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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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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] [Received: 11/15/2022] [Accepted: 03/05/2023] [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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Alayande BT, Hughes Z, Fitzgerald TN, Riviello R, Bekele A, Rice HE. With equity in mind: Evaluating an interactive hybrid global surgery course for cross-site interdisciplinary learners. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001778. [PMID: 37141197 PMCID: PMC10159197 DOI: 10.1371/journal.pgph.0001778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
There is limited understanding of the role of transcultural, cross-site educational partnerships for global surgery training between high- and low- or middle-income country (LMIC) institutions. We describe the development, delivery, and appraisal of a hybrid, synchronous, semester-long Global Surgical Care course by global health collaborators from widely different contexts, and evaluate the equity of the collaboration. The course was collaboratively modified by surgical educators and public health professionals with emphasis on collaboration ethics. Faculty from high-income and LMICs were paired to deliver lectures. To collaborate internationally, students and faculty participated either onsite or online. Perceptions and knowledge gained were quantitatively evaluated through participant and faculty cross-sectional surveys, using Likert scales, prioritization rankings, and free text responses analysed qualitatively. Equity was assessed using the Fair Trade Learning rubric and additional probes. Thirty-five learners from six institutions participated. Teams produced mock National, Surgical, Obstetric, and Anaesthesia Plans (NSOAPs) for selected LMICs, and reported a 9% to 65% increase in self-reported global health competencies following the course. Online learners had favourable perceptions of learning, but experienced connectivity challenges. Barriers to effective group work included time differences and logistics of communication for dispersed team members. Individuals taking the course for academic credit scored significantly higher than other learners in peer assessments of participation (8.56±1.53 versus 5.03±3.14; p<0.001). Using the Fair Trade Rubric, 60% of equity indicators were ideal, and no respondents perceived neo-colonialism in the partnership. Blended, synchronous, interdisciplinary global surgery courses based on "North-South" partnerships with a focus on equity in design and delivery are feasible but require careful and deliberate planning to minimize epistemic injustice. Such programs should address surgical systems strengthening, and not create dependency. Equity in such engagements should be evaluated and monitored in an ongoing fashion to stimulate discussion and continuous improvement.
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Affiliation(s)
- Barnabas Tobi Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Zoe Hughes
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Tamara N Fitzgerald
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke University School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Robert Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke University School of Medicine, Duke University, Durham, North Carolina, United States of America
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Shlobin NA, Garcia RM, Bernstein M. Neuropalliative care for the neurosurgeon: a primer. J Neurosurg 2022; 137:850-858. [PMID: 34920433 DOI: 10.3171/2021.9.jns211872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/16/2021] [Indexed: 11/06/2022]
Abstract
Many neurosurgical conditions are incurable, leading to disability or severe symptoms, poor quality of life, and distress for patients and families. The field of neuropalliative care (NPC) addresses the palliative care (PC) needs of individuals living with neurological conditions. Neurosurgeons play an important role within multidisciplinary NPC teams because of their understanding of the natural history of and treatment strategies for neurosurgical conditions, longitudinal patient-physician relationships, and responsibility for neurosurgical emergencies. Moreover, patients with neurosurgical conditions have unique PC needs given the trajectories of neurosurgical diseases, the realities of prognostication, psychosocial factors, communication strategies, and human behavior. PC improves outcomes among neurosurgical patients. Despite the importance of NPC, neurosurgeons often lack formal training in PC skills, which include identifying patients who require PC, assessing a patient's understanding and preferences regarding illness, educating patients, building trust, managing symptoms, addressing family and caregiver needs, discussing end-of-life care, and recognizing when to refer patients to specialists. The future of NPC involves increasing awareness of the approach's importance, delineating priorities for neurosurgeons with regard to NPC, increasing emphasis on PC skills during training and practice, expanding research efforts, and adjusting reimbursement structures to incentivize the provision of NPC by neurosurgeons.
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Affiliation(s)
- Nathan A Shlobin
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Roxanna M Garcia
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mark Bernstein
- 2Division of Neurosurgery, Toronto Western Hospital, University of Toronto; and
- 3Temmy Latner Center for Palliative Care, Mount Sinai Hospital, University of Toronto, Ontario, Canada
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Khader J, Glicksman RM, Mheid S, Mansour A, Giuliani ME, Gospodarowicz M, Almousa A, Abdel-Razeq H, Rodin D. Enhancing International Cancer Organization Collaborations: King Hussein Cancer Center and Princess Margaret Cancer Centre Model for Collaboration. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:763-769. [PMID: 32926325 DOI: 10.1007/s13187-020-01878-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 06/11/2023]
Abstract
Collaborative partnerships, which link two health organizations with shared characteristics to achieve common goals and to improve healthcare quality, are becoming increasingly common in oncology. The purpose of this study is to review the collaboration between King Hussein Cancer Center (KHCC) and Princess Margaret Cancer Centre (PM). The context, input, process, and product (CIPP) model, a quasi-experimental form of program evaluation, has been applied to the KHCC-PM collaboration. This model is well suited to evaluate complex collaborations as it does not assume linear relationships. Data sources include stakeholders' judgements of the collaboration, assessment of achievements, and informal interviews with key participants involved in the program. KHCC and PM are recognized as high-caliber comprehensive cancer centers, with a common goal of delivering high-quality care to patients. Through personal relationships among faculty in the centers and the perceived opportunities for mutual benefit, KHCC and PM signed a memorandum of understanding in 2013 to enter into a formal partnership. This partnership has been an evolving process that started with collaboration on education and grew to include clinical care. Research is an area for potential future collaboration. Enabling factors in the collaboration include dedication of individuals involved, trusting relationships amongst faculty, and the reciprocal nature of the relationship. Challenges have been financial, competing interests, and the absence of a successful collaborative model to follow. The KHCC and PM collaboration has been successful. A strategic plan is being developed and followed to guide areas of expansion.
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Affiliation(s)
- Jamal Khader
- Department of Radiation Oncology, King Hussein Cancer Center, P.O Box 1269, Amman, 11941, Jordan
| | - Rachel M Glicksman
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Sara Mheid
- Department of Radiation Oncology, King Hussein Cancer Center, P.O Box 1269, Amman, 11941, Jordan.
| | - Asem Mansour
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Meredith E Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Mary Gospodarowicz
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Abdelatif Almousa
- Department of Radiation Oncology, King Hussein Cancer Center, P.O Box 1269, Amman, 11941, Jordan
| | | | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
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International Survey of Medical Students Exposure to Relevant Global Surgery (ISOMERS): A Cross-Sectional Study. World J Surg 2022; 46:1577-1584. [PMID: 35106648 PMCID: PMC9174132 DOI: 10.1007/s00268-022-06440-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2021] [Indexed: 11/30/2022]
Abstract
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.
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Agrawal A, Mohan R, Mishra R, Moscote-Salazar LR, Florez-Perdomo WA. Letter to the Editor Regarding "A Bibliographic Analysis of the Most Cited Articles in Global Neurosurgery". World Neurosurg 2021; 145:533-534. [PMID: 33348505 DOI: 10.1016/j.wneu.2020.08.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, Madhya Pradesh, India.
| | - Rajashekar Mohan
- Department of Surgery, K S Hegde Medical Academy of Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Rakesh Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | | | - William Andres Florez-Perdomo
- Medicine General, University of Surcolombiana, Medico Investigador Concejo Latinoamericano de Neurointensivismo, CLaNi, Clinica Sahagún IPS, Habilitada, South America
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Miller C, Lundy P, Woodrow S. International electives in neurological surgery training: a survey of program directors from Accreditation Council for Graduate Medical Education-approved neurological surgery programs. J Neurosurg 2021; 134:1967-1973. [PMID: 32650312 DOI: 10.3171/2020.4.jns20618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The burden of neurosurgical disease in low- and middle-income countries (LMICs) has emerged as a significant factor in global health. Additionally, calls have been growing for first-world neurosurgeons to find ways to help address the international need. Allowing residents to pursue international elective opportunities in LMICs can help alleviate the burden while also providing unique educational opportunities. However, pursuing international work while in residency requires overcoming significant logistical and regulatory barriers. To better understand the general perspectives, perceived barriers, and current availability of international rotations, a survey was sent out to program directors at Accreditation Council for Graduate Medical Education (ACGME)-approved residencies. METHODS An anonymous survey was sent to all program directors at ACGME-approved residencies. The survey included branch points designed to separate programs into program directors with an existing international rotation, those interested in starting an international rotation, and those not interested in starting an international rotation. All participants were asked about the perceived value of international training and whether residents should be encouraged to train internationally on a 5-point Likert scale. The survey ended with open-response fields, encouraging thoughts on international rotations and overcoming barriers. RESULTS Forty-four percent of recipients (50/113) responded; of the 50 programs, 13 had an established international elective. Of programs without a rotation, 54% (20/37) noted that they were interested in starting an international elective. Key barriers to starting international training included funding, the Residency Review Committee approval process, call conflicts, and the establishment of international partners. Perceived learning opportunities included cultural awareness, unique pathology, ingenuity, physical examination skills, and diagnosis skills. The majority of respondents thought that international rotations were valuable (74%, 37/50) and that residents should be encouraged to pursue international educational opportunities (70%, 35/50). Program directors who maintained an existing international rotation or were interested in starting an international elective were more likely to perceive international rotations as valuable. CONCLUSIONS Recent calls from The Lancet Commission on Global Surgery for increased surgical interventions in the developing world have been expanded by neurosurgical leadership to include neurosurgical diseases. Resident involvement in international electives represents an opportunity to increase treatment of neurosurgical disease in LMICs and develop the next generation of international neurosurgeons. To increase opportunities for residents at international sites, attention should be focused on overcoming the practical and regulatory barriers at a local and national level.
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Affiliation(s)
- Christopher Miller
- 1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and
| | - Paige Lundy
- 1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and
| | - Sarah Woodrow
- 2Department of Neurological Surgery, Cleveland Clinic, Akron, Ohio
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Frange A, Duffy S, Al-Rousan T, Evensen A, Nelson BD. Trainee Perspectives Regarding Advanced Clinical Global Health Fellowships in North America. Am J Trop Med Hyg 2021; 104:2286-2292. [PMID: 33872209 PMCID: PMC8176480 DOI: 10.4269/ajtmh.20-1589] [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: 12/15/2020] [Accepted: 02/10/2021] [Indexed: 11/07/2022] Open
Abstract
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.
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Affiliation(s)
- Adam Frange
- 1Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Sean Duffy
- 2Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tala Al-Rousan
- 3University of California San Diego Herbert Wertheim School of Public Health, La Jolla, California
| | - Ann Evensen
- 2Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Brett D Nelson
- 1Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
- 4Divisions of Global Health and Neonatology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
- 5Harvard Medical School, Boston, Massachusetts
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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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Dechambenoit G, Moreau JJ, Roche PH, Cornu P. Sustainable neurosurgical training around the globe. A review and outline. Neurochirurgie 2021; 67:599-605. [PMID: 33753129 DOI: 10.1016/j.neuchi.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/25/2021] [Accepted: 03/06/2021] [Indexed: 11/19/2022]
Abstract
Sharing an equal and quality neurosurgical training across the globe without exclusion may seem utopian. However, such training is possible through educational opportunities and the ongoing digital revolution. The aim is to present the current state of neurosurgery training and education methods indicating strengths, weaknesses and opportunities. The thoughts, comments and suggestions of the authors are based on their academic experiences, training missions around the world and particularly in low- and middle-income countries by pointing out the French experience. The learning must be interactive and programmed over time, integrating varied courses and activities. Virtual reality and neurosurgical simulation need to be developed. The content of the teaching including e-learning must be evidence-based and peer-reviewed. Pedagogical training of trainers is fundamental. It is critical to evaluate the training under real working conditions. The optimization of human resources should create economies of scale that would attenuate the financial burden. The commitment of the teams, tutoring are success factors.
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Affiliation(s)
- G Dechambenoit
- Neurochirurgie, CMCO Côte d'Opale Route de Desvres, 62280 Saint Martin Boulogne, France.
| | - J-J Moreau
- Département Universitaire d'Enseignement Numérique en Santé, Faculté de Médecine, 2, rue Dr Marcland, 87025 Limoges cedex, France.
| | - P-H Roche
- Neurochirurgie Hôpital Nord, Pôle NEUROSCIENCES, Hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France.
| | - P Cornu
- Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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Westwick HJ, Elkaim LM, Obaid S, Fallah A, Tu A, Ibrahim GM, Weil AG. Interest and participation in global neurosurgery: a survey of Canadian neurosurgery residents. Neurosurg Focus 2021; 48:E21. [PMID: 32114558 DOI: 10.3171/2019.12.focus19767] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/20/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The lack of access to primary neurosurgical care presents a significant burden for patients in low- and middle-income countries (LMICs). Efforts to decrease the inequities in access to surgical care have become an increasing focus of initiatives and advocacy within the international neurosurgery community. Although residents may represent highly active members of international teams, the extent of their availability for and interest in global neurosurgery opportunities remains unclear. The objectives of this study were to assess the degree of participation, the level of interest, and the perceived barriers for residents of Canadian neurosurgery programs in engaging in neurosurgery initiatives in LMICs. METHODS A cross-sectional survey was administered to 144 residents from all accredited Canadian neurosurgery residency programs. The survey was used to determine the level of participation and interest in global neurosurgery initiatives. RESULTS The survey response rate from residents at Canadian neurosurgery programs was 45/144 (31%), although not all respondents answered every question; thus, the denominator for each question is not always 45. Most neurosurgery residents (n = 30, 68%) were unaware of any global neurosurgery opportunities available during residency. Despite 64% of residents having an interest in participation (strongly agree/agree; n = 28), with most residents planning on participating as attending staff (strongly agree/agree; n = 28, 64%), only 3 residents (7%) had taken part in LMIC neurosurgery initiatives. The most cited perceived limitations for participation were lack of time (n = 37, 84%) and finances (n = 26, 59%). CONCLUSIONS Among surveyed residents from Canadian neurosurgery programs, there was a low participation rate in global neurosurgery initiatives and limited knowledge of available opportunities, despite relatively high interest. Many respondents identified time and financial constraints as barriers to participation. Many residents felt that interest could increase were there a structured program dedicated to global neurosurgery available in their residency program.
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Affiliation(s)
| | - Lior M Elkaim
- 2Department of Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Sami Obaid
- 1Division of Neurosurgery, Department of Surgery, University of Montreal
| | - Aria Fallah
- 3Department of Neurosurgery, University of California, Los Angeles, California
| | - Albert Tu
- 4Department of Neurosurgery, Children's Minnesota, St. Paul, Minnesota
| | - George M Ibrahim
- 5Division of Neurosurgery, Department of Surgery, University of Toronto.,6Division of Neurosurgery, The Hospital for Sick Children, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; and
| | - Alexander G Weil
- 1Division of Neurosurgery, Department of Surgery, University of Montreal.,7Division of Neurosurgery, Sainte-Justine Hospital, Montreal, Quebec, Canada
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Lundy P, Miller C, Woodrow S. Current US neurosurgical resident involvement, interest, and barriers in global neurosurgery. Neurosurg Focus 2021; 48:E16. [PMID: 32114552 DOI: 10.3171/2019.12.focus19808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE It is estimated that nearly 47 million preventable deaths occur annually due the current worldwide deficit in surgical care; subsequently, the World Health Organization resolved unanimously to endorse a decree to address this deficit. Neurosurgeons from industrialized nations can help address the needs of underserved regions. Exposure during training is critical for young neurosurgeons to gain experience in international work and to cultivate career-long interest. Here, the authors explore the opinions of current residents and interest in global neurosurgery as well as the current state of international involvement, opportunities, and barriers in North American residency training. METHODS An internet-based questionnaire was developed using the authors' university's REDCap database and distributed to neurosurgical residents from US ACGME (Accreditation Council for Graduate Medical Education)-approved programs. Questions focused on the resident's program's involvement and logistics regarding international rotations and the resident's interest level in pursuing these opportunities. RESULTS A 15% response rate was obtained from a broad range of training locations. Twenty-nine percent of respondents reported that their residency program offered elective training opportunities in developing countries, and 7.6% reported having participated in these programs. This cohort unanimously felt that the international rotation was a beneficial experience and agreed that they would do it again. Of those who had not participated, 81.3% reported interest or strong interest in international rotations. CONCLUSIONS The authors' results indicate that, despite a high level of desire for involvement in international rotations, there is limited opportunity for residents to become involved. Barriers such as funding and rotation approval were recognized. It is the authors' hope that governing organizations and residency programs will work to break down these barriers and help establish rotations for trainees to learn abroad and begin to join the cause of meeting global surgical needs. To meet overarching international neurosurgical needs, neurosurgeons of the future must be trained in global neurosurgery.
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Davis RW, Sherif YA, Vu MT, Shilstone H, Scott B, Olutoye OO, Hollier L, Nuchtern J, Rosengart TK. Personalized Graduate Medical Education and the Global Surgeon: Training for Resource-Limited Settings. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:384-389. [PMID: 33332906 DOI: 10.1097/acm.0000000000003898] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PROBLEM The World Health Organization and the World Bank have identified improvement in access to surgical care as an urgent global health challenge and a cost-effective investment in public health. However, trainees in standard U.S. general surgery programs do not have adequate exposure to the procedures, technical skills, and foundational knowledge essential for providing surgical care in resource-limited settings. APPROACH The Michael E. DeBakey Department of Surgery at Baylor College of Medicine (BCM) created a 7-year global surgery track within its general surgery residency in 2014. Individualized rotations equip residents with the necessary skills, knowledge, and experience to operate in regions with low surgeon density and develop sustainable surgical infrastructures. BCM provides a formal, integrated global surgery curriculum-including 2 years dedicated to global surgery-with surgical specialty rotations in domestic and international settings. Residents tailor their individual experience to the needs of their future clinical practice, region of interest, and surgical specialty. OUTCOMES There have been 4 major outcomes of the BCM global surgery track: (1) increased exposure for trainees to a broad range of surgeries critical in resource-limited settings, (2) meaningful international partnerships, (3) contributions to global surgery scholarship, and (4) establishment of sustainable global surgery activities. NEXT STEPS To better facilitate access to safe, timely, and affordable surgical care worldwide, global surgeons should pursue expertise in topics not currently included in U.S. general surgical curricula, such as setting-specific technical skills, capacity building, and organizational collaboration. Future evaluations of the BCM global surgery track will assess the effect of individualized education on trainees' professional identities, clinical practices, academic pursuits, global surgery leadership preparedness, and comfort with technical skills not encompassed in general surgery programs. Increasing availability of quality global surgery training programs would provide a critical next step toward contributing to the delivery of safe surgical care worldwide.
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Affiliation(s)
- Rachel W Davis
- R.W. Davis is a seventh-year resident, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Youmna A Sherif
- Y.A. Sherif is a fourth-year resident, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Megan Thuy Vu
- M.T. Vu is a fifth-year resident, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Holly Shilstone
- H. Shilstone is director of education and alumni affairs, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Bradford Scott
- B. Scott is professor and vice chair for education, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Oluyinka O Olutoye
- O.O. Olutoye is professor of pediatric surgery, Department of Surgery, The Ohio State University College of Medicine, and surgeon-in-chief, Nationwide Children's Hospital, Columbus, Ohio
| | - Larry Hollier
- L. Hollier Jr is professor of surgery and chief, Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, and surgeon-in-chief, Texas Children's Hospital, Houston, Texas
| | - Jed Nuchtern
- J. Nuchtern is professor of pediatric surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, and Chief of Global Surgery, Texas Children's Hospital, Houston, Texas
| | - Todd K Rosengart
- T.K. Rosengart is professor and chair, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Sherif YA, Hassan MA, Thuy Vu M, Rosengart TK, Davis RW. Twelve Tips on enhancing global health education in graduate medical training programs. MEDICAL TEACHER 2021; 43:142-147. [PMID: 32393144 DOI: 10.1080/0142159x.2020.1762033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Investment in healthcare infrastructure in resource-limited settings is a vital and cost-effective approach for diminishing world-wide disease burden, increasing quality of life, and lengthening life expectancy. Graduate medical trainees enthusiastically express interest in supporting global health efforts that expand healthcare access and capacity in resource-limited settings. Academic institutions are responding by developing training programs to equip graduate medical trainees with the technical, interpersonal, scholastic, and ethical skillsets necessary for the pursuit of global health efforts. Drawn from real-world experience and current literature, the following twelve tips will strengthen a global health curriculum in graduate medical training programs with dedicated global health education.
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Affiliation(s)
- Youmna A Sherif
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Monalisa A Hassan
- Wake Forest School of Medicine, Wake Forest University, Winston Salem, NC, USA
| | - Megan Thuy Vu
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Todd K Rosengart
- Professor and Chairman at Baylor College of Medicine, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Rachel W Davis
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Niquen-Jimenez M, Wishart D, Garcia RM, Shlobin NA, Steinle J, Weiss H, Reynolds RA, Lam S, Rosseau G. A Bibliographic Analysis of the Most Cited Articles in Global Neurosurgery. World Neurosurg 2020; 144:e195-e203. [PMID: 32829020 PMCID: PMC7895493 DOI: 10.1016/j.wneu.2020.08.084] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Global neurosurgery is the practice of neurosurgery with the primary purpose of delivering timely, safe, and affordable neurosurgical care to all who need it. The aim of this study is to identify the most frequently cited articles in global neurosurgery through a bibliographic review to characterize articles and trends around this growing topic. METHODS The top most-cited articles in global neurosurgery were determined by searching the Web of Science database using a priori search terms. Articles with at least 5 citations were selected, and there were no time period or language restrictions. The data were extracted from each included article and all characteristics were summarized. RESULTS A total of 932 articles were identified using the search terms; 69 articles fulfilled inclusion criteria and 17 articles were selected that had more than 5 citations. The articles' number of citations ranged from 6 to 98 for the most-cited article. Authors from, or affiliated with, 14 countries contributed to the 17 articles, and the country that had the greatest representation was the United States. The main topic discussed was surgical capacity, the second topic was the treatment of different neurosurgical conditions, and volunteerism was the third topic. CONCLUSIONS There is currently a deficit in both the amount of literature surrounding the topic of global neurosurgery and how much that literature is cited. Developing innovative ways to increase academic productivity within, or in collaboration with, low-middle income countries is essential to contribute to global neurosurgery.
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Affiliation(s)
- Milagros Niquen-Jimenez
- Facultad de Medicina Humana Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Danielle Wishart
- Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Roxanna M Garcia
- Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA; Department of Neurological Surgery, Northwestern Medicine, Chicago, Illinois, USA; Institute for Global Health, Center for Healthcare Studies, Northwestern University, Chicago, Illinois, USA.
| | - Nathan A Shlobin
- Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Julia Steinle
- Faculty of Medicine, University of Münster, Münster, Germany
| | - Hannah Weiss
- Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Rebecca A Reynolds
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sandi Lam
- Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA; Department of Neurological Surgery, Northwestern Medicine, Chicago, Illinois, USA; Division of Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Geospatial Mapping of International Neurosurgical Partnerships and Evaluation of Extent of Training and Engagement. World Neurosurg 2020; 144:e898-e907. [PMID: 32992055 DOI: 10.1016/j.wneu.2020.09.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the presence, extent, and temporality of transnational neurosurgical partnerships, to understand and inform measures to address neurosurgical deficiencies in low- and middle-income countries (LMICs). METHODS A Web search was conducted to identify actors from high-income countries (HICs) participating in neurosurgical delivery and/or capacity-building with LMICs from 2010 to 2018. Descriptive data on current neurosurgical partnerships were collected from published case reports, literature reviews, reports from academic institutions, and information on stakeholder Web pages. The level of training and engagement of each partnership was separately graded based on prespecified criteria, in which grade 3 represented partnerships that have most extensive training and engagement, and grade 1, the least extent. Data were analyzed using descriptive statistics and geospatially depicted on ArcMap GIS software. RESULTS A total of 123 unique HIC-LMIC partnerships were described. Of these partnerships, 85 (69%) are derived from HICs in North America, followed by Europe, with 23 (19%). The most common LMIC partners were from Africa (n = 56, 45%) and Latin America (n = 32, 26%). In addition, most partnerships provided services in pediatric neurosurgery (88%). The most frequent engagement classifications were grade 2 (35%) or 1 (36%). Similarly, for training, the most common classifications were grade 1 (40%) or 2 (30%). CONCLUSIONS A robust network of HIC-LMIC partnerships exists with varying degrees of engagement and training activities. Several regions are particularly suitable for growth and development. Systematic consolidation and indexing of transnational neurosurgical partnerships aim to enhance resource allocation and present opportunities for future partnership.
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Onyia CU, Ojo OA. Collaborative International Neurosurgery Education for Africa–The Journey So Far and the Way Forward. World Neurosurg 2020; 141:e566-e575. [DOI: 10.1016/j.wneu.2020.05.242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
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19
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Grant CL, Robinson T, Al Hinai A, Mack C, Guilfoyle R, Saleh A. Ethical considerations in global surgery: a scoping review. BMJ Glob Health 2020; 5:e002319. [PMID: 32399258 PMCID: PMC7204923 DOI: 10.1136/bmjgh-2020-002319] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/02/2020] [Accepted: 03/14/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction An unmet burden of surgical disease exists worldwide and is disproportionately shouldered by low-income and middle-income countries (LMICs). As the field of global surgery grows to meet this need, ethical considerations need to be addressed. Currently, there are no formal guidelines to help inform relevant stakeholders of the ethical challenges and considerations facing global surgical collaborations. The aim of this scoping review is to synthesise the existing literature on ethics in global surgery and identify gaps in the current knowledge. Methods A scoping review of relevant databases to identify the literature pertaining to ethics in global surgery was performed. Eligible articles addressed at least one ethical consideration in global surgery. A grounded theory approach to content analysis was used to identify themes in the included literature and guide the identification of gaps in existing literature. Results Four major ethical domains were identified in the literature: clinical care and delivery; education and exchange of trainees; research, monitoring and evaluation; and engagement in collaborations and partnerships. The majority of published literature related to issues of clinical care and delivery of the individual patient. Most of the published literature was published exclusively by authors in high-income countries (HICs) (80%), and the majority of articles were in the form of editorials or commentaries (69.1%). Only 12.7% of articles published were original research studies. Conclusion The literature on ethics in global surgery remains sparse, with most publications coming from HICs, and focusing on clinical care and short-term surgical missions. Given that LMICs are frequently the recipients of global surgical initiatives, the relative absence of literature from their perspective needs to be addressed. Furthermore, there is a need for more literature focusing on the ethics surrounding sustainable collaborations and partnerships.
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Affiliation(s)
| | - Tessa Robinson
- Division of Pediatric Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Alreem Al Hinai
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Cheryl Mack
- Department of Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Department of Anesthesiology and Pain Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Regan Guilfoyle
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Office of Global Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Abdullah Saleh
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Office of Global Surgery, University of Alberta, Edmonton, Alberta, Canada
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Rosseau G, Johnson WD, Park KB, Hutchinson PJ, Lippa L, Andrews R, Servadei F, Garcia RM. Global neurosurgery: continued momentum at the 72nd World Health Assembly. J Neurosurg 2020; 132:1256-1260. [PMID: 31952031 PMCID: PMC7895422 DOI: 10.3171/2019.11.jns191823] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/15/2019] [Indexed: 01/15/2023]
Abstract
Global neurosurgery is the practice of neurosurgery with the primary purpose of delivering timely, safe, and affordable neurosurgical care to all who need it. This field is led by neurosurgeons, and global neurosurgery sessions are now part of every major international neurosurgical meeting. The World Federation of Neurosurgical Societies (WFNS) is working to coordinate activities and align all related activities for greater impact. This report updates the contributions made by the WFNS-WHO Liaison Committee at the most recent World Health Assembly (WHA) in 2019. The WHA is a decision-making body of the World Health Organization (WHO), attended by its 194 Member States. The WFNS has maintained official relations as a nongovernmental organization with the WHO for over 30 years, and this year 15 neurosurgical delegates attended events during the WHA. Participation by neurosurgeons continues to grow as many WHA events focused on global surgery have intrinsically involved neurosurgical leadership and participation. This year, resolution WHA72.31, entitled "Emergency and trauma care, Emergency care systems for universal health coverage: ensuring timely care for the acutely ill and injured," was passed. This resolution provides further opportunities for neurosurgical advocacy as the landscape of global surgery gains recognition and momentum.
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Affiliation(s)
- Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Walter D. Johnson
- Emergency and Essential Surgical Care Programme, World Health Organization, Geneva, Switzerland
| | - Kee B. Park
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | | | - Laura Lippa
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Russell Andrews
- Nanotechnology and Smart Systems, NASA Ames Research Center, Mountain View, California
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University, Milan, Italy
| | - Roxanna M. Garcia
- Department of Neurosurgery, McGaw School of Medicine, Northwestern University, Chicago, Illinois
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Ferraris KP, Matsumura H, Wardhana DPW, Vesagas T, Seng K, Mohd Ali MR, Ishikawa E, Matsumura A, Rosyidi RM, Mahadewa T, Kuo MF. The state of neurosurgical training and education in East Asia: analysis and strategy development for this frontier of the world. Neurosurg Focus 2020; 48:E7. [DOI: 10.3171/2019.12.focus19814] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/19/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe authors, who are from Indonesia, Japan, Malaysia, the Philippines, and Taiwan, sought to illustrate the processes of training neurosurgeons in their respective settings by presenting data and analyses of the current state of neurosurgical education across the East Asian region.METHODSThe authors obtained quantitative data as key indicators of the neurosurgical workforce from each country. Qualitative data analysis was also done to provide a description of the current state of neurosurgical training and education in the region. A strengths, weaknesses, opportunities, and threats (SWOT) analysis was also done to identify strategies for improvement.RESULTSThe number of neurosurgeons in each country is as follows: 370 in Indonesia, 10,014 in Japan, 152 in Malaysia, 134 in the Philippines, and 639 in Taiwan. With a large neurosurgical workforce, the high-income countries Japan and Taiwan have relatively high neurosurgeon to population ratios of 1 per 13,000 and 1 per 37,000, respectively. In contrast, the low- to middle-income countries Indonesia, Malaysia, and the Philippines have low neurosurgeon to population ratios of 1 per 731,000, 1 per 210,000, and 1 per 807,000, respectively. In terms of the number of training centers, Japan has 857, Taiwan 30, Indonesia 7, Malaysia 5, and the Philippines 10. In terms of the number of neurosurgical residents, Japan has 1000, Taiwan 170, Indonesia 199, Malaysia 53, and the Philippines 51. The average number of yearly additions to the neurosurgical workforce is as follows: Japan 180, Taiwan 27, Indonesia 10, Malaysia 4, and the Philippines 3. The different countries included in this report have many similarities and differences in their models and systems of neurosurgical education. Certain important strategies have been formulated in order for the system to be responsive to the needs of the catchment population: 1) establishment of a robust network of international collaboration for reciprocal certification, skills sharing, and subspecialty training; 2) incorporation of in-service residency and fellowship training within the framework of improving access to neurosurgical care; and 3) strengthening health systems, increasing funding, and developing related policies for infrastructure development.CONCLUSIONSThe varied situations of neurosurgical education in the East Asian region require strategies that take into account the different contexts in which programs are structured. Improving the education of current and future neurosurgeons becomes an important consideration in addressing the health inequalities in terms of access and quality of care afflicting the growing population in this region of the world.
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Affiliation(s)
- Kevin Paul Ferraris
- 1Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Hideaki Matsumura
- 2Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Dewa Putu Wisnu Wardhana
- 3Division of Neurosurgery, Department of Surgery, Udayana University Hospital, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Theodor Vesagas
- 4Philippine Board of Neurological Surgery and Philippine Gamma Knife Center, Cardinal Santos Medical Center, Manila, Philippines
| | - Kenny Seng
- 1Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Manila, Philippines
- 5Section of Neurosurgery, Department of Neurosciences, University of the Philippines–Philippine General Hospital, University of the Philippines College of Medicine, Manila, Philippines
| | | | - Eiichi Ishikawa
- 2Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akira Matsumura
- 2Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Rohadi Muhammad Rosyidi
- 7Department of Neurosurgery, West Nusa Tenggara Province Hospital, Faculty of Medicine, Mataram University, Mataram, Indonesia
| | - Tjokorda Mahadewa
- 8Division of Neurosurgery, Department of Surgery, Sanglah General Hospital, Faculty of Medicine, Udayana University, Bali, Indonesia; and
| | - Meng-Fai Kuo
- 9Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Zhu S, Zhu W, Qian W, He Y, Huang J. A China - Vietnam collaboration for public health care: a preliminary study. Glob Health Res Policy 2019; 4:23. [PMID: 31489379 PMCID: PMC6716849 DOI: 10.1186/s41256-019-0116-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/05/2019] [Indexed: 01/30/2023] Open
Abstract
Background Vietnam has achieved significant results in terms of improving population health and sustainable development goals (SDGs). However, several public health problems remain such as high mortality deriving from non-communicable diseases (NCDs). As part of their long-standing relationship, Vietnam and China have collaborated in various health fields. The objective of this study was to examine the current situation of public health cooperation between Vietnam and China and suggest ways to deepen future co-operations. Methods Between March and May 2018, we conducted 14 in-depth interviews with key informants from Vietnam and China. The inclusion criteria in this study were as follows: 1) researchers who worked at research institutes or universities and were engaged in health cooperation research, 2) officers who were from government agencies or international organizations (IOs) and had been involved in, or were familiar with the health cooperation projects between China and Vietnam. The interviews were audiotaped and transcribed verbatim, and then analyzed to identify current cooperation strategies and cooperation fields, as well as to provide suggestions for future collaborations. Results Current health cooperation mechanisms between China and Vietnam include bilateral and multilateral cooperation such as ASEAN Plus Three (China, Japan and ROK), ASEAN Plus One (China), the Greater Mekong sub-region, and the Lancang-Mekong Cooperation. This health cooperation can be summarized in terms of health security, health development, and health-related innovation. The health cooperation priorities outlined by our informants consisted of unimplemented SDGs such as NCD problems and the public health system. A proposal for future health collaboration was to establish a triangular cooperation between China, IOs/non-government organizations (NGOs) and Vietnam. Conclusions The existing cooperation between China and Vietnam in bilateral and multilateral levels has provided a good foundation for a deeper and more extensive future partnership. Key areas of future cooperation would be to achieve SDGs and solve NCD related problems, which can be accelerated through favorable cooperation and reliable partnerships. A triangular cooperation between China, Vietnam, and IOs/NGOs was considered as a suitable future mechanism.
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Affiliation(s)
- Si Zhu
- 1School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health Commission, Shanghai, China
| | - Wenjun Zhu
- 1School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health Commission, Shanghai, China
| | - Wenji Qian
- 1School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health Commission, Shanghai, China
| | - Yao He
- 1School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health Commission, Shanghai, China
| | - Jiayan Huang
- 1School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health Commission, Shanghai, China
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Stawicki SP, Nwomeh BC, Peck GL, Sifri ZC, Garg M, Sakran JV, Papadimos TJ, Anderson HL, Firstenberg MS, Gracias VH, Asensio JA. Training and accrediting international surgeons. Br J Surg 2019; 106:e27-e33. [DOI: 10.1002/bjs.11041] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/03/2018] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Formal international medical programmes (IMPs) represent an evolution away from traditional medical volunteerism, and are based on the foundation of bidirectional exchange of knowledge, experience and organizational expertise. The intent is to develop multidirectional collaborations and local capacity that is resilient in the face of limited resources. Training and accreditation of surgeons continues to be a challenge to IMPs, including the need for mutual recognition of competencies and professional certification.
Methods
MEDLINE, Embase and Google Scholar™ were searched using the following terms, alone and in combination: ‘credentialing’, ‘education’, ‘global surgery’, ‘international medicine’, ‘international surgery’ and ‘training’. Secondary references cited by original sources were also included. The authors, all members of the American College of Academic International Medicine group, agreed advice on training and accreditation of international surgeons.
Results and conclusion
The following are key elements of training and accrediting international surgeons: basic framework built upon a bidirectional approach; consideration of both high-income and low- and middle-income country perspectives; sourcing funding from current sources based on existing IMPs and networks of IMPs; emphasis on predetermined cultural competencies and a common set of core surgical skills; a decentralized global system for verification and mutual recognition of medical training and certification. The global medical system of the future will require the assurance of high standards for surgical education, training and accreditation.
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Affiliation(s)
- S P Stawicki
- Department of Surgery, St Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - B C Nwomeh
- Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - G L Peck
- Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Z C Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - M Garg
- Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - J V Sakran
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - T J Papadimos
- Department of Anesthesiology, College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA
| | - H L Anderson
- Department of Surgery, St Joseph Mercy Health System, Ann Arbor, Michigan, USA
| | - M S Firstenberg
- Department of Cardiovascular and Thoracic Surgery, Medical Center of Aurora, Aurora, Colorado, USA
| | - V H Gracias
- Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - J A Asensio
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Surgery, Creighton University Medical Center, Omaha, Nebraska, USA
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