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Muchatuta M, Patel S, Gonzalez Marquez C, Thilakasiri K, Manian SV, Chan J, Mssika N, Clark T, Burkholder T, Turgeon N, Kampalath VN, Poola N, Offorjebe OA, Dozois A, Hyuha G, Vaughan‐Ogunlusi O, McCammon C, Wells K, Rybarczk M, Castillo MP, Adeyeye AA, Rees CA, Dutta S, Garbern SC. Building a framework to decolonize global emergency medicine. AEM EDUCATION AND TRAINING 2024; 8:e10982. [PMID: 38765709 PMCID: PMC11099782 DOI: 10.1002/aet2.10982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 05/22/2024]
Abstract
Background Global emergency medicine (GEM) is situated at the intersection of global health and emergency medicine (EM), which is built upon a history of colonial systems and institutions that continue to reinforce inequities between high-income countries (HICs) and low- and middle-income countries (LMICs) today. These power imbalances yield disparities in GEM practice, research, and education. Approach The Global Emergency Medicine Academy (GEMA) of the Society for Academic Emergency Medicine formed the Decolonizing GEM Working Group in 2020, which now includes over 100 worldwide members. The mission is to address colonial legacies in GEM and catalyze sustainable changes and recommendations toward decolonization at individual and institutional levels. To develop recommendations to decolonize GEM, the group conducted a nonsystematic review of existing literature on decolonizing global health, followed by in-depth discussions between academics from LMICs and HICs to explore implications and challenges specific to GEM. We then synthesized actionable solutions to provide recommendations on decolonizing GEM. Results Despite the rapidly expanding body of literature on decolonizing global health, there is little guidance specific to the relatively new field of GEM. By applying decolonizing principles to GEM, we suggest key priorities for improving equity in academic GEM: (1) reframing partnerships to place LMIC academics in positions of expertise and power, (2) redirecting research funding toward LMIC-driven projects and investigators, (3) creating more equitable practices in establishing authorship, and (4) upholding principles of decolonization in the education of EM trainees from LMICs and HICs. Conclusions Understanding the colonial roots of GEM will allow us to look more critically at current health disparities and identify inequitable institutionalized practices within our profession that continue to uphold these misguided concepts. A decolonized future of GEM depends on our recognition and rectification of colonial-era practices that shape structural determinants of health care delivery and scientific advancement.
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Affiliation(s)
- Monalisa Muchatuta
- Department of Emergency MedicineSUNY Downstate Medical CenterBrooklynNew YorkUSA
| | - Shama Patel
- Department of Emergency MedicineUniversity of FloridaJacksonvilleFloridaUSA
| | | | - Kaushila Thilakasiri
- Ministry of Health Sri LankaOxford University Hospitals NHS TrustColomboSri Lanka
| | | | - Jennifer Chan
- Department of Emergency MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Ngassa Mssika
- Department of Emergency MedicineEastern Virginia Medical SchoolNorfolkVirginiaUSA
| | - Taryn Clark
- Department of Emergency MedicineSUNY Downstate Medical CenterBrooklynNew YorkUSA
| | - Taylor Burkholder
- Department of Emergency MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Nikkole Turgeon
- Department of Emergency MedicineBoston Medical CenterBostonMassachusettsUSA
| | - Vinay N. Kampalath
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Nivedita Poola
- Department of Emergency MedicineSUNY Downstate Medical CenterBrooklynNew YorkUSA
| | - O. Agatha Offorjebe
- Department of Emergency Medicine, Alpert MedicalSchool of Brown UniversityProvidenceRhode IslandUSA
| | - Adeline Dozois
- Department of Emergency MedicineAtrium Health Carolinas Medical CenterCharlotteNorth CarolinaUSA
| | - Gimbo Hyuha
- Department of Emergency MedicineMuhimbili University of Health And Allied ScienceDar es SalaamTanzania
| | | | - Carol McCammon
- Department of Emergency MedicineEastern Virginia Medical SchoolNorfolkVirginiaUSA
| | - Katie Wells
- Department of Emergency MedicineThe University of VermontBurlingtonVermontUSA
| | - Megan Rybarczk
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Maria Paula Castillo
- Department of Emergency MedicineUniversidad de Ciencias MedicasSan JoseCosta RicaUSA
| | | | - Chris A. Rees
- Emory University School of MedicineAtlantaGeorgiaUSA
| | - Sanjukta Dutta
- Department of Emergency MedicineFortis HospitalKolkataIndia
| | - Stephanie Chow Garbern
- Department of Emergency Medicine, Alpert MedicalSchool of Brown UniversityProvidenceRhode IslandUSA
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2
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Hexom BJ, Quao NSA, Bandolin NS, Bonney J, Collier A, Dyal J, Lee JA, Nicholson BD, Rybarczyk MM, Rees CA, Roy CM, Bhaskar N, Kivlehan SM. Global Emergency Medicine: A Scoping Review of the Literature from 2022. Acad Emerg Med 2024; 31:71-85. [PMID: 37813813 DOI: 10.1111/acem.14816] [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: 07/01/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE The objective was to identify the highest quality global emergency medicine (GEM) research published in 2022. The top articles are compiled in a comprehensive list of all the year's GEM articles and narrative summaries are performed on those included. METHODS A systematic PubMed search was conducted to identify all GEM articles published in 2022 and included a manual supplemental screen of 11 organizational websites for gray literature (GRAY). A team of trained reviewers and editors screened all identified titles and abstracts, based on three case definition categories: disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and emergency medicine development (EMD). Articles meeting these definitions were independently scored by two reviewers using rubrics for original research (OR), review (RE) articles, and GRAY. Articles that scored in the top 5% from each category as well as the overall top 5% of articles were included for narrative summary. RESULTS The 2022 search identified 58,510 articles in the main review, of which 524 articles screened in for scoring, respectively, 30% and 18% increases from last year. After duplicates were removed, 36 articles were included for narrative summary. The GRAY search identified 7755 articles, of which 33 were scored and one was included for narrative summary. ECRLS remained the largest category (27; 73%), followed by DHR (7; 19%) and EMD (3; 8%). OR articles remained more common than RE articles (64% vs. 36%). CONCLUSIONS The waning of the COVID-19 pandemic has not affected the continued growth in GEM literature. Articles related to prehospital care, mental health and resilience among patients and health care workers, streamlining pediatric infectious disease care, and disaster preparedness were featured in this year's review. The continued lack of EMD studies despite the global growth of GEM highlights a need for more scholarly dissemination of best practices.
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Affiliation(s)
- Braden J Hexom
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Nana Serwaa A Quao
- Department of Emergency Medicine, Accident and Emergency Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - N Shakira Bandolin
- Department of Emergency Medicine, University of California, Davis, California, USA
| | - Joseph Bonney
- Department of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Global Health and Infectious Disease Research Group, Kumasi Center for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Amanda Collier
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jonathan Dyal
- Department of Emergency Medicine, University of Texas, Houston, Texas, USA
| | - J Austin Lee
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, USA
| | - Benjamin D Nicholson
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Megan M Rybarczyk
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charlotte M Roy
- Department of Emergency Medicine, Loma Linda University, Loma Linda, California, USA
| | | | - Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
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Jafar AJN, Prager G, Ingham JF, Jones P, Kennedy H, Ingram C, Ndiaye H. Emergency medicine engagement in global health: what does 10 years of the global emergency medicine literature review tell us? Eur J Emerg Med 2023; 30:287-291. [PMID: 37387630 DOI: 10.1097/mej.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Affiliation(s)
- Anisa Jabeen Nasir Jafar
- Humanitarian and Conflict Response Institute, University of Manchester, Manchester
- Emergency Department, Salford Royal Foundation Trust, Salford
| | - Gabrielle Prager
- Humanitarian and Conflict Response Institute, University of Manchester, Manchester
| | | | - Peter Jones
- Emergency Department, Manchester Royal Infirmary
| | | | - Claire Ingram
- Tatton Unit, Pennine Care NHS Foundation Trust, Manchester, UK
| | - Haarith Ndiaye
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Massachusetts, USA
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Kivlehan SM, Hexom BJ, Bonney J, Collier A, Nicholson BD, Quao NSA, Rybarczyk MM, Selvam A, Rees CA, Roy CM, Bhaskar N, Becker TK. Global emergency medicine: A scoping review of the literature from 2021. Acad Emerg Med 2022; 29:1264-1274. [PMID: 35913419 DOI: 10.1111/acem.14575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/17/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The objective was to identify the most important and impactful peer-reviewed global emergency medicine (GEM) articles published in 2021. The top articles are summarized in brief narratives and accompanied by a comprehensive list of all identified articles that address the topic during the year to serve as a reference for clinicians, researchers, and policy makers. METHODS A systematic PubMed search was carried out to identify all GEM articles published in 2021. Title and abstract screening was performed by trained reviewers and editors to identify articles in one of three categories based on predefined criteria: disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and emergency medicine development (EMD). Included articles were each scored by two reviewers using established rubrics for original (OR) and review (RE) articles. The top 5% of articles overall and the top 5% of articles from each category (DHR, ECRLS, EMD, OR, and RE) were included for narrative summary. RESULTS The 2021 search identified 44,839 articles, of which 444 articles screened in for scoring, 25% and 22% increases from 2020, respectively. After removal of duplicates, 23 articles were included for narrative summary. ECRLS constituted the largest category (n = 16, 70%), followed by EMD (n = 4, 17%) and DHR (n = 3, 13%). The majority of top articles were OR (n = 14, 61%) compared to RE (n = 9, 39%). CONCLUSIONS The GEM peer-reviewed literature continued to grow at a fast rate in 2021, reflecting the continued expansion and maturation of this subspecialty of emergency medicine. Few high-quality articles focused on DHR and EMD, suggesting a need for further efforts in those fields. Future efforts should focus on improving the diversity of GEM research and equitable representation.
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Affiliation(s)
- Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
| | - Braden J Hexom
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Joseph Bonney
- Department of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Global Health and Infectious Disease Research Group, Kumasi Center for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Amanda Collier
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Benjamin D Nicholson
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nana Serwaa A Quao
- Department of Emergency Medicine, Accident and Emergency Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Megan M Rybarczyk
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anand Selvam
- Department of Emergency Medicine, Yale University, New Haven, Connecticut, USA
| | - Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charlotte M Roy
- Department of Emergency Medicine, Loma Linda University, Loma Linda, California, USA
| | | | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
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Garbern SC, Hyuha G, González Marqués C, Baig N, Chan JL, Dutta S, Gulamhussein MA, López Terán GP, Manji HK, Mdundo WK, Moresky RT, Mussa RY, Noste EE, Nyirenda M, Osei-Ampofo M, Rajeev S, Sawe HR, Simbila AN, Thilakasiri MCK, Turgeon N, Wachira BW, Yang RS, Yussuf A, Zhang R, Zyer A, Rees CA. Authorship representation in global emergency medicine: a bibliometric analysis from 2016 to 2020. BMJ Glob Health 2022; 7:bmjgh-2022-009538. [PMID: 35760436 PMCID: PMC9237874 DOI: 10.1136/bmjgh-2022-009538] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction High-income country (HIC) authors are disproportionately represented in authorship bylines compared with those affiliated with low and middle-income countries (LMICs) in global health research. An assessment of authorship representation in the global emergency medicine (GEM) literature is lacking but may inform equitable academic collaborations in this relatively new field. Methods We conducted a bibliometric analysis of original research articles reporting studies conducted in LMICs from the annual GEM Literature Review from 2016 to 2020. Data extracted included study topic, journal, study country(s) and region, country income classification, author order, country(s) of authors’ affiliations and funding sources. We compared the proportion of authors affiliated with each income bracket using Χ2 analysis. We conducted logistic regression to identify factors associated with first or last authorship affiliated with the study country. Results There were 14 113 authors in 1751 articles. Nearly half (45.5%) of the articles reported work conducted in lower middle-income countries (MICs), 23.6% in upper MICs, 22.5% in low-income countries (LICs). Authors affiliated with HICs were most represented (40.7%); 26.4% were affiliated with lower MICs, 17.4% with upper MICs, 10.3% with LICs and 5.1% with mixed affiliations. Among single-country studies, those without any local authors (8.7%) were most common among those conducted in LICs (14.4%). Only 31.0% of first authors and 21.3% of last authors were affiliated with LIC study countries. Studies in upper MICs (adjusted OR (aOR) 3.6, 95% CI 2.46 to 5.26) and those funded by the study country (aOR 2.94, 95% CI 2.05 to 4.20) had greater odds of having a local first author. Conclusions There were significant disparities in authorship representation. Authors affiliated with HICs more commonly occupied the most prominent authorship positions. Recognising and addressing power imbalances in international, collaborative emergency medicine (EM) research is warranted. Innovative methods are needed to increase funding opportunities and other support for EM researchers in LMICs, particularly in LICs.
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Affiliation(s)
- Stephanie Chow Garbern
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Gimbo Hyuha
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania.,Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Catalina González Marqués
- Division of Global Emergency Medicine and Humanitarian Studies, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Noor Baig
- Department of Emergency Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Jennifer L Chan
- Department of Emergency Medicine, Northwestern University, Chicago, Illinois, USA.,CrisisReady, Boston, Massachusetts, USA
| | - Sanjukta Dutta
- Department of Emergency Medicine, Fortis Hospital, Kolkata, India
| | - Masuma A Gulamhussein
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania.,Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Gloria Paulina López Terán
- Servicio de Emergencia, Hospital Santa Inés de Ambato, Ambato, Ecuador.,Servicio de Emergencia, Hospital General Ambato, Ambato, Ecuador
| | - Hussein Karim Manji
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania.,Accident and Emergency Department, Aga Khan Hospital, Dar es Salaam, United Republic of Tanzania
| | - Winnie K Mdundo
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania.,Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Rachel T Moresky
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA.,Department of Emergency Medicine, Columbia University Medical Center, New York, New York, USA
| | - Raya Yusuph Mussa
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Erin E Noste
- Department of Emergency Medicine, University of California San Diego, San Diego, California, USA
| | - Mulinda Nyirenda
- Adult Emergency and Trauma Centre, Queen Elizabeth Central Hospital, Ministry of Health - Malawi, Blantyre, Malawi.,Emergency Medicine Unit, Department of Internal Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Maxwell Osei-Ampofo
- Emergency Medical Services, Ghana National Ambulance Service, Accra, Ghana.,Department of Internal Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Sindhya Rajeev
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Hendry R Sawe
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Alphonce Nsabi Simbila
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania.,Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | | | - Nikkole Turgeon
- University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Benjamin W Wachira
- Accident & Emergency Department, The Aga Khan University, Nairobi, Kenya
| | - Rebecca S Yang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Amne Yussuf
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania.,Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Raina Zhang
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alishia Zyer
- Bryant University, Smithfield, Rhode Island, USA
| | - Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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