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Botelho F, Gerk A, Harley JM, Poenaru D. Improving Pediatric Trauma Education by Teaching Non-technical Skills: A Randomized Controlled Trial. J Pediatr Surg 2024; 59:874-888. [PMID: 38369400 DOI: 10.1016/j.jpedsurg.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/16/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Pediatric trauma is a significant cause of child mortality, and the absence of non-technical skills (NTS) among health providers is linked with errors in patients' care. In this study, we evaluate the effectiveness of a structured debriefing protocol in enhancing NTS during pediatric trauma simulation. METHODS A total of 45 medical students were successfully recruited from two medical schools, one in Brazil and one in Canada. Medical students were assigned to a control (N = 20) or intervention group (N = 25) in a randomized control trial. Following simulated scenarios, participants in the intervention group underwent NTS debriefing, while the control received standard debriefing based on the Advanced Trauma Life Support (ATLS) protocol. Students' confidence, NTS level, and performance were measured through self-assessment surveys, the Non-Technical Skills for Surgeons (NOTSS) score, and adherence to the trauma protocol, respectively. Baseline characteristics and outcomes were compared using t-tests, Mann-Whitney, Wilcoxon signed-rank Kruskal-Wallis, ANOVA, and a repeated-measures ANCOVA. A significance level was set at p < 0.05. RESULTS The workshop increased students' confidence in leading trauma resuscitation regardless of their assignment to condition. While controlling for covariates, students in the intervention group significantly improved their overall NOTSS compared to those in the control and in all categories: situational awareness, decision-making, communication and teamwork, and leadership. The intervention teams also demonstrated a significant increase in completing trauma protocol steps. CONCLUSION Implementing structured debriefing focusing on NTS enhanced these skills and improved adherence to protocol among medical students managing pediatric trauma-simulated scenarios. These findings support integrating NTS training in pediatric trauma education. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Fabio Botelho
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada; Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada.
| | - Ayla Gerk
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada
| | - Jason M Harley
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada; Steinberg Centre for Simulation and Interactive Learning, McGill University, Montreal, Canada; Institute of Health Sciences Education, McGill University, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Dan Poenaru
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada; Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada; Institute of Health Sciences Education, McGill University, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada
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Sawhney R, Proulx KR, Gerk A, Guadagno E, Poenaru D. Patient-Centered Surgical Care for Children in Low and Lower-Middle Income Countries (LMICs) - A Systematic Scoping Review of the Literature. J Pediatr Surg 2024; 59:900-907. [PMID: 38369399 DOI: 10.1016/j.jpedsurg.2024.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/22/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE Studies exploring patient-centered care (PCC) in pediatric surgery have been disproportionately concentrated in high-income countries. This review aims to characterize the adoption of key PCC domains in low and lower-middle income countries (LMICs). METHODS Seven databases were searched from inception until January 2023 to retrieve relevant articles in pediatric surgery in LMICs. We focused on six key PCC domains: patient-reported outcomes (PROs), patient-reported experiences (PREs), shared decision-making (SDM), patient/parent education, patient/parent satisfaction, and informed consent. RESULTS Of 8050 studies screened, 230 underwent full-text review, and 48 were finally included. Most were single-center (87.5%), cross-sectional studies (41.7%) from the South-East Asian (35.4%) and Eastern Mediterranean regions (33.3%). Studies most frequently focused on postoperative care (45.8%) in pediatric general surgery (18.8%), and included 1-3 PCC domains. PREs (n = 30), PROs (n = 16) and patient/parent satisfaction (n = 16) were most common. Informed consent (n = 2) and SDM (n = 1) were least studied. Only 13 studies directly elicited children's perspectives. Despite all studies originating in LMICs, 25% of first and 17.8% of senior authors lacked LMIC affiliations. CONCLUSION The adoption of PCC in LMICs appears limited, focusing predominantly on PROs and PREs. Other domains such as informed consent and SDM are rarely addressed, and the voice of children and young people is rarely heard in their care. Opportunities to enhance PCC in LMICs abound, with the potential to improve the surgical care of children in resource-limited settings. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Riya Sawhney
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
| | - Kacylia Roy Proulx
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Ayla Gerk
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dan Poenaru
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Hyman GY, Salamea JC, Gerk A, Kumar N, Wurdeman T, Park KB, Rodas E, Meara JG, Riviello R, Uribe-Leitz T, Jimbo R. Ecuador's National Surgical Strengthening Plan: first in Latin America, provides hope for surgical care agenda. Rev Panam Salud Publica 2024; 48:e22. [PMID: 38576838 PMCID: PMC10993799 DOI: 10.26633/rpsp.2024.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024] Open
Affiliation(s)
- Gabriella Y. Hyman
- The Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUnited States of AmericaThe Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
| | | | - Ayla Gerk
- The Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUnited States of AmericaThe Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
| | - Nikathan Kumar
- The Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUnited States of AmericaThe Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
| | - Taylor Wurdeman
- The Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUnited States of AmericaThe Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
| | - Kee B. Park
- The Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUnited States of AmericaThe Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
| | - Edgar Rodas
- Virginia Commonwealth UniversityRichmondUnited States of AmericaVirginia Commonwealth University, Richmond, United States of America
| | - John G. Meara
- The Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUnited States of AmericaThe Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
| | - Robert Riviello
- The Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUnited States of AmericaThe Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
| | - Tarsicio Uribe-Leitz
- The Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUnited States of AmericaThe Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
| | - Ruth Jimbo
- Pontificia Universidad Católica del EcuadorQuitoEcuadorPontificia Universidad Católica del Ecuador, Quito, Ecuador
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Gerk A, Naus A, Carroll M, Ponte L, Salgado LS, Marrazzo E, Secanho M, Botelho F, Mooney D, Ferreira R, Ferreira JL. Perceived Impact of Coronavirus Disease 2019 on Surgical Training: A Brazilian Survey. J Surg Res 2024; 295:619-630. [PMID: 38101108 DOI: 10.1016/j.jss.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 09/22/2023] [Accepted: 10/27/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Recent studies revealed that coronavirus disease 2019 (COVID-19) negatively impacted residency programs worldwide, particularly procedure-based programs. However, most studies are from high-income countries, with scarce data from low- and middle-income countries. Pandemic effects on surgical training were likely worse in strictly apprenticeship models relying heavily on surgical volume as opposed to competency-based programs. Notably, training programs in Brazil and other low- and middle-income countries follow these strict apprenticeship style frameworks. In this study, we aimed to evaluate the trainees' perceptions of the impact of COVID-19 on their Brazilian surgical programs. METHODS A cross-sectional study was performed using an anonymous survey in Portuguese, distributed via social media platforms to surgical residents enrolled in Brazilian surgery programs. Data collection took place from August 2021 to May 2022. The survey contained 30 questions on the perception of the impact of COVID-19 on surgical training. RESULTS One-hundred sixty-two residents from 17 different surgical specialties and all five regions of Brazil responded to the survey. Of 162 residents, 145 (89%) believed the pandemic negatively impacted their surgical training. Furthermore, of 162 residents, 153 (94%) reported that elective surgical volume decreased during the pandemic and 91 (56%) were redeployed to assist with COVID-19 management. As a result, 102 of 162 (63%) residents believed their surgical skills were negatively impacted by COVID-19. Yet, 95 of 162 (59%) residents reported their residency programs did not offer resources to mitigate the pandemic's impact on training. Of 162 residents, 57 (35%) reported they did not feel on track for graduation, with no statistical difference between responses by year of residency (P = 0.083). Additionally, 124 of 162 (77%) residents reported that the pandemic negatively affected their mental health, most commonly related to stress at work, stress about transmitting COVID-19, and loss in surgical training. CONCLUSIONS Most of the surveyed Brazilian surgical residents felt the COVID-19 pandemic negatively impacted their training. This leads to believe that the detrimental impacts of the pandemic exposed preexisting weaknesses in the Brazilian surgical training model's dependence on a strict apprenticeship model. Our findings suggest a crucial need to redesign surgical education programs to make residency programs more prepared for changes in surgical volume, evolve the apprenticeship model to competency-based approaches, and unify surgical training standards in low- and middle-income countries.
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Affiliation(s)
- Ayla Gerk
- Universidad Católica Argentina, Buenos Aires, Argentina; Harvard Medical School, Program in Global Surgery and Social Change, Boston, Massachusetts
| | - Abbie Naus
- Harvard Medical School, Program in Global Surgery and Social Change, Boston, Massachusetts; Boston Children's Hospital, Boston, Massachusetts
| | - Madeleine Carroll
- Harvard Medical School, Program in Global Surgery and Social Change, Boston, Massachusetts
| | - Lucas Ponte
- School of Medicine, University of Fortaleza, Fortaleza, Ceará, Brazil
| | | | - Enzzo Marrazzo
- Faculty of Medicine, Institute of Biological Sciences, Pontifícia Universidade Católica de Minas Gerais Poços de Caldas, Poços de Caldas, Minas Gerais, Brazil
| | - Murilo Secanho
- Faculty of Medical Sciences of Botucatu, UNESP Botucatu, Botucatu, São Paulo, Brazil
| | - Fabio Botelho
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Childrens' Hospital, McGill University, Montreal, Quebec, Canada
| | - David Mooney
- Harvard Medical School, Program in Global Surgery and Social Change, Boston, Massachusetts; Boston Children's Hospital, Boston, Massachusetts
| | - Roseanne Ferreira
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Júlia Loyola Ferreira
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Childrens' Hospital, McGill University, Montreal, Quebec, Canada.
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Ceccomancini R, Gerk A, Stegmann J. Effect of non-pharmacological intervention on the nutritional status of patients with Prader Willi Syndrome. Clin Nutr ESPEN 2024; 59:149-153. [PMID: 38220368 DOI: 10.1016/j.clnesp.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 10/27/2023] [Accepted: 11/28/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Obesity is highly prevalent in patients with Prader-Willi syndrome (PWS), particularly among adults. This condition, which can be morbid in many cases, is multifactorial and has a complex management. The purpose of our study was to describe the feasibility of achieving a better nutritional status, including normal weight in individuals diagnosed with PWS, through specific nutritional interventions within the framework of a transdisciplinary treatment and without resorting to pharmacological treatments or growth hormone (GH). METHODOLOGY This observational study included patients with confirmed genetic diagnosis of PWS, receiving transdisciplinary treatment in a specialized rare diseases institution. Patients under treatment with GH and those under pharmacological treatment with nutritional objectives were excluded from the study. All patients attended our institution regularly on a weekly or fortnightly basis. Anthropometric records, including weight, height, and body mass index (BMI) were evaluated in each visit from treatment onset until the last check-up. RESULTS We included 24 patients with confirmed genetic diagnosis of PWS. At baseline, 9 patients (38 %) had obesity grade III, 1 (4 %) of obesity grade II, 10 (42 %) of obesity grade I, 2 (8 %) of overweight, and 2 patients (8 %) with normal baseline weight. After a median duration of 52 months (interquartile range 23-116 months) of transdisciplinary nutritional treatment, we identified a significant reduction in BMI (baseline 40.2 ± 15.7 kg/m2 vs. follow-up 28.3 ± 6.7 kg/m2, p < 0.0001), without significant differences regarding height (baseline 1.45 ± 0.1 m vs. follow-up 1.48 ± 0.1 m, p = 0.09). CONCLUSION In this study, we demonstrated that nutritional nonpharmacologic interventions immersed in a transdisciplinary treatment enabled a consistent and sustainable improvement in BMI and nutritional status among patients with PWS.
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Affiliation(s)
| | - Ayla Gerk
- Department of Clinical Research, SPINE Foundation, Buenos Aires, Argentina; Department of Clinical Medicine, SPINE Foundation, Buenos Aires, Argentina
| | - Jorgelina Stegmann
- Department of Clinical Research, SPINE Foundation, Buenos Aires, Argentina; Department of Clinical Medicine, SPINE Foundation, Buenos Aires, Argentina.
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Jaime MP, Gerk A, Stegmann J. Effectiveness of the Kaufman Brief Intelligence Test in people with Prader-Willi syndrome. J Intellect Disabil Res 2024; 68:45-52. [PMID: 37732721 DOI: 10.1111/jir.13090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 08/18/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Evaluating intelligence using conventional tools is very complex in patients with Prader-Willi Syndrome (PWS), as it is time consuming and requires levels of care that are difficult to sustain for this population. Therefore, we explore the ability of a brief test to assess intelligence in these patients. METHODS This study included individuals with a genetically confirmed diagnosis of PWS, with regular attendance at transdisciplinary treatment in an institution dedicated to the care of rare diseases in Argentina. The Wechsler Intelligence Scale for Children (WISC-IV), the Wechsler Adult Intelligence Scale (WAIS-III) and the Kaufman Brief Intelligence Test (K-BIT) were used. RESULTS Correlation was obtained between the scales in paediatric and adult populations. Within the paediatric population, no significant differences were identified between the WISC-IV scale (Wechsler for paediatrics) and the K-BIT (56.4 ± 8.6, vs. 53.4 ± 10.1, P = 0.28), with a good agreement between the methods {intraclass correlation 0.79 [95% confidence interval (CI) 0.15-0.95]}. Regarding the adult population, the discrimination of the WAIS-III scale (Wechsler for adults) and the K-BIT of adults (16 years and over) presented an acceptable concordance [0.77 (95% CI -0.09; 0.93)], although also underestimating the results (58.3 ± 7.2 vs. 51.1 ± 11.2, P < 0.0001). CONCLUSIONS We observed the feasibility and potential usefulness of a brief intelligence test (K-BIT) in patients with PWS with an acceptable agreement with conventional tools.
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Affiliation(s)
- M P Jaime
- Department of Psycho-Physical Rehabilitation, SPINE Foundation, Buenos Aires, Argentina
| | - A Gerk
- Department of Clinical Research, SPINE Foundation, Buenos Aires, Argentina
- Department of Clinical Medicine and Nutrition, SPINE Foundation, Buenos Aires, Argentina
| | - J Stegmann
- Department of Clinical Research, SPINE Foundation, Buenos Aires, Argentina
- Department of Clinical Medicine and Nutrition, SPINE Foundation, Buenos Aires, Argentina
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González Ruiz Y, Gerk A, Stegmann J. Mental health impact on primary and secondary Prader-Willi syndrome caregivers. Child Care Health Dev 2024; 50:e13162. [PMID: 37614065 DOI: 10.1111/cch.13162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/05/2023] [Accepted: 07/28/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Caring for individuals with rare diseases can be challenging and represent a burden. Nevertheless, this has been scarcely explored in Prader-Willi syndrome (PWS). Therefore, we sought to explore the psychological impact of caregiving, as well as the differences between main caregivers and other family members. METHODS Different evaluation tools and scales were used taking into consideration the impact on caregivers. The scales were administered to those relatives who are immersed in the usual dynamics of the patient, differentiating between the main caregiver and other relatives living in the family home. RESULTS A total of 33 families of patients with genetic confirmation of PWS were included. In this survey, 32% of primary caregivers reported a high probability of anxiety, compared with 19% of non-primary caregivers (p = 0.27). Concerning depression, 40% of primary caregivers related possible or probable cases of depression compared with non-primary caregivers 13% (p = 0.04). Regarding caregiver burden evaluated using the Zarit scale, 61% of the main caregivers presented high levels of overload, compared with 29% of the other relatives (p = 0.005). Family functioning evaluated using the APGAR scale showed a total lower response from primary caregivers, but no statistically relevant results were found [25.4 ± 6.7 vs. 26.0 ± 8.2 (p = 0.72)]. CONCLUSION In this study, we observed that caring for people with PWS can have a significant effect on the mental health, burden and quality of life of caregivers, with a greater impact among primary caregivers compared with the other living relatives.
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Affiliation(s)
| | - Ayla Gerk
- Department of Clinical Medicine, SPINE Foundation, Buenos Aires, Argentina
| | - Jorgelina Stegmann
- Department of Clinical Medicine, SPINE Foundation, Buenos Aires, Argentina
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Winslow K, Gerk A, Park K, Hyman G. Surgery's place in the UHC2030 Action Agenda. Lancet 2023; 402:1234. [PMID: 37741286 DOI: 10.1016/s0140-6736(23)01890-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/05/2023] [Indexed: 09/25/2023]
Affiliation(s)
- Kiana Winslow
- Program in Global Surgery and Social Change, Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Ayla Gerk
- Program in Global Surgery and Social Change, Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Kee Park
- Program in Global Surgery and Social Change, Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Gabriella Hyman
- Program in Global Surgery and Social Change, Harvard Medical School, Harvard University, Boston, MA 02115, USA; Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.
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Kundu S, Sana H, Dutta R, Gerk A, Pigeolet M, Raykar NP. Call for standardised emergency preparedness and response. Lancet 2023; 401:1924-1925. [PMID: 37245516 DOI: 10.1016/s0140-6736(23)01070-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/12/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Shreenik Kundu
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; West China School of Medicine, Sichuan University, Chengdu, China.
| | - Hamaiyal Sana
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Bolan Medical College, Bolan University of Medical & Health Sciences, Quetta, Pakistan
| | - Rohini Dutta
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Christian Medical College and Hospital, Ludhiana, India
| | - Ayla Gerk
- Universidad Catolica Argentina, Buenos Aires, Argentina
| | - Manon Pigeolet
- Department of Pediatric Orthopedics, Hôpital universitaire Necker-Enfants malades, Paris, France
| | - Nakul P Raykar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Department of Trauma Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Faria I, Moura CB, Graner M, Campos LN, Gerk A, Bittencourt MM, Cazumbá ML, Mishaly A, Buda AM, Truche P, Bowder AN, Botelho F, Carroll M, Mooney D, Naus A. Online medical education: A student survey. Clin Teach 2023:e13582. [PMID: 37211433 DOI: 10.1111/tct.13582] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/24/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND During COVID-19, medical schools transitioned to online learning as an emergency response to deliver their education programmes. This multi-country study compared the methods by which medical schools worldwide restructured the delivery of medical education during the pandemic. METHODS This multi-country, cross-sectional study was performed using an internet-based survey distributed to medical students in multiple languages in November 2020. RESULTS A total of 1,746 responses were received from 79 countries. Most respondents reported that their institution stopped in-person lectures, ranging from 74% in low-income countries (LICs) to 93% in upper-middle-income countries. While only 36% of respondents reported that their medical school used online learning before the pandemic, 93% reported using online learning after the pandemic started. Of students enrolled in clinical rotations, 89% reported that their rotations were paused during the pandemic. Online learning replaced in-person clinical rotations for 32% of respondents from LICs versus 55% from high-income countries (HICs). Forty-three per cent of students from LICs reported that their internet connection was insufficient for online learning, compared to 11% in HICs. CONCLUSIONS The transition to online learning due to COVID-19 impacted medical education worldwide. However, this impact varied among countries of different income levels, with students from LICs and lower middle income countries facing greater challenges in accessing online medical education opportunities while in-person learning was halted. Specific policies and resources are needed to ensure equitable access to online learning for medical students in all countries, regardless of socioeconomic status.
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Affiliation(s)
- Isabella Faria
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina B Moura
- Hospital Universitário da Universidade Federal Fluminense UFF/HUAP, Niterói, Rio de Janeiro, Brazil
| | - Mariana Graner
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Letícia Nunes Campos
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | - Ayla Gerk
- Universidad Catolica Argentina, Buenos Aires, Argentina
| | | | - Maria Luíza Cazumbá
- Faculdade de Medicina, Universidade Federal de Minas Gerais, UFMG, Belo Horizonte, Minas Gerais, Brazil
| | | | - Alexandra M Buda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- School of Medicine, University of Rochester, Rochester, New York, USA
| | - Paul Truche
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Alexis N Bowder
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Madeleine Carroll
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - David Mooney
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Abbie Naus
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
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Bustorff-Silva J, Miranda ML, Rosendo A, Gerk A, Oliveira-Filho AG. Evaluation of the regional distribution of the pediatric surgery workforce and surgical load in Brazil. World J Pediatr Surg 2023; 6:e000522. [PMID: 37215247 PMCID: PMC10193071 DOI: 10.1136/wjps-2022-000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/20/2023] [Indexed: 05/24/2023] Open
Abstract
Objective The purpose of this study is to examine the regional distribution of the pediatric surgery workforce and the expected local demand for pediatric surgical procedures in Brazil. Methods We collected data on the pediatric surgical workforce, surgical volume, Gross Domestic Product per capita, and mortality for gastrointestinal tract malformations (MGITM) across the different regions of Brazil for 2019. Results Data from the Federal Medical Council reported 1515 pediatric surgery registries in Brazil, corresponding to 1414 pediatric surgeons (some pediatric surgeons are registered in more than one state), or 2.4 pediatric surgeons per 100 000 children 14 years of age and younger. There were 828 men and 586 women. The mean age was 51.5±12.8 years, and the mean time from graduation was 3.4±5.7 years. There is a higher concentration of pediatric surgeons in the wealthier Central-West, South, and Southeast regions. Individual surgical volume ranged from 88 to 245 operations/year (average 146 operations/year) depending on the region. Of these, only nine (6.1%) were high-complexity (including neonatal) operations. MGITM tended to be higher in the poorer North and Northeast regions than in other regions of Brazil. Conclusions Our findings suggest significant disparities in the surgical workforce and workload across Brazil related to socioeconomic status. Regions with an increased surgical workforce were associated with lower MGITM. The average number of complex operations performed annually by each pediatric surgeon was considerably low. Strategic investment and well-defined health policies are imperative to enhance the quality of surgical care in the different regions of Brazil. Level of evidence Retrospective review; level IV.
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Affiliation(s)
| | - Marcio Lopes Miranda
- Pediatric Surgery, State University of Campinas Medical School, Campinas, Brazil
| | - Amanda Rosendo
- Pediatric Surgery, State University of Campinas Medical School, Campinas, Brazil
| | - Ayla Gerk
- Pediatric Surgery, State University of Campinas Medical School, Campinas, Brazil
- Medicine, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
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Faria I, Campos L, Jean-Pierre T, Naus A, Gerk A, Cazumbá ML, Buda AM, Graner M, Moura CB, Pendleton A, Pompermaier L, Truche P, Ferreira JL, Bowder AN. Corrigendum to 'Gender-Based Discrimination Among Medical Students: A Cross-Sectional Study in Brazil' J Surg Res. 2022 Nov 15;283:102-109. J Surg Res 2023; 284:251. [PMID: 36603518 DOI: 10.1016/j.jss.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Isabella Faria
- Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts.
| | | | - Tayana Jean-Pierre
- Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts
| | - Abbie Naus
- Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts
| | - Ayla Gerk
- Universidad Católica Argentina, Buenos Aires, Argentina
| | | | - Alexandra M Buda
- Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts; University of Rochester Medical Center, Rochester, New York
| | - Mariana Graner
- School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Alaska Pendleton
- Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts
| | - Laura Pompermaier
- Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts; Linköping University, Linköping, Sweden
| | - Paul Truche
- Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts
| | - Júlia Loyola Ferreira
- McGill University, Montreal, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
| | - Alexis N Bowder
- Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts; Medical College of Wisconsin, Milwaukee, Wisconsin
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Faria I, Campos L, Jean-Pierre T, Naus A, Gerk A, Cazumbá ML, Buda AM, Graner M, Moura CB, Pendleton A, Pompermaier L, Truche P, Ferreira JL, Bowder AN. Gender-Based Discrimination Among Medical Students: A Cross-Sectional Study in Brazil. J Surg Res 2023; 283:102-109. [PMID: 36399801 DOI: 10.1016/j.jss.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 09/19/2022] [Accepted: 10/16/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Gender-based discrimination (GBD) creates a hostile environment during medical school, affecting students' personal life and academic performance. Little is known about how GBD affects the over 204,000 medical students in Brazil. This study aims to explore the patterns of GBD experienced by medical students in Brazil. METHODS This is a cross-sectional study using an anonymous, Portuguese survey disseminated in June 2021 among Brazilian medical students. The survey was composed of 24 questions to collect data on GBD during medical school, formal methods for reporting GBD, and possible solutions for GBD. RESULTS Of 953 responses, 748 (78%) were cisgender women, 194 (20%) were cisgender men, and 11 (1%) were from gender minorities. 65% (616/942) of respondents reported experiencing GBD during medical school. Women students experienced GBD more than men (77% versus 22%; P < 0.001). On comparing GBD perpetrator roles, both women (82%, 470/574) and men (64%, 27/42) reported the highest rate of GBD by faculty members. The occurrence of GBD by location differed between women and men. Only 12% (115/953) of respondents reported knowing their institution had a reporting mechanism for GBD. CONCLUSIONS Most respondents experienced GBD during medical school. Cisgender women experienced GBD more than cisgender men. Perpetrators and location of GBD differed for men and women. Finally, an alarming majority of students did not know how to formally report GBD in their schools. It is imperative to adopt broad policy changes to diminish the rate of GBD and its a consequential burden on medical students.
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Affiliation(s)
- Isabella Faria
- Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts.
| | | | - Tayana Jean-Pierre
- Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts
| | - Abbie Naus
- Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts
| | - Ayla Gerk
- Universidad Católica Argentina, Buenos Aires, Argentina
| | | | - Alexandra M Buda
- Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts; University of Rochester Medical Center, Rochester, New York
| | - Mariana Graner
- School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Alaska Pendleton
- Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts
| | - Laura Pompermaier
- Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts; Linköping University, Linköping, Sweden
| | - Paul Truche
- Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts
| | - Júlia Loyola Ferreira
- McGill University, Montreal, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
| | - Alexis N Bowder
- Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts; Medical College of Wisconsin, Milwaukee, Wisconsin
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Campos LN, Pawlak N, Velin L, Ruzgar NM, Gerk A, Reid K, Iraqi HA, Bentounsi Z, Drejza M, Patil D, Nassour N, Tatere HY, Riaz MMA, Zakrison TL. Raising Gender Equity Voices: Reflections from an International Virtual Assembly in Global Surgery. Int J Med Students 2021. [DOI: 10.5195/ijms.2021.1055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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