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Pawlak N, Dart C, Aguilar HS, Ameh E, Bekele A, Jimenez MF, Lakhoo K, Ozgediz D, Roy N, Terfera G, Ademuyiwa AO, Alayande BT, Alonso N, Anderson GA, Anyanwu SNC, Aregawi AB, Bandyopadhyay S, Banu T, Bedada AG, Belachew AG, Botelho F, Bua E, Campos LN, Dodgion C, Drejza M, Durieux ME, Dutta R, Erdene S, Vaz Ferreira R, Gathuya Z, Ghosh D, Jawa RS, Johnson WD, Khan FA, Navas Leon FJ, Long KL, Macleod JBA, Mahajan A, Maine RG, Malolos GZC, McClain CD, Nabukenya MT, Nthumba PM, Nwomeh BC, Ojuka DK, Penny N, Quiodettis MA, Rickard J, Roa L, Salgado LS, Samad L, Seyi-Olajide JO, Smith M, Starr N, Stewart RJ, Tarpley JL, Trostchansky JL, Trostchansky I, Weiser TG, Wobenjo A, Wollner E, Jayaraman S. Correction: Academic global surgical competencies: A modified Delphi consensus study. PLOS Glob Public Health 2023; 3:e0002414. [PMID: 37708095 PMCID: PMC10501557 DOI: 10.1371/journal.pgph.0002414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
[This corrects the article DOI: 10.1371/journal.pgph.0002102.].
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Pawlak N, Dart C, Aguilar HS, Ameh E, Bekele A, Jimenez MF, Lakhoo K, Ozgediz D, Roy N, Terfera G, Ademuyiwa AO, Alayande BT, Alonso N, Anderson GA, Anyanwu SNC, Aregawi AB, Bandyopadhyay S, Banu T, Bedada AG, Belachew AG, Botelho F, Bua E, Campos LN, Dodgion C, Drejza M, Durieux ME, Dutta R, Erdene S, Ferreira RV, Gathuya Z, Ghosh D, Jawa RS, Johnson WD, Khan FA, Leon FJN, Long KL, Macleod JBA, Mahajan A, Maine RG, Malolos GZC, McClain CD, Nabukenya MT, Nthumba PM, Nwomeh BC, Ojuka DK, Penny N, Quiodettis MA, Rickard J, Roa L, Salgado LS, Samad L, Seyi-Olajide JO, Smith M, Starr N, Stewart RJ, Tarpley JL, Trostchansky JL, Trostchansky I, Weiser TG, Wobenjo A, Wollner E, Jayaraman S. Academic global surgical competencies: A modified Delphi consensus study. PLOS Glob Public Health 2023; 3:e0002102. [PMID: 37450426 PMCID: PMC10348592 DOI: 10.1371/journal.pgph.0002102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/02/2023] [Indexed: 07/18/2023]
Abstract
Academic global surgery is a rapidly growing field that aims to improve access to safe surgical care worldwide. However, no universally accepted competencies exist to inform this developing field. A consensus-based approach, with input from a diverse group of experts, is needed to identify essential competencies that will lead to standardization in this field. A task force was set up using snowball sampling to recruit a broad group of content and context experts in global surgical and perioperative care. A draft set of competencies was revised through the modified Delphi process with two rounds of anonymous input. A threshold of 80% consensus was used to determine whether a competency or sub-competency learning objective was relevant to the skillset needed within academic global surgery and perioperative care. A diverse task force recruited experts from 22 countries to participate in both rounds of the Delphi process. Of the n = 59 respondents completing both rounds of iterative polling, 63% were from low- or middle-income countries. After two rounds of anonymous feedback, participants reached consensus on nine core competencies and 31 sub-competency objectives. The greatest consensus pertained to competency in ethics and professionalism in global surgery (100%) with emphasis on justice, equity, and decolonization across multiple competencies. This Delphi process, with input from experts worldwide, identified nine competencies which can be used to develop standardized academic global surgery and perioperative care curricula worldwide. Further work needs to be done to validate these competencies and establish assessments to ensure that they are taught effectively.
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Affiliation(s)
- Natalie Pawlak
- Tufts University, Boston, Massachusetts, United States of America
| | - Christine Dart
- Virginia Commonwealth University, Richmond, Virginia, United States of America
| | | | - Emmanuel Ameh
- National Hospital Division of Paediatric Surgery, Abuja, Nigeria
| | - Abebe Bekele
- University of Global Health Equity, Butaro, Rwanda
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Maria F. Jimenez
- Department of Surgery, Hospital Universitario Mayor Mederi, Universidad del Rosario, Bogota, Colombia
| | | | - Doruk Ozgediz
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Nobhojit Roy
- The George Institute for Global Health, New Delhi, India
| | - Girma Terfera
- Univ of Wisconsin, Madison, Wisconsin, United States of America
| | - Adesoji O. Ademuyiwa
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | | | | | | | - Soham Bandyopadhyay
- Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, United Kingdom
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Tahmina Banu
- Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
| | | | | | - Fabio Botelho
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children’s Hospital, Montreal, Canada
- Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Emmanuel Bua
- Busitema University Mbale Hospital, Mbale, Uganda
| | - Leticia Nunes Campos
- Faculty of Medical Sciences, Universidade de Pernambuco, Recife, Pernambuco, Brasil
| | - Chris Dodgion
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Michalina Drejza
- Specialty Trainee in Obstetrics and Gynaecology, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Marcel E. Durieux
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Rohini Dutta
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sarnai Erdene
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | - Dhruva Ghosh
- NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, India
| | | | - Walter D. Johnson
- Loma Linda University, Loma Linda, California, United States of America
| | | | | | - Kristin L. Long
- Univ of Wisconsin, Madison, Wisconsin, United States of America
| | - Jana B. A. Macleod
- Kenyatta University, Nairobi, Kenya
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Anshul Mahajan
- Global Surgery Fellow, WHO Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in LMICs’, Mumbai, India
| | - Rebecca G. Maine
- Department of Surgery, University of Washington, Seattle, Washington, United States of America
| | | | - Craig D. McClain
- Department of Anesthesiology, Critical Care and Pain Medicine, Program in Global Surgery, Harvard Medical School, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | | | - Peter M. Nthumba
- Department of Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Benedict C. Nwomeh
- Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | | | - Norgrove Penny
- Branch for Global Surgical Care, University of British Columbia, Vancouver, Canada
| | | | - Jennifer Rickard
- University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Lina Roa
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Lubna Samad
- Interactive Research and Development (IRD) Global, Singapore, Singapore
| | | | - Martin Smith
- University of the Witwatersrand, Johannesburg, South Africa
| | - Nichole Starr
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Richard J. Stewart
- Global Initiative for Children’s Surgery, Portland, Oregon, United States of America
| | - John L. Tarpley
- Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Vanderbilt University, Nashville, Tennessee, United States of America
| | | | | | - Thomas G. Weiser
- Department of Surgery, Stanford University, Palo Alto, California, United States of America
| | | | - Elliot Wollner
- Peter MacCallum Cancer Center and University of California, San Francisco, San Francisco, California, United States of America
| | - Sudha Jayaraman
- Department of Surgery, Center for Global Surgery, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, United States of America
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Fowler Z, Dutta R, Kilgallon JL, Wobenjo A, Bandyopadhyay S, Shah P, Jain S, Raykar NP, Roy N. Academic Output in Global Surgery after the Lancet Commission on Global Surgery: A Scoping Review. World J Surg 2022; 46:2317-2325. [PMID: 35849172 PMCID: PMC9436886 DOI: 10.1007/s00268-022-06640-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 11/30/2022]
Abstract
Background The Lancet Commission on Global Surgery (LCoGS) published its seminal report in 2015, carving a niche for global surgery academia. Six years after the LCoGS, a scoping review was conducted to see how the term 'global surgery' is characterized by the literature and how it relates to LCoGS and its domains. Methods PubMed was searched for publications between January 2015 and February 2021 that used the term ‘global surgery’ in the title, abstract, or key words or cited the LCoGS. Variables extracted included LCoGS domains, authorship metrics, geographic scope, and clinical specialty. Results The search captured 938 articles that qualified for data extraction. Nearly 80% of first and last authors had high-income country affiliations. Africa was the most frequently investigated region, though many countries within the region were under-represented. The World Journal of Surgery was the most frequent journal, publishing 13.9% of all articles. General surgery, pediatric surgery, and neurosurgery were the most represented specialties. Of the LCoGS domains, healthcare delivery and management were the most studied, while economics and financing were the least studied. Conclusion A lack of consensus on the definition of global surgery remains. Additional research is needed in economics and financing, while obstetrics and trauma are under-represented in literature using the term ‘global surgery’. Efforts in academic global surgery must give a voice to those carrying the global surgery agenda forward on the frontlines. Focusing on research capacity-building and encouraging contribution by local partners will lead to a stronger, more cohesive global surgery community. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06640-8.
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Affiliation(s)
- Zachary Fowler
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Rohini Dutta
- Christian Medical College and Hospital, Ludhiana, Punjab, India
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
| | - John L Kilgallon
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Adili Wobenjo
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
- Department of Surgery, Kenyatta University, Nairobi, Kenya
| | - Soham Bandyopadhyay
- Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, UK
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Samarvir Jain
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Nakul P Raykar
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
- Division of Trauma, Emergency Surgery, Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nobhojit Roy
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India.
- Department of Public Health Systems, Karolinska Institute, 171 77, Stockholm, Sweden.
- The George Institute of Global Health, New Delhi, India.
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Ravi K, Killen A, Alexander A, Bell-Davies F, Biganiro Sebintu J, Brazeal A, Butoyi JMV, Diaz FE, Drabile R, Fanny M, Fernie L, Gunawardana S, Hartley E, Hawu YN, Hendron H, Joseph SA, Lamahewage A, Mahagedera R, Manirambona E, Morisho BK, Muchunu P, Niyukuri A, Ntaganda E, Orliacq F, Orliacq J, Wobenjo A, Young P, Lakhoo K, Ford K. An OxPLORE Initiative Evaluating Children's Surgery Resources Worldwide: A Cross-sectional Implementation of the OReCS Document. World J Surg 2022; 46:476-485. [PMID: 34846547 PMCID: PMC8803801 DOI: 10.1007/s00268-021-06377-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The Global Initiative for Children's Surgery (GICS) group produced the Optimal Resources for Children's Surgery (OReCS) document in 2019, listing standards of children's surgical care by level of healthcare facilities within low resource settings. We have previously created and piloted an audit tool based on the OReCS criteria in a high-income setting. In this study, we aimed to validate its use in identifying gaps in children's surgery provision worldwide. METHODS Our OReCS audit tool was implemented in 10 hospitals providing children's surgery across eight countries. Collaborators were recruited via the Oxford Paediatrics Linking Our Research with Electives (OxPLORE) international network of medical students and trainees. The audit tool measured a hospital's current capacity for children's surgery. Data were analysed firstly to express the percentage of 'essential' criteria met for each specialty. Secondly, the 'OxPLORE method' was used to allocate each hospital specialty a level based on procedures performed and resources available. A User Evaluation Tool (UET) was developed to obtain feedback on the ease of use of the tool. RESULTS The percentage of essential criteria met within each category varied widely between hospitals. The level given to hospitals for subspecialties based on OReCS criteria often did not reflect their self-defined level. The UET indicated the audit tool was practicable across multiple settings. CONCLUSIONS We recommend the use of the OReCS criteria to identify areas for local hospital improvement and inform national children's surgical plans. We have made informed suggestions to increase usability of the OReCS audit tool.
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Affiliation(s)
- Krupa Ravi
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Annabel Killen
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Angus Alexander
- Department of Paediatric Surgery, The Children’s Hospital at Westmead, Westmead, Australia
| | | | | | | | | | | | - Romeo Drabile
- Department of Paediatric Surgery, Sefako Makgatho Health Sciences University, Tshwane, Gauteng Province South Africa
| | | | - Lucila Fernie
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | | | - Emma Hartley
- University of Sydney, The Children’s Hospital at Westmead, Westmead, Australia
- Central Coast Local Health District, New South Wales, Australia
| | - Yolisa N. Hawu
- Department of Paediatric Surgery, Sefako Makgatho Health Sciences University, Pretoria North, Gauteng Province South Africa
| | - Holly Hendron
- Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | | | - Emery Manirambona
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Patrick Muchunu
- Department of General Surgery, Kiambu County Hospital, Kiambu, Kenya
| | - Alliance Niyukuri
- Mercy Surgeons-Burundi, Research Department, Bujumbura, Burundi
- Hope Africa University Frank-Ogden Medical School, Bujumbura, Burundi
| | - Edmond Ntaganda
- Pediatric Surgery Service, Centre Hospitalier Universitaire de Kigali, Kigali City, Rwanda
| | | | - Josefina Orliacq
- Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - Adili Wobenjo
- Kenyatta University, Nairobi County, Kenya
- Department of General Surgery, Kiambu County Hospital, Kiambu, Kenya
| | - Pablo Young
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Kokila Lakhoo
- Department of Paediatric Surgery, University of Oxford and Oxford University Hospitals, Oxford, UK
| | - Kathryn Ford
- Department of Population, Policy and Practice, Institute of Child Health, University College London, London, UK
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Room 6607, Level 6, Headington, Oxford, Ox3 9du UK
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