Explore how medical trainees can get involved in global surgery through research, conferences, and international electives. Learn about ethical considerations like sustainability, equal partnerships, and locally driven solutions in this evolving field.

Transcript

Hello and welcome back to Surgery 101, the podcast brought to you with the help of the Department of Surgery at the University of Alberta. I’m Jonathan White coming to you direct and live from the Royal Alexander Hospital in Edmonton, Alberta. This week is the third and last in a series of episodes all about global surgery brought to us by visiting surgical education elective student Betty Ibrahu from George Washington University. In this episode she will be looking at how you can get more involved with the field of global surgery. She will be considering what opportunities are out there for medical students, what opportunities are out there for residents in surgery and what are some of the key ethical concerns you may come across in the field and how do you address those. So, let’s get ready to talk about how we can get you involved in global surgery here on Surgery 101.

Hi, my name is Betty and I am a third year medical student at The George Washington University in Washington, D.C. This is the third episode in a three-part series on global surgery. Today we will discuss how medical students can get involved in global surgery and some ethical considerations in the field. By the end of this podcast, you should be able to identify global surgery opportunities for medical students, discuss key ethical concerns of global surgery, discuss strategies to mitigate those ethical concerns. In the past two episodes, we have explored global surgery, a field working to improve health outcomes for all in need for surgical and anesthesia care. We have discussed the widespread need for increased access to surgery. We’ve explored the global surgery 2030 goals and the importance of developing a data driven national surgery, obstetric and anesthesia plan to meet these goals. That being said, how a trainee can participate in this field is the next important topic to address.

Studies have found that trainees, medical students in particular have a strong and growing interest in global health and global surgery. As global surgery continues to grow, it follows that student participation in research, conferences, and experiential learning, like international trips, internships, things like that will continue to grow. Now, global surgery, despite being a relatively small field still, has four avenues that I have identified for medical student participation. First is the Global Surgery Student Alliance, initially established in the United States with the recent establishment of the first Canadian chapters, the GSSA is an international student-run global surgery working group. The organization was established under the premise that students are a valuable resource for the advancement of global surgery. Through their website, you can find a collection of important journal articles to read, an opportunity database for students and researchers, a list of active chapters with contact information, and more. There is also a toolkit for establishing a chapter at your school or planning a global surgery event. The second way to get involved is through research. Global surgery is an academic field with new research constantly being published. How to find a PI? Well, you could start by identifying a country or topic you feel particularly strongly about. For me, for example, as a first-generation Ethiopian-Canadian, I could pick Ethiopia. Alternatively, you could pick a subtopic in global surgery you find interesting, like capacity building or orthopedics or medical education or health systems organization. Skim articles on this topic to strengthen your knowledge while also looking for commonly occurring authors. From there, you can normally find their emails either in the journal articles or through faculty information websites. Third way to get involved is through international electives. Most medical schools offer international electives through partner universities with, generally speaking, opportunities for funding. For those looking to travel abroad, this can be an excellent starting place. While the number of institutions with surgery-specific elective varies, students can also usually arrange their own trip through a PI or at the institution in their country of interest. The fourth and final way to get involved is through conferences. Conferences serve as a great way to network with other trainees, possible PIs, and future colleagues. Here’s a very short list of conferences about global surgery or with a large global surgery track. There’s the Annual Bethune Roundtable, hosted in Canada. There’s the McGill University Health Center Conference, again, annual and in Canada. There’s the Global Surgery Student Alliance Symposia, which is an annual conference in America and there’s the Incision Global Surgery Symposium, which is annual but international. Having discussed what global surgery is and how the work is being completed abroad, it would be remiss if we did not discuss the ethics of the field.

This could be a whole series of episodes alone, but I thought it would be important to briefly address some key considerations. Western medical ethics are generally built on four key pillars, beneficence, non-maleficence, respective autonomy, and justice. These pillars should, but are not always applied to global health. A 2010 article in the World Journal of Surgery outlined seven sins of humanitarian medicine. They are, one, leaving a mess behind. Two, failing to match technology to local needs. Three, failures of non-governmental organizations to cooperate with each other. Four, having no follow-up plan. Five, allowing politics to trump service. Six, going to areas where help is not needed or wanted. Seven, doing the right thing for the wrong reason. While the list may seem short, it actually distills a complex conversation about power differentials between high and lower middle-income countries into seven brief points. It highlights the importance of locally driven solutions to locally identified problems, as well as sustainability. From a research perspective, it also touches on the plethora of studies conducted in developing countries to address the issues these studies identify. As a medical student looking to participate in international electives, it is important to reflect on the role you will play. Spending time learning about the culture and language you’ll be immersed in, ensuring that you’re not giving responsibilities or clinical duties beyond your scope of practice in Canada, and assessing the relationship you will have with local trainees are just a few steps to make your role in the field a bit more ethical.

The question of how to minimize power differentials is a complex one, but there are places that we can start. Ensuring local people are at the forefront of all global surgery work, ensuring scientifically sound methodology is used to collect the data that will determine the areas of need and improvement. Collecting this data in full partnership with local universities and ensuring authorship of journal articles is reflective of this. Focusing on building local capacities, training local students, and incorporating governments, NGOs, and private stakeholders in this process. Ensuring that the rapid expansion of global surgery in Canada does not outpace the critical evaluation of the ethical considerations of these programs. Those are just a few of the ways to help ensure that global surgery at home and abroad is ethical and sustainable.

We have discussed a lot. Let’s recap what are the key messages of today’s podcast. There is a growing interest in global surgery among medical students. Medical students should seek global surgery opportunities through the Global Surgery Student Alliance, research, international electives, and conferences. Ethical considerations in global surgery include sustainability, equal partnerships between high and low and middle income countries, identifying local problems, and local approaches to those solutions. Continued usage of data-driven problem analysis, full engagement of stakeholders, and reflection and barrier setting are all small steps towards ensuring global surgery is a bit more ethical.

In the course of this three-part series on global surgery, we’ve explored what global surgery is, how it is being tackled, the role of medical students, and ethical considerations. I hope that you have enjoyed learning about this amazing field and that you find a way to get involved in your future career. Thanks for listening.

Thanks, Betty, for another excellent episode, and thanks for this whole series of three episodes all about global surgery. It’s really been awesome, and I have actually learned a lot myself. If you are listening and you would like to get involved in Surgery 101 and come and do a surgical education elective with us, just the way Betty did, please drop us a line at surgerypodcast@gmail.com, and we will see if we can work out a time for you to come and visit us in the Surgery 101 Studios, learn about education, and make a podcast of your own. This episode is dedicated to the amazing Jenny Marshall, who until very recently was our medical education program assistant for digital education here at the University of Alberta. For many years, she has been quietly working behind the scenes helping our elective students, helping our summer students, editing podcasts, editing videos. She has been an amazing member of the team and a real friend. Thanks so much Jenny for all of your help over all of these many years. We wish you all of the best in your new role and your future career. We will miss you a lot, and Surgery 101 won’t be quite the same without you. Thanks again to everyone for listening, and we will see you back here next week for another episode of Surgery 101.