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Progress on surgical system strengthening has been slow due to a disconnect between evidence generation and the information required for effective policymaking. This systematic mapping review sought to assess critical research gaps in the field of global surgery guided by the World Health Organisation Health Systems building block framework, analysis of authorship and funding patterns, and an exploration of emerging research partnership networks. Literature was systematically mapped to identify, screen, and synthesize results of publications in the global surgery field between 2015 and March 2022. We searched four databases and included literature published in seven languages. A social network analysis determined the network attributes of research institutions and their transient relationships in shaping the global surgery research agenda. We identified 2,298 relevant studies out of 92,720 unique articles searched. Research output increased from 453 in 2015-16 to 552 in 2021-22, largely due to literature on Covid-19 impacts on surgery. Sub-Saharan Africa (792/2298) and South Asia (331/2298) were the most studied regions, although high-income countries represented a disproportionate number of first (42%) and last (43%) authors. Service delivery received the most attention, including the surgical burden and quality and safety of services, followed by capacity-building efforts in low- and middle-income countries. Critical research in economics and financing, essential infrastructure and supplies, and surgical leadership necessary to guide policy decisions at the country level were lacking. Global surgical systems remain largely under-researched. Knowledge diffusion requires an emphasis on developing sustainable research partnerships and capacity across low- and middle-income countries. A renewed focus must be given to equipping countries with tools for effective decision-making to enhance investments in high-quality surgical services.

•Comprehensive, longitudinal curricula could enhance global surgery training.•Curricula should incorporate essential clinical and non-clinical elements aimed at capacity building.•Professional development, research, capacity, building, collaboration are essential components for global surgery training.

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.

A workforce trained in the development and delivery of equitable surgical care is critical in reducing the global burden of surgical disease. Academic global surgery aims to address the present inequities through collaborative partnerships that foster research, education, advocacy and training to support and increase the surgical capacity in settings with limited resources. Barriers include a deficiency of resources, personnel, equipment, and funding, a lack of communication, and geographical challenges. Multi-level partnerships remain fundamental; these types of partnerships include a wide range of trainees, professionals, institutions, and nations, yet care must be taken to avoid falling into the trap of surgical \"voluntourism\" and undermining the expertise and practice of long-standing frontline providers. Academic global surgery has the benefit of developing a community of surgeons who possess the tools needed to collaborate on individual, institutional, and international levels to address inequities in surgery that are spread variously across the globe. However, challenges for surgeons pursuing a career in global surgery include balancing clinical responsibilities while integrating global surgery as a career during training. This is due in part to the lack of mentorship, research time, grant funding, support to attend conferences, and a limitation of resources, all of which are significantly more pronounced for surgeons from low-resource countries.

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.

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.

BackgroundDisruptions in global surgery educational routines by the COVID-19 pandemic have elicited demands for alternative formats for rendering qualitative neurosurgical education. This study presents application of a novel model of online neurosurgical course, the Lecture-Panel-Discussion Model (LPDM).MethodsThis is a cross-sectional survey of participants who attended the Swedish African Neurosurgery Collaboration (SANC)-100A course. Participants evaluated the course through an online self-administered questionnaire using a 5-point Likert scale ranging from very poor—1, poor—2, average (fair)—3, good—4, to excellent—5. SANC-100A comprises a tripod of Lectures, Panel review, and interactive case Discussion. This model (LPDM) was innovated by SANC and applied at the Enugu International Neurosurgery course in February 2021.ResultsThere were 71 attendees, 19 were course faculty, while 52 were participants. Thirty-five attended from Nigeria, 11 from Sweden, 3 from Malawi, 2 from Senegal, and 1 from the UK. Among 44 participants who completed the questionnaire, there were 9 fellows and 35 residents. The overall median course Likert rating was 4.65 ± 0.1. The median overall rating for course events was similar between day 1 (Likert score = 4.45) and day 2 (Likert score = 4.55), U = 55, Z score = 1.10, P = 0.27. The median rating for lectures was 4.50 ± 0.2 and varied from 4.40 on day 1 to 4.55 on day 2. The median rating for panel review was 4.60 ± 0.1 and varied from 4.55 on day 1 to 4.65 on day 2. Interactive case discussions were rated 4.80 on both course days. There was a significant variability in the rating profiles of the course tripod: U = 24.5, P = 0.03. Fifty-one (98%) participants believe LPDM was COVID-19-compliant, while 90% believe the course was beneficial to training and practice.ConclusionInitial application of LPDM is rewarded with both high acceptance and high rating among participants.

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.

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.

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.