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Cox ML, Allen DZ, Rodriguez MM, Green JC, Kain JJ. An Analysis of Global Surgery Opportunities in American Otolaryngology Residency Programs. Laryngoscope 2024. [PMID: 38733148 DOI: 10.1002/lary.31511] [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: 01/24/2024] [Revised: 04/05/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES To depict the current state of global surgery opportunities in United States ACGME-approved Otolaryngology residency programs and compare the characteristics of programs with and without these opportunities. METHODS In this cross-sectional analysis, websites of ACGME-accredited Otolaryngology residency programs were analyzed for information on program size, rank, age, and geographic region as obtained through the Doximity platform in 2023. Additional parameters were obtained for programs listing global surgery opportunities such as funding, faculty oversight, location/region, focus, and relationship to the community served. Data were tabulated and analyzed in Microsoft Excel and Stata. RESULTS Of the 131 ACGME-accredited Otolaryngology residency programs, 26 (20%) of programs advertised a global surgery opportunity. Nine (35%) of these promoted funding, 15 (58%) offered a clinical focus, one (4%) offered a research focus, and 10 (38%) offered a combined approach. The Midwest region had the most programs with global surgery opportunities (n = 8, 31%). Less than half (42%) of programs had an established partnership with local partners within low and middle-income countries (LMICs). When comparing programs, the average Doximity rank, average program age, and average program size of programs that offered global surgery opportunities was significantly higher than those that did not (37.2 vs. 71.5, 54 vs. 41, 19.5 vs. 13.7; all p < 0.05). CONCLUSIONS Approximately one-fifth of Otolaryngology training programs have a global surgery opportunity. Programs that offer these opportunities had a higher Doximity ranking, older program age, and a larger trainee cohort. These results highlight potential areas for expanding global surgery opportunities in academic institutions. LEVEL OF EVIDENCE N/A Laryngoscope, 2024.
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Affiliation(s)
- Madisyn L Cox
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - David Z Allen
- Department of Otolaryngology, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Megan M Rodriguez
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jackson C Green
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Joshua J Kain
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
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Lin Y, Hoffner-Heinike A, Clair V, Han JJ, Louis C, Bolman R. Global cardiothoracic surgery: A survey of trainees' interests and barriers. JTCVS OPEN 2023; 16:610-618. [PMID: 38204623 PMCID: PMC10775122 DOI: 10.1016/j.xjon.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/17/2023] [Accepted: 07/31/2023] [Indexed: 01/12/2024]
Abstract
Background More than 5 billion people lack access to surgical care, disproportionately in low- and middle-income countries. The emerging literature demonstrates high interest in global surgery across specialties; however, participation in global cardiothoracic surgical care remains low. To date, there has been no research quantifying the attitudes of cardiothoracic surgeons about global surgery. Our study aimed to acquire a broader understanding of cardiothoracic surgical trainees' interest in global surgery to address barriers and promote cardiac healthcare worldwide. Methods An online survey was sent to all North American cardiothoracic surgical residents via the Thoracic Surgery Residents Association email listserv. The survey was designed in the REDCap database and administered twice, in 2021 and 2022. Data were analyzed by descriptive and chi-square analysis using Stata. Results Seventy-three cardiothoracic surgical trainees responded to our survey, of whom 95.3% considered increasing cardiothoracic surgical access to be important, and 67.2% identified this as a future career priority. Most respondents (82.8%) would participate in global surgery if opportunities were available through their home institution. Lack of opportunities (70.0%) and finances (66.7%) were the primary barriers to participation. Respondents identified funding (85%) and institutional support (83.3%) as the most significant incentives to increase involvement. Conclusions There is strong interest in global surgery among cardiothoracic trainees; however, involvement remains low. A consensus among the North American cardiothoracic surgical community is needed to address barriers to global volunteerism within surgical residency and improve access to cardiac surgery worldwide.
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Affiliation(s)
- Yihan Lin
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, Calif
| | | | - Victoria Clair
- Department of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - Jason J. Han
- Division of Cardiothoracic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Clauden Louis
- Brigham and Women's Hospital, Harvard University, Boston, Mass
| | - Ralph Bolman
- Department of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colo
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Stryker SD, Conway K, Kaeppler C, Porada K, Tam RP, Holmberg PJ, Schubert C. Underprepared: influences of U.S. medical students' self-assessed confidence in immigrant and refugee health care. MEDICAL EDUCATION ONLINE 2023; 28:2161117. [PMID: 36594616 PMCID: PMC9815430 DOI: 10.1080/10872981.2022.2161117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/19/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND United States (U.S.) census data from 2017 indicates that the percentage of persons born outside of the U.S. is increasing. However, no studies describe the amount of class time focused on immigrant and refugee health during medical school in the U.S. nor on incoming residents' confidence in providing culturally sensitive care. The objective of this study is to characterize final-year medical students' exposure to immigrant and refugee health and their confidence in caring for these populations. METHODS A voluntary, cross-sectional survey was sent electronically to fourth-year medical students at twelve U.S. medical schools in 2020, with 707 respondents (46% response rate). Questions addressed respondents' curricular exposure to immigrant and refugee health care during medical school and their confidence in providing culturally sensitive care. Chi-square tests were used to assess relationships between categorical variables, and odds ratios were calculated for dichotomized variables. RESULTS Most students (70.6%) described insufficient class time dedicated to culturally sensitive care, and many (64.5%) reported insufficient clinical exposure in caring for immigrants/refugees. The odds that incoming residents felt 'usually' or 'always' confident in their ability to provide culturally sensitive care to immigrants and refugees were higher in those with more class time on culturally sensitive care (OR 5.2 [3.6-7.4]), those with more clinical opportunities to care for immigrants and refugees (OR 7.2 [5.1-10.2]), and those who participated in a domestic low-resource or international elective (OR 1.4 [1.02-1.9]). More than half (55.3%) of respondents reported feeling 'not at all' or only 'sometimes' confident in their ability to provide culturally sensitive care to immigrants/refugees. CONCLUSIONS Most fourth-year U.S. medical students entering residency feel unprepared to deliver culturally sensitive care to immigrants and refugees. This may be mediated by increased exposure to didactic curricula class time and/or experiential clinical activities, as those factors are associated with improved student confidence.
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Affiliation(s)
- Shanna D. Stryker
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katharine Conway
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
| | - Caitlin Kaeppler
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin,USA
| | - Kelsey Porada
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin,USA
| | - Reena P. Tam
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Charles Schubert
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Reynolds CW, Kolars JC, Bekele A. Ten Questions to Guide Learners Seeking Equitable Global Health Experiences Abroad. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1107-1112. [PMID: 37094281 PMCID: PMC10516162 DOI: 10.1097/acm.0000000000005255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
"Global health experiences," clinical and research learning opportunities where learners from high-income country (HIC) institutions travel to low- and middle-income countries (LMICs), are becoming increasingly popular and prolific in the health sciences. Increased interest has been well documented among medical, pharmacy, and nursing learners who are driving these agendas at their institutions. Although such opportunities have potential to mutually benefit the learner and host, in practice they can be exploitative, benefiting HIC learners without reciprocity for LMIC hosts. Given these and other pervasive ethical concerns in global health, efforts to decolonize global health and emphasize equity are being made at the institutional level. Despite progress toward global health equity from institutions, most learners lack the resources and education needed to critically evaluate the numerous global health opportunities or equitably codesign these experiences for themselves. This article offers 10 guiding questions that learners should answer before selecting or codesigning a global health opportunity through a lens of global health equity. These prompts encompass values including motivations, reciprocity, accountability, sustainability, financial implications, self-reflection, bidirectional communication, and mitigating burden and power dynamics. The authors provide tips, pitfalls to avoid, and pragmatic examples for learners working to actualize partnerships and opportunities aligned with the movement of global health equity. With these guiding questions and accompanying reflection tool, learners, faculty members, and their LMIC partners should be better equipped to engage in mutually beneficial partnership through the framework of global health equity.
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Affiliation(s)
- Christopher W. Reynolds
- C.W. Reynolds is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-6634-391X
| | - Joseph C. Kolars
- J.C. Kolars is director, Center for Global Health Equity, senior associate dean for education and global initiatives, and Josiah Macy Jr. Professor of Health Professions Education, University of Michigan Medical School, Ann Arbor, Michigan
| | - Abebe Bekele
- A. Bekele is deputy vice chancellor of academic and research affairs, dean of the school of medicine, and professor of general and thoracic surgery, University of Global Health Equity, Butaro, Rwanda
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Dhawan A, Rammelkamp Z, Kayandabila J, Surapaneni VL. Ethical Considerations of Climate Justice and International Air Travel in Short-Term Electives in Global Health. Am J Trop Med Hyg 2023; 109:506-510. [PMID: 37549896 PMCID: PMC10484251 DOI: 10.4269/ajtmh.22-0508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 05/21/2023] [Indexed: 08/09/2023] Open
Abstract
In July 2022, the American Society of Tropical Medicine and Hygiene Green Task Force advocated to acknowledge the health impacts of climate change, particularly on those in low- and middle-income countries, and called on global health organizations to act. Simultaneously, academic medical centers are resuming Short-Term Electives in Global Health (STEGH) as travel restrictions imposed during the COVID-19 pandemic ease in most countries. International flights by trainees from academic medical centers in high-income countries (HIC) on these electives encapsulate the climate injustice of who generates carbon emissions and who bears the impacts of climate change. Using "decolonization" and "decarbonization" as guiding principles, we suggest several strategies that global medical education programs in HIC could implement. First, restructure rotations to halt STEGH with minimal benefit to host institutions, optimize trainee activities while abroad, and lengthen rotation duration. Second, programs can calculate the carbon impact of their STEGH and implement concrete measures to cut emissions. Finally, we urge academic medical centers to promote climate-resilient healthcare infrastructure in host countries and advocate for climate solutions on the global stage.
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Affiliation(s)
- Adriana Dhawan
- Division of Hospital Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Zoe Rammelkamp
- Division of Hospital Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Johnstone Kayandabila
- Arusha Lutheran Medical Centre, Arusha, Tanzania
- Eastern and Southern Africa Management Institute, Arusha, Tanzania
- London School of Tropical Medicine & Hygiene, London, United Kingdom
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Pritchard J, Alavian S, Soogoor A, Bartels SA, Hall AK. Global health competencies in postgraduate medical education: a scoping review and mapping to the CanMEDS physician competency framework. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:70-79. [PMID: 36998501 PMCID: PMC10042784 DOI: 10.36834/cmej.75275] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background Global Health opportunities are popular, with many reported benefits. There is a need however, to identify and situate Global Health competencies within postgraduate medical education. We sought to identify and map Global Health competencies to the CanMEDS framework to assess the degree of equivalency and uniqueness between them. Methods JBI scoping review methodology was utilized to identify relevant papers searching MEDLINE, Embase, and Web of Science. Studies were reviewed independently by two of three researchers according to pre-determined eligibility criteria. Included studies identified competencies in Global Health training at the postgraduate medicine level, which were then mapped to the CanMEDS framework. Results A total of 19 articles met criteria for inclusion (17 from literature search and two from manual reference review). We identified 36 Global Health competencies; the majority (23) aligned with CanMEDS competencies within the framework. Ten were mapped to CanMEDS roles but lacked specific key or enabling competencies, while three did not fit within the specific CanMEDS roles. Conclusions We mapped the identified Global Health competencies, finding broad coverage of required CanMEDS competencies. We identified additional competencies for CanMEDS committee consideration and discuss the benefits of their inclusion in future physician competency frameworks.
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Affiliation(s)
- Jodie Pritchard
- Department of Emergency Medicine, Queen’s University, Ontario, Canada
| | - Sara Alavian
- Division of Emergency Medicine, Department of Medicine, McMaster University, Ontario, Canada
| | | | - Susan A Bartels
- Department of Emergency Medicine, Queen’s University, Ontario, Canada
- Department of Public Health Sciences, Queen’s University, Ontario, Canada
| | - Andrew K Hall
- Department of Emergency Medicine, University of Ottawa, Ontario, Canada
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