Academic Global Surgery Curricula: Current Status and a Call for a More Equitable Approach

Anusha Jayaram¹, Natalie Pawlak², Alexis Kahanu³, Parisa Fallah⁴, Haniee Chung⁵, Nancy Valencia-Rojas⁶, Edgar B Rodas Jr⁶, Ahmadreza Abbaslou⁷, Adnan Alseidi⁸, Emmanuel A Ameh⁹, Abebe Bekele¹⁰, Kathleen Casey¹¹, Kathryn Chu¹², Robert Dempsey¹³, Chris Dodgion¹⁴, Randeep Jawa¹⁵, Maria F Jimenez¹⁶, Walt Johnson¹⁷, Sanjay Krishnaswami¹⁸, Gifty Kwakye¹⁹, Robert Lane²⁰, Kokila Lakhoo²¹, Kristin Long¹³, Katayoun Madani²², Fiemu Nwariaku²³, Benedict Nwomeh²⁴, Raymond Price²⁵, Steven Roser²⁶, Andrew B Rees²⁷, Nobhojit Roy²⁸, Nensi Melissa Ruzgar²⁹, Hernan Sacoto³⁰, Ziad Sifri³¹, Nichole Starr⁸, Mamta Swaroop²², Margaret Tarpley³², John Tarpley³³, Girma Terfera¹³, Thomas Weiser³⁴, Michael Lipnick³⁵, Mary Nabukenya³⁶, Doruk Ozgediz⁸, Sudha Jayaraman³⁷

Affiliations

¹ Tufts University School of Medicine, Boston, MA.
² Tufts University School of Medicine, Boston, MA. Electronic address: Natalie.pawlak@tufts.edu.
³ Hackensack University Medical Center, Edison, NJ, USA.
⁴ Department of OB/GYN, Brigham & Women's Hospital and Massachusetts General Hospital, Boston, MA, USA.
⁵ Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ Virginia Commonwealth University Department of Surgery, Richmond VA, USA.
⁷ Tehran University of Medical Sciences, Tehran, Iran.
⁸ University of California San Francisco Department of Surgery, San Francisco, CA, USA.
⁹ National Hospital Division of Paediatric Surgery, Abuja, Nigeria.
¹⁰ Addis Ababa University Department of Surgery, Addis Ababa, Ethiopia; University of Global Health Equity, Rwanda.
¹¹ Physicians for Peace.
¹² Department of Surgery, University of Cape Town, Cape Town, South Africa.
¹³ University of Wisconsin School of Medicine and Public Health, Madison WI, USA.
¹⁴ Medical College of Wisconsin Division of Trauma and Critical Care, Wauwatosa, WI, USA.
¹⁵ Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA.
¹⁶ Hospital Universitario Mayor Mederi, Department of Surgery. Universidad del Rosario, Bogota, Colombia.
¹⁷ Loma Linda University, Loma Linda CA, USA.
¹⁸ OHSU, Portland, OR, USA.
¹⁹ University of Michigan Department of Surgery, Ann Arbor, MI, USA.
²⁰ International Federation of Surgical Colleges.
²¹ University of Oxford, Oxford University Hospitals, UK.
²² Northwestern University Department of Surgery, Chicago, IL, USA.
²³ UT Southwesterm, Dallas, TX, USA.
²⁴ Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
²⁵ University of Utah Dept of Surgery, Salt Lake City, UT, USA.
²⁶ Emory University School of Medicine, Atlanta, GA, USA.
²⁷ Vanderbilt University School of Medicine, Nashville, TN, USA.
²⁸ BARC Hospital, HBNI University, Mumbai, India/ CARE-India, Bihar Technical Support Unit, Patna, Bihar, India.
²⁹ Yale University School of Medicine, New Haven, CT, USA.
³⁰ Universidad de Azuay, Cuenca, Ecuador.
³¹ Rutgers New Jersey Medical School Department of Surgery, Newark, NJ, USA.
³² University of Botswana Department of Medical Education, Gaborone, Botswana.
³³ University of Botswana Department of Surgery, Gaborone, Botswana.
³⁴ Stanford University Medical Center Department of Surgery, Stanford, CA, USA.
³⁵ University of California San Francisco Department of Anesthesia, San Francisco, CA, USA.
³⁶ Makerere University Department of Anesthesia, Kampala, Uganda.
³⁷ University of Utah Dept of Surgery, Salt Lake City, UT, USA. Electronic address: Sudha.jayaraman@hsc.utah.edu.

PMID: 34905823
DOI: 10.1016/j.jss.2021.03.061

Review

Academic Global Surgery Curricula: Current Status and a Call for a More Equitable Approach

Anusha Jayaram et al. J Surg Res. 2021 Nov.

. 2021 Nov:267:732-744.

doi: 10.1016/j.jss.2021.03.061. Epub 2021 Aug 21.

Authors

Affiliations

¹ Tufts University School of Medicine, Boston, MA.
² Tufts University School of Medicine, Boston, MA. Electronic address: Natalie.pawlak@tufts.edu.
³ Hackensack University Medical Center, Edison, NJ, USA.
⁴ Department of OB/GYN, Brigham & Women's Hospital and Massachusetts General Hospital, Boston, MA, USA.
⁵ Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ Virginia Commonwealth University Department of Surgery, Richmond VA, USA.
⁷ Tehran University of Medical Sciences, Tehran, Iran.
⁸ University of California San Francisco Department of Surgery, San Francisco, CA, USA.
⁹ National Hospital Division of Paediatric Surgery, Abuja, Nigeria.
¹⁰ Addis Ababa University Department of Surgery, Addis Ababa, Ethiopia; University of Global Health Equity, Rwanda.
¹¹ Physicians for Peace.
¹² Department of Surgery, University of Cape Town, Cape Town, South Africa.
¹³ University of Wisconsin School of Medicine and Public Health, Madison WI, USA.
¹⁴ Medical College of Wisconsin Division of Trauma and Critical Care, Wauwatosa, WI, USA.
¹⁵ Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA.
¹⁶ Hospital Universitario Mayor Mederi, Department of Surgery. Universidad del Rosario, Bogota, Colombia.
¹⁷ Loma Linda University, Loma Linda CA, USA.
¹⁸ OHSU, Portland, OR, USA.
¹⁹ University of Michigan Department of Surgery, Ann Arbor, MI, USA.
²⁰ International Federation of Surgical Colleges.
²¹ University of Oxford, Oxford University Hospitals, UK.
²² Northwestern University Department of Surgery, Chicago, IL, USA.
²³ UT Southwesterm, Dallas, TX, USA.
²⁴ Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
²⁵ University of Utah Dept of Surgery, Salt Lake City, UT, USA.
²⁶ Emory University School of Medicine, Atlanta, GA, USA.
²⁷ Vanderbilt University School of Medicine, Nashville, TN, USA.
²⁸ BARC Hospital, HBNI University, Mumbai, India/ CARE-India, Bihar Technical Support Unit, Patna, Bihar, India.
²⁹ Yale University School of Medicine, New Haven, CT, USA.
³⁰ Universidad de Azuay, Cuenca, Ecuador.
³¹ Rutgers New Jersey Medical School Department of Surgery, Newark, NJ, USA.
³² University of Botswana Department of Medical Education, Gaborone, Botswana.
³³ University of Botswana Department of Surgery, Gaborone, Botswana.
³⁴ Stanford University Medical Center Department of Surgery, Stanford, CA, USA.
³⁵ University of California San Francisco Department of Anesthesia, San Francisco, CA, USA.
³⁶ Makerere University Department of Anesthesia, Kampala, Uganda.
³⁷ University of Utah Dept of Surgery, Salt Lake City, UT, USA. Electronic address: Sudha.jayaraman@hsc.utah.edu.

PMID: 34905823
DOI: 10.1016/j.jss.2021.03.061

Abstract

Introduction: We aimed to search the literature for global surgical curricula, assess if published resources align with existing competency frameworks in global health and surgical education, and determine if there is consensus around a fundamental set of competencies for the developing field of academic global surgery.

Methods: We reviewed SciVerse SCOPUS, PubMed, African Medicus Index, African Journals Online (AJOL), SciELO, Latin American and Caribbean Health Sciences Literature (LILACS) and Bioline for manuscripts on global surgery curricula and evaluated the results using existing competency frameworks in global health and surgical education from Consortium of the Universities for Global Health (CUGH) and Accreditation Council for Graduate Medical Education (ACGME) professional competencies.

Results: Our search generated 250 publications, of which 18 were eligible: (1) a total of 10 reported existing competency-based curricula that were concurrent with international experiences, (2) two reported existing pre-departure competency-based curricula, (3) six proposed theoretical competency-based curricula for future global surgery education. All, but one, were based in high-income countries (HICs) and focused on the needs of HIC trainees. None met all 17 competencies, none cited the CUGH competency on "Health Equity and Social Justice" and only one mentioned "Social and Environmental Determinants of Health." Only 22% (n = 4) were available as open-access.

Conclusion: Currently, there is no universally accepted set of competencies on the fundamentals of academic global surgery. Existing literature are predominantly by and for HIC institutions and trainees. Current frameworks are inadequate for this emerging academic field. The field needs competencies with explicit input from LMIC experts to ensure creation of educational resources that are accessible and relevant to trainees from around the world.

Keywords: Academic surgery; Global health; Global surgery; Low-and middle-income countries; Research; Surgical education.

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Comment in

Letter Regarding: Academic Global Surgery Curricula: Current Status and a Call for a More Equitable Approach.
Pasha T, Dickson K, Chin YR, Harrison CJ. Pasha T, et al. J Surg Res. 2022 Apr;272:190-191. doi: 10.1016/j.jss.2021.10.026. Epub 2021 Dec 9. J Surg Res. 2022. PMID: 34895913 No abstract available.
Commentary on 'Academic Global Surgery Curricula - Current Status and a Call for a More Equitable Approach'.
Nthumba PM. Nthumba PM. J Surg Res. 2021 Nov;267:730-731. doi: 10.1016/j.jss.2021.04.033. Epub 2021 Aug 21. J Surg Res. 2021. PMID: 34905822 No abstract available.
Response Regarding: Academic Global Surgery Curricula: Current Status and a Call for a More Equitable Approach.
Pawlak N, Jayaraman S. Pawlak N, et al. J Surg Res. 2022 Apr;272:192. doi: 10.1016/j.jss.2021.12.001. Epub 2022 Jan 10. J Surg Res. 2022. PMID: 35027229 No abstract available.

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Academic Global Surgery Curricula: Current Status and a Call for a More Equitable Approach

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Academic Global Surgery Curricula: Current Status and a Call for a More Equitable Approach

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