Global health education in Swedish medical schools

Beyond the surface: unraveling global health curriculum insights through interviews of learners and educators using the CIPP model

PURPOSE

Our study aimed to delve beyond a surface-level understanding and explore the various dimensions of the global health curriculum from the perspective of both learners and educators using the Context, Input, Process, and Product (CIPP) model.

METHODS

From 2020 to 2021, interviews were conducted with a total of 10 individuals, including five students who had taken at least one elective course and at least one elective research course, three teaching assistants (TA), and two faculty members who had taken more than four global health courses in multiple phases in the global health curriculum. Semi-structured interview questions based on the CIPP model were used and qualitative data were analyzed through content analysis.

RESULTS

The study identified 12 sub-themes. Students held idealized views of global health careers and sought to bridge the gap through global health classes. They desired early exposure to global health courses, emphasizing both pre-medical and clinical phases. Challenges in adjusting course difficulty and recruiting faculty were identified, along with a preference for interactive teaching methods and offline discussions. The curriculum promoted reflection on medicine's essence, expanded career perspectives, and emphasized competencies like altruism, communication skills, and crisis management in the evolving global health landscape.

CONCLUSION

This study showed that a comprehensive approach is possible from the perspective of learners and educators by identifying strengths, weaknesses, and the value of the curriculum's goals, plans, implementations, and results through the CIPP model. For optimal curriculum design, a sequential approach from basic to advanced courses is essential, promoting hands-on global health experiences for students.

What is the role of global health and sustainable development in Swedish medical education? A qualitative study of key stakeholders' perspectives

BACKGROUND

Global health and sustainable development have increasingly been recognised as important parts of medical education, yet education on these issues remains fragmented and scarce. In 2020, a bill to reform the national medical curricula across all Swedish medical schools was introduced, including a greater emphasis on global health and sustainable development. This study aimed to explore the perspectives of key stakeholders in medical education on the role of global health and sustainable development in Swedish medical education.

METHODS

This was a qualitative study based on semi-structured interviews with 11 key stakeholders in medical education, broadly defined as faculty board members (dean and/or vice-deans for medical education) and/or programme chairs representing six universities. Data were analysed using qualitative content analyis (QCA). The study was conducted according to the Consolidated Criteria for Reporting Qualitative research (COREQ) guidelines.

RESULTS

Stakeholders discussed the challenges and opportunities associated with the modification of medical education, which was seen as necessary modernisation to fit the changing societal perception of the role of medical doctors. The anchoring process of redesigning the curriculum and integrating global health and sustainable development was discussed, with emphasis on ownership and mandate and the role of teachers and students in the process. Finding a shared understanding of global health and sustainable development was perceived as a challenge, associated with resistance due to fear of curriculum overload. To overcome this, integrating global health and sustainable development with other topics and developing existing components of the curricula were seen as important. Additionally, it was stressed that fostering capacity building and developing infrastructure, including utilization of digital tools and collaborations, were essential to ensure successful implementation.

CONCLUSIONS

Medical institutions should prepare future doctors to respond to the needs of a globalised world, which include knowledge of global health and sustainable development. However, conceptual uncertainties and questions about ownership remain among key stakeholders in medical education. Yet, key stakeholders also highlight that the inclusion of global health and sustainable development in the new curricula represents multiple overarching educational opportunities that can bring about necessary improvement.

International Survey of Medical Students Exposure to Relevant Global Surgery (ISOMERS): A Cross-Sectional Study

BACKGROUND

The principles of global surgery should be taught as a part of the core curriculum in medical schools. The need for medical students to be familiar with the topic is increasing in acceptance. There is, however, a paucity of data on how medical students are exposed to global surgery. This study aims to evaluate exposure of medical students to global surgery, awareness of the key messages of the Lancet Commission on Global Surgery, global surgery career aspirations and barriers to said aspirations.

METHODS

ISOMERS was a multi-centre, online, cross-sectional survey of final year medical students globally. The questionnaire utilised a combination of Likert-scale, multiple-choice, and free text questions.

RESULTS

In this study, 1593 final year medical students from 144 medical schools in 20 countries participated. The majority (n = 869/1496, 58.1%) believed global surgery to be relevant, despite 17.7% (n = 271/1535) having any exposure to global surgery. Most participants (n = 1187/1476, 80.4%) wanted additional resources on global surgery. Difficulty in providing appropriate care for patients living abroad (n = 854/1242, 68.8%) was the most common perceived barrier to a career in global surgery.

CONCLUSIONS

Participants believed global surgery was a relevant topic for medical students and wanted additional resources that they could access on global surgery. It is critical for medical students to become aware that global surgery is a field that aims to address inequity in surgical care not just internationally, but nationally and locally as well.

Global health education in China's medical schools: A national cross-sectional study

INTRODUCTION

Despite China's large and growing global presence, data about global health (GH) education (GHE) in China's medical schools are limited. We aimed to describe GHE in these schools and determine whether some may teach GH concepts without labeling them as such.

METHODS

In 2019, 161 Chinese medical schools eligible for accreditation by the Ministry of Education were invited to complete a questionnaire as part of a national survey. Data were analyzed using descriptive analyses, Chi-square tests, Fisher exact tests, and logit models.

RESULTS

Approximately 57% of schools completed the survey (n = 93). 33 (35.5%) indicated that GHE was included in the curriculum. Although the majority of responding schools reported the absence of GH in the curriculum, GH topics were identified at many institutions. Schools affiliated with the central government or an aspiring world-class university were more likely to report the inclusion of GHE and offered more opportunities at international away sites.

CONCLUSIONS

Chinese medical schools are frequently teaching GH topics, but may not label the instruction as such. Policy-makers and educators should be equipped with a global perspective to facilitate GHE at China's medical schools and take measures to address differences between schools.

Global surgery for medical students - is it meaningful? A mixed-method study

Introduction

There has been an increase in global health courses at medical universities in high-income countries. Their effect on students, however, is poorly understood. In 2016 an elective global surgery course was introduced for medical students at Karolinska Institutet in Sweden. The course includes a theoretical module in Sweden and a two-week clinical rotation in Uganda. The present study aimed to assess the format and determine its effect on students’ knowledge of global surgery and approach towards patients of non-Swedish origin.

Method

A mixed-methods design was used. Semi-structured case-based interviews were conducted individually with 18 students and analysed using qualitative content analysis. Examination scores and the course evaluation were analysed with Kruskal Wallis one-way analysis of variance, Pearson’s Chi-square and a Wilcoxon signed-rank test as appropriate.

Results

The course was appreciated and students reported gained insights and interest in global surgery. Students’ ability to reason about global surgery issues was improved after the course. Students considered complicating aspects in the meeting with patients of non-Swedish origin. Students with abroad clinical experience felt less compelled to act on preconceptions.

Discussion

The global surgery course at Karolinska Institutet is appreciated and students gained valuable knowledge. The case-based interviews acted as a catalyst for reflection and showed that students felt insecure as they lacked knowledge about globally common surgical conditions and struggled with generalized preconceptions of patients of non-Swedish origin. To further support students to integrate theoretical knowledge and professional development, we suggest the introduction of problem-based learning.

Conclusion

The ability of the course to inspire students’ commitment to global surgery is promising as this engagement is the key to reaching the goal of equitable health globally. Offering such courses is a step towards inspiring and recruiting the future clinicians and researchers needed for expanding the field of global surgery.

National, collaborative evaluation of medical student and faculty perspectives on global surgery - Survey of undergraduate respondents on global surgery education (SURGE): A cross-sectional study

INTRODUCTION

It is estimated that 28-32% of the global burden of disease can be treated with surgery. Most of this burden is concentrated in low and middle-income countries, underpinning the importance of the topic of global surgery (GS). The multidisciplinary principles of GS are increasingly recognised as being key to modern practice and as such, must be fostered at early stages of medical training. However, it is unclear whether medical students are being exposed to GS. This study aimed to assess the importance of GS and its presence in medical curricula.

METHODS

A novel, 22-item online questionnaire was developed and disseminated to medical students and faculty members using social media platforms. Data collection was conducted by a collaboration of medical students, who acted as regional leads at their institutions.

RESULTS

795 medical students and 141 faculty members representing 38/42 (90.4%) of UK medical schools completed the questionnaire. Only 84 students (10.6%) were previously exposed to GS. Most students (66.3%) and faculty (60.6%) agreed that GS should be an integral part of the curriculum. Only 20 students (2.5%) were familiar with what a career in GS means.

CONCLUSION

Approximately two-third of students and faculty agree that global surgery should be an integral part of the mandatory curriculum. Findings of this study should underpin further incorporation of GS into curricula, as high-income countries can decisively contribute to achieving the global surgery 2030 targets, by training a new generation of clinicians who are ready for the challenges of the 21st century.

Global health education for medical students in Italy

BACKGROUND

Global health education (GHE) in Italy has spread since the first decade of 21st century. The presence of global health (GH) courses in Italy was monitored from 2007 to 2013. In 2019, a new survey was proposed to assess the availability of educational opportunities in Italian medical schools.

METHODS

An online survey was carried out using a questionnaire administered to a network of interested individuals with different roles in the academic world: students, professors, and members of the Italian Network for Global Health Education. The features of courses were analysed through a score.

RESULTS

A total of 61 responses were received from affiliates of 33 out of the 44 medical schools in Italy. The national mean of GH courses for each faculty was 1.2, reflecting an increase from 2007. The courses increased nationwide, resulting in a dispersed GHE presence in northern, central and southern Italy. One of the most critical points was related to the nature of "elective" courses, which were not mandatory in the curricula. Enrollees tended to be students genuinely interested in GH issues. Some community and service-learning experiences, referred to as GH gyms, were also detected at national and international levels.

CONCLUSIONS

GHE has spreading in Italy in line with the vision of the Italian Network for Global Health Education. Although progress has been made to disperse GH courses around the country, more academic commitment is needed to include GH in the mandatory curricula of medical schools and other health faculties.

Trainee Perspectives Regarding Advanced Clinical Global Health Fellowships in North America

Postgraduate clinical global health (GH) training is a rapidly evolving field. To understand and improve training opportunities, we sought the perspectives of current and former trainees related to their advanced clinical training or global health fellowships and the anticipated impact on their careers. Clinical GH fellowships across North America were identified through websites and previous studies. An e-mail was sent to program directors to invite all current and former GH fellows to complete a web-based questionnaire. We contacted 100 GH fellowship programs. Fifty-two fellows from 10 different specialties completed the survey. The median fellowship length was 23.3 months, with an annual median of 4.8 months spent in low-income and middle-income countries, which was less than their reported ideal of 6 months. The majority reported satisfaction, the anticipation of career benefits, and that they would recommend fellowship training to others. Challenges included insufficient funding, mentorship, and formal curricula. Conducting research in high-income countries was a significant negative predictor of fellowship satisfaction. Most fellows (73.1%) were not at all or only a little concerned about the absence of fellowship accreditation, with only 17.3% desiring accreditation. Survey respondents were largely satisfied with their training and valued program flexibility and educational opportunities, including advanced tropical medicine certificates or diplomas. However, to improve fellowship training, improvements are needed in mentorship, standardized curricula, institutional support, and funding. For GH fellowship training to be effective and sustainable, institutions will need to balance the needs of fellows, training programs, and the communities (low-, middle-, and high-income countries) where the fellows serve.

Integrating Global Health Within Dental Education: Inter-University Collaboration for Scaling Up a Pilot Curriculum

Background:

New education programs are developing to improve global health awareness. Dental students have demonstrated interest in international settings but are largely unaware of global health topics. The Timothy A. DeRouen Center for Global Oral Health of the University of Washington (UW) and Harvard School of Dental Medicine expanded a competency-based global health curriculum (Global Health Starter Kit) by integrating it within the UW School of Dentistry (UW SOD) existing elective course “Global Oral Health” to undergraduates, pre-, and doctorate students from the UW SOD and Public Health. The study objective was to evaluate the curriculum effectiveness by assessing 1) Knowledge and Attitudes (survey), and 2) Didactic coursework (global trends, global goals, primary care, social determinants and risks, and ethics and sustainability).

Methods:

Eligibility included enrolled students with both pre- and post-assessments. Descriptive statistics were conducted to present demographic data. Significant changes on survey and didactic evaluations were analyzed with paired t-tests (p < 0.05).

Findings:

The population (N = 15) represented 88% of the class. All Knowledge categories had a significant increase (p < 0.05), except in the topic of tropical diseases. At baseline, Attitudes categories had high scores and did not significantly increase by the end of the course. Even though all Didactic categories improved, only Social Determinants and Risks showed a significant increase (p < 0.01).

Conclusion:

Competency-based global health learning can be implemented in the dental curriculum. While the study shows promising results, efforts to identify areas for improvement as well as considerations of the institution’s culture need to be assessed and addressed for each teaching cycle.

Effects of gender and grade on differences in physiotherapy students' interest and reasons for participating in overseas volunteer programs

[Purpose] The purpose of the present study was to evaluate the gender and grade differences in interest and reasons associated with overseas volunteer participation among physiotherapy students using a cross-sectional survey. [Participants and Methods] The participants were 1,093 physiotherapy students who were enrolled at the International University of Health and Welfare's Ohtawara, Narita, Odawara, and Fukuoka campuses in 2017. A cross-sectional design was used to study the differences between gender and among undergraduate grade levels. The degree of interest and reasons associated with overseas volunteer participation were evaluated by a questionnaire survey using a four-point scale. [Results] Female students were significantly more interested and active in overseas volunteer participation than male students. As for participation by students' grades, significant differences were found in three items only among female students. [Conclusion] Female students were significantly more active at volunteering than male students. It was suggested that we need to encourage students to engage in overseas volunteer participation from the time of admission, especially female students.

Students' perceptions of global health competencies in the doctor of pharmacy (PharmD) curriculum

INTRODUCTION

This study sought to determine pharmacy students' self-assessment of their level of competency in specified global health statements across various schools. It also evaluated attributes associated with competency and perception of importance, as well as explored students' perspectives on how best to incorporate global health content into pharmacy education.

METHODS

Cross-sectional survey administered online to pharmacy students from three pharmacy schools in the United States.

RESULTS

The self-assessed competency of pharmacy students in global health topic areas was low. Current or prior exposures outside of the PharmD curriculum to the global health content presented in the survey were significant indicators of self-assessed competency scores. Within individual participating schools, demographic characteristics such as gender, age category, speaking a non-English language, and progression through the PharmD curriculum were also significantly associated with competency scores reported. Most respondents (96%) agreed that relevant global health education should be incorporated into the pharmacy curriculum.

CONCLUSIONS

Pharmacy students generally perceive global health competencies to be of great importance in practice, but acknowledge their deficiencies in this area. The current burden of global health education at the schools surveyed relies on individual student experience rather than curricular support. Ensuring that future pharmacists understand their role in global health teams and are able to achieve the necessary level of competency to function in interdisciplinary initiatives will require more strategic incorporation of relevant content into the curriculum.

Medical education: an Italian contribution to the discussion on global health education

BACKGROUND

In Italy an important contribution to the spread of global health education (GHE) grew from the establishment and work of the Italian Network for Global Health Education (INGHE). INGHE gave a national shared definition of global health (GH), grounded in the theory of determinants of health, inspired by a vision of social justice, and committed to reduce health inequities. The aim of this article is to share with the international community INGHE's point of view on Medical Education.

METHODS

To express its view of medical education at the national level, INGHE established a dedicated commission, which elaborated a first draft of the document and then shared and discussed it with all other members.

RESULTS

INGHE elaborated a paper where it explained the need to change medical education in order to prepare future health professionals for the challenges of the globalized and unequal world. In this article the authors summarize the experience of INGHE and share with the international community its document.

CONCLUSIONS

The authors believe it is necessary now, more than ever, to insert this new approach to health at social and academic levels. Students should play a fundamental role in the spread of GHE, and activities related with GHE could be considered an important part of the third mission of universities to promote social justice.

Global Health Learning Outcomes in Pharmacy Students Completing International Advanced Pharmacy Practice Experiences

Objective. To examine the global health learning outcomes of Doctor of Pharmacy (PharmD) students from three US schools who participated in international advanced pharmacy practice experiences (APPEs). Methods. A mixed-methods, prospective study was used to assess fourth-year PharmD students at three US pharmacy schools who participated in an international APPE during the 2017-2018 academic year and a matched cohort (control group) of PharmD students who did not participate in an international APPE. To evaluate students' self-perceived growth in the Consortium of Universities for Global Health (CUGH) competencies, all students completed a 13-item retrospective pre-post instrument using a five-point Likert scale. The students who had completed an international APPE were invited to participate in a focus group (N=22). Paired and independent t tests and multiple linear regression were used to analyze data. Qualitative open-ended questions and focus group data were mapped to knowledge, skills, and attitudes themes. Results. The students who completed an international APPE (N=81) showed significantly more growth in CUGH competencies than students who did not (mean improvement in total score of 10.3 [7.0] vs 2.4 [6.0]). International APPE participation was the only significant predictor of growth in CUGH competencies. The international APPE students reported improvements in cultural awareness and appreciation, communication skills, problem-solving skills, adaptability, self-awareness, personal and professional outlook, and global health perspective. Conclusion. Pharmacy students' participation in international APPEs led to significant improvement in all CUGH competencies. The CUGH competency framework appears to be a suitable instrument to assess pharmacy students' global health learning outcomes.

Development of a Novel Global Surgery Course for Medical Schools

OBJECTIVE

We endeavored to create a comprehensive course in global surgery involving multinational exchange.

DESIGN

The course involved 2 weeks of didactics, 2 weeks of clinical rotations in a low-resource setting and 1 week for a capstone project. We evaluated our success through knowledge tests, surveys of the students, and surveys of our Zimbabwean hosts.

SETTING

The didactic portions were held in Sweden, and the clinical portion was primarily in Harare with hospitals affiliated with the University of Zimbabwe.

PARTICIPANTS

Final year medical students from Lund University in Sweden, Harvard Medical School in the USA and the University of Zimbabwe all participated in didactics in Sweden. The Swedish and American students then traveled to Zimbabwe for clinical work. The Zimbabwean students remained in Sweden for a clinical experience.

RESULTS

The course has been taught for 3 consecutive years and is an established part of the curriculum at Lund University, with regular participation from Harvard Medical School and the University of Zimbabwe. Participants report significant improvements in their physical exam skills and their appreciation of the needs of underserved populations, as well as confidence with global surgical concepts. Our Zimbabwean hosts thought the visitors integrated well into the clinical teams, added value to their own students' experience and believe that the exchange should continue despite the burden associated with hosting visiting students.

CONCLUSIONS

Here we detail the development of a course in global surgery for medical students that integrates didactic as well as clinical experiences in a low-resource setting. The course includes a true multilateral exchange with students from Sweden, the United States and Zimbabwe participating regularly. We hope that this course might serve as a model for other medical schools looking to establish courses in this burgeoning field.

Development of a global health bachelor curriculum in China: a Delphi study

OBJECTIVE

This study aimed to establish the first global health bachelor curriculum in China.

DESIGN

The Delphi methodology was used to determine expert consensus on which courses should be included in the global health bachelor curriculum. A literature review and a workshop proceeding were performed to generate courses. Then a two-round Delphi process was conducted with 28 invited experts from universities, health administrative departments and non-governmental organisations to rate courses using a 5-point Likert scale. Additionally, the experts could alter, add or delete courses as appropriate. Consensus was predefined as a mean score of 4 or above and the percent agreement (proportion of panel members scoring 'very important' or 'important') no less than 75%.

RESULTS

The responses in the two-round Delphi process were 85.7% and 70.8%, respectively. In the first round, 12 courses did not meet the inclusion criteria and were removed. Based on the participants' comments, 32 courses were included in round 2. In the second round, the consensus was reached on 31 courses which were selected as the final curriculum. These courses were categorised into five modules, including General Knowledge, Methodology, Global Health Issues, Intercultural Communication, and Health Policy and Programme Management.

CONCLUSION

This study established the first global health bachelor curriculum in China. It will provide guidance for other educational institutions to develop similar programmes or curricula in the future.

National survey of international electives for global health in undergraduate medical education in Japan, 2011-2014

Interest in global health in medical education is increasing in Western countries, whereas data from non-Western countries is scarce. Here, we conducted a nationwide study of international clinical electives at Japanese medical schools from 2011 to 2013. We constructed a 28-item cross-sectional survey in Japanese to investigate the rate and characteristics of both Japanese students going abroad and international students coming on exchange to Japan. The surveys were sent to the administrative offices of all 80 Japanese medical schools in each of the three years, through the Japan Medical Education Foundation. All 80 medical schools responded to the questionnaire (response rate, 100%). An average of 70 of the 80 medical universities provided exchange programs across the three years to allow students to travel abroad as part of the school curriculum and obtain academic credit. The schools provided support in the form of in- and outside-class preparatory programs, tuition fee exemptions and housing. The most popular destinations for Japanese students going abroad were Europe and North America, which may reflect the desire of Japanese students to acquire medical knowledge or experience through exposure to the English language. In contrast, the most common countries of origin of international exchange students coming to Japan were Asian countries such as South Korea, Thailand and Taiwan, with pediatrics being the most popular elective. Foreign exchange programs are becoming increasingly incorporated into the Japanese medical education curriculum and can help to strengthen international partnerships and collaborations.

Global Health Competency Self-Confidence Scale: Tool Development and Validation

The scale, designed to measure students' self-assessment of their confidence in 11 competency domains before and after participating in global placements, was found to be reliable and correlated well with an earlier validated scale.

Background:

Global health education in tertiary institutions worldwide is at an all-time high. Until recently, most evaluations of student learning from a global exposure was in the form of a reflective paper with little information that would enable standardized assessment of the competencies gained. In 2015, the Consortium of Universities for Global Health (CUGH) published a set of interprofessional global health competencies that were drawn upon to create a Global Health Competency Self-Confidence Scale and workbook. This study reports the development and validation of the scale and its implications for global health education.

Methods:

In total, 126 graduate students from a university in New York State participated in the validation process of the Global Health Competency Self-Confidence Scale—an 11-domain, 22-item competency self-assessment to measure the level of confidence of students before and after undertaking a global learning experience. The team used factor analysis to compare the scale to the Global Health Competency Survey for content validity and reliability.

Results:

Reliability and validity of the scale was determined. An exploratory factor analysis identified 4 standalone components as: (1) Ethical and Professional Practice, (2) Capacity Strengthening and Planning, (3) Structural and Social Determinants of Health, and (4) Strategic Analysis. The scale showed excellent internal consistency (Cronbach's alpha=0.92) and test-retest reliability (reliability (r)=0.455; P<.001). Concurrent validity was established.

Conclusion:

The Global Health Competency Self-Confidence Scale contributes to a further consolidation and refinement of competency groupings into components of global health education and offers a scale to assess student learning in global placements.

Training Young Russian Physicians in Uganda: A Unique Program for Introducing Global Health Education in Russia

BACKGROUND

Global health is a new concept in Russia. There has been an ongoing academic collaboration between the Yale School of Medicine in the United States and Makerere University College of Health Sciences in Uganda since 2010, and the US Western Connecticut Health Network/University of Vermont College of Medicine since 2012, to introduce global health concepts to Kazan State Medical University (KSMU) in Russia. The purpose was to educate Russian physicians and medical trainees about the practice of clinical medicine and medical education, as well as the general practice of global health in culturally diverse, resource-limited settings.

OBJECTIVES

The aim of this study was to evaluate the initial outcomes of this multi-institutional partnership and to assess the impact of the global health elective on the participants and on KSMU.

METHODS

Participants were selected to attend a 6-week elective in global health at Mulago Hospital in Kampala, Uganda. The elective consisted of clinical experience, education about Uganda's common diseases, and region-specific sociocultural classes. It included a predeparture orientation and, upon return, completion of a standard questionnaire to assess the program's impact.

RESULTS

Since 2010, there have been 20 KSMU members (4 medical students, 4 interns, 9 residents, 2 fellows, and 1 faculty member) who have participated in the program. As a result of the elective, the participants reported increased knowledge of tropical medicine (70%) and HIV/AIDS (75%), and 95% reported increased cultural sensitivity and desire to work with the underserved. The majority noted a very positive impact of their careers (90%) and personal life (80%). KSMU established the first successful collaborative program in global health education in Russia, leading to the integration of tropical medicine and global health courses in medical school curriculum.

CONCLUSION

This elective has proven highly effective in introducing the concept of global health to faculty, fellows, residents, and medical students at KSMU. It trained these participants to address the challenges faced by physicians in culturally diverse and resource-limited countries.

Global Surgery 2030: a roadmap for high income country actors

The Millennium Development Goals have ended and the Sustainable Development Goals have begun, marking a shift in the global health landscape. The frame of reference has changed from a focus on 8 development priorities to an expansive set of 17 interrelated goals intended to improve the well-being of all people. In this time of change, several groups, including the Lancet Commission on Global Surgery, have brought a critical problem to the fore: 5 billion people lack access to safe, affordable surgical and anaesthesia care when needed. The magnitude of this problem and the world's new focus on strengthening health systems mandate reimagined roles for and renewed commitments from high income country actors in global surgery. To discuss the way forward, on 6 May 2015, the Commission held its North American launch event in Boston, Massachusetts. Panels of experts outlined the current state of knowledge and agreed on the roles of surgical colleges and academic medical centres; trainees and training programmes; academia; global health funders; the biomedical devices industry, and news media and advocacy organisations in building sustainable, resilient surgical systems. This paper summarises these discussions and serves as a consensus statement providing practical advice to these groups. It traces a common policy agenda between major actors and provides a roadmap for maximising benefit to surgical patients worldwide. To close the access gap by 2030, individuals and organisations must work collectively, interprofessionally and globally. High income country actors must abandon colonial narratives and work alongside low and middle income country partners to build the surgical systems of the future.