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Nwagbata A, Dutta R, Jayaram A, Thivalapill N, Jain S, Faria I, Alty IG, Gadgil A, Roy N, Raykar NP. Beyond the Ivory Tower: Perception of academic global surgery by surgeons in low- and middle-income countries. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002979. [PMID: 38483892 PMCID: PMC10939292 DOI: 10.1371/journal.pgph.0002979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024]
Abstract
Interest in global surgery has surged amongst academics and practitioners in high-income countries (HICs), but it is unclear how frontline surgical practitioners in low-resource environments perceive the new field or its benefit. Our objective was to assess perceptions of academic global surgery amongst surgeons in low- and middle-income countries (LMICs). We conducted a cross-sectional e-survey among surgical trainees and consultants in 62 LMICs, as defined by the World Bank in 2020. This paper is a sub-analysis highlighting the perception of academic surgery and the association between practice setting and responses using Pearson's Chi-square test. Analyses were completed using Stata15. The survey received 416 responses, including 173 consultants (41.6%), 221 residents (53.1%), 8 medical graduates (1.9%), and 14 fellows (3.4%). Of these, 72 responses (17.3%) were from low-income countries, 137 (32.9%) from lower-middle-income countries, and 207 (49.8%) from upper-middle-income countries. 286 respondents (68.8%) practiced in urban areas, 34 (8.2%) in rural areas, and 84 (20.2%) in both rural and urban areas. Only 185 (44.58%) were familiar with the term "global surgery." However, 326 (79.3%) agreed that collaborating with HIC surgeons for research is beneficial to being a global surgeon, 323 (78.8%) agreed that having an HIC co-author improves likelihood of publication in a reputable journal, 337 (81.6%) agreed that securing research funding is difficult in their country, 195 (47.3%) agreed that their institutions consider research for promotion, 252 (61.0%) agreed that they can combine research and clinical practice, and 336 (82%) are willing to train HIC medical students and residents. A majority of these LMIC surgeons noted limited academic incentives to perform research in the field. The academic global surgery community should take note and foster equitable collaborations to ensure that this critical segment of stakeholders is engaged and has fewer barriers to participation.
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Affiliation(s)
- Arinzechukwu Nwagbata
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Trauma, Burn, and Critical Care, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Rohini Dutta
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle Income Countries, Mumbai, India
| | - Anusha Jayaram
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Neil Thivalapill
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle Income Countries, Mumbai, India
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Samarvir Jain
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle Income Countries, Mumbai, India
| | - Isabella Faria
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Isaac G. Alty
- Department of Trauma, Burn, and Critical Care, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Anita Gadgil
- The George Institute for Global Health, New Delhi, India
| | - Nobhojit Roy
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle Income Countries, Mumbai, India
- The George Institute for Global Health, New Delhi, India
- Karolinska Institutet, Stockholm, Sweden
| | - Nakul P. Raykar
- Department of Trauma, Burn, and Critical Care, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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Academic Global Surgery: Creating Opportunities, Equity, and Diversity. Ann Glob Health 2023; 89:12. [PMID: 36819966 PMCID: PMC9936913 DOI: 10.5334/aogh.3972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/11/2022] [Indexed: 02/16/2023] Open
Abstract
A workforce trained in the development and delivery of equitable surgical care is critical in reducing the global burden of surgical disease. Academic global surgery aims to address the present inequities through collaborative partnerships that foster research, education, advocacy and training to support and increase the surgical capacity in settings with limited resources. Barriers include a deficiency of resources, personnel, equipment, and funding, a lack of communication, and geographical challenges. Multi-level partnerships remain fundamental; these types of partnerships include a wide range of trainees, professionals, institutions, and nations, yet care must be taken to avoid falling into the trap of surgical "voluntourism" and undermining the expertise and practice of long-standing frontline providers. Academic global surgery has the benefit of developing a community of surgeons who possess the tools needed to collaborate on individual, institutional, and international levels to address inequities in surgery that are spread variously across the globe. However, challenges for surgeons pursuing a career in global surgery include balancing clinical responsibilities while integrating global surgery as a career during training. This is due in part to the lack of mentorship, research time, grant funding, support to attend conferences, and a limitation of resources, all of which are significantly more pronounced for surgeons from low-resource countries.
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Bredbeck BC, Delaney LD, Kwakye G. Demographic Factors Associated With Research and Career Interests in Aspiring Academic Surgeons: What are the Implications for Tomorrow's Workforce? JOURNAL OF SURGICAL EDUCATION 2022; 79:1447-1453. [PMID: 35732577 PMCID: PMC10473172 DOI: 10.1016/j.jsurg.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/11/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the research and career interests of aspiring academic surgeons and determine the influence of demographic factors. DESIGN Cross-sectional survey SETTING: Single institution, academic general surgery residency program PARTICIPANTS: Medical students invited to interview during 2019-2020 and 2020-2021 residency cycle RESULTS: One hundred fifty-four of 160 (96%) potential respondents representing 63 medical schools completed the survey, American Association for Public Opinion Research Response Rate 6. Fifty-three percent of the study population was female. Seventeen percent identified as Black, 14% Asian, 13% Latinx, 50% white, and 6% other. Respondents were most interested in education, professional development, and surgical culture (32%) followed by basic and translational science (23%), global and community health (20%), and health services (18%). On multiple logistic regression, interest in global/community health was associated with identifying as Black (OR 5.9 [2.0, 17.8] p = 0.001) and female (OR 2.7 [1.0, 7.0] p = 0.044). A plurality of participants were undecided on future specialty (n = 63, 41%). The most common specialty interests were surgical oncology (n = 28, 18%); trauma, acute care, or surgical critical care (n = 21, 14%); pediatric and cardiothoracic surgery (n = 20 for each, 13%); and abdominal transplant (n = 15, 10%). CONCLUSIONS In this cross-sectional survey of highly competitive academic general surgery applicants, respondents who were underrepresented in medicine (URiM) and women were more interested in research fields with a history of lower relative NIH funding. In light of these findings, academic programs seeking a more diverse residency workforce should consider strategies beyond recruitment to promote the scholarly achievement of women and URiM residents.
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Affiliation(s)
- Brooke C Bredbeck
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan.
| | - Lia D Delaney
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan
| | - Gifty Kwakye
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
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Rethinking Global Health Education in Plastic Surgery Residency. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3775. [PMID: 34584823 PMCID: PMC8460216 DOI: 10.1097/gox.0000000000003775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022]
Abstract
Surgical disease is now among the most common, preventable, and growing contributors to the global burden of disease. The attitudes of trainees toward global surgery and the viability of a global surgery as an academic track have blossomed. More optimized experiences within residency education are necessary, however, to prepare the next generation of global surgeons. The field of plastic surgery is thus at an important crossroads in the effort to incorporate global surgery into training programs in a uniform fashion across the country. The recent American Council of Academic Plastic Surgeons meeting in February 2020 was dedicated to identifying strategies that will enhance the adoption of global surgery practices within plastic surgery. In this article, we discuss the principles, themes, and ideas that emerged from this session, and further develop concrete initiatives believed to be potentially fruitful. Some have been discussed in other surgical disciplines or presented in isolation to the plastic surgery community, but never as a cohesive set of recommendations that take into account the background and shortfalls of the current model for global health education in the 21st century. We then introduce five recommendations to optimize learner education: (1) clarification of learner expectations and roles; (2) domestic teaching for optimization of field experiences; (3) expansion of longitudinal, formal rotations; (4) strengthening of the role of research; and (5) integration of program financing.
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Tsang VWL, Luo LH, Kisa P, Blair GK. Ten Global Surgical Care Statements for Children: examining our commitment to the future. Pediatr Surg Int 2021; 37:957-964. [PMID: 33689002 DOI: 10.1007/s00383-021-04875-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The lack of access to essential surgery for many of our world's children is a global health crisis. A third of all deaths in the pediatric population are due to surgical conditions. In low- and middle-income countries, an average of nine in ten children lack access to basic surgical care. METHODS This review examines ten commitment statements ratified by numerous global pediatric surgical organizations aimed at addressing existing gaps in global surgical care for children. They are substantiated by a review of literature and represent over-arching principles. RESULTS They prompt the recognition of childhood surgical disease as a global health priority and advocate for availability to safe surgical and anesthetic care. Calls to action highlight the importance of capacity building in the areas of education, data gathering, workforce, research, and international collaborations. DISCUSSION Eventually, there is the hope for widespread approval of the guiding principles they represent and that the statements themselves, as encapsulations of these beliefs, may act as a continued call for advocacy and action for the necessary work, resources, and funding to mitigate global pediatric surgical disparities.
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Affiliation(s)
- Vivian W L Tsang
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Lerly H Luo
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Phyllis Kisa
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda
| | - Geoffrey K Blair
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Guilfoyle R, Morzycki AD, Saleh A. What makes global healthcare partnerships successful? A systematic review. Glob Public Health 2021; 17:662-671. [PMID: 33689576 DOI: 10.1080/17441692.2021.1892795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Academic communities are increasingly involved in efforts to address the overwhelming burden of disease in low-middle income countries. There is, however, little research dedicated to understanding the best approach to creating a successful and sustainable global healthcare project. Our objective was to review the shared characteristics of successful healthcare partnerships between high- and low-middle income countries. Two independent reviewers conducted a systematic review. Articles, describing collaborative, healthcare partnerships between a high- and low-middle income countries between 1910 and September 2018, were included. Twenty-six articles were included. The majority of collaborations were initiated by either the host institution or as a joint decision between institutions. The primary goal of these collaborations revolved around medical education/training and curriculum development. Two partnerships, after more than a decade of collaboration, had achieved a self-sustaining programme. Lack of funding was identified as a major barrier to sustainability. Successful global healthcare partnerships require true collaboration and equal participation of all partners. Funding should be secured prior to programme development in anticipation of a minimum 10-year project. A minimum list of guidelines has been proposed to improve the chances of both a successful and sustainable collaboration.
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Affiliation(s)
- Regan Guilfoyle
- Division of Plastic Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Abdullah Saleh
- Division of Pediatric General Surgery, University of Alberta, Edmonton, AB, Canada
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Rising Global Opportunities Among Orthopaedic Surgery Residency Programs. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00102. [PMID: 33725703 PMCID: PMC7738025 DOI: 10.5435/jaaosglobal-d-20-00102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022]
Abstract
Objective: We surveyed Orthopaedic Surgery Residency (OSR) programs to determine international opportunities by the academic institutional region within the United States, location of the international experience, duration, residency program year (PGY), funding source, and resident participation to date. Design: We emailed a survey to all OSR programs in the United States to inquire about global opportunities in their residency programs. Further contact was made through an additional e-mail and up to three telephone calls. Data were analyzed using descriptive and chi-square statistics. This study was institutional review board exempt. Setting: This research study was conducted at the University of Nebraska Medical Center, a tertiary care facility in conjunction with the University of Nebraska Medical Center College of Medicine. Participants: The participants of this research study included program directors and coordinators of all OSR programs (185) across the United States. Results: A total of 102 OSR programs completed the survey (55% response rate). Notably, 50% of the responding programs offered a global health opportunity to their residents. Of the institutions that responded, those in the Midwest or South were more likely to offer the opportunity than institutions found in other US regions, although regional differences were not significant. Global experiences were most commonly: in Central or South America (41%); 1 to 2 weeks in duration (54%); and during PGY4 or PGY5 (71%). Furthermore, half of the programs provided full funding for the residents to participate in the global experience. In 33% of the programs, 10 or more residents had participated to date. Conclusions: Interest in global health among medical students is increasing. OSR programs have followed this trend, increasing their global health opportunities by 92% since 2015. Communicating the availability of and support for international opportunities to future residents may help interested students make informed decisions when applying to residency programs.
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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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Kauffmann RM, Neuzil K, Koch R, Terhune KP. Global Surgery Electives: A Strategy to Improve Care to Domestic Underserved Populations? J Surg Res 2020; 255:247-254. [PMID: 32570127 DOI: 10.1016/j.jss.2020.05.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/17/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In the United States, a shortage of general surgeons exists, primarily in rural, poor, and minority communities. Identification of strategies that increase resident interest in underserved regions provides valuable information in understanding and addressing this shortage. In particular, surgical experience abroad exposes residents to practice in low-resource and rural settings. As residency programs increasingly offer global surgery electives, we explore whether the presence of an international surgical rotation affects graduates' future practice patterns in underserved communities domestically. METHODS We surveyed general surgery residency graduates at a single academic institution. Those who finished general surgery residency from 2001 to 2018 were included. Participant demographics, current practice demographics, and perceptions related to global surgery and underserved populations were collected. Respondents were stratified based on whether they did ("after") or did not ("before") have the opportunity to participate in the Kijabe rotation (started in 2011), defined by graduation year. RESULTS Out of 119 eligible program graduates, 64 (53.7%) completed the survey, and 33 (51.6%) of the respondents graduated following the implementation of the Kijabe rotation. Two participants defined their primary current practice location as international. Fifteen (45.5%) in the "After" group indicated an interest in working with underserved populations following residency, compared to 5 (17.8%) of the "Before" group (P = 0.074). Furthermore, 20 (60.6%) respondents in the "After" group expressed interest in working with underserved populations even if it meant making less money. In the "Before" group, only 13 (46.4%) responded similarly (P = 0.268). Eleven (9.2%) residents rotated at Kijabe. Those who participated in the Kijabe rotation reported an uninsured rate of 36.7% for their current patient population, compared to rate of 13.9% in those who did not rotate there (P = 0.22). CONCLUSIONS At a single institution, our results suggest that participation in an international surgical rotation in a resource-constrained setting may be associated with increased care for underserved populations in future clinical practice. These results could be due to self-selection of residents who prioritize global surgery as part of their residency experience, or due to increased exposure to underserved patients through global surgery.
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Affiliation(s)
- Rondi M Kauffmann
- Vanderbilt University Medical Center, Division of Surgical Oncology and Endocrine Surgery, Nashville, Tennessee.
| | - Kevin Neuzil
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Rachel Koch
- Vanderbilt University Medical Center, Division of General Surgery, Nashville, Tennessee
| | - Kyla P Terhune
- Vanderbilt University Medical Center, Division of General Surgery, Nashville, Tennessee
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The Impact of Implementing a Comprehensive Surgical Program on the Surgical Cohort at a Remote Referral Hospital in Southeastern Liberia. World J Surg 2019; 44:680-688. [PMID: 31722076 DOI: 10.1007/s00268-019-05277-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Liberia has an extreme health workforce shortage, particularly with respect to surgery. JJ Dossen Memorial (JJD) is a public referral hospital supported by Partners in Health. METHODS We designed and implemented a comprehensive surgical program at JJD. Using case logs, clinic records, and transfer data between December 2016 and April 2018, we evaluated the impact of this program on the surgical cohort and examined temporal trends in patient origin using GIS. RESULTS The mean number of cases per day increased from 1.7 ± 1.0 to 2.4 ± 1.3 (p < 0.001). The proportion of females decreased from 59.8 to 51.2% (p = 0.03), and mean age decreased from 32.2 ± 14.2 to 29.8 ± 16.5 years (p = 0.05). The proportion of elective procedures, C-sections, and laparotomies did not change, but hernias decreased from 28.9 to 22.3% (p = 0.05) and oncologic surgery increased from 0.0 to 5.6% (p < 0.001). A smaller proportion of cases were performed under local or general anesthesia, while a larger proportion were performed under spinal and sedation (p < 0.001). Outward surgical transfers decreased from 13.1 to 5.4% (p < 0.001). The mean distance from patient residence to JJD increased from 24.8 ± 29.0 to 32.3 ± 41.9 km (p = 0.01). GIS analysis revealed a broader distribution of patient origins. CONCLUSIONS Surgeons are desperately needed in referral hospitals to address the large burden of surgical disease in Liberia. The implementation of a surgical program significantly changed the demographics of the surgical cohort and the surgical case mix. Our data can inform training for health workers in Liberia and elsewhere.
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Hedt-Gauthier BL, Riviello R, Nkurunziza T, Kateera F. Growing research in global surgery with an eye towards equity. Br J Surg 2019; 106:e151-e155. [DOI: 10.1002/bjs.11066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/12/2018] [Accepted: 10/30/2018] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Global surgery research is often generated through collaborative partnerships between researchers from both low- and middle-income countries (LMICs) and high-income countries (HICs). Inequitable engagement of LMIC collaborators can limit the impact of the research.
Methods
This article describes evidence of inequities in the conduct of global surgery research and outlines reasons why the inequities in this research field may be more acute than in other global health research disciplines. The paper goes on to describe activities for building a collaborative research portfolio in rural Rwanda.
Results
Inequities in global surgery research collaborations can be attributed to: a limited number and experience of researchers working in this field; time constraints on both HIC and LMIC global surgery researchers; and surgical journal policies. Approaches to build a robust, collaborative research portfolio in Rwanda include leading research trainings focused on global surgery projects, embedding surgical fellows in Rwanda to provide bidirectional research training and outlining all research products, ensuring that all who are engaged have opportunities to grow in capacities, including leading research, and that collaborators share opportunities equitably. Of the 22 published or planned papers, half are led by Rwandan researchers, and the research now has independent research funding.
Conclusion
It is unacceptable to gather data from an LMIC without meaningful engagement in all aspects of the research and sharing opportunities with local collaborators. The strategies outlined here can help research teams build global surgery research portfolios that optimize the potential for equitable engagement.
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Affiliation(s)
- B L Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health/Rwanda, Kigali, Rwanda
| | - R Riviello
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - F Kateera
- Partners In Health/Rwanda, Kigali, Rwanda
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Value of Global Surgical Activities for US Academic Health Centers: A Position Paper by the Association for Academic Surgery Global Affairs Committee, Society of University Surgeons Committee on Global Academic Surgery, and American College of Surgeons' Operation Giving Back. J Am Coll Surg 2018; 227:455-466.e6. [DOI: 10.1016/j.jamcollsurg.2018.07.661] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/11/2018] [Indexed: 11/17/2022]
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Sawaya RD, Breslin KA, Abdulrahman E, Chapman JI, Good DM, Moran L, Mullan PC, Badaki-Makun O. A Global Health Research Checklist for clinicians. Int J Emerg Med 2018; 11:25. [PMID: 29675594 PMCID: PMC5908775 DOI: 10.1186/s12245-018-0176-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/23/2018] [Indexed: 11/10/2022] Open
Abstract
Global health research has become a priority in most international medical projects. However, it is a difficult endeavor, especially for a busy clinician. Navigating the ethics, methods, and local partnerships is essential yet daunting.To date, there are no guidelines published to help clinicians initiate and complete successful global health research projects. This Global Health Research Checklist was developed to be used by clinicians or other health professionals for developing, implementing, and completing a successful research project in an international and often low-resource setting. It consists of five sections: Objective, Methodology, Institutional Review Board and Ethics, Culture and partnerships, and Logistics. We used individual experiences and published literature to develop and emphasize the key concepts. The checklist was trialed in two workshops and adjusted based on participants' feedback.
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Affiliation(s)
- Rasha D. Sawaya
- Division of Emergency Medicine, The American University of Beirut Medical Center, PO box 11-0236, Riad El-Solh, Beirut, 1107 2020 Lebanon
| | - Kristen A. Breslin
- Children’s National Health System, The George Washington University School of Medicine and Health Sciences, 111, Michigan Ave, NW, Washington, DC, 20010 USA
- Division of Emergency Medicine, Children’s National Medical Center, 111, Michigan Ave, NW, Washington, DC, 20010 USA
| | - Eiman Abdulrahman
- Children’s National Health System, The George Washington University School of Medicine and Health Sciences, 111, Michigan Ave, NW, Washington, DC, 20010 USA
- Division of Emergency Medicine, Children’s National Medical Center, 111, Michigan Ave, NW, Washington, DC, 20010 USA
| | - Jennifer I. Chapman
- Children’s National Health System, The George Washington University School of Medicine and Health Sciences, 111, Michigan Ave, NW, Washington, DC, 20010 USA
- Division of Emergency Medicine, Children’s National Medical Center, 111, Michigan Ave, NW, Washington, DC, 20010 USA
| | - Dafina M. Good
- Children’s National Health System, The George Washington University School of Medicine and Health Sciences, 111, Michigan Ave, NW, Washington, DC, 20010 USA
- Division of Emergency Medicine, Children’s National Medical Center, 111, Michigan Ave, NW, Washington, DC, 20010 USA
| | - Lili Moran
- Children’s National Health System, The George Washington University School of Medicine and Health Sciences, 111, Michigan Ave, NW, Washington, DC, 20010 USA
- Division of Emergency Medicine, Children’s National Medical Center, 111, Michigan Ave, NW, Washington, DC, 20010 USA
| | - Paul C. Mullan
- Department of Emergency Medicine, Children’s Hospital of The King’s Daughters, 601 Children’s Lane, Norfolk, VA 23507 USA
| | - Oluwakemi Badaki-Makun
- Department of Pediatrics, Division of Emergency Medicine, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
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Fallah PN, Bernstein M. Barriers to participation in global surgery academic collaborations, and possible solutions: a qualitative study. J Neurosurg 2018:1-9. [PMID: 29624152 DOI: 10.3171/2017.10.jns17435] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 10/18/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVEThere is a global lack of access to surgical care, and this issue disproportionately affects those in low- and middle-income countries. Global surgery academic collaborations (GSACs) between surgeons in high-income countries and those in low- and middle-income countries are one possible sustainable way to address the global surgical need. The objective of this study was to examine the barriers to participation in GSACs and to suggest ways to increase involvement.METHODSA convenience sample of 86 surgeons, anesthesiologists, other physicians, residents, fellows, and nurses from the US, Canada, and Norway was used. Participants were all health care providers from multiple specialties and multiple academic centers with varied involvement in GSACs. More than half of the participants were neurosurgeons. Participants were interviewed in person or over Skype in Toronto over the course of 2 months by using a predetermined set of open-ended questions. Thematic content analysis was used to evaluate the participants' responses.RESULTSBased on the data, 3 main themes arose that pointed to individual, community, and system barriers for involvement in GSACs. Individual barriers included loss of income, family commitments, young career, responsibility to local patients, skepticism of global surgery efforts, ethical concerns, and safety concerns. Community barriers included insufficient mentorship and lack of support from colleagues. System barriers included lack of time, minimal academic recognition, insufficient awareness, insufficient administrative support and organization, and low political and funding support.CONCLUSIONSSteps can be taken to address some of these barriers and to increase the involvement of surgeons from high-income countries in GSACs. This could lead to a necessary scale-up of global surgery efforts that may help increase worldwide access to surgical care.
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Affiliation(s)
| | - Mark Bernstein
- 2Division of Neurosurgery, Department of Surgery, University of Toronto; and.,3Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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15
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Incorporation of a Global Surgery Rotation into an Academic General Surgery Residency Program: Impact and Perceptions. World J Surg 2018. [DOI: 10.1007/s00268-018-4562-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Emil S, O'Neill J, Poenaru D. Let our fellows go: a plea for allowing global surgery electives during pediatric surgical training. J Pediatr Surg 2017; 52:2088-2090. [PMID: 28947325 DOI: 10.1016/j.jpedsurg.2017.08.070] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/27/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED In the last 2 years, a coalescence of forces has brought the needs of surgical patients in low resource settings to the top of the international healthcare policy agenda. This same dynamic has propelled academic global surgery, and particularly education, to the forefront. The proportion of surgical trainees seeking global surgical experiences, and interested in incorporating global surgery into their clinical and academic career, has risen sharply. International surgical electives are now allowed in a number of surgical residency programs, if they meet strict criteria. However, the Accreditation Council for Graduate Medical Education (ACGME) currently does not allow international electives during pediatric surgical training. This decision has not been contested by the American Board of Surgery (ABS) or the Association of Pediatric Surgery Training Program Directors (APSTPD). Valid concerns exist regarding international pediatric surgical electives. In this article, the authors address these concerns and exhort the APSTPD, the ABS, and the ACGME to re-examine their position on the value of pediatric global surgery electives. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Sherif Emil
- Department of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre; Montreal, Quebec.
| | - James O'Neill
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN; Bethany Kids Children's Hospital at AIC Kijabe Hospital, Kijabe, Kenya
| | - Dan Poenaru
- Department of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre; Montreal, Quebec
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17
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Pope R, Shaker M, Ganesh P, Larkins-Pettigrew M, Pickett SD. Barriers to Global Health Training in Obstetrics and Gynecology. Ann Glob Health 2016; 82:625-629. [DOI: 10.1016/j.aogh.2016.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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18
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Tanis E, Caballero C, Collette L, Verleye L, den Dulk M, Lacombe D, Schuhmacher C, Werutsky G. The European Organization for Research and Treatment for Cancer (EORTC) strategy for quality assurance in surgical clinical research: Assessment of the past and moving towards the future. Eur J Surg Oncol 2016; 42:1115-22. [DOI: 10.1016/j.ejso.2016.04.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/31/2016] [Accepted: 04/20/2016] [Indexed: 11/24/2022] Open
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Abstract
Although vertical health care delivery models certainly will remain a vital component in the provision of surgery in low-and-middle-income countries, it is clear now that the sustainability of global surgery will depend on more than just surgeons operating. Instead, what is needed is a comprehensive approach, that is, a horizontal integration that develops sustainable human resources, physical infrastructure, administrative oversight, and financing mechanisms in the developing world. We propose that such a strategy for development would necessarily involve an active role by academic institutions of high-income countries.
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20
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Krishnaswami S, Swaroop M. Preparing and Sustaining Your Career in Academic Global Surgery. ACADEMIC GLOBAL SURGERY 2016. [DOI: 10.1007/978-3-319-14298-2_4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Love TP, Martin BM, Tubasiime R, Srinivasan J, Pollock JD, Delman KA. Emory global surgery program: learning to serve the underserved well. JOURNAL OF SURGICAL EDUCATION 2015; 72:e46-e51. [PMID: 25700841 DOI: 10.1016/j.jsurg.2015.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/15/2014] [Accepted: 01/13/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Timothy P Love
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Benjamin M Martin
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Ronald Tubasiime
- Department of Surgery, Soddo Christian Hospital, Wolaitta Soddo, Ethiopia; Pan-African Academy of Christian Surgeons, Fayetteville, North Carolina
| | - Jahnavi Srinivasan
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jonathan D Pollock
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia; Department of Surgery, Soddo Christian Hospital, Wolaitta Soddo, Ethiopia; Pan-African Academy of Christian Surgeons, Fayetteville, North Carolina
| | - Keith A Delman
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
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22
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Chao TE, Riesel JN, Anderson GA, Mullen JT, Doyle J, Briggs SM, Lillemoe KD, Goldstein C, Kitya D, Cusack JC. Building a global surgery initiative through evaluation, collaboration, and training: the Massachusetts General Hospital experience. JOURNAL OF SURGICAL EDUCATION 2015; 72:e21-e28. [PMID: 25697510 DOI: 10.1016/j.jsurg.2014.12.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/12/2014] [Accepted: 12/31/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The Massachusetts General Hospital (MGH) Department of Surgery established the Global Surgery Initiative (GSI) in 2013 to transform volunteer and mission-based global surgery efforts into an educational experience in surgical systems strengthening. The objective of this newly conceived mission is not only to perform advanced surgery but also to train surgeons beyond MGH through international partnerships across disciplines. At its inception, a clear pathway to achieve this was not established, and we sought to identify steps that were critical to realizing our mission statement. SETTING Massachusetts General Hospital, Boston, MA, USA and Mbarara Regional Referral Hospital, Mbarara, Uganda PARTICIPANTS Members of the MGH and MRRH Departments of Surgery including faculty, fellows, and residents RESULTS The MGH GSI steering committee identified 4 steps for sustaining a robust global surgery program: (1) administer a survey to the MGH departmental faculty, fellows, and residents to gauge levels of experience and interest, (2) catalog all ongoing global surgical efforts and projects involving MGH surgical faculty, fellows, and residents to identify areas of overlap and opportunities for collaboration, (3) establish a longitudinal partnership with an academic surgical department in a limited-resource setting (Mbarara University of Science and Technology (MUST) at Mbarara Regional Referral Hospital (MRRH)), and (4) design a formal curriculum in global surgery to provide interested surgical residents with structured opportunities for research, education, and clinical work. CONCLUSIONS By organizing the collective experiences of colleagues, synchronizing efforts of new and former efforts, and leveraging the funding resources available at the local institution, the MGH GSI hopes to provide academic benefit to our foreign partners as well as our trainees through longitudinal collaboration. Providing additional financial and organizational support might encourage more surgeons to become involved in global surgery efforts. Creating a partnership with a hospital in a limited-resource setting and establishing a formal global surgery curriculum for our residents allows for education and longitudinal collaboration. We believe this is a replicable model for building other academic global surgery endeavors that aim to strengthen health and surgical systems beyond their own institutions.
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Affiliation(s)
- Tiffany E Chao
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Johanna N Riesel
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Geoffrey A Anderson
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer Doyle
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Susan M Briggs
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | - David Kitya
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - James C Cusack
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Charles AG, Samuel JC, Riviello R, Sion MK, Tarpley MJ, Tarpley JL, Olutoye OO, Marcus JR. Integrating global health into surgery residency in the United States. JOURNAL OF SURGICAL EDUCATION 2015; 72:e88-e93. [PMID: 25168712 DOI: 10.1016/j.jsurg.2014.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/10/2014] [Accepted: 05/05/2014] [Indexed: 06/03/2023]
Affiliation(s)
- Anthony G Charles
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina.
| | - Jonathan C Samuel
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Robert Riviello
- Brigham and Women's Hospital, Center for Surgery and Public Health, Boston, Massachusetts
| | - Melanie K Sion
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Margaret J Tarpley
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - John L Tarpley
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
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Wackerbarth JJ, Campbell TD, Wren S, Price RR, Maier RV, Numann P, Kushner AL. Global opportunities on 239 general surgery residency Web sites. J Surg Res 2015; 198:115-9. [PMID: 26055214 DOI: 10.1016/j.jss.2015.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/11/2015] [Accepted: 05/13/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many general surgical residency programs lack a formal international component. We hypothesized that most surgery programs do not have international training or do not provide the information to prospective applicants regarding electives or programs in an easily accessible manner via Web-based resources. MATERIALS AND METHODS Individual general surgery program Web sites and the American College of Surgeons residency tool were used to identify 239 residencies. The homepages were examined for specific mention of international or global health programs. Ease of access was also considered. Global surgery specific pages or centers were noted. Programs were assessed for length of rotation, presence of research component, and mention of benefits to residents and respective institution. RESULTS Of 239 programs, 24 (10%) mentioned international experiences on their home page and 42 (18%) contained information about global surgery. Of those with information available, 69% were easily accessible. Academic programs were more likely than independent programs to have information about international opportunities on their home page (13.7% versus 4.0%, P = 0.006) and more likely to have a dedicated program or pathway Web site (18.8% versus 2.0%, P < 0.0001). Half of the residencies with global surgery information did not have length of rotation available. Research was only mentioned by 29% of the Web sites. Benefits to high-income country residents were discussed more than benefits to low- and middle-income country residents (57% versus 17%). CONCLUSIONS General surgery residency programs do not effectively communicate international opportunities for prospective residents through Web-based resources and should seriously consider integrating international options into their curriculum and better present them on department Web sites.
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Affiliation(s)
- Joel J Wackerbarth
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; University of Washington School of Medicine, Seattle, Washington.
| | | | - Sherry Wren
- Center for Global Health and Innovation, Stanford University, Stanford, California
| | - Raymond R Price
- Center for Global Surgery, University of Utah, Salt Lake City, Utah; Education Intermountain Medical Center, Intermountain Healthcare, Salt Lake City, Utah
| | - Ronald V Maier
- Harborview Medical Center, University of Washington, Seattle, Washington
| | - Patricia Numann
- Department of Surgery Emerita, SUNY Upstate Medical University, Syracuse, New York
| | - Adam L Kushner
- Surgeons OverSeas, New York, New York; Department of Surgery, Columbia University, New York, New York; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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25
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Sarr MG, Behrns KE, Warshaw AL. Lancet Commission. Editor's note. Surgery 2015; 157:833. [PMID: 25934018 DOI: 10.1016/j.surg.2015.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
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Grigorian A, Sicklick JK, Kingham TP. International surgical residency electives: a collaborative effort from trainees to surgeons working in low- and middle-income countries. JOURNAL OF SURGICAL EDUCATION 2014; 71:694-700. [PMID: 24776855 PMCID: PMC6082620 DOI: 10.1016/j.jsurg.2014.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/25/2014] [Accepted: 03/04/2014] [Indexed: 05/22/2023]
Abstract
In today's ever-globalizing climate, the academic sector bears a certain responsibility to incorporate global health opportunities into residency training programs. The worldwide unmet surgical need has been growing; it has been estimated by the World Health Organization that by 2030, surgical diseases will contribute significantly to the burden of global health. International electives (IE) offered during training may partially address this growing need. In addition, it can help trainees develop a heightened awareness of the social determinants of health in resource-limited areas, as well as gain insight into different cultures, health beliefs, and pathologic conditions. General surgery residency programs that offer IE may also stand to benefit by attracting a broader applicant pool, as well as by having the ability to train residents to rely less upon expensive tests and equipment, while further developing residents' physical examination and communications skills. The challenges that IE pose for trainees include the required adaptation to an environment devoid of an advanced and modern medical system, and a difficulty in learning a new language, culture, and local customs. However, IE may also be hazardous for home institutions as they may drain local resources and take limited educational experiences away from local providers. Despite the active promotion of international volunteerism by the American Board of Surgery, few surgery residency programs offer IE as part of the curriculum, with cost and supervision being the major obstacles to overcome. Consequently, it may be difficult to generate American surgical leaders in international health. In this article, we outline the steps needed to bring IE to an institution and how general surgery residency programs can help bridge the gap between surgeons in high-income countries and the growing surgical needs of the international community.
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Affiliation(s)
- Areg Grigorian
- University of California, San Diego School of Medicine, La Jolla, California.
| | - Jason K Sicklick
- Division of Surgical Oncology, Department of Surgery, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California
| | - T Peter Kingham
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; Surgeons OverSeas (SOS), New York, New York
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Chambers KJ, Creighton F, Abdul-Aziz D, Cheney M, Randolph GW. Global health-related publications in otolaryngology are increasing. Laryngoscope 2014; 125:848-51. [DOI: 10.1002/lary.24906] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/10/2014] [Accepted: 08/05/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Kyle J. Chambers
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts
| | - Francis Creighton
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts
| | - Dunia Abdul-Aziz
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts
| | - Mack Cheney
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts
| | - Gregory W. Randolph
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts
- Division of Surgical Oncology, Department of Surgery; Massachusetts General Hospital; Boston Massachusetts U.S.A
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28
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Drake FT, Quiroga E, Kariuki HW, Shisanya KA, Hotchkiss MP, Monroe-Wise A, Drake JK, Mburu J, Farquhar C, Flum DR. Traumatic near amputation secondary to hippopotamus attack: lessons for surgeons. J Surg Res 2014; 188:58-63. [PMID: 24411302 DOI: 10.1016/j.jss.2013.11.1091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 11/04/2013] [Accepted: 11/15/2013] [Indexed: 11/19/2022]
Abstract
A 34-y-old man presented to Naivasha District Hospital (NDH) in Naivasha Town, Kenya, with near-complete below-knee amputation and hemorrhage after a hippopotamus attack. Residents from the University of Washington (UW), Departments of Surgery, Anesthesia, and Medicine, were rotating at NDH with the Clinical Education Partnership Initiative, a joint venture of UW and University of Nairobi. These providers met the patient in the operating theater. The leg was mangled with severely traumatized soft tissues and tibia-fibula fractures. The visiting UW Surgery resident (R3) and an NDH medical officer (second-year house officer) performed emergency below-knee completion amputation--the first time either had performed this operation. The three major vessel groups were identified and ligated. Sufficient gastrocnemius and soleus were preserved for future stump construction. The wound was washed out, packed with betadine-soaked gauze, and wrapped in an elasticized bandage. Broad-spectrum antibiotics were initiated. Unfortunately, the patient suffered infection and was revised above the knee. After a prolonged course, the patient recovered well and was discharged home. NDH house officers and UW trainees collaborated successfully in an emergency and conducted the postoperative care of a patient with a serious and challenging injury. Their experience highlights the importance of preparedness, command of surgical basics, humility, learning from mistakes, the expertise of others, a digitally connected surgical community, and the role of surgery in global health. These lessons will be increasingly pertinent as surgical training programs create opportunities for their residents to work in developing countries; many of these lessons are equally applicable to surgical practice in the developed world.
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Affiliation(s)
- Frederick Thurston Drake
- Department of Surgery, University of Washington, Seattle, Washington; Clinical Education Partnership Initiative (CEPI), University of Washington, Seattle, Washington and University of Nairobi, Nairobi, Kenya; Surgical Outcomes Research Center (SORCE), Department of Surgery, University of Washington, Seattle, Washington; Department of Global Health, University of Washington, Seattle, Washington.
| | - Elina Quiroga
- Department of Global Health, University of Washington, Seattle, Washington; Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Washington
| | - Hazel W Kariuki
- Clinical Education Partnership Initiative (CEPI), University of Washington, Seattle, Washington and University of Nairobi, Nairobi, Kenya; Department of Surgery, Naivasha District Hospital, Ministry of Health, Republic of Kenya, Naivasha Town, Kenya
| | - Kizito A Shisanya
- Clinical Education Partnership Initiative (CEPI), University of Washington, Seattle, Washington and University of Nairobi, Nairobi, Kenya; Department of Surgery, Naivasha District Hospital, Ministry of Health, Republic of Kenya, Naivasha Town, Kenya
| | - Matthew P Hotchkiss
- Clinical Education Partnership Initiative (CEPI), University of Washington, Seattle, Washington and University of Nairobi, Nairobi, Kenya; Department of Anesthesia, University of Washington, Seattle, Washington
| | - Aliza Monroe-Wise
- Clinical Education Partnership Initiative (CEPI), University of Washington, Seattle, Washington and University of Nairobi, Nairobi, Kenya; Department of Medicine, University of Washington, Seattle, Washington
| | - John K Drake
- Bienville Orthopaedic Specialists, Ocean Springs, Mississippi
| | - Joseph Mburu
- Clinical Education Partnership Initiative (CEPI), University of Washington, Seattle, Washington and University of Nairobi, Nairobi, Kenya; Naivasha District Hospital, Ministry of Health, Republic of Kenya, Naivasha Town, Kenya
| | - Carey Farquhar
- Clinical Education Partnership Initiative (CEPI), University of Washington, Seattle, Washington and University of Nairobi, Nairobi, Kenya; Department of Global Health, University of Washington, Seattle, Washington; Bienville Orthopaedic Specialists, Ocean Springs, Mississippi; Department of Epidemiology, University of Washington, Seattle, Washington
| | - David R Flum
- Department of Surgery, University of Washington, Seattle, Washington; Surgical Outcomes Research Center (SORCE), Department of Surgery, University of Washington, Seattle, Washington
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Chu KM, Jayaraman S, Kyamanywa P, Ntakiyiruta G. Building research capacity in Africa: equity and global health collaborations. PLoS Med 2014; 11:e1001612. [PMID: 24618823 PMCID: PMC3949667 DOI: 10.1371/journal.pmed.1001612] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Kathryn Chu and colleagues discuss the impact of high-income country investigators conducting research in low- and middle-income countries and explore lessons from the effective and equitable relationships that exist. Please see later in the article for the Editors' Summary
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Affiliation(s)
- Kathryn M. Chu
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Department of Surgery, Boston, Massachusetts, United States of America
- * E-mail:
| | - Sudha Jayaraman
- Virginia Commonwealth University Medical Center, Department of Surgery, Richmond, Virginia, United States of America
| | - Patrick Kyamanywa
- University of Rwanda, School of Medicine, Department of Surgery, Butare, Rwanda
| | - Georges Ntakiyiruta
- University of Rwanda, School of Medicine, Department of Surgery, Butare, Rwanda
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30
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Lyons JL, Coleman ME, Engstrom JW, Mateen FJ. International electives in neurology training: a survey of US and Canadian program directors. Neurology 2013; 82:119-25. [PMID: 24319037 DOI: 10.1212/wnl.0000000000000019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To ascertain the current status of global health training and humanitarian relief opportunities in US and Canadian postgraduate neurology programs. BACKGROUND There is a growing interest among North American trainees to pursue medical electives in low- and middle-income countries. Such training opportunities provide many educational and humanitarian benefits but also pose several challenges related to organization, human resources, funding, and trainee and patient safety. The current support and engagement of neurology postgraduate training programs for trainees to pursue international rotations is unknown. METHODS A survey was distributed to all program directors in the United States and Canada (December 2012-February 2013) through the American Academy of Neurology to assess the training opportunities, institutional partnerships, and support available for international neurology electives. RESULTS Approximately half of responding programs (53%) allow residents to pursue global health-related electives, and 11% reported that at least 1 trainee participated in humanitarian relief during training (survey response rate 61%, 143/234 program directors). Canadian programs were more likely to allow residents to pursue international electives than US programs (10/11, 91% vs 65/129, 50%, p = 0.023). The number of trainees participating in international electives was low: 0%-9% of residents (55% of programs) and 10%-19% of residents (21% of programs). Lack of funding was the most commonly cited reason for residents not participating in global health electives. If funding was available, 93% of program directors stated there would be time for residents to participate. Most program directors (75%) were interested in further information on global health electives. CONCLUSIONS In spite of high perceived interest, only half of US neurology training programs include international electives, mostly due to a reported lack of funding. By contrast, the majority of Canadian programs that responded allow international electives, likely due to clearer guidelines from the Royal College of Physicians and Surgeons of Canada compared to the Accreditation Council of Graduate Medical Education. However, the number of both Canadian and US neurology trainees venturing abroad remains a minority. Most program directors are interested in learning more information related to global health electives for neurology residents.
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Affiliation(s)
- Jennifer L Lyons
- From the Department of Neurology (J.L.L.), Brigham and Women's Hospital, Boston, MA; the American Academy of Neurology (M.E.C.), Minneapolis, MN; the Department of Neurology (J.W.E.), University of California at San Francisco; the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; and the Department of International Health (F.J.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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31
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Elobu AE, Kintu A, Galukande M, Kaggwa S, Mijjumbi C, Tindimwebwa J, Roche A, Dubowitz G, Ozgediz D, Lipnick M. Evaluating international global health collaborations: perspectives from surgery and anesthesia trainees in Uganda. Surgery 2013; 155:585-92. [PMID: 24612624 DOI: 10.1016/j.surg.2013.11.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 11/15/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The number of international academic partnerships and global health programs is expanding rapidly worldwide. Although the benefits of such programs to visiting international partners have been well documented, the perceived impacts on host institutions in resource-limited settings have not been assessed adequately. We sought to describe the perspectives of postgraduate, Ugandan trainees toward international collaborations and to discuss how these perceptions can be used to increase the positive impact of international collaborations for the host institution. METHODS We conducted a descriptive, cross-sectional survey among anesthesia and surgery trainees at Makerere College of Health Sciences (Kampala, Uganda) using a pretested, self-administered questionnaire. Data were summarized as means or medians where applicable; otherwise, descriptive statistical analyses were performed. RESULTS Of 43 eligible trainees, 77% completed the questionnaire. The majority (75%) agreed that visiting groups improve their training, mostly through skills workshops and specialist camps. A substantial portion of trainees reported that international groups had a neutral or negative impact on patient care (40%). Only 15% agreed that research projects conducted by international groups are in priority areas for Uganda. Among those surveyed, 28% reported participation in these projects, but none has published as a coauthor. Nearly one-third of trainees (31%) reported discomfort with the ethics of some clinical decisions made by visiting faculty. CONCLUSION The current perspective from the surgery and anesthesia trainees of Makerere College of Health Sciences demonstrates rich ground for leveraging international collaborations to improve training, primarily through skills workshops, specialist camps, and more visiting faculty involvement. This survey also identified potential challenges in collaborative research and ethical dilemmas that warrant further examination.
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Affiliation(s)
- Alex E Elobu
- Makerere University College of Health Science, Kampala, Uganda.
| | - Andrew Kintu
- Makerere University College of Health Science, Kampala, Uganda
| | - Moses Galukande
- Makerere University College of Health Science, Kampala, Uganda
| | - Sam Kaggwa
- Makerere University College of Health Science, Kampala, Uganda
| | - Cephas Mijjumbi
- Makerere University College of Health Science, Kampala, Uganda
| | | | - Anthony Roche
- Makerere University College of Health Science, Kampala, Uganda
| | - Gerald Dubowitz
- Makerere University College of Health Science, Kampala, Uganda
| | - Doruk Ozgediz
- Makerere University College of Health Science, Kampala, Uganda
| | - Michael Lipnick
- Makerere University College of Health Science, Kampala, Uganda
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Global surgery: Parallels with surgical research and innovation. Surgery 2013; 154:645-6. [DOI: 10.1016/j.surg.2013.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 05/16/2013] [Indexed: 11/24/2022]
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Finlayson SRG. How should academic surgeons respond to enthusiasts of global surgery? Surgery 2013; 153:871-2. [PMID: 23701877 DOI: 10.1016/j.surg.2013.02.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 02/22/2013] [Indexed: 11/29/2022]
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