Elective Courses in Global Surgery for Undergraduate Medical Students: A Narrative Review and a Proposal for European Universities

Authors

DOI:

https://doi.org/10.5195/ijms.2022.1598

Keywords:

Medical Students, General Surgery/education, Global Health, International Cooperation, Curriculum

Abstract

Global surgery (GS) is the discipline of improving health by expanding universal access to surgical care. GS is an essential part of the global health (GH) concept, but it is almost invariably neglected in academic settings. This review assesses the engagement of undergraduate medical students in the field of GS. PubMed, Embase, and Web of Science were searched with focus on electives organized by universities and only eight results were found. The scientific literature on this topic is scarce and uneven, and the number of students involved in these experiences is considerably low. Although few, the existing electives prove that building sustainable and useful GS projects is possible and that both students from high-income countries (HICs) and low-income and middle-income countries (LMICs) can extensively benefit from these experiences. Given the currently low involvement of European universities and medical schools, of which the authors are part, this review aims at encouraging European universities to organize GS electives for their students. In addition, this review suggests key activities to undertake in such electives including theoretical sections, research projects, and bilateral international rotations between HICs and LMICs.

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Author Biographies

Giovanni Rossi, Department of Health Sciences, Medicine and Surgery, San Paolo Hospital Location, University of Milan, Milan, Italy.

Giovanni Rossi is an Italian medical student attending the last year at the University of Milan.

Gioele Fusato, Department of Health Sciences, Medicine and Surgery, San Paolo Hospital Location, University of Milan, Milan, Italy

Gioele Fusato is an Italian medical student attending the last year at the University of Milan.

Tindara Scirocco, Department of Health Sciences, Medicine and Surgery, San Paolo Hospital Location, University of Milan, Milan, Italy

Tindara Scirocco is an Italian medical student attending the last year at the University of Milan.

Paolo Rodi, Department of Surgery, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Univerditätsmedizin Berlin, Berlin, Germany

Paolo Rodi is an italian MD from University of Milan currently resident in general surgery at Charité University Hospital, Berlin, for many years ranked as best European hospital. He is attending the MSc European Master in Disaster Medicine and focuses his research efforts on global surgery and health, and disaster management.

Simone Villa, Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy

Simone Villa is an Italian MD working as a research fellow at the University of Milan on Tuberculosis, Covid-19, and Global Health. He is currently studying epidemiology at LSHTM.

Mario C. B. Raviglione, Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy

Mario C. Raviglione is professor of Global Health at the University of Milan, Italy. He was Director of the Global Tuberculosis Programme at WHO in 2003-2017 and had worked at WHO since 1991. A graduate from Turin University, Italy, he trained in internal medicine, infectious diseases, and AIDS at Cabrini Medical Centre & NY Medical College, New York, and Beth Israel Hospital, Harvard Medical School, Boston. He is one of the 10 most cited authors worldwide in the TB field. His work consists of some 350 publications in journals and books, including the past 8 editions of the Harrison's Principles of Internal Medicine and chapters in public health books. His production has been cited more than >67,000 times and his h-index is 111. He has been Honorary Professor at the Queen Mary University of London, UK, since November 2019. He was Professeur Titulaire at the Global Studies Institute of the University of Geneva in 2019-2020.

References

Dare AJ, Grimes CE, Gillies R, Greenberg SL, Hagander L, Meara JG, et al. Global surgery: defining an emerging global health field. Lancet. 2014 Dec 20;384(9961):2245-7.

Shrime MG, Bickler WS, Alkire BC, Mock A. Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health 2015; 3: S8–9.

Bath M, Bashford T, Fitzgerald JE. What is 'global surgery'? Defining the multidisciplinary interface between surgery, anaesthesia and public health. BMJ Glob Health. 2019;4(5):e001808.

Bale AG, Sifri ZC. Does Global Surgery Interest Influence the Choice of Surgical Residency Program? J Surg Educ. 2021;78(6):e137-e144.

Wladis A, Roy N, Löfgren J. Lessons for all from the early years of the global surgery initiative. Br J Surg. 2019 Jan;106(2):e14-e16.

Mahler H. Surgery and Health for All. Address by Mahler Dr H, Director General of the WHO to the XXII Biennial World Congress of the International College of Surgeons, Mexico City, 29 June 1980.

Farmer PE, Kim JY. Surgery and global health: a view from beyond the OR. World J Surg. 2008;32(4):533-6.

Debas HT, Gosselin R, McCord C, Thind A. Surgery. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al, editors. Disease Control Priorities in Developing Countries. 2nd ed. New York: Oxford University Press; 2006. p. 1245-60.

Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569-624.

Sixty-eighth World Health Assembly. Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage; 2015.

Binda C, Zivkovic I, Duffy D, Blair G, Baird R. Evaluation of Interventions Addressing Timely Access to Surgical Care in Low-Income and Low-Middle-Income Countries as Outlined by the LANCET Commission 2030 Global Surgery Goals: A Systematic Review. World J Surg. 2021;45(8):2386-2397.

Davies JI, Gelb AW, Gore-Booth J, Martin J, Mellin-Olsen J, Åkerman C, et al. Global surgery, obstetric, and anaesthesia indicator definitions and reporting: An Utstein consensus report. PLoS Med. 2021;18(8):e1003749.

Quene TM, Bust L, Louw J, Mwandri M, Chu KM. Global surgery is an essential component of global health. Surgeon. 2022;20(1):9-15.

Jumbam DT, Kanmounye US, Alayande B, Bekele A, Maswime S, Makasa EMM, et al. Voices beyond the Operating Room: centring global surgery advocacy at the grassroots. BMJ Glob Health. 2022;7(3):e008969.

Marks IH, Patel SB, Holmer H, Billingsley ML, Philipo GS. Letter from the future surgeons of 2030. Lancet. 2015;386(10007):1942.

InciSioN Collaborative. International Survey of Medical Students Exposure to Relevant Global Surgery (ISOMERS): A Cross-Sectional Study. World J Surg. 2022;46(7):1577-1584.

Chin-Quee A, White L, Leeds I, MacLeod J, Master VA. Medical student surgery elective in rural Haiti: a novel approach to satisfying clerkship requirements while providing surgical care to an underserved population. World J Surg. 2011;35(4):739-44.

Leeds IL, Srinivasan J, Pattaras JG, Master VA. A win for all: faculty-student partnerships in surgical humanitarianism. Bull Am Coll Surg. 2013;98(2):12-7.

Martin BM, Love TP, Srinivasan J, Sharma J, Pettitt B, Sullivan C, et al. Designing an ethics curriculum to support global health experiences in surgery. J Surg Res. 2014;187(2):367-70.

Hugar LA, McCullough CM, Quinn ME, Kapadia SM, Pettitt BJ. Scaling up short-term humanitarian surgery: a global surgery elective for senior medical students. J Surg Educ. 2014;71(6):871-7.

Leeds IL, Hugar LA, Pettitt BJ, Srinivasan J, Master VA. International surgical clerkship rotation: perceptions and academic performance. Am J Surg. 2013;206(2):280-6.

Moren A, Cook M, McClain M, Doberne J, Kiraly L, Perkins RS, et al. A pilot curriculum in international surgery for medical students. J Surg Educ. 2015;72(4):e9-e14.

Elharram M, Dinh T, Lalande A, Ge S, Gao S, Noël G. Global Health Values of a Multidirectional Near Peer Training Program in Surgery, Pathology, Anatomy, Research Methodology, and Medical Education for Haitian, Rwandan, and Canadian Medical Students. Ann Glob Health. 2017;83(2):274-280.

Anderson GA, Albutt K, Holmer H, Muguti G, Mbuwayesango B, Muchuweti D, et al. Development of a Novel Global Surgery Course for Medical Schools. J Surg Educ. 2019;76(2):469-479.

Kühner S, Ekblad S, Larsson J, Löfgren J. Global surgery for medical students - is it meaningful? A mixed-method study. PLoS One. 2021;16(10):e0257297.

Peck GL, Hanna JS, Scott EM, Mehta D, Model Z, Sarma D, et al. A longitudinal surgical systems strengthening research program for medical students: the exploration of a model for global health education. Glob Health Res Policy. 2021;6(1):34.

Abou El Ela Bourquin B, Gnanakumar S, Bath MF, Bashford T, Menon DK, Hutchinson PJ. The international health elective: a stepping stone for tomorrow's global surgeons and anaesthetists. Perspect Med Educ. 2018;7(4):228-231.

Mansfield RC, Ford K, Lakhoo K, Gardner L, Ndukwe G, De Berker H. G290(P) Linking paediatric oncology research with electives. Arch Dis Child 2018;103:A118-A119.

Ford K, Gunawardana S, Manirambona E, Philipoh GS, Mukama B, Kanyamuhunga A, et al. Investigating Wilms' Tumours Worldwide: A Report of the OxPLORE Collaboration-A Cross-Sectional Observational Study. World J Surg. 2020;44(1):295-302.

Manirambona E, Gunawardana S, Hathaway H, Lakhoo K, Ford K, Kanyamuhunga A. A comparison of nutritional status in patients with neuroblastoma in Rwanda and United Kingdom: a cross-sectional observational study conducted by the OxPLORE collaboration. Ann Pediatr Surg. 2022;18(39).

Vervoort D, Bentounsi Z. InciSioN: Developing the Future Generation of Global Surgeons. J Surg Educ. 2019;76(4):1030-1033.

International Student Surgical Network. Home. Available from: https://incisionetwork.org/. Last updated: unavailable; cited Jun 30, 2022.

Global Surgery Students Alliance. Home. Available from: https://www.globalsurgerystudents.org/. Last updated: unavailable; cited Jun 30, 2022.

European Commission. Erasmus + EU programme for education, training, youth and sport. Available from: https://erasmus-plus.ec.europa.eu/it. Last updated: unavailable; cited Jun 30, 2022.

Żebryk P, Przymuszała P, Nowak JK, Cerbin-Koczorowska M, Marciniak R, Cameron H. The Impact of ERASMUS Exchanges on the Professional and Personal Development of Medical Students. Int J Environ Res Public Health. 2021;18(24):13312.

Crump JA, Sugarman J; Working Group on Ethics Guidelines for Global Health Training (WEIGHT). Ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg. 2010;83(6):1178-82.

Krishnaswami S, Stephens CQ, Yang GP, Nwomeh BC, Swaroop M, Nadler EP, et al. An academic career in global surgery: a position paper from the Society of University Surgeons Committee on Academic Global Surgery. Surgery. 2018;163(4):954-960.

Thompson MJ, Huntington MK, Hunt DD, Pinsky LE, Brodie JJ. Educational effects of international health electives on U.S. and Canadian medical students and residents: a literature review. Acad Med. 2003;78(3):342-7.

Jeffrey J, Dumont RA, Kim GY, Kuo T. Effects of international health electives on medical student learning and career choice: results of a systematic literature review. Fam Med. 2011;43(1):21-8.

Gishen K, Thaller SR. Surgical Mission Trips as an Educational Opportunity for Medical Students. J Craniofac Surg. 2015;26(4):1095-6.

Kauffmann RM, Neuzil K, Koch R, Terhune KP. Global Surgery Electives: A Strategy to Improve Care to Domestic Underserved Populations? J Surg Res. 2020;255:247-254.

Slifko SE, Vielot NA, Becker-Dreps S, Pathman DE, Myers JG, Carlough M. Students with global experiences during medical school are more likely to work in settings that focus on the underserved: an observational study from a public U.S. institution. BMC Med Educ. 2021;21(1):552.

Crane J. Scrambling for Africa? Universities and global health. Lancet. 2011;377(9775):1388-90.

Bodnar BE, Claassen CW, Solomon J, Mayanja-Kizza H, Rastegar A. The effect of a bidirectional exchange on faculty and institutional development in a global health collaboration. PLoS One. 2015;10(3):e0119798.

Bothara RK, Tafuna'i M, Wilkinson TJ, Desrosiers J, Jack S, Pattemore PK, et al. Global health classroom: mixed methods evaluation of an interinstitutional model for reciprocal global health learning among Samoan and New Zealand medical students. Global Health. 2021;17(1):99.

Mullan F. The metrics of the physician brain drain. N Engl J Med. 2005;353(17):1810-8.

Cometto G, Tulenko K, Muula AS, Krech R. Health workforce brain drain: from denouncing the challenge to solving the problem. PLoS Med. 2013;10(9):e1001514.

Rohrbaugh R, Kellett A, Peluso MJ. Bidirectional Exchanges of Medical Students Between Institutional Partners in Global Health Clinical Education Programs: Putting Ethical Principles into Practice. Ann Glob Health. 2016;82(5):659-664.

Abimbola S, Pai M. Will global health survive its decolonisation? Lancet. 2020;396(10263):1627-1628.

Eichbaum QG, Adams LV, Evert J, Ho MJ, Semali IA, van Schalkwyk SC. Decolonizing Global Health Education: Rethinking Institutional Partnerships and Approaches. Acad Med. 2021;96(3):329-335.

Garba DL, Stankey MC, Jayaram A, Hedt-Gauthier BL. How Do We Decolonize Global Health in Medical Education? Ann Glob Health. 2021;87(1):29.

Stoltenberg M, Rumas N, Parsi K. Global health and service learning: lessons learned at US medical schools. Med Educ Online. 2012;17.

Bozinoff N, Dorman KP, Kerr D, Roebbelen E, Rogers E, Hunter A, et al. Toward reciprocity: host supervisor perspectives on international medical electives. Med Educ. 2014;48(4):397-404.

Jacquet GA, Sarfaty S, Tupesis JP. Comments on 'Protecting the health of medical students on international electives in low-resource settings. J Travel Med. 2018;25(1).

Ten Cate O, Durning S. Peer teaching in medical education: twelve reasons to move from theory to practice. Med Teach. 2007;29(6):591-9.

Tang TS, Hernandez EJ, Adams BS. "Learning by teaching": a peer-teaching model for diversity training in medical school. Teach Learn Med. 2004;16(1):60-3.

Published

2022-12-31 — Updated on 2023-02-16

How to Cite

Rossi, G., Fusato, G., Scirocco, T., Rodi, P., Villa, S., & Raviglione, M. C. B. . (2023). Elective Courses in Global Surgery for Undergraduate Medical Students: A Narrative Review and a Proposal for European Universities. International Journal of Medical Students, 10(4), 395–404. https://doi.org/10.5195/ijms.2022.1598