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. 2020 Nov 30;63(6):E551-E561.
doi: 10.1503/cjs.008219.

North-South surgical training partnerships: a systematic review

Tim Greive-Price  1 , Hardee Mistry  1 , Robert Baird  1
Affiliations

North-South surgical training partnerships: a systematic review

Tim Greive-Price et al. Can J Surg. .

Abstract
in English, French

Background: Fostering the success of surgical trainees from low- and middle-income countries (LMICs) plausibly addresses the existing workforce deficit in a sustainable manner, but it is unclear whether and how these trainees are targeted as strategic learners for educational exchanges. The purpose of this review was to assess the quality and outcomes of existing literature on exchanges of surgical trainees between high-income countries (HICs) and LMICs.

Methods: We conducted a systematic review of reported instances of surgical training exchanges between HICs and LMICs. After database searching, 2 independent reviewers evaluated titles, abstracts and manuscripts. Selected studies were critically appraised with the use the Critical Assessment Skills Programme Qualitative Checklist and analyzed for trainee level, institutions, countries and subspecialties, as well as reported outcomes of the exchange.

Results: Twenty-eight reports met the inclusion criteria and were analyzed. Most publications (18 [64%]) detailed North-to-South exchanges; 1 exchange was bidirectional. General surgery was the most common discipline identified, with 9 other subspecialties described involving learners at all phases of training. Reports were generally of good quality, although outcomes were reported variably, and most authors failed to acknowledge the ethical implications of their study.

Conclusion: The articles identified described a variety of surgical exchanges across disciplines, learner types and host/home countries. Few of the exchanges prioritized the learning of surgical trainees from LMICs. There is an increasing need to formalize these exchanges via clear goals and objectives, as well as to prioritize the proper matching of educational goals with local clinical needs.

Level of evidence: V - Evidence from systematic reviews of descriptive and qualitative studies.

Contexte: Le soutien à la réussite des chirurgiens en formation des pays à revenu faible ou moyen (PRFM) pourrait concrètement aider à remédier au manque d’effectifs actuel de façon durable. On ignore toutefois si ces apprenants sont ciblés par les programmes d’échanges en tant que candidats stratégiques et quelles sont les méthodes de recrutement employées. La présente revue vise à évaluer la qualité et les résultats des publications sur les échanges entre pays à revenu élevé (PRE) et PRFM auxquels participent des chirurgiens en formation.

Méthodes: Nous avons procédé à une revue systématique des cas rapportés d’échanges étudiants en chirurgie entre PRE et PRFM. Après une recherche dans les bases de données, 2 évaluateurs indépendants ont passé en revue les titres, les résumés et les manuscrits retenus. Les études sélectionnées ont fait l’objet d’une évaluation critique d’après la liste de contrôle pour la recherche qualitative CASP (Critical Assessment Skills Programme Qualitative Checklist); les critères d’analyse comprenaient le niveau de scolarité des apprenants, les établissements, les pays et les surspécialités, ainsi que les résultats rapportés pour l’échange.

Résultats: Au total, 28 rapports répondaient aux critères d’inclusion et ont donc été analysés. La plupart d’entre eux (18 [64%]) traitaient d’échanges du nord au sud; un échange était bidirectionnel. La chirurgie générale était la discipline la plus souvent recensée; on a aussi décrit la participation d’apprenants à différentes étapes de leur formation pour 9 autres surspécialités. Les rapports étaient en général de bonne qualité, mais la présentation des résultats variait, et la majorité des auteurs ont omis de rendre compte des considérations éthiques de leur étude.

Conclusion: Les articles évalués décrivaient des échanges étudiants en chirurgie se rapportant à une multitude de disciplines, de types d’apprenants et de pays d’origine et d’accueil. Peu de programmes d’échanges priorisaient l’apprentissage des chirurgiens en formation issus des PRFM. Il est de plus en plus pressant de baliser les échanges étudiants en établissant des buts et des objectifs clairs, et de faire une priorité de la juste correspondance des objectifs pédagogiques et des besoins cliniques locaux.

Niveau de preuve: V — Preuve issue de revues systématiques d’études descriptives et qualitatives.

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Conflict of interest statement

None declared

Figures

Fig. 1
Fig. 1
Flow diagram showing selection of articles included in review. LMIC = low- or middle-income country.
Fig. 2
Fig. 2
World map showing all high-income countries, and low- and middle-income countries in included studies, and their roles in the described exchanges. Values in red = number of times as home country; values in blue = number of times as host country.
Fig. 3
Fig. 3
Critical appraisal across studies as determined with the Critical Assessment Skills Programme Qualitative Checklist.
Fig. 4
Fig. 4
Critical appraisal of individual studies as determined with the Critical Assessment Skills Programme Qualitative Checklist.
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References

    1. Meara JG, Greenberg SLM. The Lancet Commission on Global Surgery Global surgery 2030: evidence and solutions for achieving health, welfare and economic development. Surgery. 2015;157:834–5. - PubMed
    1. Ng-Kamstra JS, Greenberg SLM, Abdullah F, et al. Global Surgery 2030: a roadmap for high income country actors. BMJ Glob Health. 2016;1:e000011. - PMC - PubMed
    1. Haider A, Scott JW, Gause CD, et al. Development of a unifying target and consensus indicators for global surgical systems strengthening: proposed by the Global Alliance for Surgery, Obstetric, Trauma, and Anaesthesia Care (the G4 Alliance) World J Surg. 2017;41:2426–34. - PMC - PubMed
    1. Goodman LF, St-Louis E, Yousef Y, et al. The Global Initiative for Children’s Surgery: optimal resources for improving care. Eur J Pediatr Surg. 2018;28:51–9. - PubMed
    1. Watters DA, Guest GD, Tangi V, et al. Global surgery system strengthening: it is all about the right metrics. Anesth Analg. 2018;126:1329–39. - PubMed

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