North–South surgical training partnerships: a systematic review

Greive-Price, Tim; Mistry, Hardee; Baird, Robert

doi:10.1503/cjs.008219

Cited by 11 publications

(8 citation statements)

References 58 publications

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“…Our review identified many more programmes sending HIC surgical trainees to LMICs, than bi-directional, LMIC to HIC or LMIC to LMIC programmes. This is consistent with the findings of other studies [ 12 ]. The presence of HIC surgical trainees may undoubtedly in some circumstances provide significant benefit to the LMIC host institution [ 48 , 82 ].…”

Section: Discussionsupporting

confidence: 94%

“…Although “[t]he last ten years have seen the rise of global surgery as an academic pursuit” [ 10 ], in global surgery partnerships, clinical training continues to predominate over academic education [ 11 ]. Looking specifically at North–South surgical training partnerships Greive-Price et al found mostly “educational exchanges between HICs and LMICs” which, in general “flowed North to South… typically at the resident level, with most originating from North America and travelling to sub-Saharan Africa” [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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

2021

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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.

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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

2021

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“…Contributing factors are well known, including limited resources/infrastructure, inconsistency in training programmes, lack of postgraduate opportunities and limited access to advanced technologies/simulation. There is a growing evidence that simulation-based training should be incorporated into training programmes to improve surgical education14 while potentially useful exchanges between LMIC/HIC surgical trainees often neglect the learning needs of LMIC trainees as educational goals poorly matched to local clinical needs 15. Our study aimed to address these issues by designing the programme based on both WHO guidance and input from generalists and specialists in Uganda to ensure high-yield content for this setting.…”

Section: Discussionmentioning

confidence: 99%

Virtual reality technology for surgical learning: qualitative outcomes of the first virtual reality training course for emergency and essential surgery delivered by a UK–Uganda partnership

Please,

Narang,

Bolton

et al. 2024

BMJ Open Qual

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IntroductionThe extensive resources needed to train surgeons and maintain skill levels in low-income and middle-income countries (LMICs) are limited and confined to urban settings. Surgical education of remote/rural doctors is, therefore, paramount. Virtual reality (VR) has the potential to disseminate surgical knowledge and skill development at low costs. This study presents the outcomes of the first VR-enhanced surgical training course, ‘Global Virtual Reality in Medicine and Surgery’, developed through UK-Ugandan collaborations.MethodsA mixed-method approach (survey and semistructured interviews) evaluated the clinical impact and barriers of VR-enhanced training. Course content focused on essential skills relevant to Uganda (general surgery, obstetrics, trauma); delivered through: (1) hands-on cadaveric training in Brighton (scholarships for LMIC doctors) filmed in 360°; (2) virtual training in Kampala (live-stream via low-cost headsets combined with smartphones) and (3) remote virtual training (live-stream via smartphone/laptop/headset).ResultsHigh numbers of scholarship applicants (n=130); registrants (Kampala n=80; remote n=1680); and attendees (Kampala n=79; remote n=556, 25 countries), demonstrates widespread appetite for VR-enhanced surgical education. Qualitative analysis identified three key themes: clinical education and skill development limitations in East Africa; the potential of VR to address some of these via 360° visualisation enabling a ‘knowing as seeing’ mechanism; unresolved challenges regarding accessibility and acceptability.ConclusionOutcomes from our first global VR-enhanced essential surgical training course demonstrating dissemination of surgical skills resources in an LMIC context where such opportunities are scarce. The benefits identified included environmental improvements, cross-cultural knowledge sharing, scalability and connectivity. Our process of programme design demonstrates that collaboration across high-income and LMICs is vital to provide locally relevant training. Our data add to growing evidence of extended reality technologies transforming surgery, although several barriers remain. We have successfully demonstrated that VR can be used to upscale postgraduate surgical education, affirming its potential in healthcare capacity building throughout Africa, Europe and beyond.

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“…Some pediatric and internal medicine residency programs have also developed exchange programs with LMIC partner institutions [68][69][70]. However, few surgical training programs have developed such exchange programs [49,[70][71][72][73][74][75]. A 2020 systematic review of surgical training partnerships between HIC and LMIC by Price et al found that only one partnership offered bidirectional exchange and only two offered South-to-North exchange.…”

Section: From Unidirectional Capacity Building To Bidirectional Exchangementioning

confidence: 99%

Qualitative Analysis of the Host‐Perceived Impact of Unidirectional Global Surgery Training in Kijabe, Kenya: Benefits, Challenges, and a Desire for Bidirectional Exchange

et al. 2022

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Background As globalization of surgical training increases, growing evidence demonstrates a positive impact of global surgery experiences on trainees from high-income countries (HIC). However, few studies have assessed the impact of these largely unidirectional experiences from the perspectives of host surgical personnel from low- and middle-income countries (LMIC). This study aimed to assess the impact of unidirectional visitor involvement from the perspectives of host surgical personnel in Kijabe, Kenya. Methods Voluntary semi-structured interviews were conducted with 43 host surgical personnel at a tertiary referral hospital in Kijabe, Kenya. Qualitative analysis was used to identify salient and recurring themes related to host experiences with visiting surgical personnel. Perceived benefits and challenges of HIC involvement and host interest in bidirectional exchange were assessed. Results Benefits of visitor involvement included positive learning experiences (95.3%), capacity building (83.7%), exposure to diverse practices and perspectives (74.4%), improved work ethic (51.2%), shared workload (44.2%), access to resources (41.9%), visitor contributions to patient care (41.9%), and mentorship opportunities (37.2%). Challenges included short stays (86.0%), visitor adaptation and integration (83.7%), cultural differences (67.4%), visitors with problematic behaviors (53.5%), learner saturation (34.9%), language barriers (32.6%), and perceived power imbalances between HIC and LMIC personnel (27.9%). Nearly half of host participants expressed concerns about the lack of balanced exchange between HIC and LMIC programs (48.8%). Almost all (96.9%) host trainees expressed interest in a bidirectional exchange program. Conclusion As the field of global surgery continues to evolve, further assessment and representation of host perspectives is necessary to identify and address challenges and promote equitable, mutually beneficial partnerships between surgical programs in HIC and LMIC.

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North–South surgical training partnerships: a systematic review

Cited by 11 publications

References 58 publications

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

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

Virtual reality technology for surgical learning: qualitative outcomes of the first virtual reality training course for emergency and essential surgery delivered by a UK–Uganda partnership

Qualitative Analysis of the Host‐Perceived Impact of Unidirectional Global Surgery Training in Kijabe, Kenya: Benefits, Challenges, and a Desire for Bidirectional Exchange

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