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Background Over the past decade, since the 2015 Lancet Commission on Global Surgery (LCoGS) highlighted the global burden of disease attributable to a lack of safe surgical care, medical degree-granting institutions across the United States (US) have worked to increase engagement in global surgery. The research team aimed to analyze the current landscape and provide an overview of all US-based global surgery programs. It was predicted that most medical institutions in the US would not have established programs. For those with global surgery programs, their mission statements and demonstrated output were classified according to a list of five domains, including bidirectionality, education, partnerships, research, and service. These domains were generated from the priorities outlined by the LCoGS 2030 objectives as there is no universally accepted gold standard for quality evaluation in global surgery education. The team hypothesized that mission statements for existing programs would meet a majority, but not all, of the five domains, and that programs would demonstrate less output than their projected goals. Methods The team conducted a qualitative analysis of all global surgery programmatic offerings across the US. A list of terms was established to analyze the websites published for each US allopathic (MD) and osteopathic (DO) program. An Excel matrix was produced that outlined all desired information. The domains were used to organize and classify the collected data. Results Out of 194 US MD- and DO- granting institutions, 39 had global surgery programs. Twenty-five programs had missions that addressed three to four of the domains and 12 programs projected pursuit of all five domains. Of the 12 programs that projected this mission to meet all five objectives, six demonstrated tangible output in all five areas. Bidirectionality was the most common domain not addressed by programs in either their mission statement or output. Conclusions Global surgery is a nascent field, and as predicted, the majority of medical institutions do not have a global surgery program. Furthermore, institutions with programs and well-defined missions did meet a majority of the five domains. Contrary to the team’s prediction, most existing programs demonstrated equal or greater output than their expressed goals.

Introduction Although the recent expansion of pediatric surgical services in Rwanda has improved patient outcomes, pediatric surgery specialists are available only at referral hospitals. Children with surgical conditions are often first evaluated by non-specialist physicians at district or regional hospitals prior to definitive transfer. Knowledge gaps exist in the initial management of pediatric surgical conditions among non-specialist physicians. This study assesses the impact of a needs-directed short course for non-specialist physicians in Rwanda. Methods Nine prioritized pediatric surgical conditions were identified through an expert-led modified two-stage Delphi. Course content was created to fill knowledge gaps, determined through a needs assessment. Pediatric surgeons and local trainees delivered the course to non-specialist physicians at five district and regional hospitals. Participant reactions and knowledge were analyzed using RStudiov1.1.4, and thematic analysis was performed on free text responses. Results Fifty-nine non-specialist physicians with heterogeneous experience participated. Participants rated the course highly, and self-rated knowledge and confidence increased on all conditions. Overall knowledge-based scores and initial management for all conditions improved substantially. More participants indicated that they knew how to contact a member of the pediatric surgical team after the course. Positive themes included acquisition of knowledge that was relevant to practice, effective course execution, and the interactive nature of the course. Themes for improvement centered on desire for more content and course availability. Conclusions As pediatric surgical capacity improves, safe initial management is critical. A novel, needs-directed short course for non-specialist physicians appears to be an effective way to address knowledge gaps and improve the referral process through direct connection with specialists. Providing such a course on a regular basis to senior medical students and new graduates is a promising avenue to improving the provision of safe, timely pediatric surgical care.

Background Workforce shortages, resource limitations, and inadequate capacity in African higher education institutions are significant challenges that hinder their global competitiveness in generating knowledge products. Academic partnerships have been established to address these gaps. It is essential to evaluate these partnerships to ensure they align with principles of ethics, equity, reciprocity, and the achievement of shared goals. The University of Global Health Equity (UGHE) is an institution that employs a partnership-based model to deliver high-quality surgical education. The aim of the study was to assess its partnership based surgical education programs. Methods This study was conducted at UGHE using a sequential exploratory mixed-methods design that incorporates perspectives of learners, facility and partners. Qualitative interviews were conducted with students, faculty, and partners involved in UGHE’s surgical education programs within the last three years. Thematic analysis was employed to interpret the interview data. Quantitative data were summarized using descriptive statistics and presented in charts and tables with integration in a joint display. Results Twenty-one interviews were conducted, revealing 4 key themes from the thematic analysis: (1) A needs-based approach is used to determine the suitability of partnerships (2), UGHE and its partners worked towards equitable outcomes (3), Positive outcomes of the partnership model (4) Challenges faced in delivering surgical education using a partnership model and proposed solutions. Most participants viewed the model positively, identifying benefits such as diverse exposure, improved student experiences, faculty development, and technology transfer. However, institutional and systemic gaps that limit maximum benefits were noted. The quantitative survey had a 42% response rate with 31 responses from undergraduate and postgraduate students. All students agreed that didactic and simulation sessions led by UGHE partners enhanced their learning. A significant difference ( p  <.001) was found between postgraduate and undergraduate students’ responses regarding the adequacy of time for partner-facilitated sessions. Conclusions The results underscore the significant positive impact of UGHE’s institutional partnership-based model in delivering surgical education, especially in enhancing student learning and faculty capacity. However, communication gaps, lack of resources, and time prevent the partnership-based model from reaching full potential.

Increasing equity in global surgery necessitates a drastic and swift increase in surgical access, particularly in low and middle-income countries. While there has been a global push to increase medical education and surgical training in recent decades, smaller states often struggle to establish sustainable domestic training programs to meet local needs. Transnational medical education collaborations have helped to increase the medical workforce in some of these countries, like Solomon Islands. Solomon Islands offers an interesting example of surgical workforce development given the absence of any medical school or general surgery training programs. The country has one of the lowest physician-to-population ratios in the world (0.24 doctors per 1,000 people) and suffers from chronic healthcare infrastructural insufficiency in the face of a high burden of infectious and non-communicable diseases. Most physicians in Solomon Islands are trained in Papua New Guinea, Fiji, Cuba, and China. Upon their return, newly graduated registrars must then undergo training in Solomon Islands to ensure clinical preparedness. Surgical training programs for qualified Solomon Islands physicians are offered primarily by the University of Papua New Guinea (UPNG) and Fiji National University. While the externalization of medical education and surgical training has helped increase the number of surgeons in the country, it has also posed practical and structural challenges to domestic surgery services, namely in terms of surgical practice standardization, trainee retention, and workforce alignment. Additionally, international medical education partnerships have been impacted by changing political circumstances. Efforts to establish domestic training programs may help to expand surgical access and standardize surgical practice nationwide, but such efforts also face barriers to establishment and long-term operation.

Cardiothoracic surgery remains one of the most challenging specialties to train in, particularly in resource-limited settings where traditional apprenticeship-based models remain impracticable. This article addresses how emerging digital technologies - virtual reality (VR) simulators, augmented reality (AR) platforms, artificial intelligence (AI) surgical training platforms, and tele-mentoring platforms - are transforming cardiothoracic surgical training globally. We present convincing evidence from African implementation studies demonstrating that these innovative approaches can effectively address critical training gaps. For instance, a recent systematic review identified that tele-mentoring initiatives in Rwanda significantly improved outcomes in cardiac surgery procedures. These technologies offer numerous advantages over conventional training methods, including risk-free simulation environments, standardized skill assessment, remote expert advice, and the ability to repeatedly practice complex procedures. However, significant barriers to large-scale implementation persist, particularly in low-resource settings. Significant barriers include limited technological infrastructure, high cost of implementation, lack of reliable internet connectivity, and resistance to changing traditional training paradigms. The article proposes a multifaceted strategy to cover these gaps and suggests policy adjustments to incorporate virtual training into national surgical education courses, low-budget simulation solutions establishment, global cooperation in training, and curricula tailored to environments. We make available successful worldwide collaboration models, such as the Pan-African Association of Surgeons’ VR learning program and Operation Smile’s virtual mentorship efforts. The discussion pinpoints the promise for strategic use of these digital training solutions in revolutionizing cardiothoracic surgery training in low-resource settings, ultimately enhancing access to lifesaving surgical services while maintaining high standards of training quality and patient safety.

Cardiothoracic surgery (CTS) remains one of the least diverse surgical specialties, marked by significant gender and racial disparities. Despite increased medical school enrollment and the inclusion of more women and underrepresented minorities in the medical workforce, the number of locally trained cardiothoracic surgeons remains disproportionately low, particularly in regions with limited access to specialized care. This lack of diversity is compounded by systemic barriers such as limited exposure to the specialty, a shortage of mentors and role models, and the persistence of gender bias and discrimination. These factors contribute to a workforce that does not adequately reflect the demographic diversity of the patient population, further hindering access to quality care. To address these challenges, this article outlines several policy recommendations aimed at improving equity in CTS training and workforce development. Key strategies include increasing awareness and exposure to CTS among medical students, expanding training opportunities, and establishing regional centers of excellence. Gender equity should be prioritized through the implementation of zero-tolerance policies for discrimination and harassment, and financial incentives should be introduced to retain cardiothoracic professionals locally. Additionally, mentorship, collaboration, and international partnerships can enhance surgical skills and knowledge sharing across regions. Public health policies focusing on improving access to cardiothoracic services, particularly in underserved communities, are critical for reducing disparities. Enhanced community awareness campaigns, improved data collection, and strengthened healthcare infrastructure are vital to ensure equitable access to care. Ultimately, achieving equity in CTS requires collaborative efforts between governments, academic institutions, healthcare providers, and international partners, aimed at building a resilient and diverse cardiothoracic workforce capable of meeting the needs of diverse populations.

Climate change is an emerging global health crisis, disproportionately affecting low- and middle-income countries (LMICs) where health outcomes are increasingly compromised by environmental stressors such as pollution, natural disasters, and human migration. With a focus on promoting health equity, Global Surgery advocates for expanding access to surgical care and enhancing health outcomes, particularly in resource-limited and disaster-affected areas like LMICs. The healthcare industry—and more specifically, surgical care—significantly contributes to the global carbon footprint, primarily through resource-intensive settings, i.e. operating rooms that generate greenhouse gases and substantial medical waste. Therefore, Global Surgery efforts aimed at improving surgical access through an increase in surgical volumes may inadvertently exacerbate health challenges for vulnerable populations by further contributing to environmental degradation. This predicament is particularly pronounced in LMICs, who already suffer from a disproportionate share of the global burden of disease, and where the demand for surgery is rising without corresponding resilient infrastructure. LMICs face a double jeopardy of health inequity coupled with climate vulnerability. As a movement positioned to improve health around the world, Global Surgery has an increasingly significant role in envisioning and ensuring a sustainable future. Global Surgery initiatives must prioritise sustainable infrastructure in both high-income countries (HICs) and LMICs, all while accounting for the unequal polluting contributions between HICs and LMICs and, consequently, moral responsibilities moving forward. Moreover, through targeting upstream causes of poor health at urban and perioperative levels, Global Surgery’s interventions may help to reduce the global burden of disease—avoiding preventable surgeries and their carbon footprints from the outset. Altogether, Global Surgery and climate change are two matters of social justice whose solutions must synergistically centralise the health of both the planet and its most vulnerable people.

Introduction In low-income countries, clinicians trained through a context-specific trauma surgery fellowship program (TFP) can help reduce injury-related mortality to levels closer to those observed in higher-resource settings. Successful implementation, however, hinges on buy-in from local clinicians. We assessed clinician support for a potential TFP in Uganda, considering perceived need, curricular recommendations, barriers, and motivating factors. Methods After cognitive interviews with experts and questionnaire pilot testing, we cross-sectionally surveyed Ugandan consultants (general surgeons and procedural specialists involved in trauma care) and surgical residents at a tertiary, national referral hospital. Respondent percentages were calculated for multiple-choice answers, and we performed thematic analysis of free-text responses using a primarily inductive approach. Results Among 46 faculty (from 13 specialties) and 42 resident respondents, 86% supported a Ugandan TFP. Respondents recommended incorporating emergency general surgery (66%), critical care (84%), and international rotations (76%) into the curriculum. Severe resource and structural deficiencies (82%) and concern about governmental support for post-training employment and compensation (66%) were leading perceived barriers to TFP implementation. Most faculty felt a TFP would improve patient outcomes (93%), overall trainee education (77%), and clinical efficiency (68%). Free-text responses were consistent with survey themes, indicating acute awareness of current trauma system inadequacies and conviction that a TFP would reduce injury-related mortality. Conclusions Ugandan clinicians who care for injured patients view a TFP as crucial to improving injury-related outcomes, despite known barriers. TFP implementation should incorporate curricular recommendations from this survey and address widespread concerns about financial and infrastructural support from the national government and local institutions.

Incorporating infection prevention and control (IPC) is crucial for strengthening global surgery, particularly in low- and middle-income countries (LMICs). This review article highlights the critical role IPC plays in ensuring equitable and sustainable surgical care, aligning with the Sustainable Development Goals (SDG) 3 and 10, which aim to promote health and reduce inequalities. Surgical site infections (SSIs) and other healthcare-associated infections (HAIs) disproportionately affect LMICs, where IPC infrastructure is often underdeveloped. Without robust IPC measures, surgeries in these regions can result in higher morbidity, mortality, and healthcare costs, exacerbating disparities in healthcare access and outcomes. Despite global efforts, such as the World Health Organization (WHO) Guidelines on the Prevention of Surgical Site Infections, IPC integration in surgical practices remains inconsistent, particularly in resource-constrained settings. More widespread adoption and implementation are necessary. By embedding IPC within global surgery frameworks, health systems can improve surgical outcomes, reduce costs, and enhance the resilience of healthcare systems. Effective IPC reduces extended hospital stays, limits the spread of antimicrobial resistance, and increases trust in surgical services. Moreover, the cost savings from preventing SSIs are substantial, benefiting both healthcare systems and patients by reducing the need for prolonged care and antibiotic treatments. This review article calls for greater integration of IPC measures in global surgery initiatives to ensure that surgical interventions are both life-saving and equitable. Strengthening IPC is not optional but essential for achieving the broader goals of universal health coverage and improving public health outcomes globally.

Background Recovery after major surgery is a key priority identified by patients, communities and policymakers in low- and middle-income countries (LMICs), with important societal and financial implications. With global burden of surgical diseases rising, little is known about how well patients return to normal activities after surgery in these settings. This study aimed to describe patterns of return to normal activity after major abdominal surgery and identify associated factors in LMICs. Methods This was a pre-planned analysis of a cluster-randomised randomised trial testing routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection in seven LMICs (India, Mexico, Rwanda, Benin, South Africa, Nigeria, Ghana). 961 patients were excluded because of incomplete missing primary outcome. The primary outcome measure was a patients self-reported full return to their normal activities at 30 days after surgery. Factors associated with return to normal activities within 30-days of surgery was explored using a Bayesian mixed-effects logistic regression model. Sensitivity analyses were performed accounting for missing data. Results 12,340 patients across 81 centres were included. Overall, 65.3% (8064/12340) patients had returned to normal activity by 30-days after surgery. Patients undergoing surgery for benign than cancer surgery (67.0% vs. 59.7%), minor compared to major surgery (71.0% vs. 63.5%), and non-midline compared to midline (74.9% vs. 58.7%) had higher rates of return to normal activities within 30-days from abdominal surgery. In an adjusted model, factors associated with return to normal activities are benign surgery (OR: 0.61, 95% CI: 0.53–0.71), minor surgery (OR: 0.56, 95% CI: 0.49–0.64), and non-midline operations (OR: 1.57, 95% CI: 1.41–1.75). When accounting for missing data, consistent findings were observed. Conclusions With rising need for surgical care and non-communicable disease globally, this study highlights the groups of patients at critical need for improving return to normal activity or recovery after surgery in LMICs. Improving access and implementation of rehabilitation pathways, aligned to the World Health Organisation, may be crucial to improve financial risk protection to patient and reduce productivity loss to the economy.