-term surgical missions performed by the International Surgical Health Initiative to Ghana and Peru. Between 2017 and 2019, procedures included inguinal hernia repairs and total abdominal hysterectomies (TAHs). Operative records were reviewed for case type, duration, and immediate postoperative complications. Cases were categorized as involving two attending co-surgeons (AA) or one attending and resident assistant (RA). RESULTS There were 135 operative cases between 2017 and 2019; the majority (82%) involved a resident assistant. There were no statistically significant differences in case times between the attending assistant (AA) and resident assistant (RA) cohorts in both case types. All 23 postoperative complications were classified as Clavien-Dindo Grade I. In addition, resident assistance did not lead to a statistically significant increase in complication rate; 26% in the AA cohort versus 74% in the RA cohort (P = 0.3). CONCLUSIONS This pilot study examining 135 operative cases over 2 y of humanitarian surgeries demonstrates that there were no differences in operative duration or complication rates between the AA and RA cohorts. We propose that surgical trainee involvement in low- and middle-income settings do not adversely impact operative case times or postoperative complications.
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Affiliation(s)
- Julia Riccardi
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Vennila Padmanaban
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
| | - Frank T Padberg
- Division of Vascular Surgery, Rutgers New Jersey Medical School, VA New Jersey Healthcare System, East Orange, New Jersey
| | - Michael E Shapiro
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ziad C Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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Sherif YA, Hassan MA, Thuy Vu M, Rosengart TK, Davis RW. Twelve Tips on enhancing global health education in graduate medical training programs. MEDICAL TEACHER 2021; 43:142-147. [PMID: 32393144 DOI: 10.1080/0142159x.2020.1762033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Investment in healthcare infrastructure in resource-limited settings is a vital and cost-effective approach for diminishing world-wide disease burden, increasing quality of life, and lengthening life expectancy. Graduate medical trainees enthusiastically express interest in supporting global health efforts that expand healthcare access and capacity in resource-limited settings. Academic institutions are responding by developing training programs to equip graduate medical trainees with the technical, interpersonal, scholastic, and ethical skillsets necessary for the pursuit of global health efforts. Drawn from real-world experience and current literature, the following twelve tips will strengthen a global health curriculum in graduate medical training programs with dedicated global health education.
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Affiliation(s)
- Youmna A Sherif
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Monalisa A Hassan
- Wake Forest School of Medicine, Wake Forest University, Winston Salem, NC, USA
| | - Megan Thuy Vu
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Todd K Rosengart
- Professor and Chairman at Baylor College of Medicine, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Rachel W Davis
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Gralow JR, Asirwa FC, Bhatt AS, Bourlon MT, Chu Q, Eniu AE, Loehrer PJ, Lopes G, Shulman LN, Close J, Von Roenn J, Tibbits M, Pyle D. Recommendations from the ASCO Academic Global Oncology Task Force. JCO Glob Oncol 2020; 6:1666-1673. [PMID: 33151772 PMCID: PMC7713550 DOI: 10.1200/go.20.00497] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In recognition of the rising incidence and mortality of cancer in low- and middle-resource settings, as well as the increasingly international profile of its membership, ASCO has prioritized efforts to enhance its engagement at a global level. Among the recommendations included in the 2016 Global Oncology Leadership Task Force report to the ASCO Board of Directors was that ASCO should promote the recognition of global oncology as an academic field. The report suggested that ASCO could serve a role in transitioning global oncology from an informal field of largely voluntary activities to a more formal discipline with strong research and well-defined training components. As a result of this recommendation, in 2017, ASCO formed the Academic Global Oncology Task Force (AGOTF) to guide ASCO’s contributions toward formalizing the field of global oncology. The AGOTF was asked to collect and analyze key issues and barriers toward the recognition of global oncology as an academic discipline, with an emphasis on training, research, and career pathways, and produce a set of recommendations for ASCO action. The outcome of the AGOTF was the development of recommendations designed to advance the status of global oncology as an academic discipline.
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Affiliation(s)
- Julie R Gralow
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | - Maria T Bourlon
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Quyen Chu
- Louisiana State University Health Sciences Center, Shreveport, LA
| | | | | | | | | | | | | | | | - Doug Pyle
- American Society of Clinical Oncology, Alexandria, VA
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Wilkinson KH, Bowder AN, Goldblatt MI, Olson L, Dodgion CM. General Surgery Applicants are Interested in Global Surgery, but Does It Affect Their Rank List? J Surg Res 2020; 257:449-454. [PMID: 32892144 DOI: 10.1016/j.jss.2020.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 07/21/2020] [Accepted: 08/02/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The interest of medical students and surgery residents in global surgery continues to grow. Few studies have examined how the presence of global surgery opportunities influences an applicant's decision to choose a surgical training program. We designed a survey to examine the interest in global surgery among general surgery residency applicants and the influence of a global surgery rotation on a general surgery residency applicant's rank list. METHODS In March 2019, an online 20-question qualitative survey was administered to all general surgery applicants to a single academic institution. Results were stratified into two applicant groups; applicants from domestic or international medical schools. The survey was designed to capture demographic information, previous global rotations or experiences, future interest in global surgery opportunities, and the importance of global surgery in choosing a residency program. RESULT s: A total of 179 (21% response rate) applicants completed the entire survey. Of the respondents 81% were interested in a global surgery rotation during residency, 56% considered a global surgery opportunity as moderately to extremely important to their residency rankings, 71% said they would rank a residency higher if it had a funded global surgery program compared to one without funding and 58% of the surveyed applicants were interested in incorporating global surgery into their future career. CONCLUSIONS Global surgery opportunities are important to some general surgery residency applicants. A majority of applicants believe a funded global surgery would positively influence their rank list. As residency programs train residents for their future careers greater consideration needs to be given to developing global surgery opportunities.
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Affiliation(s)
| | - Alexis N Bowder
- Medical College of Wisconsin, General Surgery Deparment, Milwaukee, Wisconsin.
| | - Matthew I Goldblatt
- Medical College of Wisconsin, General Surgery Deparment, Milwaukee, Wisconsin
| | - Lisa Olson
- Medical College of Wisconsin, General Surgery Deparment, Milwaukee, Wisconsin
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Yibrehu B, Kancherla R, Azzie G. Global Surgery Opportunities in Canadian General Surgery Residencies: A Cross-Sectional Study. JOURNAL OF SURGICAL EDUCATION 2020; 77:1186-1193. [PMID: 32536576 DOI: 10.1016/j.jsurg.2020.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/05/2020] [Accepted: 03/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE In recent years, there has been an explosion of interest in global surgery (GS) among students, residents, and surgeons. However, little information regarding the landscape of GS in general surgery residencies exists. This study was therefore designed to explore the opportunities and the framework for global surgery in Canadian general surgery training programs. DESIGN The Program Director (PD) at each Canadian general surgery residency program was invited to complete an online survey. RESULTS All 17 PDs participated. Only 3 institutions have a formal curriculum in GS, while 9 have an Office of GS. Seven residencies mention GS on their department website. Ten of 17 residencies have had trainees participate in GS experiences in the last academic year. Funding or pre-experience training is available at less than half of all institutions. Only one residency ranked GS exposure as being "very important" to their program. Across all programs, the average ranking of GS experiences was 2.3 out of 5, which translates descriptively to being of "little importance". Despite this, 10 PDs identified GS as attractive to applicants, and 5 stated their plans to expand GS opportunities at their institution. CONCLUSIONS This is the first study to look at the GS landscape in general surgery residencies across Canada. These results may inform graduating medical students and residents about the current status of GS in Canadian residencies. This study may also assist other residencies in the development and tailoring of GS programs.
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Affiliation(s)
- Betel Yibrehu
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
| | | | - Georges Azzie
- Hospital for Sick Children, Toronto, Ontario, Canada
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Kauffmann RM, Neuzil K, Koch R, Terhune KP. Global Surgery Electives: A Strategy to Improve Care to Domestic Underserved Populations? J Surg Res 2020; 255:247-254. [PMID: 32570127 DOI: 10.1016/j.jss.2020.05.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/17/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In the United States, a shortage of general surgeons exists, primarily in rural, poor, and minority communities. Identification of strategies that increase resident interest in underserved regions provides valuable information in understanding and addressing this shortage. In particular, surgical experience abroad exposes residents to practice in low-resource and rural settings. As residency programs increasingly offer global surgery electives, we explore whether the presence of an international surgical rotation affects graduates' future practice patterns in underserved communities domestically. METHODS We surveyed general surgery residency graduates at a single academic institution. Those who finished general surgery residency from 2001 to 2018 were included. Participant demographics, current practice demographics, and perceptions related to global surgery and underserved populations were collected. Respondents were stratified based on whether they did ("after") or did not ("before") have the opportunity to participate in the Kijabe rotation (started in 2011), defined by graduation year. RESULTS Out of 119 eligible program graduates, 64 (53.7%) completed the survey, and 33 (51.6%) of the respondents graduated following the implementation of the Kijabe rotation. Two participants defined their primary current practice location as international. Fifteen (45.5%) in the "After" group indicated an interest in working with underserved populations following residency, compared to 5 (17.8%) of the "Before" group (P = 0.074). Furthermore, 20 (60.6%) respondents in the "After" group expressed interest in working with underserved populations even if it meant making less money. In the "Before" group, only 13 (46.4%) responded similarly (P = 0.268). Eleven (9.2%) residents rotated at Kijabe. Those who participated in the Kijabe rotation reported an uninsured rate of 36.7% for their current patient population, compared to rate of 13.9% in those who did not rotate there (P = 0.22). CONCLUSIONS At a single institution, our results suggest that participation in an international surgical rotation in a resource-constrained setting may be associated with increased care for underserved populations in future clinical practice. These results could be due to self-selection of residents who prioritize global surgery as part of their residency experience, or due to increased exposure to underserved patients through global surgery.
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Affiliation(s)
- Rondi M Kauffmann
- Vanderbilt University Medical Center, Division of Surgical Oncology and Endocrine Surgery, Nashville, Tennessee.
| | - Kevin Neuzil
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Rachel Koch
- Vanderbilt University Medical Center, Division of General Surgery, Nashville, Tennessee
| | - Kyla P Terhune
- Vanderbilt University Medical Center, Division of General Surgery, Nashville, Tennessee
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Morris MC, Baker JE, Edwards MJ. Surgeons, Scholars, and Leaders Symposium: A 5-Year Experience. Am Surg 2020. [DOI: 10.1177/000313481908501224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Department of Surgery at the University of Cincinnati developed the Surgeons, Scholars, and Leaders Symposium to address the underappreciated aspects of surgical education that are critical in the development of the academic surgeon. Surgical education has undergone many gaps since the beginning of a traditional surgical residency, first pioneered by Dr. Halsted in 1904; still, many gaps in surgical education remain. Topics such as research, financial planning, leadership, career development, and many others are not adequately addressed in formalized training. The Surgeons, Scholars, and Leaders Symposium was first held in January 2015 in Jackson Hole, WY, and has subsequently become an annual event. Recurrent themes addressed at the Symposium include global health, resident autonomy, research program development, leadership, mentorship, career development, and managing transitions. The annual Surgeons, Scholars, and Leaders Symposium has been instrumental in addressing these underappreciated aspects of surgeon development and will continue to be an important venue for the next generation of surgical leaders.
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Affiliation(s)
- Mackenzie C. Morris
- Department of Surgery, Section of General Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Jennifer E. Baker
- Department of Surgery, Section of General Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Michael J. Edwards
- Department of Surgery, Section of General Surgery, University of Cincinnati, Cincinnati, Ohio
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Glynn EH, Guarner J, Hall A, Nelson AM, Andiric LR, Milner DA, Eichbaum Q. Survey of Global Health Education and Training in Pathology Residency Programs in the United States. Am J Clin Pathol 2020; 153:374-379. [PMID: 31755908 DOI: 10.1093/ajcp/aqz178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study assessed the prevalence, general interest, and barriers to implementing global health curricula in pathology residency programs. METHODS We conducted a survey of 166 US pathology residency programs. RESULTS Thirty-two (195) of 166 programs responded. Of these, 13% have a formalized global health program (n = 4), and the majority indicated at least some general interest in global health among trainees (88%, n = 28) and faculty (94%, n = 30), albeit at a low to moderate level. Funding limitations, regulatory constraints, and insufficient knowledge of global health were frequently cited barriers to developing a global health program. CONCLUSIONS Few US pathology departments incorporate global health education into postgraduate training. The importance of pathology in global health has been underappreciated, despite its critical role in the delivery of health care in resource-limited settings. One solution is for pathology departments to expand global health educational opportunities for trainees.
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Affiliation(s)
- Emily H Glynn
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Allison Hall
- Department of Pathology, Duke University Medical Center, Durham, NC
| | | | | | - Dan A Milner
- American Society for Clinical Pathology, Chicago, IL
| | - Quentin Eichbaum
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
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Morgan J, Galvin S, Goldstein J, Fant C, Murphy R, Doobay-Persaud A. From Creation to Evaluation: A Comprehensive Global Health Scholars Program for Graduate Medical Education Trainees. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520951821. [PMID: 32913894 PMCID: PMC7444107 DOI: 10.1177/2382120520951821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/31/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Recently, participation in clinical global health rotations has significantly increased among graduate medical education (GME) trainees. Despite the many benefits these experiences provide, many ethical challenges exist. Well-intentioned partnerships and participants often encounter personal and professional dilemmas related to safety, social responsibility, and accountability. We designed a curriculum to provide trainees of all specialties with a comprehensive educational program aimed at delivering culturally mindful and ethically responsible clinical care in resource-constrained settings. METHODS The McGaw Global Health Clinical Scholars Program (GHCS) at Northwestern University offers a 2-year curriculum for selected GME trainees across specialties interested in global health. Each trainee must complete the following components: core lectures, peer journal club, specialty-specific lectures, a mentorship agreement, ethics and skill-based simulations, a global health field experience, a poster presentation, and a mentored scholarly project. RESULTS Since 2014, 84 trainees from 13 specialties have participated in the program with 50 current trainees and 39 graduates. Twenty-five trainees completed exit surveys, of which 95% would recommend this program to other trainees and 84% felt more prepared to deliver global health care. In addition, 78% reported career plans that included global health and/or work with underserved populations. Trainees described "acceptance of differences and respect for those differences" and "understanding sustainability" as learning points from the program. DISCUSSION Providing a comprehensive global health education program across specialties can be feasible and effective. GME trainees who participated in this program report feeling both more prepared for clinical experiences and more likely to serve the underserved anywhere.
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Affiliation(s)
- Jennifer Morgan
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Shannon Galvin
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL; Center for Global Health Education, Northwestern University Institute for Global Health, Chicago, IL, USA
| | - Joshua Goldstein
- Graduate Medical Education, McGaw Medical Center of Northwestern University, Chicago, IL, USA
| | - Colleen Fant
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Pediatric Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Robert Murphy
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern University Institute for Global Health, Chicago, IL, USA
| | - Ashti Doobay-Persaud
- Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Center for Global Health Education, Northwestern University Institute for Global Health, Chicago, IL, USA
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Bath M, Bashford T, Fitzgerald JE. What is 'global surgery'? Defining the multidisciplinary interface between surgery, anaesthesia and public health. BMJ Glob Health 2019; 4:e001808. [PMID: 31749997 PMCID: PMC6830053 DOI: 10.1136/bmjgh-2019-001808] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/20/2019] [Accepted: 09/28/2019] [Indexed: 12/11/2022] Open
Abstract
'Global surgery' is the term adopted to describe a rapidly developing multidisciplinary field aiming to provide improved and equitable surgical care across international health systems. Sitting at the interface between numerous clinical and non-clinical specialisms, it encompasses multiple aspects that surround the treatment of surgical disease and its equitable provision across health systems globally. From defining the role of, and need for, optimal surgical care through to identifying barriers and implementing improvement, global surgery has an expansive remit. Advocacy, education, research and clinical components can all involve surgeons, anaesthetists, nurses and allied healthcare professionals working together with non-clinicians, including policy makers, epidemiologists and economists. Long neglected as a topic within the global and public health arenas, an increasing awareness of the extreme disparities internationally has driven greater engagement. Not necessarily restricted to specific diseases, populations or geographical regions, these disparities have led to a particular focus on surgical care in low-income and middle-income countries with the greatest burden and needs. This review considers the major factors defining the interface between surgery, anaesthesia and public health in these settings.
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Affiliation(s)
- Michael Bath
- Centre for Neuroscience, Surgery, and Trauma, Queen Mary University of London, London, UK
| | - Tom Bashford
- NIHR Global Health Research Group on Neurotrauma, Division of Anaesthesia, University of Cambridge, Cambridge, UK
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Pirrocco F, Goodman I, Pitt MB. Leveraging Peer Teaching for Global Health Elective Preparation: Implementation of a Resident-Led Global Health Simulation Curriculum. Glob Pediatr Health 2019; 6:2333794X19851108. [PMID: 31205986 PMCID: PMC6537236 DOI: 10.1177/2333794x19851108] [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: 01/09/2019] [Revised: 04/08/2019] [Accepted: 04/22/2019] [Indexed: 12/05/2022] Open
Abstract
Introduction. As more trainees engage in global health
electives, the call for best practices in predeparture preparation grows.
However, many residency programs may not have the infrastructure or staffing in
place to consistently meet these expectations. Objective. To
assess the feasibility, benefits, and limitations of having residents trained to
facilitate and implement a global health preparatory simulation curriculum.
Approach. In 2016, we had 5 residents undergo online
Simulation Use for Global Away Rotations (SUGAR) facilitator training. Since
then, we have conducted 3 simulation sessions from 2016 to 2018. Feedback was
obtained from 75% of our participants, which was found to be similar to feedback
obtained from attending-led models. Lessons Learned. A
resident-led global health preparatory curriculum provides a sustainable model
for residency programs without placing additional burden on attending
faculty.
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Affiliation(s)
- Fiona Pirrocco
- Tsehootsooi Medical Center, Department of Pediatrics, Fort Defiance, AZ
| | - Ian Goodman
- University of Massachusetts Medical School-Baystate Medical Center, Department of Emergency Medicine, Springfield, MA
| | - Michael B Pitt
- University of Minnesota, Department of Pediatrics, Minneapolis, MN
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A Review of Gynecologic Oncology in the Global Setting: Educating and Training the Next Generation of Women's Health Providers. Obstet Gynecol Surv 2019; 74:40-49. [PMID: 30648726 DOI: 10.1097/ogx.0000000000000630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Importance Women in low- and middle-income countries (LMICs) are responsible for the stability of their families. Child survival is directly linked to the health and well-being of their mother. Cancer is the leading cause of morbidity and mortality worldwide, and the incidence and mortality for women from cancer are projected to increase over the coming decades. Gynecologic cancer outcomes are improved when women are cared for by a gynecologic oncologist; however, there are limited specialized providers in LMICs. Increasing interest and involvement from specialists in the United States will improve partnerships abroad and the care of women worldwide. Objective To summarize the importance of global gynecologic oncology care and the current data for US trainees in obstetrics and gynecology to participate in clinical and capacity-building opportunities. Evidence Acquisition We performed a PubMed literature search for articles pertaining to the topic of global health education in obstetrics and gynecology and gynecologic oncology specifically. Results Many obstetric and gynecologic residency programs offer international opportunities, but these are less than those in other specialties and are more frequently focused in obstetrics. Many gynecologic oncology fellowship programs offer international experiences for fellows; however, the time and resources required are limited. Several US and international programs are ongoing to improve capacity building for gynecologic oncology in LMICs with local trainees. Conclusions and Relevance Training and care in gynecologic oncology care worldwide are improving through efforts at multiple levels. Continued efforts are needed to improve US trainee international education and experience.
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Oar A, Yap M, Rodin D, McNiven A, Papadakos J, Giuliani M. Postgraduate Global Health Competency Profile for Radiation Oncology. Clin Oncol (R Coll Radiol) 2018; 30:810-816. [DOI: 10.1016/j.clon.2018.08.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/22/2018] [Accepted: 07/25/2018] [Indexed: 12/19/2022]
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Johnston PF, Scholer A, Bailey JA, Peck GL, Aziz S, Sifri ZC. Exploring residents' interest and career aspirations in global surgery. J Surg Res 2018; 228:112-117. [DOI: 10.1016/j.jss.2018.02.056] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/07/2018] [Accepted: 02/27/2018] [Indexed: 01/08/2023]
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Ozgediz D. Global experiences in fellowship training: A valuable opportunity to match competencies with contemporary priorities and needs. J Pediatr Surg 2018; 53:1254-1255. [PMID: 29605265 DOI: 10.1016/j.jpedsurg.2018.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/04/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Doruk Ozgediz
- Yale University, Department of Surgery, Section of Pediatric Surgery, 333 Cedar St., New Haven, CT 06520.
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Abstract
STATEMENT Providers and educators increasingly participate in global health work during their careers. Simulation can play an important role in both preparing learners for work in resource-limited settings and training providers in these countries. However, little guidance exists for educators interested in creating and implementing scenarios for these settings. We discuss several key considerations unique to global health simulation ranging from addressing common cultural differences surrounding healthcare and varied regional approaches to disease identification and management to understanding precisely what resources exist in the setting and what strategies can be used to provide care when the expected resources are not available. We also discuss specific strategies for considering sustainability and for facilitating scenarios in these settings. We developed our recommendations on the basis of existing literature and our own work designing and implementing simulation curricula in resource-limited countries and preparing providers for work in these settings.
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Incorporation of a Global Surgery Rotation into an Academic General Surgery Residency Program: Impact and Perceptions. World J Surg 2018. [DOI: 10.1007/s00268-018-4562-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Patel P, Satterfield C, Walcher C, Goodman M, Dacso M. Faculty interest and barriers to participation in global health education. COGENT MEDICINE 2018. [DOI: 10.1080/2331205x.2018.1466403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Premal Patel
- Division of General Medicine, Department of Medicine, Center for Global Health Education, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, USA
| | - Caley Satterfield
- Center for Global Health Education, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, USA
| | - Christen Walcher
- Center to Eliminate Health Disparities, and Center for Global Health Education, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, USA
| | - Michael Goodman
- Center for Tropical Diseases, Department of Internal Medicine, Center to Eliminate Health Disparities, Health Policy and Legislative Affairs, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, USA
| | - Mathew Dacso
- Division of General Medicine, Department of Medicine, Center for Global Health Education, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, USA
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Krishnaswami S, Stephens CQ, Yang GP, Nwomeh BC, Swaroop M, Nadler EP, Holterman AX, Simeone DM, Kingham TP, Merchant N, Orloff SL. An academic career in global surgery: a position paper from the Society of University Surgeons Committee on Academic Global Surgery. Surgery 2017; 163:954-960. [PMID: 29254606 DOI: 10.1016/j.surg.2017.10.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/02/2017] [Accepted: 10/14/2017] [Indexed: 02/07/2023]
Abstract
In recent years, as the high burden of surgical disease and poor access to surgical care in low- and middle-income countries have gained recognition as major public health problems, interest in global health has surged among surgical trainees and faculty. Traditionally, clinical volunteerism was at the forefront of the high-income country response to the significant burden of surgical disease in low- and middle-income countries. However, sustainable strategies for providing surgical care in low- and middle-income countries increasingly depend on bilateral clinical, research, and education collaborations to ensure effective resource allocation and contextual relevance. Academic global surgery creates avenues for interested surgeons to combine scholarship and education with their clinical global surgery passions through incorporation of basic/translational, education, clinical outcomes, or health services research with global surgery. Training in global health, either within residency or through advanced degrees, can provide the necessary skills to develop and sustain such initiatives. We further propose that creating cross-continental, bidirectional collaborations can maximize funding opportunities. Academic institutions are uniquely positioned to lead longitudinal and, importantly, sustainable global surgery efforts. However, for the individual global surgeon, the career path forward may be unclear. This paper reviews the development of academic global surgery, delineates the framework and factors critical to training global surgeons, and proposes models for establishing an academic career in this field. Overall, with determination, the academic global surgeon will not only carve out a niche of expertise but will define this critical field for future generations.
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Affiliation(s)
- Sanjay Krishnaswami
- Department of Surgery, Division of Pediatric Surgery, Oregon Health & Science University, Portland, OR, USA.
| | - Caroline Q Stephens
- Department of Surgery, Division of Pediatric Surgery, Oregon Health & Science University, Portland, OR, USA
| | - George P Yang
- Department of Surgery, Stanford University, Stanford, CA, USA; Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Benedict C Nwomeh
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Mamta Swaroop
- Division of Trauma & Critical Care, Department of Surgery, Northwestern University, Chicago, IL, USA
| | - Evan P Nadler
- Department of Surgery, Division of Pediatric Surgery, Children's National Medical Center, Washington, DC, WA, USA
| | - Ai-Xuan Holterman
- Department of Surgery/Pediatric Surgery, Children's Hospital of Illinois, University of Illinois College of Medicine at Peoria, IL, USA
| | - Diane M Simeone
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nipun Merchant
- Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, FL, USA
| | - Susan L Orloff
- Department of Surgery, Division of Abdominal Organ Transplantation/Hepatobiliary Surgery, Oregon Health & Science University, Portland, OR, USA
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Mehta A, Xu T, Murray M, Casey KM. Medical Student Perceptions of Global Surgery at an Academic Institution: Identifying Gaps in Global Health Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1749-1756. [PMID: 28767491 DOI: 10.1097/acm.0000000000001832] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Robust global health demands access to safe, affordable, timely surgical care for all. The long-term success of global surgery requires medical students to understand and engage with this emerging field. The authors characterized medical students' perceptions of surgical care relative to other fields within global health. METHOD An optional, anonymous survey was given to all Johns Hopkins medical students from February to March 2016 to assess perceptions of surgical care and its role in global health. RESULTS Of 480 students, 365 (76%) completed the survey, with 150 (41%) reporting global health interests. One-third (34%) of responding students felt that surgical care is one of two fields with the greatest potential global health impact in the future, second to infectious disease (49%). A minority (28%) correctly identified that trauma results in more deaths worldwide than obstetric complications or HIV/AIDS, tuberculosis, and malaria combined. Relative to other examined fields, students perceived surgical care as the least preventive and cost-effective, and few students (3%) considered adequate surgical care the best indicator of a robust health care system. Students believed that practicing in a surgical field was least amenable to pursuing a global health career, citing several barriers. CONCLUSIONS Medical students have several perceptions of global surgery that contradict current evidence and literature, which may have implications for their career choices. Opportunities to improve students' global health knowledge and awareness of global surgery career paths include updating curricula, fostering meaningful international academic opportunities, and creating centers of global surgery and global health consortia.
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Affiliation(s)
- Ambar Mehta
- A. Mehta is a fourth-year medical student, Johns Hopkins School of Medicine, Baltimore, Maryland. T. Xu is a recent graduate, Johns Hopkins School of Medicine, Baltimore, Maryland. M. Murray is a fourth-year medical student, Johns Hopkins School of Medicine, Baltimore, Maryland. K.M. Casey is president-elect, Alliance for Surgery and Anesthesia Presence, Newport, Rhode Island
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Kaur G, Tabaie S, Brar J, Tangel V, Pryor KO. Global health education in United States anesthesiology residency programs: a survey of resident opportunities and program director attitudes. BMC MEDICAL EDUCATION 2017; 17:215. [PMID: 29145835 PMCID: PMC5689206 DOI: 10.1186/s12909-017-1056-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/02/2017] [Indexed: 05/07/2023]
Abstract
BACKGROUND Interest in global health during postgraduate residency training is increasing across medical specialties, and multiple disciplines have categorized global health training opportunities in their arena. No such cataloging exists for anesthesiology residency programs. The aim of this study was to assess and characterize global health opportunities and the attitudes of program directors (PDs) in U.S. anesthesiology residency programs towards this training. METHODS A cross-sectional 20-question survey on global health opportunities was distributed to 128 ACGME accredited anesthesiology residency program directors via email between October 2015 and January 2016. Descriptive statistics and exploratory inferential analyses were applied. Maximal nonresponse selection bias was estimated. RESULTS The overall response rate was 44%. Of those who responded, 61% reported that their residency program had a global health elective, with a maximal bias estimate of 6.5%. 45% of program directors with no global health elective reported wanting to offer one. 77% of electives have articulated educational goals, but there is substantial heterogeneity in curricula offered. Program director attitudes regarding the value of global health programs differed significantly between those with and without existing programs. CONCLUSIONS The proportion of U.S. anesthesiology residency programs offering global health electives is similar to that in other medical specialties. There is inconsistency in program structure, goals, curriculum, and funding. Attitudes of program directors differ between programs with and without electives, which may reflect bidirectional influence to be investigated further. Further studies are needed to codify curricula, assess effectiveness, and validate methodologies.
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Affiliation(s)
- Gunisha Kaur
- 525 East 68th Street Box 124, New York, NY 10065 USA
| | - Sheida Tabaie
- 525 East 68th Street Box 124, New York, NY 10065 USA
| | - Jasmit Brar
- 525 East 68th Street Box 124, New York, NY 10065 USA
| | | | - Kane O. Pryor
- 525 East 68th Street Box 124, New York, NY 10065 USA
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Global Health Imaging in Radiology Residency: A Survey of Canadian Radiology Residents. Can Assoc Radiol J 2017; 68:348-356. [PMID: 28720414 DOI: 10.1016/j.carj.2017.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 01/30/2017] [Accepted: 02/06/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The study sought to determine Canadian radiology resident perception of and interest in global health imaging (GHI) and the barriers they encounter in pursuing GHI experiences during residency training. METHODS A peer-reviewed, online, anonymous, multiple-choice survey was distributed to Canadian radiology residents at English-language programs. RESULTS Fifty residents responded to the survey (∼16% response rate); 72% of respondents perceived an unmet need for medical imaging in the developing world. A majority of residents (60%) would have been likely to participate in a GHI experience if one had been available during their residency; 65% planned on pursuing international outreach work as future radiologists, 81% of whom with on-site collaboration in education and training of local staff. However, 82% of respondents were uncertain or believed they would not be adequately prepared to help improve access and availability of medical imaging services in developing countries upon completion of residency. Overall, residents believed a GHI program would increase their knowledge of infectious diseases, increase their exposure to diseases at advanced stage presentation, enhance their knowledge of basic imaging modalities, and improve their cultural competence. Lack of information about opportunities, lack of funding, and lack of infrastructure were ranked as the most important barriers to participating in a radiology rotation in a developing country during residency. CONCLUSION While many Canadian radiology residents are interested in participating in GHI, their preparation to do so may be inadequate. Formalizing international GHI rotations may alleviate barriers impeding their pursuit.
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Harfouche M, Krowsoski L, Goldberg A, Maher Z. Global surgical electives in residency: The impact on training and future practice. Am J Surg 2017; 215:200-203. [PMID: 28404204 DOI: 10.1016/j.amjsurg.2017.03.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 03/30/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate perceptions regarding the value of global surgical electives (GSEs) and pursuit of a career in global surgery amongst residents and surgeons. METHODS We sent an anonymous questionnaire to all current and former surgical residents of our tertiary-care, university-based institution from the years 2000-2013. Questions addressed the experience and value of practicing surgery in low or middle income countries (LMIC) in residency and as a career. RESULTS Twenty-three (40%) graduates (G) and 36 (84%) surgical residents (R) completed the survey. Thirteen residents (36%) and 13 (52%) graduates had delivered surgical care in a LMIC. Respondents stated that their experience positively impacted patient care (G = 80% vs R = 75%) and learning (G = 75% vs R = 90%). Of the 4 graduates still working in a LMIC, the majority (75%) were providing less than 2 months of care. Logistical reasons and family obligations were the most common barriers (n = 13). CONCLUSION Few graduates are able to incorporate global surgery into their practice despite interest. For enduring participation, logistical and family support is needed.
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Affiliation(s)
| | | | - Amy Goldberg
- Temple University Hospital, Philadelphia, PA, USA.
| | - Zoe Maher
- Temple University Hospital, Philadelphia, PA, USA.
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Hau DK, Smart LR, DiPace JI, Peck RN. Global health training among U.S. residency specialties: a systematic literature review. MEDICAL EDUCATION ONLINE 2017; 22:1270020. [PMID: 28178918 PMCID: PMC5328369 DOI: 10.1080/10872981.2016.1270020] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/23/2016] [Indexed: 05/29/2023]
Abstract
BACKGROUND Interest in global health training during residency is increasing. Global health knowledge is also becoming essential for health-care delivery today. Many U.S. residency programs have been incorporating global health training opportunities for their residents. We performed a systematic literature review to evaluate global health training opportunities and challenges among U.S. residency specialties. METHODS We searched PubMed from its earliest dates until October 2015. Articles included were survey results of U.S. program directors on global health training opportunities, and web-based searches of U.S. residency program websites on global health training opportunities. Data extracted included percentage of residency programs offering global health training within a specialty and challenges encountered. RESULTS Studies were found for twelve U.S. residency specialties. Of the survey based studies, the specialties with the highest percentage of their residency programs offering global health training were preventive medicine (83%), emergency medicine (74%), and surgery (71%); and the lowest were orthopaedic surgery (26%), obstetrics and gynecology (28%), and plastic surgery (41%). Of the web-based studies, the specialties with the highest percentage of their residency programs offering global health training were emergency medicine (41%), pediatrics (33%), and family medicine (22%); and the lowest were psychiatry (9%), obstetrics and gynecology (17%), and surgery (18%). The most common challenges were lack of funding, lack of international partnerships, lack of supervision, and scheduling. CONCLUSION Among U.S. residency specialties, there are wide disparities for global health training. In general, there are few opportunities in psychiatry and surgical residency specialties, and greater opportunities among medical residency specialties. Further emphasis should be made to scale-up opportunities for psychiatry and surgical residency specialties.
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Affiliation(s)
- Duncan K. Hau
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Luke R. Smart
- Center for Global Health, Weill Cornell Medical College, New York, NY, USA
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Jennifer I. DiPace
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Robert N. Peck
- Center for Global Health, Weill Cornell Medical College, New York, NY, USA
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
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Global Health Education in Gastroenterology Fellowship: A National Survey. Dig Dis Sci 2016; 61:3443-3450. [PMID: 27796765 DOI: 10.1007/s10620-016-4308-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 09/08/2016] [Indexed: 12/09/2022]
Abstract
BACKGROUND Interest in global health (GH) education is increasing across disciplines. AIMS To assess exposure to and perception of GH training among gastroenterology fellows and program directors across the USA. METHODS Design: Electronic survey study. SETTING The questionnaire was circulated to accredited US gastroenterology fellowship programs, with the assistance of the American Gastroenterological Association. PARTICIPANTS Gastroenterology program directors and fellows. RESULTS The questionnaire was returned by 127 respondents (47 program directors, 78 fellows) from 55 training programs (36 % of all training programs). 61 % of respondents had prior experience in GH. 17 % of programs offered GH curriculum with international elective (13 %), didactic (9 %), and research activity (7 %) being the most common. Fellows had adequate experience managing hepatitis B (93 %), cholangiocarcinoma (84 %), and intrahepatic duct stones (84 %). 74, 69 and 68 % reported having little to no experience managing hepatitis E, tuberculosis mesenteritis, or epidemic infectious enteritis, respectively. Most fellows would participate in an elective in an underserved area locally (81 %) or a 4-week elective abroad (71 %), if available. 44 % of fellows planned on working or volunteering abroad after fellowship. Barriers to establishing GH curriculum included funding (94 %), scheduling (88 %), and a lack of standardized objectives (78 %). Lack of interest, however, was not a concern. Fellows (49 %), more than faculty (29 %) (χ 2 = 21.9; p = 0.03), believed that GH education should be included in fellowship curriculum. CONCLUSIONS Program directors and trainees recognize the importance of GH education. However, only 17 % of ACGME-approved fellowship programs offer the opportunity. Global health curriculum may enhance gastroenterology training.
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Yao CA, Taro TB, Wipfli HL, Ly S, Gillenwater JT, Costa MA, Gutierrez RD, Magee W. The Tsao Fellowship in Global Health: A Model for International Fellowships in a Surgery Residency. J Craniofac Surg 2016; 27:282-5. [PMID: 26963297 DOI: 10.1097/scs.0000000000002495] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To present a model for integrated global health fellowships in plastic surgical residency training. BACKGROUND National surveys have found that North American surgical residents have significant interest in international training. While global health training opportunities exist, less than a third of these are housed within surgical residency programs; even fewer are designed specifically for plastic surgery residents. METHODS The Tsao Fellowship was created through a partnership between Operation Smile, Children's Hospital Los Angeles, Shriners Hospital for Children, and the University of Southern California. Designed for Accreditation Council for Graduate Medical Education accredited plastic surgery residents between their third and fourth years of residency, the fellowship curriculum is completed over 24 months and divided into 3 areas: clinical research, international reconstructive surgery fieldwork, and the completion of a Master of Science in Clinical and Biomedical Investigations. RESULTS The Tsao Fellowship has matriculated 4 fellows: 3 have graduated from the program and 1 is in the current cycle. Fellows completed 4 to 7 international missions each cycle and have performed an aggregate total of 684 surgical procedures. Each fellow also conducted 2 to 6 research projects and authored several publications. All fellows continue to assume leadership roles within the field of global reconstructive surgery. CONCLUSIONS Comprehensive global health fellowships provide invaluable opportunities beyond surgical residency. The Tsao Fellowship is a model for integrating international surgical training with global health research in plastic surgical residency that can be applied to other residency programs and different surgical specialties.
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Affiliation(s)
- Caroline A Yao
- *Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California †Department of Plastic and Reconstructive Surgery, Shriners Hospital for Children ‡Division of Plastic and Reconstructive Surgery, Children's Hospital Los Angeles §USC Institute of Global Health, Keck School of Medicine of the University of Southern California, Los Angeles, CA
- Division of Plastic Surgery, Indiana University, Indianapolis, IN ¶Keck School of Medicine of the University of Southern California, Los Angeles, CA
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Building a Sustainable Global Surgical Program in an Academic Department
of Surgery. Ann Glob Health 2016; 82:630-633. [DOI: 10.1016/j.aogh.2016.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Easter SR, Raglan GB, Little SE, Schulkin J, Robinson JN. Perspectives on global health amongst obstetrician gynecologists: A national survey. J Int Med Res 2016; 46:586-595. [PMID: 27565747 PMCID: PMC5971485 DOI: 10.1177/0300060516658378] [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] [Indexed: 11/15/2022] Open
Abstract
Objective To characterize contemporary attitudes toward global health amongst board-certified obstetricians-gynecologists (Ob-Gyns) in the US. Methods A questionnaire was mailed to members of the American College of Obstetricians and Gynecologists. Respondents were stratified by interest and experience in global health and group differences were reported. Results A total of 202 of 400 (50.5%) surveys were completed; and 67.3% (n = 136) of respondents expressed an interest in global health while 25.2% (n = 51) had experience providing healthcare abroad. Personal safety was the primary concern of respondents (88 of 185, 47.6%), with 44.5% (57 of 128) identifying 2 weeks as an optimal period of time to spend abroad. The majority (113 of 186, 60.8%) cited hosting of local physicians in the US as the most valuable service to developing a nation’s healthcare provision. Conclusion Despite high interest in global health, willingness to spend significant time abroad was limited. Concerns surrounding personal safety dovetailed with the belief that training local physicians in the US provides the most valuable service to international efforts. These attitudes and concerns suggest novel solutions will be required to increase involvement of Ob-Gyns in global women’s health.
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Affiliation(s)
- Sarah Rae Easter
- 1 Division of Maternal-Fetal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Greta B Raglan
- 2 Research Department, American College of Obstetricians and Gynecologists, Washington, DC, USA.,3 Department of Psychology, American University, Washington, DC, USA
| | - Sarah E Little
- 1 Division of Maternal-Fetal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jay Schulkin
- 2 Research Department, American College of Obstetricians and Gynecologists, Washington, DC, USA.,4 Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA
| | - Julian N Robinson
- 1 Division of Maternal-Fetal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Sauerbier A, Macerollo A, Györfi O, Balicza P, Moarcas M, Papp V, Zis P, Klingelhoefer L, Saifee T, Struhal W, Sellner J. Insufficient global health education in European neurological post-graduate training: a European Association of Young Neurologists and Trainees survey. Eur J Neurol 2016; 23:1680-1683. [PMID: 27477894 DOI: 10.1111/ene.13072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE The awareness of and demand for neurological expertise in global health (GH) have emerged over recent years and have become more relevant due to the increasing numbers of refugees from developing countries arriving in Europe. This study aimed to assess the provision of GH education and opportunities for international exchange during neurology post-graduate training with a focus on Europe. METHODS We developed a questionnaire covering different aspects of and interest in GH education on behalf of the European Association of Young Neurologists and Trainees. Residents in neurology and junior neurologists (RJN) were approached to complete this survey. RESULTS Completed questionnaires were returned by 131 RJNs, of whom 65.7% were women and 84.0% were between 26 and 35 years old. In total, almost one-third (29.0%) of RJNs reported that their residency programs offered training in GH. Limited education was reported for women's or children's health and neurological disorders of immigrants and refugees, as only 22.1%, 25.2% and 22.1% of RJNs reported that such training was offered, respectively. The curriculum rarely included coverage of the global impact of neurological disorders. Definite plans to volunteer in a developing country were reported by 7.6%. The majority of the participants acknowledged the importance of GH training and international exchange during post-graduate education. CONCLUSION This survey corroborates the interest in and appreciation of GH education by European RJNs. However, there are shortcomings in training and opportunities for international exchange. Academic neurology and international bodies, including the European Academy of Neurology, are requested to address this.
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Affiliation(s)
- A Sauerbier
- King's College London and King's College Hospital, London, UK.
| | - A Macerollo
- Institute of Neurology, Faculty of Brain Sciences, Sobell Department of Motor Neuroscience and Movement Disorders, University College of London, London, UK
| | - O Györfi
- National Institute of Psychiatry and Addictions, Nyírő Gyula Hospital, Budapest, Hungary
| | - P Balicza
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - M Moarcas
- Department of Neurology, Emergency Clinical County Hospital Brasov, Brasov, Romania
| | - V Papp
- Department of Neurology, Holstebro Hospital, Holstebro, Denmark
| | - P Zis
- Department of Neurology, Evangelismos Hospital, Athens, Greece.,Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.,University of Sheffield, Sheffield, UK
| | - L Klingelhoefer
- Department of Neurology, Technical University Dresden, Dresden, Germany
| | - T Saifee
- UCL Institute of Neurology, Queen Square, Neurology, London, UK
| | - W Struhal
- Clinic of Neurology 2, Medical Campus III, Kepler University Clinic, Linz, Austria
| | - J Sellner
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
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Sobral FA, Bowder AN, Smith L, Ravipati A, Suh MK, Are C. Current status of international experiences in general surgery residency programs in the United States. SPRINGERPLUS 2016; 5:586. [PMID: 27247883 PMCID: PMC4864783 DOI: 10.1186/s40064-016-2270-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/03/2016] [Indexed: 12/31/2022]
Abstract
Background The aim of this study is to identify, quantify, and characterize the international experiences available for general surgery residents in the general surgery residency programs in the United States (US). Methods The Fellowship and Residency Electronic Interactive Database (FREIDA) database was used to identify all the general surgery residency programs in the US. Each institution was contacted by both e-mail and telephone. Respondents were asked if an international experience was available for residents within their program and, if available, details of the experience were obtained. Results A total of 253 general surgery residency programs were identified using the FREIDA database. Eighty-six (34 %) programs were noted to offer an international experience for their residents. A majority are incorporated into the PGY 3 and PGY 4 level of training with a duration of 1–4 weeks. Common locations are evenly distributed among the Americas and Africa and are usually funded through a combination of resident and department funding. Conclusions US resident interest in global health is growing along with an increasing demand for surgical care worldwide. This is one of the first studies to identify, quantify, and characterize in detail the international experiences currently available to general surgery residents within the general surgery training programs in the US. These results can help general surgery residency applicants with an interest in global health and also pave the path for residency programs to develop future international experiences.
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Affiliation(s)
- Filipe A Sobral
- Mount Sinai Doctors, Long Island, 325 Park Ave., Huntington, NY 11743 USA
| | - Alexis N Bowder
- College of Medicine, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198 USA
| | - Lynette Smith
- College of Public Health, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198 USA
| | - Advaitaa Ravipati
- University of South Florida, 4202 E. Fowler Ave., Tampa, FL 33620 USA
| | - Melissa K Suh
- Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198 USA
| | - Chandrakanth Are
- Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198 USA
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Lukolyo H, Rees CA, Keating EM, Swamy P, Schutze GE, Marton S, Turner TL. Perceptions and Expectations of Host Country Preceptors of Short-Term Learners at Four Clinical Sites in Sub-Saharan Africa. Acad Pediatr 2016; 16:387-93. [PMID: 26581780 DOI: 10.1016/j.acap.2015.11.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/03/2015] [Accepted: 11/06/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The demand for global health electives among medical students and residents has grown substantially, yet perspectives of international hosts are not well documented. This study aimed to assess how host country supervising clinical preceptors perceive learners on short-term global health electives of up to 6 weeks. METHODS This study used a cross-sectional survey design and assessed international clinical preceptors' perceptions of short-term learners' (STLs) professional behaviors, medical knowledge, competency in systems-based care, as well as the benefits and burdens of hosting STLs. Surveys were sent to all clinical preceptors (n = 47) at 4 clinical sites in sub-Saharan Africa in 2015. RESULTS Thirty-two preceptors (68%) responded to the survey. Most respondents (97%) were satisfied in their role hosting STLs and reported that STLs enhanced patient care and the professional image of the clinical site. Nearly half of respondents (45%) reported decreased self-perceived efficiency in clinical care tasks. Qualitative data identified concerns related to STLs' professionalism and teamwork. Respondents also identified knowledge gaps in understanding differences in health systems and epidemiology in host country settings. Respondents preferred that rotations last at least 4 weeks and that STLs complete predeparture training. CONCLUSIONS STLs were largely positively regarded by international host clinical preceptors. To improve mutuality of benefits, sending institutions should ensure learners understand host country expectations of professionalism and that learners are well prepared for medical, ethical, and cultural challenges through participation in predeparture curricula that prepare them clinically and emotionally for these international experiences. Rotations of at least 4 weeks may enhance benefits to learners and hosts.
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Affiliation(s)
- Heather Lukolyo
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
| | - Chris A Rees
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex
| | | | - Padma Swamy
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex
| | - Gordon E Schutze
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex
| | - Stephanie Marton
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex
| | - Teri L Turner
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex
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Evans FM, Mallepally NR, Dubowitz G, Vasilopoulos T, McClain CD, Enneking K. Factors influencing anesthesia residency selection: impact of global health opportunities. Can J Anaesth 2016; 63:674-81. [PMID: 27117988 DOI: 10.1007/s12630-016-0629-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/16/2015] [Accepted: 03/11/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE There is growing evidence to suggest that the current generation of medical students and young physicians is interested in global health. However, there are few data on the interest in global health by students pursuing a career in anesthesiology. The objective of this survey was to evaluate the importance of global health opportunities in regard to applicants' choice of anesthesiology residency programs. METHODS Anesthesiology residency program directors in the United States were invited to distribute an online survey to recently matched residents. To reduce study bias, the survey included a wide selection of reasons for program choices in addition to global health. Participants were asked to rate independently, on a scale of 1 to 10 (1 = least important, 10 = most important), the importance that each factor had on their selection of an anesthesiology residency program. RESULTS Of the 117 U.S. anesthesiology programs contacted, 87 (74%) distributed the survey. Completed surveys were obtained from 582 of 1,092 (53%) polled participants. All factors assessed were rated between 5 and 9 and the global health median [interquartile range] rating was 6 [3-7]. Nearly half of the survey respondents were interested in incorporating global health into future careers. More than three-quarters reported being interested in participating in, or reading about, global health activities during their residency. Responders with previous global health experience, or who were interested in an "in-country" experience, were more likely to choose programs that had global health opportunities available during residency. CONCLUSIONS Anesthesia residency program applicants are interested in global health. Having a global health opportunity was an important reason for choosing a residency program, comparable to some more traditional factors. Regardless of previous global health experience, the majority of future anesthesia residents are either planning or considering participation in global health activities during or after training.
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Affiliation(s)
- Faye M Evans
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Bader 3, Boston, MA, USA.
| | | | - Gerald Dubowitz
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| | | | - Craig D McClain
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Bader 3, Boston, MA, USA
| | - Kayser Enneking
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
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Abstract
Although vertical health care delivery models certainly will remain a vital component in the provision of surgery in low-and-middle-income countries, it is clear now that the sustainability of global surgery will depend on more than just surgeons operating. Instead, what is needed is a comprehensive approach, that is, a horizontal integration that develops sustainable human resources, physical infrastructure, administrative oversight, and financing mechanisms in the developing world. We propose that such a strategy for development would necessarily involve an active role by academic institutions of high-income countries.
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Jensen S, Tadlock MD, Douglas T, Provencher M, Ignacio RC. Integration of Surgical Residency Training With US Military Humanitarian Missions. JOURNAL OF SURGICAL EDUCATION 2015; 72:898-903. [PMID: 25623551 DOI: 10.1016/j.jsurg.2014.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/26/2014] [Accepted: 12/09/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe how the US Navy integrates surgical resident training during hospital ship-based humanitarian activities and discuss the potential operative and educational benefits during these missions. DESIGN Retrospective review of predeployment surgical plans, operative case logs, and after-action reports from United States Naval Ship (USNS) Mercy humanitarian deployments from 2006 to 2012. SETTING The USNS Mercy hospital ship. PARTICIPANTS We enrolled 24 surgical residents from different surgical specialties including general surgery, obstetrics and gynecology, urology, otolaryngology, and ophthalmology. RESULTS During 4 planned deployments (2006-2012), 2887 surgical procedures were performed during 20 humanitarian missions conducted by the USNS Mercy in 9 different Southeast Asian countries. Of all the general surgery eligible procedures performed, 1483 (79%) were defined categories under the current general surgery Accreditation Council for Graduate Medical Education guidelines, including abdominal (31%); skin, soft tissue, and breast (21%); ear, nose, and throat (20.5%); plastic surgery (15.5%); and pediatric (12%) cases. The number of surgical cases completed by each resident ranged from 30 to 67 cases over a period of 4 to 6 weeks during the overseas humanitarian rotation. CONCLUSIONS The US Navy's humanitarian experience provides a unique educational opportunity for young military surgeons to experience various global health systems, diverse cultures, and complex logistical planning without sacrificing the breadth and depth of surgical training. This model may provide a framework to develop future international electives for other general surgery training programs.
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Affiliation(s)
- Shane Jensen
- Department of General Surgery, Naval Medical Center San Diego, San Diego, California
| | - Matthew D Tadlock
- Department of General Surgery, Naval Hospital Camp Pendleton, Camp Pendleton, California
| | - Trent Douglas
- Department of Plastic Surgery, Naval Medical Center San Diego, San Diego, California
| | - Matthew Provencher
- Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, California
| | - Romeo C Ignacio
- Department of General Surgery, Naval Medical Center San Diego, San Diego, California.
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Bale AG, Sifri ZC. Surgery resident participation in short-term humanitarian international surgical missions can supplement exposure where program case volumes are low. Am J Surg 2015; 211:294-9. [PMID: 26277425 DOI: 10.1016/j.amjsurg.2015.05.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/30/2015] [Accepted: 05/08/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND General surgery training programs face declining case volume and diversity. We wanted to determine if resident participation in international surgical missions would increase exposure to cases underrepresented in our program case mix. METHODS Accreditation Council for Graduate Medical Education program data from 2008 to 2011 (University of Medicine and Dentistry-New Jersey Medical School, Newark, NJ) were analyzed to identify categories where volume was below national average. This was compared with case logs from 3 missions conducted by International Surgical Health Initiatives between 2011 and 2012. RESULTS All chief residents completed more than minimum required index cases. Categories head and neck, alimentary tract, abdomen, and endocrine showed percentile below national average. Seven residents participated in 3 missions to Philippines and Sierra Leone. Sixty-five percent of the operations performed were in the 4 low-volume categories. CONCLUSIONS International surgery missions expose residents to a high volume and variety of cases. Participation can be one way to increase case volume and diversity during training. Cases completed on missions with board certified surgeons should be considered for Accreditation Council for Graduate Medical Education credit.
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Affiliation(s)
- Asha G Bale
- Department of Surgery, Palisades Medical Center, 7600 River Road, North Bergen, NJ 07047, USA.
| | - Ziad C Sifri
- Department of Surgery, Rutgers University New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, USA
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Chao TE, Riesel JN, Anderson GA, Mullen JT, Doyle J, Briggs SM, Lillemoe KD, Goldstein C, Kitya D, Cusack JC. Building a global surgery initiative through evaluation, collaboration, and training: the Massachusetts General Hospital experience. JOURNAL OF SURGICAL EDUCATION 2015; 72:e21-e28. [PMID: 25697510 DOI: 10.1016/j.jsurg.2014.12.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/12/2014] [Accepted: 12/31/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The Massachusetts General Hospital (MGH) Department of Surgery established the Global Surgery Initiative (GSI) in 2013 to transform volunteer and mission-based global surgery efforts into an educational experience in surgical systems strengthening. The objective of this newly conceived mission is not only to perform advanced surgery but also to train surgeons beyond MGH through international partnerships across disciplines. At its inception, a clear pathway to achieve this was not established, and we sought to identify steps that were critical to realizing our mission statement. SETTING Massachusetts General Hospital, Boston, MA, USA and Mbarara Regional Referral Hospital, Mbarara, Uganda PARTICIPANTS Members of the MGH and MRRH Departments of Surgery including faculty, fellows, and residents RESULTS The MGH GSI steering committee identified 4 steps for sustaining a robust global surgery program: (1) administer a survey to the MGH departmental faculty, fellows, and residents to gauge levels of experience and interest, (2) catalog all ongoing global surgical efforts and projects involving MGH surgical faculty, fellows, and residents to identify areas of overlap and opportunities for collaboration, (3) establish a longitudinal partnership with an academic surgical department in a limited-resource setting (Mbarara University of Science and Technology (MUST) at Mbarara Regional Referral Hospital (MRRH)), and (4) design a formal curriculum in global surgery to provide interested surgical residents with structured opportunities for research, education, and clinical work. CONCLUSIONS By organizing the collective experiences of colleagues, synchronizing efforts of new and former efforts, and leveraging the funding resources available at the local institution, the MGH GSI hopes to provide academic benefit to our foreign partners as well as our trainees through longitudinal collaboration. Providing additional financial and organizational support might encourage more surgeons to become involved in global surgery efforts. Creating a partnership with a hospital in a limited-resource setting and establishing a formal global surgery curriculum for our residents allows for education and longitudinal collaboration. We believe this is a replicable model for building other academic global surgery endeavors that aim to strengthen health and surgical systems beyond their own institutions.
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Affiliation(s)
- Tiffany E Chao
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Johanna N Riesel
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Geoffrey A Anderson
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer Doyle
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Susan M Briggs
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | - David Kitya
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - James C Cusack
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Knudson MM, Tarpley MJ, Numann PJ. Global surgery opportunities for U.S. surgical residents: an interim report. JOURNAL OF SURGICAL EDUCATION 2015; 72:e60-e65. [PMID: 25920572 DOI: 10.1016/j.jsurg.2015.03.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 02/23/2015] [Accepted: 03/19/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION In 2011, the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Surgery developed guidelines that allowed time spent and cases performed outside of the United States by surgical residents from ACGME-accredited training programs to be applied toward program completion. We hypothesized that the number of programs with global surgical rotations would have increased after that important development. We also sought to determine the characteristics that led to sustainment of such programs. METHODS An Institutional Review Board-approved electronic survey was sent to all 253 program directors of ACGME-approved general surgery residencies requesting information on international rotations available to residents. Responses were requested from program directors with extant rotations. Survey questions focused on locations, funding, nature of the rotations, faculty involvement, keys to success, and the barriers to overcome during program development and sustainment. RESULTS The survey reported 34 surgery residency programs offering global surgery rotations, up from 23 just 5 years previously. Of these reporting programs, 25 have been approved by the ACGME. Most rotations occur in the postgraduate year 3 or 4 and are primarily clinical rotations. Africa is the main destination. Resident supervision is provided by a mixture of host and home surgeons. A dedicated faculty is considered to be the most important element for success while funding remains a major impediment. CONCLUSIONS The interest in global surgery continues to increase, and general surgical programs will strive to meet the expectations of residents looking for international exposure. Collaboration could facilitate resident opportunities and potentially be more cost-effective.
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Affiliation(s)
- M Margaret Knudson
- Department of Surgery, University of California, San Francisco General Hospital and Trauma Center, San Francisco, California
| | | | - Patricia J Numann
- Department of Surgery Emerita, SUNY Upstate Medical University, Syracuse, New York
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Hoehn RS, Davis BR, Huber NL, Edwards MJ, Lungu D, Logan JM. A systematic approach to developing a global surgery elective. JOURNAL OF SURGICAL EDUCATION 2015; 72:e15-e20. [PMID: 25817013 DOI: 10.1016/j.jsurg.2015.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 11/05/2014] [Accepted: 01/19/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Interest in global health has been increasing for years among American residents and medical students. Many residency programs have developed global health tracks or electives in response to this need. OBJECTIVES Our goal was to create a global surgery elective based on a synergistic partnership between our institution and a hospital in the developing world. DESIGN We created a business plan and 1-year schedule for researching potential sites and completing a pilot rotation at our selected hospital. SETTING We administered a survey to general surgery residents at the University of Cincinnati and visited medical facilities in Sierra Leone, Cameroon, and Malawi. PARTICIPANTS The survey was given to all general surgery residents. A resident and a faculty member executed the fact-finding trip as well as the pilot rotation. RESULTS Our general surgery residents view an international elective as integral to residency training and would participate in such an elective. After investigating 6 hospitals in sub-Saharan Africa, we conducted a pilot rotation at our selected hospital and gained the necessary information to organize a curriculum. We will begin sending senior residents for 8-week rotations in the coming academic year. CONCLUSIONS By systematically approaching the process of creating a global surgery elective, we were able to gain considerable insight into choosing a location and organizing the elective.
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Affiliation(s)
- Richard S Hoehn
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Bradley R Davis
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | - Jocelyn M Logan
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
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Kotagal M, Quiroga E, Ruffatto BJ, Adedipe AA, Backlund BH, Nathan R, Roche A, Sajed D, Shah S. Impact of point-of-care ultrasound training on surgical residents' confidence. JOURNAL OF SURGICAL EDUCATION 2015; 72:e82-7. [PMID: 25911457 PMCID: PMC4786300 DOI: 10.1016/j.jsurg.2015.01.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/30/2014] [Accepted: 01/29/2015] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Point-of-care ultrasound (POCUS) is a vital tool for diagnosis and management of critically ill patients, particularly in resource-limited settings where access to diagnostic imaging may be constrained. We aimed to develop a novel POCUS training curriculum for surgical practice in the United States and in resource-limited settings in low- and middle-income countries and to determine its effect on surgical resident self-assessments of efficacy and confidence. DESIGN We conducted an observational cohort study evaluating a POCUS training course that comprised 7 sessions of 2 hours each with didactics and proctored skills stations covering ultrasound applications for trauma (Focused Assessement with Sonography for Trauma (FAST) examination), obstetrics, vascular, soft tissue, regional anesthesia, focused echocardiography, and ultrasound guidance for procedures. Surveys on attitudes, prior experience, and confidence in point-of-care ultrasound applications were conducted before and after the course. SETTING General Surgery Training Program in Seattle, Washington. PARTICIPANTS A total of 16 residents participated in the course; 15 and 10 residents completed the precourse and postcourse surveys, respectively. RESULTS The mean composite confidence score from pretest compared with posttest improved from 23.3 (±10.2) to 37.8 (±6.7). Median confidence scores (1-6 scale) improved from 1.5 to 5.0 in performance of FAST (p < 0.001). Residents reported greater confidence in their ability to identify pericardial (2 to 4, p = 0.009) and peritoneal fluid (2 to 4.5, p < 0.001), to use ultrasound to guide procedures (3.5 to 4.0, p = 0.008), and to estimate ejection fraction (1 to 4, p = 0.004). Both before and after training, surgical residents overwhelmingly agreed with statements that ultrasound would improve their US-based practice, make them a better surgical resident, and improve their practice in resource-limited settings. CONCLUSIONS After a POCUS course designed specifically for surgeons, surgical residents had improved self-efficacy and confidence levels across a broad range of skills.
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Affiliation(s)
- Meera Kotagal
- Department of Surgery, University of Washington, Seattle, Washington; Surgical Outcomes Research Center (SORCE), Seattle, Washington.
| | - Elina Quiroga
- Department of Surgery, University of Washington, Seattle, Washington
| | | | - Adeyinka A Adedipe
- Division of Emergency Medicine, University of Washington, Seattle, Washington
| | - Brandon H Backlund
- Division of Emergency Medicine, University of Washington, Seattle, Washington
| | - Robert Nathan
- Department of Radiology, University of Washington, Seattle, Washington
| | - Anthony Roche
- Department of Anesthesiology, University of Washington, Seattle, Washington
| | - Dana Sajed
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Sachita Shah
- Division of Emergency Medicine, University of Washington, Seattle, Washington
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Swain JD, Matousek AC, Scott JW, Cooper Z, Smink DS, Bolman RM, Finlayson SRG, Zinner MJ, Riviello R. Training surgical residents for a career in academic global surgery: a novel training model. JOURNAL OF SURGICAL EDUCATION 2015; 72:e104-e110. [PMID: 25911458 DOI: 10.1016/j.jsurg.2015.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/23/2014] [Accepted: 01/16/2015] [Indexed: 06/04/2023]
Abstract
Academic global surgery is a nascent field focused on improving surgical care in resource-poor settings through a broad-based scholarship agenda. Although there is increasing momentum to expand training opportunities in low-resource settings among academic surgical programs, most focus solely on establishing short-term elective rotations rather than fostering research or career development. Given the complex nature of surgical care delivery and programmatic capacity building in the resource-poor settings, many challenges remain before global surgery is accepted as an academic discipline and an established career path. Brigham and Women's Hospital has established a specialized global surgery track within the general surgery residency program to develop academic leaders in this growing area of need and opportunity. Here we describe our experience with the design and development of the program followed by practical applications and lessons learned from our early experiences.
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Affiliation(s)
- JaBaris D Swain
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexi C Matousek
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John W Scott
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Zara Cooper
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Douglas S Smink
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ralph Morton Bolman
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Michael J Zinner
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert Riviello
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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50
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Kelly K, McCarthy A, McLean L. Distributed learning or medical tourism? A Canadian residency program's experience in global health. JOURNAL OF SURGICAL EDUCATION 2015; 72:e33-e45. [PMID: 25882664 DOI: 10.1016/j.jsurg.2015.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 12/10/2014] [Accepted: 01/08/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Global health experiences (GHEs) are becoming increasingly prevalent in surgical residency education. Although it may seem intuitive that participation in GHEs develops CanMEDS competencies, this has not been studied in depth in surgery. The purpose of this study is (1) to explore if and how otolaryngology-head and neck surgery (OHNS) resident participation in GHEs facilitates the development of CanMEDS competencies and (2) to develop an OHNS GHE tool to facilitate the integration of CanMEDS into GHE participation and evaluation. METHODS An online survey explored the GHEs of current and past OHNS residents in Canada. Based on the data collected and a literature review, a foundational tool was then created to (1) enable OHNS residents to structure their GHEs into CanMEDS-related learning objectives and (2) enable OHNS program directors to more effectively evaluate residents' GHEs with respect to CanMEDS competencies. RESULTS Participants' GHEs varied widely. These experiences often contributed informally to the development of several CanMEDS competencies. However, few residents had concrete objectives, rarely were CanMEDS roles clearly incorporated, and most residents were not formally evaluated during their experience. Residents felt they achieved greater learning when predeparture objectives and postexperience reflections were integrated into their GHEs. CONCLUSIONS Although GHEs vary widely, they can serve as valuable forums for developing CanMEDS competencies among participating residents. Without clear objectives that adhere to the CanMEDS framework or formal assessment methods however, residents in GHEs risk becoming medical tourists. The use of an objective and evaluation tool may facilitate the creation of predeparture learning objectives, encourage self-reflection on their GHE, and better enable program directors to evaluate residents participating in GHEs.
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Affiliation(s)
- Kate Kelly
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario.
| | - Anne McCarthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario
| | - Laurie McLean
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario
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