Personalized Graduate Medical Education and the Global Surgeon: Training for Resource-Limited Settings

Underprepared: influences of U.S. medical students' self-assessed confidence in immigrant and refugee health care

BACKGROUND

United States (U.S.) census data from 2017 indicates that the percentage of persons born outside of the U.S. is increasing. However, no studies describe the amount of class time focused on immigrant and refugee health during medical school in the U.S. nor on incoming residents' confidence in providing culturally sensitive care. The objective of this study is to characterize final-year medical students' exposure to immigrant and refugee health and their confidence in caring for these populations.

METHODS

A voluntary, cross-sectional survey was sent electronically to fourth-year medical students at twelve U.S. medical schools in 2020, with 707 respondents (46% response rate). Questions addressed respondents' curricular exposure to immigrant and refugee health care during medical school and their confidence in providing culturally sensitive care. Chi-square tests were used to assess relationships between categorical variables, and odds ratios were calculated for dichotomized variables.

RESULTS

Most students (70.6%) described insufficient class time dedicated to culturally sensitive care, and many (64.5%) reported insufficient clinical exposure in caring for immigrants/refugees. The odds that incoming residents felt 'usually' or 'always' confident in their ability to provide culturally sensitive care to immigrants and refugees were higher in those with more class time on culturally sensitive care (OR 5.2 [3.6-7.4]), those with more clinical opportunities to care for immigrants and refugees (OR 7.2 [5.1-10.2]), and those who participated in a domestic low-resource or international elective (OR 1.4 [1.02-1.9]). More than half (55.3%) of respondents reported feeling 'not at all' or only 'sometimes' confident in their ability to provide culturally sensitive care to immigrants/refugees.

CONCLUSIONS

Most fourth-year U.S. medical students entering residency feel unprepared to deliver culturally sensitive care to immigrants and refugees. This may be mediated by increased exposure to didactic curricula class time and/or experiential clinical activities, as those factors are associated with improved student confidence.

Chinese digestive surgery interns' learning quality and English reading proficiency during COVID-19 pandemic: Comparison between face-to-face versus WeChat teaching and learning

Gastrointestinal clinical teaching is of vital important for gastrointestinal surgery interns. However, during COVID-19 pandemic, due to frequent lockdowns and essential social distancing policy implemented in China, face-to-face teaching was interrupted significantly. To find a cost-effective way to deliver medical education to ensure that teaching and learning would be continued and uninterrupted, many social media tools and mobile applications have been used in medical teaching and learning. WeChat has been frequently employed in teaching and learning in many disciplines in Chinese universities due to its powerful functions and free cost. This study compared Chinese digestive surgery interns' learning quality, English reading proficiency, and learning satisfaction in two teaching conditions: the traditional face-to-face teaching versus WeChat teaching via an experiment. The study recruited 60 final year clinical medical students, who were randomly and equally assigned into two groups: traditional face-to-face teaching versus WeChat teaching. Interns' learning quality and learning satisfaction were measured by Likert-scale questionnaires; and their English reading proficiency was measured by the reading section in a standardized English test. The results showed that interns in WeChat group had significantly higher learning quality on understanding mechanisms and current knowledge by both self-assessment and peer-assessment. WeChat group also outperformed face-to-face group on inferencing, details, and main ideas in English reading. With regard to learning satisfaction, WeChat group were higher on learning interests, learning objectives, learning format, and English reading proficiency than face-to-face group. However, interns did not differ in terms of their learning satisfaction on medical skills, which might indicate that WeChat had limitations on training interns' medical practical ability.

Representation of Global Health Initiatives in Plastic Surgery Training: A Social Media Analysis

INTRODUCTION

Over the last several years, various social media platforms have been used to increase collaboration, education, and research internationally. The purpose of this study was to evaluate how plastic surgery residency programs use social media to promote global surgery education, research, and collaboration.

METHODS

A full list of active integrated residency programs was obtained from the American College of Academic Plastic Surgeons website. A total of 82 programs were identified. Instagram, Facebook, and Twitter were searched for active accounts. Only accounts dedicated to plastic surgery programs or had a significant amount of residency-related content were included. Inclusion criteria included posts relating to global health, global surgery, mission trips, international plastic surgery education, and global surgery research. Caption language was analyzed and classified as either "resident education in global surgery," "an individual's interest in global surgery," "research in global surgery," "visiting international professor," or "global collaboration." Image content was then assessed for "images with patients," "images with other surgeons/residents," "images of international location," a combination thereof, "other," or "none."

RESULTS

Instagram was by far the most used by plastic surgery residency programs with a total of 76 programs having accounts compared with only 32 programs and 33 programs having Facebook and Twitter accounts, respectively. There was no significant difference in the proportional number of posts relating to global surgery across the 3 platforms (P = 0.1911). On all 3 social media platforms, the majority of posts fell into the category of "international collaboration" with 42.5%, 50.7%, and 48.8% on Instagram, Facebook, and Twitter, respectively. None of the caption categories examined showed a significantly different proportion of posts across the 3 platforms. Image analysis showed a significant difference in the proportional representation across the 3 platforms in the categories of "images with other surgeons/residents" (P = 0.0196) "images with patients" (P = 0.0082), combination (P = 0.0225), and other (P = 0.0114).

CONCLUSIONS

Although social media offers programs an easy way to promote global surgery research, collaboration, and education with a wider audience, it is being underused for this purpose as evident by the relatively lower number of postings on each platform relating to this content.

Ethics of Educating American Global Surgeons: An Approach to Conscientious Training on the Individual, Departmental, and Institutional Levels

Global surgery is a medical field dedicated to the facilitation of timely access to safe, affordable, and high-quality surgical healthcare worldwide, including support for necessary surgery and anesthesia infrastructure. Standard surgical training in the US does not provide necessary exposure to the range of surgical operations and nontechnical skills critical to practice in resource-limited contexts. Therefore, academic medical institutions have sought to bridge this training gap by establishing global surgery-focused rotations, fellowships, and integrated global surgery residencies. However, the presence of trainees pursuing education for careers in resource-variable settings presents an added layer of ethical complexity that must be carefully considered on the individual, programmatic, and institutional level. This article reviews the complexities relevant to global surgery trainees across these levels and offers potential mechanisms for addressing these ethical challenges.

Global Surgery Education and Training Programmes-a Scoping Review and Taxonomy

Global surgery is an emerging field of study and practice, aiming to respond to the worldwide unmet need for surgical care. As a relatively new concept, it is not clear that there is a common understanding of what constitutes "global surgery education and training". This study examines the forms that global surgery education and training programmes and interventions take in practice, and proposes a classification scheme for such activities. A scoping review of published journal articles and internet websites was performed according to the PRISMA Extension for Scoping Review guidelines. PubMed MEDLINE, EMBASE and Google were searched for sources that described global surgery education and training programme. Only sources that explicitly referenced a named education programme, were surgical in nature, were international in nature, were self-described as "global surgery" and presented new information were included. Three hundred twenty-seven records were identified and 67 were ultimately included in the review. "Global surgery education and training" interventions described in the literature most commonly involved both a High-Income Country (HIC) institution and a Low- and Middle-Income Country (LMIC) institution. The literature suggests that significant current effort is directed towards academic global surgery programmes in HIC institutions and HIC surgical trainee placements in LMICs. Four categories and ten subcategories of global surgery education and training were identified. This paper provides a framework from which to study global surgery education and training. A clearer understanding of the forms that such interventions take may allow for more strategic decision making by actors in this field.