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Mediratta S, Lippa L, Venturini S, Demetriades AK, El-Ouahabi A, Gandía-González ML, Harkness W, Hutchinson P, Park KB, Rabiei K, Rosseau G, Schaller K, Servadei F, Lafuente J, Kolias AG. Current state of global neurosurgery activity amongst European neurosurgeons. J Neurosurg Sci 2024; 68:371-378. [PMID: 35147400 DOI: 10.23736/s0390-5616.21.05447-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The expanding field of global neurosurgery calls for a committed neurosurgical community to advocate for universal access to timely, safe, and affordable neurosurgical care for everyone, everywhere. The aim of this study was to assess the current state of global neurosurgery activity amongst European neurosurgeons and to identify barriers to involvement in global neurosurgery initiatives. METHODS Cross-sectional study through dissemination of a web-based survey, from September 2019 to January 2020, to collect data from European neurosurgeons at various career stages. Descriptive analysis was conducted on respondent data. RESULTS Three hundred and ten neurosurgeons from 40 European countries responded: 53.5% regularly follow global neurosurgery developments, and 29.4% had travelled abroad with a global neurosurgery collaborative, with 23.2% planning a future trip. Respondents from high income European countries predominantly travelled to Africa (41.6%) or Asia (34.4%), whereas respondents from middle income European countries frequently traversed Europe (63.2%) and North America (47.4%). Cost implications (66.5%) were the most common barrier to global neurosurgery activity, followed by interference with current practice (45.8%), family duties (35.2%), difficulties obtaining humanitarian leave (27.7%) and lack of international partners (27.4%). 86.8% would incorporate a global neurosurgery period within training programmes. CONCLUSIONS European neurosurgeons are interested in engaging in global neurosurgery partnerships, and several sustainable programs focused on local capacity building, education and research have been established over the last decade. However, individual and system barriers to engagement persist. We provided insight into these to allow development of tailored mechanisms to overcome such barriers, enabling European neurosurgeons to advocate for the Global Surgery 2030 goals.
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Affiliation(s)
- Saniya Mediratta
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK -
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge, UK -
| | - Laura Lippa
- Department of Neurosurgery, Ospedali Riuniti, Livorno, Italy
| | - Sara Venturini
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | | | | | - Maria L Gandía-González
- Department of Neurosurgery, Hospital Universitario La Paz, Madrid, Spain
- CranioSPain Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Superior Center for University Studies La Salle, Autonomous University of Madrid, Madrid, Spain
| | | | - Peter Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge, UK
| | - Kee B Park
- Harvard Medical School, Department of Global Health and Social Medicine, Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Boston, MA, USA
| | - Katrin Rabiei
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Gail Rosseau
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Karl Schaller
- Division of Neurosurgery, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Franco Servadei
- IRCCS Humanitas Clinic, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Jesus Lafuente
- Department of Neurosurgery, Hospital del Mar, Barcelona, Spain
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge, UK
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Yang G, Bekele A, Krishnaswami S, Ameh E, Sifri Z, Aisuodionoe-Shadrach O, Swaroop M, Orloff S, Abdullah F, Nwomeh B, Chen M, Charles A, Ezeme C, Juillard C, Menezes C, Chitalu M, Nwariaku F, Jawa RS. Cultural competency and ethical behavior for collaboration in limited-resource settings: Guidelines from the Society of University Surgeons Academic Global Surgery Committee and the Association for Academic Global Surgery. Surgery 2024; 176:108-114. [PMID: 38609784 DOI: 10.1016/j.surg.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/02/2024] [Accepted: 02/26/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND There are an increasing number of global surgery activities worldwide. With such tremendous growth, there is a potential risk for untoward interactions between high-income country members and low-middle income country members, leading to programmatic failure, poor results, and/or low impact. METHODS Key concepts for cultural competency and ethical behavior were generated by the Academic Global Surgery Committee of the Society for University Surgeons in collaboration with the Association for Academic Global Surgery. Both societies ensured active participation from high-income countries and low-middle income countries. RESULTS The guidelines provide a framework for cultural competency and ethical behavior for high-income country members when collaborating with low-middle income country partners by offering recommendations for: (1) preparation for work with low-middle income countries; (2) process standardization; (3) working with the local community; (4) limits of practice; (5) patient autonomy and consent; (6) trainees; (7) potential pitfalls; and (8) gray areas. CONCLUSION The article provides an actionable framework to address potential cultural competency and ethical behavior issues in high-income country - low-middle income country global surgery collaborations.
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Affiliation(s)
- George Yang
- Department of Surgery, University of Alabama, Birmingham, AL
| | - Abebe Bekele
- University of Global Health Equity, Kigali, Rwanda
| | | | - Emmanuel Ameh
- Department of Surgery, National Hospital, Abuja, Nigeria
| | - Ziad Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | | | - Mamta Swaroop
- Department of Surgery, Kern Medical Center, Bakersfield, CA
| | - Susan Orloff
- Department of Surgery, Oregon Health & Sciences University, Portland, OR
| | - Fizan Abdullah
- Department of Surgery, Northwestern University and Lurie Children's Hospital of Chicago, Chicago, IL
| | - Benedict Nwomeh
- Department of Surgery, Ohio State University and Nationwide Childrens Hospital, Columbus, OH
| | - Mike Chen
- Department of Surgery, University of Alabama, Birmingham, AL
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Catherine Juillard
- Department of Surgery, University of California Los Angeles, Los Angeles, CA
| | | | | | - Fiemu Nwariaku
- Department of Surgery, University of Utah, Salt Lake City, UT
| | - Randeep S Jawa
- Department of Surgery, Stony Brook Medicine, Stony Brook, NY.
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Coleman PA, Devine EP, Luis Boquin Orenday T, Springer BD. Operation Walk: The Ethics of Global Surgery and Health. J Arthroplasty 2024; 39:1389-1390. [PMID: 38604281 DOI: 10.1016/j.arth.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Affiliation(s)
- Paul A Coleman
- Physician Assistant Studies East Falls & New Jersey Program, College of Health Professions, Department of Health Sciences and Clinical Practice, Philadelphia, Pennsylvania
| | - Erin P Devine
- Department of Anesthesiology, Atrium Health, Charlotte, North Carolina
| | | | - Bryan D Springer
- Department of Orthopedic Surgery, Mayo Clinic Florida, Jacksonville, Florida
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Nwagbata A, Dutta R, Jayaram A, Thivalapill N, Jain S, Faria I, Alty IG, Gadgil A, Roy N, Raykar NP. Beyond the Ivory Tower: Perception of academic global surgery by surgeons in low- and middle-income countries. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002979. [PMID: 38483892 PMCID: PMC10939292 DOI: 10.1371/journal.pgph.0002979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024]
Abstract
Interest in global surgery has surged amongst academics and practitioners in high-income countries (HICs), but it is unclear how frontline surgical practitioners in low-resource environments perceive the new field or its benefit. Our objective was to assess perceptions of academic global surgery amongst surgeons in low- and middle-income countries (LMICs). We conducted a cross-sectional e-survey among surgical trainees and consultants in 62 LMICs, as defined by the World Bank in 2020. This paper is a sub-analysis highlighting the perception of academic surgery and the association between practice setting and responses using Pearson's Chi-square test. Analyses were completed using Stata15. The survey received 416 responses, including 173 consultants (41.6%), 221 residents (53.1%), 8 medical graduates (1.9%), and 14 fellows (3.4%). Of these, 72 responses (17.3%) were from low-income countries, 137 (32.9%) from lower-middle-income countries, and 207 (49.8%) from upper-middle-income countries. 286 respondents (68.8%) practiced in urban areas, 34 (8.2%) in rural areas, and 84 (20.2%) in both rural and urban areas. Only 185 (44.58%) were familiar with the term "global surgery." However, 326 (79.3%) agreed that collaborating with HIC surgeons for research is beneficial to being a global surgeon, 323 (78.8%) agreed that having an HIC co-author improves likelihood of publication in a reputable journal, 337 (81.6%) agreed that securing research funding is difficult in their country, 195 (47.3%) agreed that their institutions consider research for promotion, 252 (61.0%) agreed that they can combine research and clinical practice, and 336 (82%) are willing to train HIC medical students and residents. A majority of these LMIC surgeons noted limited academic incentives to perform research in the field. The academic global surgery community should take note and foster equitable collaborations to ensure that this critical segment of stakeholders is engaged and has fewer barriers to participation.
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Affiliation(s)
- Arinzechukwu Nwagbata
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Trauma, Burn, and Critical Care, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Rohini Dutta
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle Income Countries, Mumbai, India
| | - Anusha Jayaram
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Neil Thivalapill
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle Income Countries, Mumbai, India
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Samarvir Jain
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle Income Countries, Mumbai, India
| | - Isabella Faria
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Isaac G. Alty
- Department of Trauma, Burn, and Critical Care, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Anita Gadgil
- The George Institute for Global Health, New Delhi, India
| | - Nobhojit Roy
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle Income Countries, Mumbai, India
- The George Institute for Global Health, New Delhi, India
- Karolinska Institutet, Stockholm, Sweden
| | - Nakul P. Raykar
- Department of Trauma, Burn, and Critical Care, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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Hoffman GS, Parvin-Nejad FP, Linz MS, Salter SE, Goydos C, Padmanaban V, Nwomeh BC, Mshelbwala PM, Sifri ZC. The Impact of Global Collaboration on the Academic Focus of the West African College of Surgeons: Are Worldwide Efforts Aligning with Local Priorities? World J Surg 2023; 47:2319-2327. [PMID: 37284848 DOI: 10.1007/s00268-023-07075-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Global collaboration has the potential to induce a shift in research focus away from the priorities of those in low- and low-middle-income countries (LICs and LMICs). This study quantified international collaboration among surgery publications by Fellows of the West African College of Surgeons (WACS) and investigated if collaboration with upper-middle-income and high-income countries (UMICs and HICs) decreases the homophily of research focus. METHODS Publications by WACS surgery Fellows from 1960 to 2019 were characterized as local WACS publications, collaborative publications without UMIC/HIC participation, or collaborative publications with UMIC/HIC participation. Research topics were determined for each publication, and topic percentages were compared between collaboration groups. RESULTS We analyzed 5065 publications. Most (3690 publications, 73%) were local WACS publications, while 742 (15%) were collaborative publications with UMIC/HIC participation and 633 (12%) were collaborative publications without UMIC/HIC participation. UMIC/HIC collaborations contributed to 49% of the increase (378 out of 766 publications) from 2000 to 2019. Topic homophily was significantly lower between local WACS publications and collaborations with UMIC/HIC participation (differed in nine research topics) than it was between local WACS publications and collaborations without UMIC/HIC participation (differed in two research topics). CONCLUSIONS Publications without international collaboration comprise most WACS research, but the rate of UMIC/HIC collaborations is rapidly increasing. We found that UMIC/HIC collaborations decreased the homophily of topic focus in WACS publications, indicating that global collaborations need to have greater emphasis on the priorities of those in LICs and LMICs.
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Affiliation(s)
- Gary S Hoffman
- Rutgers New Jersey Medical School, 185 S Orange Avenue, Newark, NJ, 07103, USA.
| | | | - Matthew S Linz
- Rutgers New Jersey Medical School, 185 S Orange Avenue, Newark, NJ, 07103, USA
| | - S Elina Salter
- Rutgers New Jersey Medical School, 185 S Orange Avenue, Newark, NJ, 07103, USA
| | - Christopher Goydos
- Rutgers New Jersey Medical School, 185 S Orange Avenue, Newark, NJ, 07103, USA
| | - Vennila Padmanaban
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Benedict C Nwomeh
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Philip M Mshelbwala
- Division of Pediatric Surgery, Department of Surgery, University of Abuja Teaching Hospital, Gwagwalada, FCT, Nigeria
| | - Ziad C Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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Khalid MU, Mac A, Biderman M, Errett L, Sriharan A. Partnering to build surgical capacity in low-resource settings: a qualitative study of Canadian global surgeons. BMJ Open 2023; 13:e070148. [PMID: 36948558 PMCID: PMC10040043 DOI: 10.1136/bmjopen-2022-070148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVES This qualitative study aimed to explore the perspectives of Canadian global surgeons with experience developing surgical education partnerships with low- and middle-income countries (LMICs) for the purpose of identifying factors for success. DESIGN A purposive sample of leaders from global surgery programmes at Canadian Faculties of Medicine participated in virtual semi-structured interviews. A six-phase thematic analysis was performed using a constructivist lens on verbatim transcripts by three independent researchers. Key factors for success were thematically collated with constant comparison and inter-investigator triangulation in NVivo software until theoretical saturation was reached. PARTICIPANTS Fifteen surgeons, representing 11 subspecialties at 6 Canadian academic institutions and a combined experience across 6 continents, were interviewed between January and June 2022. RESULTS Four facilitators for success of global surgery training programmes were identified, with a strong undertone of relationship-building permeating all subthemes: (1) facilitative skill sets and infrastructure, (2) longitudinal engagement, (3) local ownership and (4) interpersonal humility. Participants defined facilitative skill sets to include demonstrated surgical competence and facilitative infrastructure to include pre-existing local networks, language congruency, sustainable funding and support from external organisations. They perceived longitudinal engagement as spanning multiple trips, enabled by strong personal motivation and arrangements at their home institutions. Ownership of projects by local champions, including in research output, was noted as key to preventing brain drain and catalysing a ripple effect of surgical trainees. Finally, interviewees emphasised interpersonal humility as being crucial to decolonising the institution of global surgery with cultural competence, reflexivity and sustainability. CONCLUSIONS The interviewed surgeons perceived strong cross-cultural relationships as fundamental to all other dimensions of success when working in low-resource capacity-building. While this study presents a comprehensive Canadian perspective informed by high-profile leadership in global surgery, a parallel study highlighting LMIC-partners' perspectives will be critical to a more complete understanding of programme success.
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Affiliation(s)
- Muhammad Uzair Khalid
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Amanda Mac
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maya Biderman
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lee Errett
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Abi Sriharan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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7
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Foretia DA. To decolonize global surgery and global health we must be radically intentional. Am J Surg 2023; 225:595-596. [PMID: 36302698 DOI: 10.1016/j.amjsurg.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Denis A Foretia
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon; Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, TN, USA; Global Surgery Institute, University of Tennessee Health Science Center, Memphis, TN, USA.
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8
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Academic Global Surgery: Creating Opportunities, Equity, and Diversity. Ann Glob Health 2023; 89:12. [PMID: 36819966 PMCID: PMC9936913 DOI: 10.5334/aogh.3972] [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: 09/21/2022] [Accepted: 11/11/2022] [Indexed: 02/16/2023] Open
Abstract
A workforce trained in the development and delivery of equitable surgical care is critical in reducing the global burden of surgical disease. Academic global surgery aims to address the present inequities through collaborative partnerships that foster research, education, advocacy and training to support and increase the surgical capacity in settings with limited resources. Barriers include a deficiency of resources, personnel, equipment, and funding, a lack of communication, and geographical challenges. Multi-level partnerships remain fundamental; these types of partnerships include a wide range of trainees, professionals, institutions, and nations, yet care must be taken to avoid falling into the trap of surgical "voluntourism" and undermining the expertise and practice of long-standing frontline providers. Academic global surgery has the benefit of developing a community of surgeons who possess the tools needed to collaborate on individual, institutional, and international levels to address inequities in surgery that are spread variously across the globe. However, challenges for surgeons pursuing a career in global surgery include balancing clinical responsibilities while integrating global surgery as a career during training. This is due in part to the lack of mentorship, research time, grant funding, support to attend conferences, and a limitation of resources, all of which are significantly more pronounced for surgeons from low-resource countries.
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9
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Rosenberg A, Jayaram A, Still M, Hauser B, Dworkin M, Faktor K, Petroze R. Global Surgery Opportunities for General Surgery Residents: Are We Making Progress? J Surg Res 2022; 279:436-441. [PMID: 35841812 PMCID: PMC9750801 DOI: 10.1016/j.jss.2022.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/13/2022] [Accepted: 06/10/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Global surgery efforts have significantly expanded in the last decade. While an increasing number of general surgery residents are incorporating global surgery experiences and research into their training, few resources are available for residency applicants to evaluate opportunities at programs to which they are applying. MATERIALS AND METHODS A 17-question survey of all general surgery residency program directors (PDs) was conducted by the Global Surgery Student Alliance through emails to the Association of Program Directors in Surgery listserv. PDs indicated if they wished to remain anonymous or include program information in an upcoming online database. RESULTS Two hundred fifty eight general surgery PDs were emailed the survey and 45 (17%) responses were recorded. Twenty eight (62%) programs offered formal global surgery experiences for residents, including clinical rotations, research, and advocacy opportunities. Thirty one (69%) programs were developing a global health center. Forty two (93%) respondents indicated that global surgery education was an important aspect of surgical training. Barriers to global surgery participation included a lack of funding, time constraints, low faculty participation, and minimal institutional interest. CONCLUSIONS While most respondents felt that global surgery was important, less than two-thirds offered formal experiences. Despite the significant increase in public awareness and participation in global surgery, these numbers remain low. While this study is limited by a 17% response rate, it demonstrates that more efforts are needed to bolster training, research, and advocacy opportunities for surgical trainees and promote a global perspective on healthcare.
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Affiliation(s)
- Ashley Rosenberg
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia; Global Surgery Student Alliance, Cambridge Massachusetts.
| | - Anusha Jayaram
- Tufts University School of Medicine, Boston, Massachusetts; Global Surgery Student Alliance, Cambridge Massachusetts
| | - Megan Still
- Global Surgery Student Alliance, Cambridge Massachusetts; Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida
| | - Blake Hauser
- Harvard Medical School, Boston, Massachusetts; Global Surgery Student Alliance, Cambridge Massachusetts
| | - Myles Dworkin
- Department of Orthopedic Surgery, Brown University, Providence, Rhode Island; Global Surgery Student Alliance, Cambridge Massachusetts
| | - Kara Faktor
- Department of Surgery, University of California San Francisco, San Francisco, California; Global Surgery Student Alliance, Cambridge Massachusetts
| | - Robin Petroze
- Division of Pediatric Surgery, University of Florida College of Medicine, Gainesville, Florida
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Zivanov CN, Joseph J, Pereira DE, MacLeod JBA, Kauffmann RM. Qualitative Analysis of the Host-Perceived Impact of Unidirectional Global Surgery Training in Kijabe, Kenya: Benefits, Challenges, and a Desire for Bidirectional Exchange. World J Surg 2022; 46:2570-2584. [PMID: 35976431 PMCID: PMC9383670 DOI: 10.1007/s00268-022-06692-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 11/25/2022]
Abstract
Background As globalization of surgical training increases, growing evidence demonstrates a positive impact of global surgery experiences on trainees from high-income countries (HIC). However, few studies have assessed the impact of these largely unidirectional experiences from the perspectives of host surgical personnel from low- and middle-income countries (LMIC). This study aimed to assess the impact of unidirectional visitor involvement from the perspectives of host surgical personnel in Kijabe, Kenya. Methods Voluntary semi-structured interviews were conducted with 43 host surgical personnel at a tertiary referral hospital in Kijabe, Kenya. Qualitative analysis was used to identify salient and recurring themes related to host experiences with visiting surgical personnel. Perceived benefits and challenges of HIC involvement and host interest in bidirectional exchange were assessed. Results Benefits of visitor involvement included positive learning experiences (95.3%), capacity building (83.7%), exposure to diverse practices and perspectives (74.4%), improved work ethic (51.2%), shared workload (44.2%), access to resources (41.9%), visitor contributions to patient care (41.9%), and mentorship opportunities (37.2%). Challenges included short stays (86.0%), visitor adaptation and integration (83.7%), cultural differences (67.4%), visitors with problematic behaviors (53.5%), learner saturation (34.9%), language barriers (32.6%), and perceived power imbalances between HIC and LMIC personnel (27.9%). Nearly half of host participants expressed concerns about the lack of balanced exchange between HIC and LMIC programs (48.8%). Almost all (96.9%) host trainees expressed interest in a bidirectional exchange program. Conclusion As the field of global surgery continues to evolve, further assessment and representation of host perspectives is necessary to identify and address challenges and promote equitable, mutually beneficial partnerships between surgical programs in HIC and LMIC.
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Affiliation(s)
- Catherine N Zivanov
- Eskind Family Biomedical Library and Learning Center, Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN, 37240, USA
| | - James Joseph
- Department of Surgery, Africa Inland Church Kijabe Hospital, Kijabe, Kenya
| | - Daniel E Pereira
- Eskind Family Biomedical Library and Learning Center, Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN, 37240, USA
| | - Jana B A MacLeod
- Department of Surgery, Africa Inland Church Kijabe Hospital, Kijabe, Kenya.,Department of Surgery and Orthopedics, Kenyatta University School of Medicine, Nairobi, Kenya
| | - Rondi M Kauffmann
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, 597 Preston Research Building, 2220 Pierce Ave, Nashville, TN, 37232, USA.
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11
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Richmond R, LeeVan E, Dodgion C, Chin TL, Mengesha MG, Jember D, Gari T, Gebrehana E, Alseidi A, Bell N, Long K, Gadisa A, Tefera G, Schroeder ME. Coaching for impact: successful implementation of a multi-national, multi-institutional synchronous research course in Ethiopia. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2022; 1:20. [PMID: 38013716 PMCID: PMC9122240 DOI: 10.1007/s44186-022-00020-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 03/28/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022]
Abstract
Purpose Under the American College of Surgeons' Operation Giving Back, several US institutions collaborated with a teaching and regional referral hospital in Ethiopia to develop a surgical research curriculum. Methods A virtual, interactive, introductory research course which utilized a web-based classroom platform and live educational sessions via an online teleconferencing application was implemented. Surgical and public health faculty from the US and Ethiopia taught webinars and led breakout coaching sessions to facilitate participants' project development. Both a pre-course needs assessment survey and a post-course participation survey were used to examine the impact of the course. Results Twenty participants were invited to participate in the course. Despite the majority of participants having connection issues (88%), 11 participants completed the course with an 83% average attendance rate. Ten participants successfully developed structured research proposals based on their local clinical needs. Conclusion This novel multi-institutional and multi-national research course design was successfully implemented and could serve as a template for greater development of research capacity building in the low- and middle-income country (LMIC) setting.
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Affiliation(s)
- Robyn Richmond
- Department of Surgery, Texas Tech University Health Sciences Center, 3601 4th Street, MS #8312, Lubbock, TX 79430 USA
| | - Elyse LeeVan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Chris Dodgion
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI USA
| | - Theresa L. Chin
- Department of Surgery, University of California Irvine, Orange, CA USA
| | - Mengistu G. Mengesha
- Department of Surgery, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Dawit Jember
- Department of Surgery, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Taye Gari
- Department of Surgery, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Ephrem Gebrehana
- Department of Surgery, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA USA
| | - Natalie Bell
- American College of Surgeons, Operation Giving Back, Chicago, IL USA
| | - Kristin Long
- School of Medicine and Public Health, University of Wisconsin, Madison, WI USA
| | - Anteneh Gadisa
- Department of Surgery, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Girma Tefera
- School of Medicine and Public Health, University of Wisconsin, Madison, WI USA
| | - Mary E. Schroeder
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI USA
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Velin L, Lantz A, Ameh EA, Roy N, Jumbam DT, Williams O, Elobu A, Seyi-Olajide J, Hagander L. Systematic review of low-income and middle-income country perceptions of visiting surgical teams from high-income countries. BMJ Glob Health 2022; 7:e008791. [PMID: 35483711 PMCID: PMC9052057 DOI: 10.1136/bmjgh-2022-008791] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/05/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The shortage of surgeons, anaesthesiologists and obstetricians in low-income and middle-income countries (LMICs) is occasionally bridged by foreign surgical teams from high-income countries on short-term visits. To advise on ethical guidelines for such activities, the aim of this study was to present LMIC stakeholders' perceptions of visiting surgical teams from high-income countries. METHOD We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in November 2021, using standardised search terms in PubMed/Medline (National Library of Medicine), EMBASE (Elsevier), Global Health Database (EBSCO) and Global Index Medicus, and complementary hand searches in African Journals Online and Google Scholar. Included studies were analysed thematically using a meta-ethnographic approach. RESULTS Out of 3867 identified studies, 30 articles from 15 countries were included for analysis. Advantages of visiting surgical teams included alleviating clinical care needs, skills improvement, system-level strengthening, academic and career benefits and broader collaboration opportunities. Disadvantages of visiting surgical teams involved poor quality of care and lack of follow-up, insufficient knowledge transfers, dilemmas of ethics and equity, competition, administrative and financial issues and language barriers. CONCLUSION Surgical short-term visits from high-income countries are insufficiently described from the perspective of stakeholders in LMICs, yet such perspectives are essential for quality of care, ethics and equity, skills and knowledge transfer and sustainable health system strengthening. More in-depth studies, particularly of LMIC perceptions, are required to inform further development of ethical guidelines for global surgery and support ethical and sustainable strengthening of LMIC surgical systems.
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Affiliation(s)
- Lotta Velin
- Department of Biomedical and Clinical Sciences, Linköping University, Centre for Teaching and Research in Disaster Medicine and Traumatology, Linkoping, Sweden
| | - Adam Lantz
- Department of Clinical Sciences in Lund, Orthopedic Surgery, Helsingborg Hospital, Faculty of Medicine, Lund University, Lund, Sweden
| | - Emmanuel A Ameh
- Department of Surgery, National Hospital Abuja, Abuja, Federal Capital Territory, Nigeria
| | - Nobhojit Roy
- WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, Mumbai, India
- The George Institute for Global Health, New Delhi, India
| | - Desmond T Jumbam
- Department of Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | - Omolara Williams
- Department of Surgery, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Alex Elobu
- Gastrointestinal Surgery, Mulago Hospital, Kampala, Uganda
- Institute of Digestive Diseases, Kampala, Uganda
| | - Justina Seyi-Olajide
- Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
| | - Lars Hagander
- Department of Clinical Sciences in Lund, Pediatric Surgery, Skåne University Hospital in Lund, Faculty of Medicine, Lund University, Lund, Sweden
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Training low-middle-income (LMIC) pediatric surgeons in a high-income country (HIC) program. Pediatr Surg Int 2022; 38:269-276. [PMID: 34591153 DOI: 10.1007/s00383-021-05027-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND A popular paradigm to support surgical education for low- and middle-income countries (LMICs) is partnering with high-income country (HIC) surgeons. These relationships may, however, be asymmetric and fail to optimally address the most pressing curricular needs. We explored the effectiveness of our LMIC-HIC educational partnership. METHODS Through a partnership between a HIC (Canada) and a LMIC (Uganda), three candidate surgeons were commissioned for a custom designed 1-year training experience at our HIC accredited pediatric surgical training centre as part of their overall formal education. The training curriculum was developed in collaboration with the LMIC pediatric surgeon and utilized competency-based medical education principles. A Likert and short-answer survey tool was administered to these trainees upon completion of their training. RESULTS All prescribed milestones as well as specialty certification by examination of the College of Surgeons of East, Central and Southern Africa was achieved by participating fellows, each of whom have begun clinical practice, leadership and teaching roles in their home country. Although several obstacles were identified by fellows, all agreed that the experience boosted their clinical and teaching abilities, and was worth the effort. CONCLUSION This endeavour in global pediatric surgical training represents a significant innovation in surgical education partnerships and would be reproducible across different surgical subspecialties and contexts. Such collaborative efforts represent a feasible upskilling opportunity towards addressing global surgical service capacity. LEVEL OF EVIDENCE V.
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Nthumba PM. Commentary on 'Academic Global Surgery Curricula - Current Status and a Call for a More Equitable Approach'. J Surg Res 2021; 267:730-731. [PMID: 34905822 DOI: 10.1016/j.jss.2021.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Peter Muli Nthumba
- Department of Plastic Surgery, AIC Kijabe Hospital, Kenya; Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
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15
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Jayaram A, Nunez KC, Flores M, Hill SE, Hong KW, Peck CJ, Rapaport S, Stankey M, Stingl CS, Wariso B, Webb J, Wight C, Fallah PN. Development of an Open-Access Webinar Series on Pathways for Global Surgery Engagement for Applicants to US Residency Programs. J Surg Res 2021; 272:17-25. [PMID: 34922266 DOI: 10.1016/j.jss.2021.10.012] [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: 06/07/2021] [Revised: 09/23/2021] [Accepted: 10/10/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Global surgery (GS) training pathways in residency are unclear and vary by specialty and program. Furthermore, information on these pathways is not always accessible. To address this gap, we produced a collection of open-access webinars for senior medical students focused on identifying GS training pathways during residency. METHODS The Global Surgery Student Alliance (GSSA) is a national nonprofit that engages US students and trainees in GS education, research, and advocacy. GSSA organized nine one-hour, specialty-specific webinars featuring residents of surgical specialties, anesthesia, and OBGYN programs. Live webinars were produced via Zoom from August to October 2020, and all recordings were posted to the GSSA YouTube channel. Medical students moderated webinars with predetermined standardized questions and live questions submitted by attendees. Participant data were collected in mandatory registration forms. RESULTS A total of 539 people were registered for 9 webinars. Among registrants, 189 institutions and 36 countries were represented. Registrants reported education/training levels from less than undergraduate education to attending physicians, while medical students represented the majority of registrants. Following the live webinars, YouTube recordings of the events were viewed 839 times. Webinars featuring otolaryngology and general surgery residents accrued the greatest number of registrations, while anesthesia accrued the least. CONCLUSIONS Medical students at all levels demonstrated interest in both the live and recorded specialty-specific webinars on GS in residency. To address the gap in developing global surgery practitioners, additional online, open-access education materials and mentorship opportunities are needed for students applying to US residencies.
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Affiliation(s)
- Anusha Jayaram
- Tufts University School of Medicine, Boston, Massachusetts; Global Surgery Student Alliance, Cambridge, Massachusetts.
| | - Kristin Cardiel Nunez
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota; Global Surgery Student Alliance, Cambridge, Massachusetts
| | - Michael Flores
- Yale School of Medicine, New Haven, Connecticut; Global Surgery Student Alliance, Cambridge, Massachusetts
| | - Sarah Em Hill
- University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas; Global Surgery Student Alliance, Cambridge, Massachusetts
| | - Kyung Woo Hong
- University of Florida, Gainesville, Florida; Global Surgery Student Alliance, Cambridge, Massachusetts
| | - Connor J Peck
- Yale School of Medicine, New Haven, Connecticut; Global Surgery Student Alliance, Cambridge, Massachusetts
| | - Sarah Rapaport
- Johns Hopkins University School of Medicine;, Baltimore, Maryland; Global Surgery Student Alliance, Cambridge, Massachusetts
| | - Makela Stankey
- Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Cybil Sierra Stingl
- Virginia Commonwealth University School of Medicine, Richmond, Virginia; Global Surgery Student Alliance, Cambridge, Massachusetts
| | - Bathsheba Wariso
- MHS-Meharry Medical College, Nashville, Tennessee; Global Surgery Student Alliance, Cambridge, Massachusetts
| | - Joshua Webb
- University of Utah School of Medicine, Salt Lake City, Utah; Global Surgery Student Alliance, Cambridge, Massachusetts
| | - Caroline Wight
- Tufts University School of Medicine - Maine Track, Portland, Maine; Global Surgery Student Alliance, Cambridge, Massachusetts
| | - Parisa N Fallah
- Brigham and Women's Hospital, Massachusetts General Hospital, Boston, Massachusetts; Global Surgery Student Alliance, Cambridge, Massachusetts
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Salgado LS, Campos LN, Yabrude ATZ, Buda AM, Amaral VF, Ribeiro LLPA, Barbosa FS, Pimentel RCS, Mishaly A, Neto JB, Bezerra AH, Alonso N. Assessing Brazilian Medical Student Awareness About Global Surgery: A Survey-Based Study. J Surg Res 2021; 271:14-23. [PMID: 34814048 DOI: 10.1016/j.jss.2021.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/24/2021] [Accepted: 10/10/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Global surgery is an interdisciplinary field that advocates for access to equitable, affordable surgical services for all people. Engaging medical students in the field can strengthen the surgical workforce in low- and middle-income countries. We aim to investigate Brazilian medical students' acknowledgment of global surgery and their preferred learning platforms. MATERIALS AND METHODS We performed a cross-sectional study through an anonymous Portuguese survey on Google Forms, consisting of 30 mixed multiple-choice and five-point Likert scale questions. Students enrolled in a Brazilian medical school from the second to sixth academic year fulfilled inclusion criteria. The association between qualitative variables was assessed using Chi-square, Fisher's exact test, or binary logistic model. RESULTS We received 1,345 responses from 208 medical schools. Only 20.9% (282/1,345) of participants reported awareness of global surgery, who were predominantly female. 96.5% (1,298/1,345) declared interest in knowing more about global surgery and participants indicated social media (71.6%, 202/282) as the prevalent manner to gain awareness on it, followed by webinars (63.5%, 179/282). Extracurricular classes were the most preferable option among students (61.4%, 827/1,345) to get acquainted with the field, followed by internships (59.4%, 812/1,345), workshops (57%, 767/1,345), and social media (53.4%, 730/1,345). The main obstacles to pursue a global surgery career were lack of national opportunities (32%, 431/1,345) and adequate training (25.4%, 341/1,345). CONCLUSION We outlined the most strategic pathways to raising awareness on global surgery among Brazilian medical students, providing relevant insights on its education in similar settings.
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Affiliation(s)
- Lucas S Salgado
- União Educacional do Vale do Aço, School of Medicine, Ipatinga, MG, Brazil.
| | - Letícia N Campos
- Universidade de Pernambuco, Faculty of Medical Sciences, Recife, PE, Brazil
| | - Angela T Z Yabrude
- Universidade Regional de Blumenau, School of Medicine, Blumenau, SC, Brazil
| | | | - Vivian F Amaral
- Faculdade de Medicina de Marília, Department of Medicine, Marília, SP, Brazil
| | | | - Felipe S Barbosa
- Faculdade de Medicina de Marília, Department of Medicine, Marília, SP, Brazil
| | | | - Asher Mishaly
- Universidade Nove de Julho, School of Medicine, São Paulo, SP, Brazil
| | - João B Neto
- Faculdade de Medicina da Universidade de São Paulo, University of Sao Paulo, São Paulo, Brazil
| | | | - Nivaldo Alonso
- Department of Plastic Surgery, University of São Paulo, São Paulo, Brazil
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Sebopelo LA, Bourcier AJ, Dada OE, Adegboyega G, Nteranya DS, Kanmounye US. Retrospective review of Google Trends to gauge the popularity of global surgery worldwide: A cross-sectional study. Ann Med Surg (Lond) 2021; 71:102950. [PMID: 34703591 PMCID: PMC8524754 DOI: 10.1016/j.amsu.2021.102950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction Global surgery is a growing movement worldwide, but its expansion has not been quantified. Google Search is the most popular search engine worldwide, and Google Trends analyzes its queries to determine popularity trends. We used Google Trends to analyze the regional and temporal popularity of global surgery (GS). Furthermore, we compared GS with global health (GH) to understand if the two were correlated. Methods This is a retrospective cross-sectional study examining Google Trends of GS and GH. We searched the terms "global surgery" and "global health" on Google Trends (Google Inc., CA, USA) from January 2004 to May 2021. We identified time trends and compared the two search terms using SPSS v26 (IBM, WA, USA) to run summary descriptive analyses and Wilcoxon rank-sum tests. Results The ten countries most interested in GS were India (5.0%), the United Kingdom (5.0%), Ireland (4.0%), the United States (4.0%), Australia (3.0%), Canada (3.0%), New Zealand (3.0%), Germany (2.0%), South Africa (2.0%), and Nigeria (1.0%). GS became more popular after 2015 (2.3% vs. 1.3%, P < 0.001) and was consistently less popular than GH (1.6% vs. 45.3%, P = 0.04). The difference between GS and GH interest levels increased after 2015 (45.4% vs. 42.9%, P = 0.04). Conclusion GS is less popular than GH, more popular in high-income countries, and has become more popular after 2015 when the Lancet Commission on Global Surgery published its seminal report. The World Health Organization passed resolution WHA 68.15. Future advocacy efforts should target low- and middle-income countries primarily.
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Garcia-Marin F. Access to oral & maxillofacial surgery in Sub-Saharan African countries. J Oral Biol Craniofac Res 2021; 11:608-611. [PMID: 34567965 PMCID: PMC8449080 DOI: 10.1016/j.jobcr.2021.09.001] [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: 08/17/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022] Open
Abstract
In many regions of Africa, and especially in rural areas, basic health services are scarce, access to general surgery very difficult and Oral and Maxillofacial Surgery non-existent. In these regions, patients with pathologies in the maxillofacial area, whether malformations, tumours, infections, trauma, etc., do not have the possibility of receiving any treatment, and the mortality rate from any of these pathologies is very high. Patients who survive with these maxillofacial pathologies will have to face all their lives, in addition to the limitations of their disease, the stigma of social marginalization linked to the obvious visibility of any facial deformity. Achieving universal access to surgery (including oral and craniomaxillofacial surgery) for all human beings is part of the Sustainable Development Goals set by the UN for 2030. Achieving these goals requires the cooperation of all: public and private sectors, academic institutions, professional associations, NGOs, international agencies, medical industry and the entire global Oral and Craniomaxillofacial surgery community.
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Affiliation(s)
- Fernando Garcia-Marin
- Instituto Maxilofacial y Dental, Hospital Universitario San Francisco de Asís, Madrid, Spain
- Universidad Alfonso X el Sabio. Madrid, Spain
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Carey TA. Solving the Puzzle of Global Health Inequity: Completing the Picture Piece by Piece by Piece. ACTA ACUST UNITED AC 2021; 1:195-208. [PMID: 34622214 PMCID: PMC8397854 DOI: 10.1007/s43477-021-00022-3] [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: 05/22/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
Achieving health equity is an ongoing priority for the global community. Understanding, supporting, and addressing the challenges that face health workers is a critical component of the solution to this problem. The University of Global Health Equity (UGHE) in Rwanda has established the Institute of Global Health Equity Research (IGHER) to contribute to the generation of new knowledge through high-quality research and research training that seeks to improve our understanding of the important issues that influence the distribution of health and healthcare globally. With an unrelenting emphasis on increased impact by prioritizing implementation research, IGHER is particularly interested in amassing a compendium of important research lessons to increase the likelihood that effective implementation strategies will be employed to enhance healthcare service provision. IGHER organizes research according to five foundational research questions, which address different elements that are pivotal to a comprehensive approach to appreciating the nuanced realities of effective healthcare service provision. UGHE outputs for 2020 indicate that: appropriate resourcing of healthcare services is critical for the eradication of global health inequities; policy reform is required for many healthcare innovations and initiatives to be implemented adequately; and high-quality research that is applicable to different contexts is essential for eradicating global health inequities. Furthermore, reimagining healthcare delivery will benefit from an intentional, ongoing, bidirectional influence between evidence-based pedagogy (methods and practices of teaching, education, and instruction) and supporting research activity such that education and instruction inform the research conducted and research findings are fed back to the classroom to help improve education and instruction. As IGHER continues to grow, the valuable insights afforded by high-impact implementation research will increase. These insights will help to inform the development and use of evidence-based implementation strategies for the adoption, scaling, and sustainability of equitable, effective, and efficient health services globally.
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Affiliation(s)
- Timothy A Carey
- Institute of Global Health Equity Research, University of Global Health Equity, PO Box 6955, Kigali, 20093 Rwanda
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An Assessment Tool for Hand Surgical Education Needs and Capacity in Resource-Limited Settings. Plast Reconstr Surg 2021; 148:42e-50e. [PMID: 34181609 DOI: 10.1097/prs.0000000000008054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hand surgeons have the potential to substantially decrease the surgical disability burden in the developing world through educator trips. The Lancet Commission supports contextually driven educator trips grounded in the needs of local hosts, yet few organizations perform a comprehensive assessment of learning interests or the hosting institutions' surgical capacity before the trips. METHODS The authors adapted the Personnel, Infrastructure, Procedures, Equipment, and Supplies questionnaire, which was modified from the World Health Organization's validated Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. The authors revised each aspect of the questionnaire to reflect items pertinent to upper extremity surgery and hand trauma care. They added sections to gauge self-identified learning needs, local disease burden, operative resources, and current practices. The tool was distributed by means of Qualtrics; descriptive statistics were used to summarize data. The authors analyzed the data for all participants and performed two subgroup analyses to examine variation by regions and countries. RESULTS The authors received 338 responses from 27 countries. There was wide variability in local surgical disease burden, learning interests, and skill level of upper extremity procedures. Although learners were most interested in learning tendon transfers and microsurgical techniques, the majority did not have adequate infrastructure at their institution to sustain capacity for microvascular procedures. CONCLUSIONS Needs assessments can gauge how best to provide education during short-term visiting educator trips and optimize its impact in resource-limited settings. Understanding the needs, learning interests, and availability of resources of local learners is imperative to creating a sustainable global surgical workforce.
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Olivieri DJ, Yu ZZ, Tabin GC, Thapa R, Greenberg PB. Characterising transnational ophthalmic surgical partnerships by engagement and training. Clin Exp Ophthalmol 2021; 49:347-356. [PMID: 33751766 DOI: 10.1111/ceo.13920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transnational ophthalmic partnerships exist between high-income countries (HICs) and low- and middle-income countries (LMICs) in varying capacities. We analyzed partnership stakeholders to better understand and address disparities in ophthalmic surgical care. METHODS An international Web search was conducted to identify surgeons, foundations or organisations participating in ophthalmic delivery and/or capacity building from 2010 to 2019. Partnerships were defined through clinical activities, education and training and/or research support. Descriptive data on current ophthalmic partnerships were collected from published reports, literature reviews and information on stakeholder webpages. Partnerships were classified by the extent of engagement and training: grade I 'engagement' represented documented partnerships of at least 1 year and grade I 'training' limited or poorly defined skills transfer programmes, while grade III 'engagement' represented partnerships with well-documented fiscal investment and/or research productivity and grade III 'training' established training programmes. Data were analysed using descriptive statistics and geospatially depicted on Tableau (Mountain View, CA) and ArcMap software (Redlands, CA). RESULTS In total, 209 unique HIC-LMIC partnerships encompassing 92 unique countries were described. The most common HIC partners were from North America (123; 59%), followed by Europe (75; 36%). The most common LMIC partners were from Africa (102; 49%), followed by Asia-Pacific (54; 26%) and Latin America (44; 21%). Additionally, partnerships most frequently provided services in cataract (48%), glaucoma (25%) and diabetic retinopathy (25%). The most common 'engagement' classifications were grade I (36%) or II (40%); the most common 'training' classifications were grade I (61%) or II (23%). CONCLUSION Transnational ophthalmic partnerships exist with varying degrees of both engagement and training. Partnerships are stronger in research collaboration and direct services, and weaker in LMIC-directed training programmes.
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Affiliation(s)
- Daniel J Olivieri
- Division of Ophthalmology, Alpert Medical School, Brown University, Providence, Rhode Island, USA.,Section of Ophthalmology, Providence VA Medical Center, Providence, Rhode Island, USA.,Watson Institute for International and Public Affairs, Brown University, Providence, Rhode Island, USA
| | - Zane Z Yu
- Division of Ophthalmology, Alpert Medical School, Brown University, Providence, Rhode Island, USA.,Section of Ophthalmology, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Geoffrey C Tabin
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Raba Thapa
- Vitreo-Retina Service, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Paul B Greenberg
- Division of Ophthalmology, Alpert Medical School, Brown University, Providence, Rhode Island, USA.,Section of Ophthalmology, Providence VA Medical Center, Providence, Rhode Island, USA
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Velin L, Lartigue JW, Johnson SA, Zorigtbaatar A, Kanmounye US, Truche P, Joseph MN. Conference equity in global health: a systematic review of factors impacting LMIC representation at global health conferences. BMJ Glob Health 2021; 6:bmjgh-2020-003455. [PMID: 33472838 PMCID: PMC7818815 DOI: 10.1136/bmjgh-2020-003455] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Global health conferences are important platforms for knowledge exchange, decision-making and personal and professional growth for attendees. Neocolonial patterns in global health at large and recent opinion reports indicate that stakeholders from low- and middle-income countries (LMICs) may be under-represented at such conferences. This study aims to describe the factors that impact LMIC representation at global health conferences. METHODS A systematic review of articles reporting factors determining global health conference attendance was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles presenting conference demographics and data on the barriers and/or facilitators to attendance were included. Articles were screened at title and abstract level by four independent reviewers. Eligible articles were read in full text, analysed and evaluated with a risk of bias assessment. RESULTS Among 8765 articles screened, 46 articles met inclusion criteria. Thematic analysis yielded two themes: 'barriers to conference attendance' and 'facilitators to conference attendance'. In total, 112 conferences with 254 601 attendees were described, of which 4% of the conferences were hosted in low-income countries. Of the 98 302 conference attendees, for whom affiliation was disclosed, 38 167 (39%) were from LMICs. CONCLUSION 'Conference inequity' is common in global health, with LMIC attendees under-represented at global health conferences. LMIC attendance is limited by systemic barriers including high travel costs, visa restrictions and lower acceptance rates for research presentations. This may be mitigated by relocating conferences to visa-friendly countries, providing travel scholarships and developing mentorship programmes to enable LMIC researchers to participate in global conferences.
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Affiliation(s)
- Lotta Velin
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Jean-Wilguens Lartigue
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- State University of Haiti Faculty of Medicine and Pharmacy, Port-au-Prince, Ouest, Haiti
| | - Samantha Ann Johnson
- Medicine, Life Sciences & Psychology Department, University of Warwick, Coventry, West Midlands, UK
| | - Anudari Zorigtbaatar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- McGill University Faculty of Medicine, Montreal, Québec, Canada
| | - Ulrick Sidney Kanmounye
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, University of Kinshasa Faculty of Medicine, Kinshasa, Congo (the Democratic Republic of the)
| | - Paul Truche
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of General Surgery, Rutgers Robert Wood Johnson Medical School New Brunswick, New Brunswick, New Jersey, USA
| | - Michelle Nyah Joseph
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, West Midlands, UK
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