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Objective: An expert panel made recommendations to optimize surgical education and training based on the effects of contemporary challenges. Background: The inaugural Blue Ribbon Committee (BRC I) proposed sweeping recommendations for surgical education and training in 2004. In light of those findings, a second BRC (BRC II) was convened to make recommendations to optimize surgical training considering the current landscape in medical education. Methods: BRC II was a panel of 67 experts selected on the basis of experience and leadership in surgical education and training. It was organized into subcommittees which met virtually over the course of a year. They developed recommendations, along with the Steering Committee, based on areas of focus and then presented them to the entire BRC II. The Delphi method was chosen to obtain consensus, defined as Z80% agreement among the panel. Cronbach α was computed to assess the internal consistency of 3 Delphi rounds. Results: Of the 50 recommendations, 31 obtained consensus in the following aspects of surgical training (# of consensus recommendation/# of proposed): Workforce (1/5); Medical Student Education (3/8); Work Life Integration (4/6); Resident Education (5/7); Goals, Structure, and Financing of Training (5/8); Education Support and Faculty Development (5/6); Research Training (7/9); and Educational Technology and Assessment (1/1). The internal consistency was good in Rounds 1 and 2 and acceptable in Round 3. Conclusions: BRC II used the Delphi approach to identify and recommend 31 priorities for surgical education in 2024. We advise establishing a multidisciplinary surgical educational group to oversee, monitor, and facilitate implementation of these recommendations. [ABSTRACT FROM AUTHOR]

Background: One of the core indicators recommended by the Lancet Commission is surgical workforce density, aiming to improve the number of surgery, anesthetists, and obstetric (SAO) providers to 20 per 100,000 population by 2030. We assessed SAO workforce capacity in Somalia and made recommendations for improvement. Method: A cross‐sectional study was conducted using a structured questionnaire from the WHO Program for Global Surgery and Social Change (PGSSC) Surgical Assessment Tool. All hospitals that offer surgical care services were included. A descriptive analysis was conducted using the statistical software SPSS. Results: Of the 55 surveyed facilities providing surgical care services, 28 (50.9%) were public, mainly in urban areas. We found that there were 474 SAO specialists and non‐specialists (SAO providers) and 446 other important personnel (e.g., midwives, radiologists, and pathologists). Out of 474 SAOs, Banadir had 288. Overall, surgery specialties were the most prevalent profession among SAO providers' workforce, accounting for 160 (33.7%) surgery specialists, with 1.2 per 100,000 population. The six states of Somalia have 54 OB/GYN specialists (0.4 per 100,000 population). There were a total of 22 anesthesia specialists, with a ratio of 0.2 anesthesia specialists per 100,000 population. Conclusion: We found a serious shortage of the SAO workforce in Somalia, and it is unlikely to meet the 2030 Lancet Commission on Global Surgery targets. There is a need for additional training of SAO providers who can offer effective leadership in surgical care services to combat the extremely avoidable surgical‐related morbidities and mortalities. [ABSTRACT FROM AUTHOR]

Background: In the last 30 years, significant advances have been made in pediatric medical care globally. However, there is a persistent urban‐rural gap which is more pronounced in low middle‐income countries than high‐income countries, similar urban‐rural gap exists in India. While on one hand, health care is on par or better than healthier nations thriving international medical tourism industry, some rural parts have reduced access to high‐quality care. Aim: With this background, we aim to provide an overview of the present and future of healthcare in India. Methodology: With the cumulative health experience of the authors or more than 100 years, we have provided our experience and expertise about healthcare in India in this narrative educational review. This is supplemented by the government plans and non government plans as appropriate. References are used to justify as applicable. Results: With the high percentage of pediatric population like other low to middle‐income countries, India faces challenges in pediatric surgery and anesthesia due to limited resources and paucity of specialized training, especially in rural areas. Data on the access and quality of care is scarce, and the vast rural population and uneven resource distribution add to the challenges along with the shortage of pediatric surgeons in these areas of specialized care. Addressing these challenges requires a multi faceted strategy that targets both immediate and long‐term healthcare needs, focusing on improving the facilities and training healthcare professionals. Solutions could include compulsory rural service, district residency programs, increasing postgraduate or residency positions, and safety courses offered by national and international organizations like Safer Anesthesia from Education Pediatrics, Vital Anesthesia Simulation Training, and World Federation of Society of Anesthesiologists pediatric fellowships. Conclusion: India has achieved great strides in perioperative health care and safety. It has become the major international medical industry due to high‐quality care, access and costs. Crucially, India needs to establish local hubs for pediatric perioperative care training to enhance healthcare delivery for children. [ABSTRACT FROM AUTHOR]

Background: With the primary objective of addressing the disparity in global surgical care access, the College of Surgeons of East, Central, and Southern Africa (COSECSA) trains surgeons. While sufficient operative experience is crucial for surgical training, the extent of utilization of minimally invasive techniques during COSECSA training remains understudied. Methods: We conducted an extensive review of COSECSA general surgery trainees' operative case logs from January 1, 2015, to December 31, 2020, focusing on the utilization of minimally invasive surgical procedures. Our primary objective was to determine the prevalence of laparoscopic procedures and compare this to open procedures. We analyzed the distribution of laparoscopic cases across common indications such as cholecystectomy, appendicitis, and hernia operations. Additionally, we examined the impact of trainee autonomy, country development index, and hospital type on laparoscopy utilization. Results: Among 68,659 total cases, only 616 (0.9%) were laparoscopic procedures. Notably, 34 cases were conducted during trainee external rotations in countries like the United Kingdom, Germany, and India. Gallbladder and appendix pathologies were most frequent among the 582 recorded laparoscopic cases performed in Africa. Laparoscopic cholecystectomy accounted for 29% (276 of 975 cases), laparoscopic appendectomy for 3% (76 of 2548 cases), and laparoscopic hernia repairs for 0.5% (26 of 5620 cases). Trainees self-reported lower autonomy for laparoscopic (22.5%) than open cases (61.5%). Laparoscopy usage was more prevalent in upper-middle-income (2.7%) and lower-middle-income countries (0.8%) compared with lower-income countries (0.5%) (p < 0.001). Private (1.6%) and faith-based hospitals (1.5%) showed greater laparoscopy utilization than public hospitals (0.5%) (p < 0.001). Conclusions: The study highlights the relatively low utilization of minimally invasive techniques in surgical training within the ECSA region. Laparoscopic cases remain a minority, with variations observed based on specific diagnoses. The findings suggest a need to enhance exposure to minimally invasive procedures to ensure well-rounded training and proficiency in these techniques. [ABSTRACT FROM AUTHOR]

BACKGROUND: An updated examination of the surgeon experience during the Covid-19 pandemic is lacking. This study sought to describe how surgeon stress levels and sources of stress evolved over the pandemic. METHODS: An electronic survey was administered to surgeons at four academic hospitals at 6-months and 12-months following an initial telephone survey. The primary outcome was stress level and secondary outcomes were the individual stressors. Thematic analysis was applied to free text responses. RESULTS: A total of 103 and 53 responses were received at 6-months and 12-months, respectively. The mean overall stress level was 5.35 (SD 1.89) at 6-months and 4.83 (SD 2.19) at 12-months. Mean number of stressors declined from 3.77 (SD 2.39) to 2.06 (SD 1.60, P

There are documented differences in salary for male and female surgeons. Understanding the differences in the clinical practice, composition of male and female surgeons may provide a better understanding of reimbursement differences. We aim to evaluate the differences of Medicare reimbursement for different categories of clinical practice for male and female colorectal surgeons. This retrospective cohort study compared Medicare claims made by male and female board-certified colorectal surgeons from the Medicare Provider Utilization and Payment Data between 2013 and 2017. Medicare claims were categorized by surgeon gender. Submitted claims were evaluated based on the following seven procedure categories: open abdominal surgery, laparoscopic abdominal surgery, anorectal surgery, diagnostic endoscopy, therapeutic endoscopy, and inpatient/outpatient services. The main outcomes were number of charges submitted by clinical activity category and procedural code variation billed through Medicare. Secondary outcome was category of procedure activity that each surgeon cohort had participated in. A total of 62,866 claims were reviewed, of which 10,058 (16.0%) were made by female surgeons and 52,808 (84.0%) were made by male surgeons. On average, male surgeons submitted more claims per year, a greater variety of claims per year, and higher revenue generating claims than female surgeons (P < 0.001). Male and female colorectal surgeons may participate in different categories of clinical activities that result in male surgeons performing more and higher relative value units-generating activity than female surgeons. [ABSTRACT FROM AUTHOR]

The global shortage of skilled anaesthesiologists, surgeons and obstetricians is a leading cause of high unmet surgical need. Although anaesthetic and surgical task-shifting are widely practised to mitigate this barrier, little is known about their safety and efficacy. This systematic review seeks to highlight the existing evidence on the clinical outcomes of patients operated on by non-physicians or non-specialist physicians globally. Relevant articles were identified by searching four databases (MEDLINE, EMBASE, CINAHL and Global Health) in all languages between January 2008 and February 2022. Retrieved documents were screened against pre-specified inclusion and exclusion criteria, and their qualities were appraised critically. Data were extracted by two independent reviewers and findings were synthesized narratively. In total, 40 studies have been included. Thirty-five focus on task-shifting for surgical and obstetric procedures, whereas four studies address anaesthetic task-shifting; one study covers both interventions. The majority are located in sub-Saharan Africa and the USA. Seventy-five per cent present perioperative mortality outcomes and 85% analyse morbidity measures. Evidence from low- and middle-income countries, which primarily concentrates on caesarean sections, hernia repairs and surgical male circumcisions, points to the overall safety of non-surgeons. On the other hand, the literature on surgical task-shifting in high-income countries (HICs) is limited to nine studies analysing tube thoracostomies, neurosurgical procedures, caesarean sections, male circumcisions and basal cell carcinoma excisions. Finally, only five studies pertaining to anaesthetic task-shifting across all country settings answer the research question with conflicting results, making it difficult to draw conclusions on the quality of non-physician anaesthetic care. Overall, it appears that non-specialists can safely perform high-volume, low-complexity operations. Further research is needed to understand the implications of surgical task-shifting in HICs and to better assess the performance of non-specialist anaesthesia providers. Future studies must adopt randomized study designs and include long-term outcome measures to generate high-quality evidence. [ABSTRACT FROM AUTHOR]

Background: Consequences from the COVID-19 pandemic have resulted in the secondary impact of cessation of elective surgical services, amplifying the waiting list problem with devastating patient and surgical training repercussions. With the introduction of the first regional inter-trust daycase elective care centre pilot in Northern Ireland, we aim to assess the impact of this pathway on elective inguinal hernia waiting lists, patient outcomes, and influence on surgical training. Methods: Data was collected prospectively over a 10-week pilot of consecutive elective day case hernia lists at a newly established regional day surgery centre. Key operative time points for each patient were collated via the Theatre Management System (TMS). Retrospective patient feedback was collected from participating patients via 26-question telephone survey at 6 weeks post-operatively. Trainees allocated to the participating units during this pilot received a retrospective electronic survey. Results: Fifty-five patients underwent open unilateral elective inguinal hernia repair, 54% of cases were trainee led. Median trainee operating time of 53 minutes compared with 51 minutes for consultant led procedures, with no significant difference consultant vs non-consultant as primary operator (p>0.05). On completion of the pilot, waiting list numbers were reduced by a third, 75% of trainees feedback reported increased confidence with surgical operative exposure, and high levels of patient satisfaction reported. Conclusion: Inter-trust day surgery at a dedicated green site could successfully contribute to resuming and reforming surgical services, addressing the impact on mounting waiting lists with positive patient impact as well as providing an excellent training opportunity to narrow the observed training deficit. [ABSTRACT FROM AUTHOR]

Seasonality has been studied in select conditions treated by surgeons and internists, but is not well understood regarding overall procedural volume in general surgery. Furthermore, much of the literature is limited due to lack of use of seasonal-trend–decomposition analyses. All admissions with general surgery procedures were pooled from NIS 2002-2014, monthly hospitalization rates calculated, and seasonal-trend decomposition performed. Emergent admissions, accounting for 9% of the average annual incidence, had more prominent seasonality than elective admissions. Inpatient surgical-procedural volume remained relatively stable throughout the year and decreased only in the third quarter. Procedures for acute intra-abdominal conditions and traumas peaked in summer months, while endoscopies, tracheostomies and gastrostomies peaked in winter months. Many surgical pathologies and corresponding general-surgery procedures obey circannual patterns. Surgical workforce remains in high demand throughout the year except for fall and winter holidays. Understanding seasonal variation in such demand may be important for staffing and resource planning. • Many surgical pathologies display seasonal patterns relevant for surgeon workflow. • Emergent admissions demonstrate more prominent seasonality than elective ones. • The volume of inpatient surgical procedures decreases at the end of the calendar year. • Acute intra-abdominal conditions and traumas peak in summer months. • Peaks in elective cases may be related to insurance deductibles. [ABSTRACT FROM AUTHOR]

Abstract Five billion people around the world lack access to safe and affordable surgical, anaesthetic, and obstetric care. There is a link between countries in which women are underrepresented in the surgical workforce and those struggling to meet their surgical need. In this commentary article, the underrepresentation of women in low- and middle-income country’s (LMIC) surgical workforce is discussed. It is argued that the issue is self-reinforcing. On one hand, active change requires a sufficient number of female surgeons to initiate it. On the other, women can only start to penetrate the surgical workforce once they are safe, healthy, and motivated enough to do so, in turn depending on the presence of female surgeons to advocate for their female patients and empower future generations of young girls and women.

Objective: To determine the association between SAO workforce and mortality from emergent surgical and obstetric conditions within US HR Rs. Background: SAO workforce per capita has been identified as a core metric of surgical capacity by the Lancet Commission on Global Surgery, but its utility has not been assessed at the subnational level for a high-income country. Methods: The number of practicing surgeons, anesthesiologists, and obstetricians per capita was estimated for all HRRs using the US Health Resources & Services Administration Area Health Resource File Database. Deaths due to emergent general surgical and obstetric conditions were determined from the Center for Disease Control and Prevention WONDER database. We utilized B-spline quantile regression to model the relationship between SAO workforce and emergent surgical mortality at different quantiles of mortality and calculated the expected change in mortality associated with increases in SAO workforce. Results: The median SAO workforce across all HRRs was 74.2 per 100,000 population (interquartile range 33.3-241.0). All HRRs met the Lancet Commission on Global Surgery lower target of 20 SAO per 100,000, and 97.7% met the upper target of 40 per 100,000. Nearly 2.8 million Americans lived in HRRs with fewer than 40 SAO per 100,000. Increases in SAO workforce were associated with decreases in surgical mortality in HRRs with high mortality, with minimal additional decreases in mortality above 60 to 80 SAO per 100,000. Conclusions: Increasing SAO workforce capacity may reduce emergent surgical and obstetric mortality in regions with high surgical mortality but diminishing returns may be seen above 60 to 80 SAO per 100,000. Trial Registration: N/A [ABSTRACT FROM AUTHOR]

Five billion people around the world lack access to safe and affordable surgical, anaesthetic, and obstetric care. There is a link between countries in which women are underrepresented in the surgical workforce and those struggling to meet their surgical need. In this commentary article, the underrepresentation of women in low- and middle-income country's (LMIC) surgical workforce is discussed. It is argued that the issue is self-reinforcing. On one hand, active change requires a sufficient number of female surgeons to initiate it. On the other, women can only start to penetrate the surgical workforce once they are safe, healthy, and motivated enough to do so, in turn depending on the presence of female surgeons to advocate for their female patients and empower future generations of young girls and women. [ABSTRACT FROM AUTHOR]

In 1998, a Wyoming cyclist noticed what he initially thought was a scarecrow was actually a person. When he took the time to investigate, he found Matthew Shepherd bound to a fence, beaten and left for dead, attacked for being gay. This heinous act of hatred represented a shift in how the United States treats hate crimes, leveeing severe ramifications for the motivations themselves. Although progress has been made, many in medicine who identify in as LGBTQI+ choose to conceal their truths out of fear. With available evidence suggesting a worsening shortage of surgeons in the country, populations of interested people cannot be excluded. Data on representation is severely lacking but is key to attract candidates; inclusivity, modern vocabularies, and the demonstration of engagement are important. Surgical organizations must understand the importance of being a welcoming, mentoring, and allying environment for interested LGBTQI+ candidates, serving as beacons for their interest, or we will simply remain complicit in seeing only scarecrows. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to define the training background of the actual surgical workforce providing care to pediatric patients in North Carolina (NC). Background: Due to database limitations, pediatric surgical workforce studies have not included general surgeons (GS) who operate on children. Defining the role of GS in care delivery affects policy for clinical care and general and pediatric surgical training. Methods: We performed a retrospective review of the NC Hospital Discharge Database (2011–2017), including pediatric patients (<18 years) undergoing the most frequent general surgery procedures. Descriptive and correlational analysis over surgical provider [Pediatric Surgeon (PS), GS], and other specialties (OSS), was performed using logistic regression modeling to identify factors associated with surgery by a PS. Results: Of the 57,265 discharges analyzed, pediatric, general, and other specialty surgeons operated on 25,514 (44.6%), 18,581 (32.5%), and 9049 (15.8%), respectively. In a logistic regression model, PS had lower odds of operating on older patients [odds ratio (OR) 0.9, 95% confidence interval (CI) 0.90-0.91]. However, PS were more likely to operate on female patients (OR 1.58, 95% CI 1.53-1.65), Black (OR 1.49, 95% CI 1.43-1.56), and other minority patients (OR 1.23, 95% CI 1.17-1.29) when compared to white patients. PS were also more likely to operate on patients with private insurance (OR 1.38, 95% CI 1.33–1.43) compared to government insurance, and patients undergoing emergency surgery (OR 1.44, 95% CI 1.38–1.50). Conclusion: In NC, general surgeons performed a third of the operations on children. After controlling for covariates, pediatric surgeons in NC are more likely to operate on minority and emergency surgery patients, and this is the first study to describe this important practice pattern. [ABSTRACT FROM AUTHOR]

Objectives: A paucity of literature exists about childbearing during otolaryngology residency. Pregnancy is a common part of many physician life cycles, but the timing of residency and the rigors of surgical training amplify the challenges. This study was designed to understand the experiences of childbearing otolaryngology residents and support them during this major life event. Unique challenges include long training, shortage of role models, combination surgical and clinical work, and higher rates of infertility. Study Design: Qualitative research. IRB exempt. Setting: United States. Methods: To capture modern perspectives, 16 current and former otolaryngology residents that experienced pregnancy and childbirth during residency in all four geographic regions of the United States in the past 10 years were recruited to participate in individual structured qualitative interviews. Results: Although there was significant training program and personal anxiety reported by childbearing otolaryngology residents, many surgeons experienced healthy pregnancies and postpartum recoveries with minimal disruption to clinical productivity and minimal disruption to their training programs. Multiple recurring themes were identified among the participants spanning the entire childbearing process: increased incidence of pregnancy complications and preterm labor, pregnancy stigma from leadership and coresidents, scheduling logistics regarding call and parental leave, and challenging transitions back to clinical work while navigating breastfeeding and childcare. Conclusion: There are actional recommendations that programs can address to make childbearing during residency accessible and acceptable. Understanding these challenges is an important step to encouraging childbearing residents to prosper in academic otolaryngology, increasing the diversity at the highest levels of the field. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Introduction: There are numerous reasons for underutilization of the public health sector for surgery in Pakistan. This results in patients being diverted to private hospitals or tertiary care centers in urban areas. Diversions overburden the hospitals and significantly increase out-of-pocket costs for the patients. This study aims to determine the barriers to surgical care in first-level hospitals in Pakistan's Sindh province., Methods: We conducted a concurrent nested mixed methods study from May to June 2021 in public sector first-level hospitals in the Sindh province. Fifteen hospitals in six districts were surveyed. A consolidated hospital assessment tool adapted from the World Health Organization's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was used for quantitative data collection. Interview guides were developed for staff interviews., Results: Availability of trained staff was found to be the biggest barrier to the provision of safe surgery. Only eight hospitals had a general surgeon, anesthesiologist, and obstetrician/gynecologist, while the remaining had 1-2 of the three disciplines. Thirteen hospitals had a functioning x-ray machine, while 14 facilities had functioning ultrasound machines with trained personnel to operate them. Only three facilities always had blood available for transfusion. The qualitative component corroborated that the biggest barrier to providing surgical care was the lack of human resources., Conclusions: The lack of human resources is difficult to overcome. We found evidence of task-shifting to medical officers and trainee anesthesiologists, but this is without discrete regulation and monitoring. Building surgical workforce capacity must be addressed in the interest of quality care., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Since 2010, most graduating physicians in Brazil have been female, nevertheless gender disparities among surgical specialties still exist. This study aims to explore whether the increase in female physicians has translated to increased female representation among surgical specialties in Brazil. Data on gender, years of practice, and specialty was extracted from Demografia Médica do Brasil , from 2015 to 2020. The percentage of women across 18 surgical, anesthesia, and obstetric (SAO) specialties and the relative increases in female representation during the study period were calculated. Of the 18 SAO specialties studied, 16 (88%) were predominantly male (>50%). Only obstetrics/gynecology and breast surgery showed a female predominance, with 58% and 52%, respectively. Urology, neurosurgery, and orthopedic surgery and traumatology were the three specialties with the largest presence of men - and the lowest absolute growth in the female workforce from 2015 to 2020. In Brazil, where significant gender disparities persist, women are still underrepresented in surgical specialties. Female presence is predominant in surgical specialties dedicated to the care of female patients, while it remains poor in those with male patient dominance. Over the last 5 y, the proportion of women working in SAO specialties has grown, but not as much as in nonsurgical specialties. Future studies should focus on investigating the causes of gender disparities in Brazil to understand and tackle the barriers to pursuing surgical specialties. • Since 2010, women have been the majority of Brazilian medical school graduates. • In Brazil, women are still underrepresented in surgical specialties. • Women in surgical specialties have increased, but not as much as other specialties. • Strategies to advocate for gender equity in the surgical field are still needed. [ABSTRACT FROM AUTHOR]

Purpose: General surgeons, anesthesiologists, obstetricians and gynecologists (ob–gyns), and orthopedic surgeons are the vital disciplines to provide emergency surgery within a healthcare system. This paper aims to examine the relationship (if any) between multidimensional poverty (MDP) and GDP per-capita with the emergency surgery workforce density in Colombia. Methods: We performed an ecological study, where the observation units were the 32 Colombian departments. The total numbers of general surgeons, anesthesiologists, ob–gyns, and orthopedic surgeons were obtained from the "Registro Unico Nacional de Talento Humano en Salud" (ReTHUS) registry. The 2020 population projections, the incidence of MDP and the GDP per capita were obtained from the Colombian National Administrative Department of Statistics. A spearman's correlation coefficient was calculated to measure the strength of the correlations between the surgical workforce density with MDP and GDP per-capita. Results: There were significant moderate inverse linear correlations between the incidence of multidimensional poverty and workforce density. The correlation coefficients for the incidence of multidimensional poverty and the workforce density were − 0.5273, − 0.5620, − 0.4704, and − 0.4612 for surgeons, anesthesiologists, ob–gyns, and orthopedic surgeons, respectively. Conversely, the correlation coefficients for the GDP per-capita and the workforce density were 0.4045, 0.3822, 0.4404, and 0.3742 for surgeons, anesthesiologists, ob–gyns, and orthopedic surgeons, respectively. Conclusion: This study found that Colombian trauma and emergency surgery workforce density was inversely and directly correlated with multidimensional poverty and GDP per-capita levels, respectively. The relationship of these economic indicators with the surgical capacity deserves further investigation. [ABSTRACT FROM AUTHOR]

BackgroundMedical workforce shortages represent a major challenge in low- and middle-income countries, including those in Africa. Despite this, there is a dearth of information regarding the location and practice of African surgeons following completion of their training. In response to the call by the WHO Global Code of Practice on the International Recruitment of Health Personnel for a sound evidence base regarding patterns of practice and migration of the health workforce, this study describes the current place of residence, practice and setting of Ethiopian surgical residency graduates since commencement of their surgical training in Ethiopia or in Cuba.MethodsThis study presents data from a survey of all Ethiopian surgical residency training graduates since the programme's inception in 1985.ResultsA total of 348 Ethiopians had undergone surgical training in Ethiopia or Cuba since 1985; data for 327 (94.0 %) of these surgeons were collected and included in the study. The findings indicated that 75.8 % of graduates continued to practice in Ethiopia, with 80.9 % of these practicing in the public sector. Additionally, recent graduates were more likely to remain in Ethiopia and work within the public sector. The average total number of surgeons per million inhabitants in Ethiopia was approximately three and 48.0 % of Ethiopian surgeons practiced in Addis Ababa.ConclusionsEthiopian surgeons are increasingly likely to remain in Ethiopia and to practice in the public sector. Nevertheless, Ethiopia continues to suffer from a drastic surgical workforce shortage that must be addressed through increased training capacity and strategies to combat emigration and attrition.

Background: The Association of Surgeons of East Africa (ASEA) was formed in 1952. In 1996 a Steering Committee was formed to transform ASEA into a surgical college. The College of Surgeons of East Central and Southern Africa was officially launched in December 1999 in Nairobi, Kenya. Today the College consists of 14 constituent member countries but trains in 20 countries in Sub-Saharan Africa.Programmes: COSECSA runs a 5 year training programme in all the surgical specialties. In the first 2 years trainees do the Membership (MCS) programme. This is followed by 3 years of the Fellowship (FCS) programme. More recently the College has started a 2 year sub-specialty Fellowship in paediatric orthopaedics.Graduates: The main aim of the College was to expand and improve surgical training in the COSECSA region. This goal was partially realised in December 2020 when the total number of surgeons produced by the College from inception reached 557.Retention: Another key success story of COSECSA is that the majority of graduates have remained in the region leading to a high retention rate of 88.3%.Women in Surgery Africa (wisa): Since the formation of WISA in 2015 the College has witnessed an increase in the number of female trainees. Currently only 9% of surgeons in the region are women.Conclusion: In its current Strategic Plan (2021-2025) COSECSA aims not only to increase the surgical workforce in the region but also to modernise its training programmes and strengthen its governance structures. [ABSTRACT FROM AUTHOR]

Abstract Introduction The Lancet Commission for Global Surgery identified an adequate surgical workforce as one indicator of surgical care accessibility. Many countries where women in surgery are underrepresented struggle to meet the recommended 20 surgeons per 100,000 population. We evaluated female surgeons’ experiences globally to identify strategies to increase surgical capacity through women. Methods Three database searches identified original studies examining female surgeon experiences. Countries were grouped using the World Bank income level and Global Gender Gap Index (GGGI). Results Of 12,914 studies meeting search criteria, 139 studies were included and examined populations from 26 countries. Of the accepted studies, 132 (95%) included populations from high-income countries (HICs) and 125 (90%) exclusively examined populations from the upper 50% of GGGI ranked countries. Country income and GGGI ranking did not independently predict gender equity in surgery. Female surgeons in low GGGI HIC (Japan) were limited by familial support, while those in low income, but high GGGI countries (Rwanda) were constrained by cultural attitudes about female education. Across all populations, lack of mentorship was seen as a career barrier. HIC studies demonstrate that establishing a critical mass of women in surgery encourages female students to enter surgery. In HICs, trainee abilities are reported as equal between genders. Yet, HIC women experience discrimination from male co-workers, strain from pregnancy and childcare commitments, and may suffer more negative health consequences. Female surgeon abilities were seen as inferior in lower income countries, but more child rearing support led to fewer women delaying childbearing during training compared to North Americans and Europeans. Conclusion The relationship between country income and GGGI is complex and neither independently predict gender equity. Cultural norms between geographic regions influence the variability of female surgeons’ experiences. More research is needed in lower income and low GGGI ranked countries to understand female surgeons’ experiences and promote gender equity in increasing the number of surgical providers.

Abstract Background Lack of providers in surgery, anesthesia, and obstetrics (SAO) is a primary driver of limited surgical capacity worldwide. We aimed to identify predictors of entry into Surgery, Anesthesia, and Obstetrics and Gynecology (SAO) fields and preference of working in the public sector in Brazil which may help in profiling medical students for recruitment into these needed areas. Methods A questionnaire was applied to all Brazilian medical graduates registered with a Board of Medicine from 2014 to 2015. Twenty-three characteristics were analyzed. Logistic regression was used to determine predictors’ influence on outcome. Results There were 4601 (28.2%) responders to the survey, of which 40.5% (CI 34.7–46.5%) plan to enter SAO careers. Of the 23 characteristics analyzed, eight differed significantly between those who planned to work in SAO and those who did not. Of those eight characteristics, just three were significant predictors in the regression model: preference for working in the hospital setting, having spent more than 70% of their clinical years in practical activities, and valuing the substantial earning potential. These three factors explained only 6.3% of the variance in SAO preference. Within the graduates who preferred SAO careers, there were only two predictors for working in the public sector (“preparatory time before medical school” and valuing “prestige/status”). Conclusions Factors affecting specialty and sector choice are multifaceted and difficult to predict. Future programs to fill provider gaps should identify methods other than medical student profiling to assure specialty and sector needs are met.

Abstract Background Little is known about operative volume, distribution of cases, or capacity of the public sector to deliver essential surgical services in Uganda. Methods A standardized mixed-methods surgical assessment and retrospective operative logbook review were completed at 16 randomly selected public hospitals serving 64·0% of Uganda’s population. Results A total of 3014 operations were recorded, annualizing to a surgical volume of 36,670 cases/year or 144·5 operations/100,000people/year. Absolute surgical volume was greater at regional referral than general hospitals (p

Background: Māori are significantly under‐represented in the surgical workforce in Aotearoa New Zealand. There needs to be more effort and initiative action to address this lack of diversity in order to ultimately achieve proportionality so that more Māori surgeons are available to help treat and care for their communities. Methods: An independent kaupapa Māori wānanga (course) initiative, using a 'by Māori, for Māori' approach, and adhering to tīkanga Māori (Māori lore and protocols) was developed to support and prepare Māori Non‐Training Surgical Registrars for the Royal Australasian College of Surgeons Surgical Education and Training (SET) interviews. This paper reviews the inception of the wānanga, its content, and shares experiences had by attendees. Results: Those who attended this wānanga agreed unanimously that this initiative dramatically improved their preparation for SET interviews. In 2020, the wānanga produced a significant success rate amongst attendees with 80% of wānanga attendees selected for SET training positions. Conclusion: This kaupapa Māori initiative illustrates a successful active measure that can be taken to support Māori doctors seeking selection in surgical training programmes. The initiative seeks to address inequity in the surgical workforce in Aotearoa New Zealand. [ABSTRACT FROM AUTHOR]

Background: Consequences from the COVID-19 pandemic have resulted in the secondary impact of cessation of elective surgical services, amplifying the waiting list problem with devastating patient and surgical training repercussions. With the introduction of the first regional inter-trust daycase elective care centre pilot in Northern Ireland, we aim to assess the impact of this pathway on elective inguinal hernia waiting lists, patient outcomes, and influence on surgical training., Methods: Data was collected prospectively over a 10-week pilot of consecutive elective day case hernia lists at a newly established regional day surgery centre. Key operative time points for each patient were collated via the Theatre Management System (TMS). Retrospective patient feedback was collected from participating patients via 26-question telephone survey at 6 weeks post-operatively. Trainees allocated to the participating units during this pilot received a retrospective electronic survey., Results: Fifty-five patients underwent open unilateral elective inguinal hernia repair, 54% of cases were trainee led. Median trainee operating time of 53 minutes compared with 51 minutes for consultant led procedures, with no significant difference consultant vs non-consultant as primary operator (p>0.05). On completion of the pilot, waiting list numbers were reduced by a third, 75% of trainees feedback reported increased confidence with surgical operative exposure, and high levels of patient satisfaction reported., Conclusion: Inter-trust day surgery at a dedicated green site could successfully contribute to resuming and reforming surgical services, addressing the impact on mounting waiting lists with positive patient impact as well as providing an excellent training opportunity to narrow the observed training deficit., (Copyright © 2024 Ulster Medical Society.)

Abstract Background Awareness of ergonomics in surgery is growing, but whether musculoskeletal (MSK) injuries in surgery influence trainee career choices remains unknown. This study aimed to characterize medical students' MSK pain during surgical rotations and determine whether ergonomics influence student interest in surgical fields. Methods An online survey was administered to medical students in North Carolina. Students were asked about specialty interest, MSK pain on surgical rotations, and deterrents from surgical fields. Students were exposed to literature about ergonomics in surgery then queried again about relative specialty interest (medical versus surgical). Differences in specialty interest before and after the exposure were compared using a Wilcoxon signed-rank test. Results Of 243 participants, 44.0% were interested in pursuing a surgical specialty. Overall, 75.3% reported MSK pain during their surgical rotation, with the average daily pain score highest during surgery rotations compared to all other clinical rotations. The worst pain was reported in the feet and low back while "standing in the operating room" (81.2%) or "retracting" (59.4%). Among students initially interested in surgery but whose interest changed to a medical specialty during medical school, "physical demands of the field" was a common deterrent (36.4%). After exposure to literature regarding the incidence of MSK injuries in surgery, student interest in surgical fields on a 10-point scale significantly decreased (average −0.5 points; P < 0.01). Conclusions High incidence of MSK injury among surgeons may be one factor deterring medical students from surgical careers. Ergonomic interventions may be important both to improve surgeon longevity and maintain the surgical workforce. [ABSTRACT FROM AUTHOR]

Background: Little is known about operative volume, distribution of cases, or capacity of the public sector to deliver essential surgical services in Uganda.Methods: A standardized mixed-methods surgical assessment and retrospective operative logbook review were completed at 16 randomly selected public hospitals serving 64·0% of Uganda's population.Results: A total of 3014 operations were recorded, annualizing to a surgical volume of 36,670 cases/year or 144·5 operations/100,000people/year. Absolute surgical volume was greater at regional referral than general hospitals (p < 0·001); but, relative surgical volume/catchment population was greater at the general versus regional level (p = 0·03). Most patients undergoing operations were women (78·3%) with a mean age of 26·9 years. The overall case distribution was 69·0% obstetrics/gynecology, 23·7% general surgery, 4·0% orthopedics, and 3·3% other subspecialties. Cesarean sections were the most common operation (55·8%). Monthly operative volume was strongly predicted by number of surgical, anesthetic, and obstetric physician providers (훽=10·72, p = 0·005, R2 = 0·94) when controlling for confounders. Notably, operative volume was not correlated with availability of electricity, oxygen, light source, suction, blood, instruments, suture, gloves, intravenous fluid, or antibiotics.Conclusion: An understanding of operative case volume and distribution is essential in facilitating targeted interventions to strengthen surgical capacity. These data suggest that surgical workforce is the critical driver of operative volume in the Ugandan public sector. Investment in the surgical workforce is imperative to ensure access to safe, timely, and affordable surgical and anaesthesia care. [ABSTRACT FROM AUTHOR]

Background Current global surgery initiatives focus on increasing surgical workforce; however, it is unclear whether this approach would be helpful globally, as patients in low-resource countries may not be able to reach hospitals in a timely fashion without formal Emergency Medical Services (EMS). We hypothesize that increased surgical workforce correlates with decreased road traffic deaths (RTDs) only in countries with EMS. Methods Estimated RTDs were obtained from the Global Status Report on Road Safety 2013, which estimated the RTD rate in 2010 (RTD 2010). The classification of EMS was defined by the Global Status Report on Road Safety 2009. The density of surgeons, anesthesiologists, and obstetricians (SAO density) and 2010 income classification were accessed from the World Bank. Multivariable regression analysis was performed adjusting for different countries, income levels, and trauma system characteristics. Sensitivity analysis was performed. Results One-fourth of the countries reported not having formal EMS ( n = 41, 23.4%). On adjusted analysis, SAO density was not associated with changes in RTD 2010 in countries without EMS ( n = 25, P = 0.50). However, in countries with EMS, each increase in SAO density per 100,000 population decreased RTDs by 0.079 per 100,000 population ( n = 97, P <0.001). Income was the only other factor resulting in reduced mortality rates ( P = 0.004). Sensitivity analysis confirmed these findings. Conclusions Increases in surgical workforce reduce RTDs only when EMS exist. Surgical workforce and EMS must be seen as part of the same system and developed together to maximize their effect in reducing RTDs. Global health initiatives should be tailored to individual country need. Level of Evidence Level II (Ecological study). [ABSTRACT FROM AUTHOR]

This article is based on the Hugh Greenwood Lecture delivered at the 2016 Congress of the British Association of Paediatric Surgeons. It presents the view of the global surgery movement from the bottom of the surgical food chain and proposes what HICs (high-income countries) can do for global surgery in a coordinated fashion. From the LMIC (low- and middle-income countries) surgeon perspective, global surgery is transitioning from the charity-based surgery model to codevelopment with multiple stakeholders. The caveats and current opportunities are described using two case studies. Surgeons may not play a pivotal role in the solutions. The future of the surgical workforce, innovation, workarounds, unmet burden of disease, and health metrics are discussed and multidisciplinary solutions proposed for the entire chain of surgical healthcare delivery in LMIC. A new breed of “essential surgeons”, technology solutions for intellectual and physical isolation, competency-based credentialing, industry-driven innovation, task sharing over task shifting, prioritizing delivery based on surgical burden, and a rota-based overseas model of help are proposed as solutions for the issues facing global surgery. Evidence level Level V. [ABSTRACT FROM AUTHOR]

Surgery continues to be an increasingly vital component of public health and aspect of patient care in rural communities. An anticipated shortage of surgeons within the next decade in the United States prompts a growing concern for increasing the delivery of essential surgical care to these populations. When considering the existing barriers to surgical healthcare in rural communities, there is a sense of urgency to identify innovative approaches that will promote a sustainable surgeon workforce. A narrative review was conducted to investigate the current state of access to essential surgical care in rural communities. Qualitative and quantitative data were collected to better understand the key issues in rural healthcare and to provide statistical data related to the status of the surgical workforce. With the anticipated shortage of surgeons in both rural and urban areas, this review highlights the importance of enacting immediate measures to address the concern. This review has accomplished the initial objectives of gaining a better understanding of the current state of access to surgical care in rural communities and utilizing this knowledge to provide recommendations to readily attain a sustainable number of rural surgeons. With each approach addressing ways to address the contributory issues to the surgeon shortage, this review reveals a new avenue of integrating valuable aspects from each approach, rather than relying on a single approach. In particular, enhancing the overall pipeline of medical training to attending status may prove to be more beneficial for achieving this goal. Ultimately, this may be accomplished by introducing additional rural surgical mentorship opportunities for medical students, developing a rural surgery fellowship, and incorporating a market-based response that will correspond to attractive incentives that help to retain a sustainable number of surgeons working in rural areas., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2023, Long et al.)