Breast Cancer Rehabilitation Services in South Africa and Survivor Experience of These Services in Two Dedicated Cancer Units

Purpose Integrated rehabilitation health care pathways are implemented to meet both physical and clinical needs of breast cancer survivors as they transition from medical treatment to long term survivorship. The aim of this study was to assess current South African upper limb rehabilitation service provision, and perspectives of these from health professionals and breast cancer survivors.

Methods A sequential explanatory mixed-methods design informed this study. Service provision was evaluated via an online survey questionnaire completed by health practitioners working in public and private breast cancer units. Focus groups were conducted with both public health practitioners providing the services and breast cancer survivors accessing the services.

Results This study has revealed a dearth of rehabilitation services for breast cancer survivors in the public health sector of South Africa. Data reveal an overstretched, understaffed and poorly trained public health sector, unable to deliver adequate upper limb services to breast cancer survivors. Focus group data suggests that this is due to financial austerity rather than poor recognition of the need. Limited patient education is driving poor upper limb outcomes and barriers to change in exercise behaviour.

Conclusion Current South African upper limb rehabilitation services do not cater for the needs of breast cancer survivors, leading to poor health outcomes.

Lessons learned from organizing and evaluating international virtual training for healthcare professionals

Education is a critical part of capacity building in global health partnerships.1 Medical training conferences designed for providers in low-to-middle-income countries (LMICs) address equity in global health by reducing financial, political, and language barriers.2 However, the COVID-19 pandemic has disrupted gatherings, added further travel restrictions, and exhausted already strained financial resources for individuals from LMICs to attend conferences. To continue providing quality education, training, and professional development in the midst of the global crisis, organizations had to rapidly transition to virtual platforms.3,4 The pandemic has accelerated the process of adoption of innovative technological solutions, including learning management systems (LMS) (e.g., Moodle, Canvas) and virtual meeting platforms (e.g., Zoom, Google Hangouts, GoToMeeting) that transcend geographic and temporal boundaries, enhancing the potential of reaching a wider audience. This has also had the benefit of addressing some of the preexisting barriers for conference attendees from LMICs.
This transition was not unprecedented; as early as 2009,The US Commitment to Global Health: Recommendations for the Public and Private Sectors report by the US Institute of Medicine5 created a framework to guide investments and implementation in global health, including sharing knowledge, investing in people and institutions, and engaging in respectful partnerships. Virtual international meetings have been held successfully prior to the pandemic in response to environmental concerns and financial limitations.6-10 Prior studies documented the benefits of utilizing online formats for medical education, including training healthcare professionals via virtual conferences.11 Among those benefits include saving time, resources, and money.11,12 In addition, virtual conferences help healthcare associations and universities increase their global outreach by forming international partnerships and collaborations, as well as disseminating their research at a global scale.11 Despite their benefits of online and virtual formats, researchers indicate that evaluating the effectiveness of online platforms for medical education still remains a challenge.12,13 To address the challenge, our multidisciplinary team at Children’s Hospital Los Angeles (CHLA) partnered with the Armenian Eye Care Project (AECP) to co-host a series of three international virtual training conferences on ophthalmology and pediatrics for healthcare professionals in the Republic of Armenia and its surrounding regions between September 2020 and February 2021. The conference planning began in December 2019. Due to the COVID-19 pandemic, we transitioned to a fully virtual format in June 2020. Our evaluation strategy included a collection of quantitative and qualitative data from the conference participants through a post-conference survey and semi-structured interviews on their experiences and perceptions. Below, we are sharing the lessons learned from the process of organizing and evaluating virtual training conferences.

Obstetric neonatal emergency simulation workshops in remote and regional South India: a qualitative evaluation

Background
Healthcare facilities in remote locations with poor access to a referral centre have a high likelihood of health workers needing to manage emergencies with limited support. Obstetric and neonatal clinical training opportunities to manage childbirth emergencies are scant in these locations, especially in low- and middle-income countries.

Objectives
This study aimed to explore the factors, which influenced healthcare worker experience of attending birth emergencies in remote and regional areas of South India, and the perceived impact of attending the Obstetric and Neonatal Emergency Simulation (ONE-Sim) workshop on these factors.

Design
Qualitative descriptive study using pre- and post-workshop qualitative surveys.

Settings
Primary healthcare facilities in remote/regional settings in three states of South India.

Participants
A total of 125 healthcare workers attended the workshops, with 85 participants completing the pre- and post-workshop surveys included in this study. Participants consisted of medical and nursing staff and other health professionals involved in care at childbirth.

Methods
ONE-Sim workshops (with a learner-centred approach) were conducted across three different locations for interprofessional teams caring for birthing women and their newborns, using simulation equipment and immersive scenarios. Thematic analysis was employed to the free-text responses obtained from the surveys consisting of open-ended questions.

Results
Participants identified their relationship with the patient, the support provided by other health professionals, identifying their gaps in knowledge and experience, and the scarcity of resources as factors that influenced their experience of birth emergencies. Following the workshops, participant learning centred on improving team and personal performance and approaching future emergencies with greater confidence.

Conclusions
Challenges experienced by healthcare workers across sites in remote and regional South India were generally around patient experience, senior health professional support and resources. The technical and interpersonal skills introduced through the ONE-Sim workshop may help to address some of these factors in practice.

The impact of the COVID-19 pandemic on global neurosurgical education: a systematic review

The COVID-19 pandemic has disrupted neurosurgical training worldwide, with the shutdown of academic institutions and the reduction of elective surgical procedures. This impact has disproportionately affected LMICs (lower- and/or middle-income countries), already burdened by a lack of neurosurgical resources. Thus, a systematic review was conducted to examine these challenges and innovations developed to adapt effective teaching and learning for medical students and neurosurgical trainees. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and The Cochrane Handbook of Systematic Reviews of Interventions. MEDLINE, PubMed, Embase and Cochrane databases were accessed, searching and screening literature from December 2019 to 5th December 2020 with set inclusion and exclusion criteria. Screening identified 1254 articles of which 26 were included, providing data from 96 countries. Twenty-three studies reported transition to online learning, with 8 studies also mentioned redeployment into COVID wards with 2 studies mentioning missed surgical exposure as a consequence. Of 7 studies conducted in LMICs, 3 reported residents suffering financial insecurities from reduced surgical caseload and recession. Significant global disruption in neurosurgical teaching and training has arisen from the COVID-19 pandemic. Decreased surgical exposure has negatively impacted educational provision. However, advancements in virtual technology have allowed for more affordable, accessible training especially in LMICs. Using this, initiatives to reduce physical and mental stress experienced by trainees should be paramount.

Global Surgery Education and Training Programmes—a Scoping Review and Taxonomy

Global surgery is an emerging field of study and practice, aiming to respond to the worldwide unmet need for surgical care. As a relatively new concept, it is not clear that there is a common understanding of what constitutes “global surgery education and training”. This study examines the forms that global surgery education and training programmes and interventions take in practice, and proposes a classification scheme for such activities. A scoping review of published journal articles and internet websites was performed according to the PRISMA Extension for Scoping Review guidelines. PubMed MEDLINE, EMBASE and Google were searched for sources that described global surgery education and training programme. Only sources that explicitly referenced a named education programme, were surgical in nature, were international in nature, were self-described as “global surgery” and presented new information were included. Three hundred twenty-seven records were identified and 67 were ultimately included in the review. “Global surgery education and training” interventions described in the literature most commonly involved both a High-Income Country (HIC) institution and a Low- and Middle-Income Country (LMIC) institution. The literature suggests that significant current effort is directed towards academic global surgery programmes in HIC institutions and HIC surgical trainee placements in LMICs. Four categories and ten subcategories of global surgery education and training were identified. This paper provides a framework from which to study global surgery education and training. A clearer understanding of the forms that such interventions take may allow for more strategic decision making by actors in this field

Undergraduate Surgical Education: a Global Perspective

Undergraduate surgical education is failing to prepare medical students to care for patients with surgical conditions, and has been significantly compromised by the COVID-19 pandemic. We performed a literature review and undertook semi-structured reflections on the current state of undergraduate surgical education across five countries: Egypt, Morocco, Somaliland, Kenya, and the UK. The main barriers to surgical education at medical school identified were (1) the lack of standardised surgical curricula with mandatory learning objectives and (2) the inadequacy of human resources for surgical education. COVID-19 has exacerbated these challenges by depleting the pool of surgical educators and reducing access to learning opportunities in clinical environments. To address the global need for a larger surgical workforce, specific attention must be paid to improving undergraduate surgical education. Solutions proposed include the development of a standard surgical curriculum with learning outcomes appropriate for local needs, the incentivisation of surgical educators, the incorporation of targeted online and simulation teaching, and the use of technology.

Analysing a Global Health Education Framework for Public Health Education Programs in India

Academic global health is of increasing interest to educators and students in public health but competency domains as well as education pathways that deliver this training, are still being identified and refined. This thesis was undertaken using an education program development paradigm and aimed to analyse the factors shaping global health education in India by examining multistakeholder perspectives. The research framework consisted of four components: curriculum and content, students, faculty and key experts, and employers. Studies captured the perspectives of students through a survey and focus group discussions, faculty and other key experts through semi-structured interviews, and employers through job advertisement analysis. We identified eleven global health competency domains focussed on three aspects: foundational competencies, core public health skills and soft skills. Global health and public health were seen as interconnected, with global health having transnational context and public health having a more national focus. Global health was seen as a nascent concept in India and although integration of global health education into the public health curriculum was supported, there were concerns given that public health is still too new a discipline in India. Global health competencies were seen as a ‘step up’ from the public health competencies. Based on the results, a two-level approach to global health education is proposed for Indian public health institutions. The first approach, targeted at recent graduates, focuses on a ‘foundational global health education’ within public health programs such as an MPH. The second approach is an ‘Executive Global Health Certificate Program’, aimed at experienced public health professionals planning to enter the global health workforce. This thesis has outlined a framework for Indian and other LMIC institutions looking to expand the scope of public health education and intend to develop global health education programs.

Foundation for International Education in Neurosurgery: The Next Half-Century of Service Through Education

The Foundation for International Education in Neurological Surgery (FIENS) was founded in 1969, decades before globalization became a worldwide phenomenon (1–3). Initially, efforts were focused on service delivery in under-resourced areas via short mission trips by individual neurosurgeons. The wisdom of furthering the impact by creating sustainable training programs in partnership with host organizations developed over time (3). FIENS is a neurosurgeons foundation working in partnership with various organizations to increase global access to neurosurgery missions through the principle of “service through education (3).” FIENS shifted its focus from a service delivery-centered approach to an approach centered on global health systems strengthening by emphasizing local neurosurgery resident education and residency program development (3). It has become clear that the integration of neurosurgical efforts within the local health system amplifies the overall impact of FIENS initiatives by promoting sustainable change through collaborative action in the service of local health system goals. From this point forward, initiatives coordinated by FIENS incorporated local stakeholders and workforce in addition to mechanisms for service delivery, health infrastructure, information management, governance, and funding.

Additionally, FIENS-supported trainees expressed the need for ongoing support in the early stages of their careers. In response, the Foundation expanded its scope to include postgraduate education, evolved, as global health organizations must, understand that lasting impact occurs through teaching, leading to self-sustaining health systems in regions of need.

Feasibility of the application of multimedia animations as preoperative guides for urgent abdominal surgeries in public hospitals in Brazi

Introduction: Preoperative education helps patients feel less anxious and improve self-care while decreasing hospitalization time and demand for postoperative analgesia. Health literacy, culture and language play vital roles in patients’ understanding of health issues and may influence treatment outcomes. Obstacles are more evident in low and middle income countries (LMICs), where inadequate patient education levels are higher and hospital resources lower. Methodology: This is a prospective pilot study assessing the feasibility of online preoperative multimedia animations as guides for surgical patients in an LMIC. Patients admitted to a public hospital in Brazil for acute cholecystitis or appendicitis were included. Feasibility was represented by acceptability rate and ease of integration with department protocols. Results: Thirty-four patients were included in the study. Twenty-six patients concluded the intervention (feasibility rate of 76.5%). Demographic factors seemed to affect results, indicated by higher acceptability from those with lower education levels, from younger patients and from women. No issues were reported regarding integration to local protocols. Discussion: Few studies have evaluated use of multimedia resources for preoperative patients. No studies assessed the use of animations and none analyzed digital patient education resources in an LMIC. This study demonstrated that the use of animations for patient education in LMICs is feasible. A step-based protocol approach is proposed by this study to aid the implementation of patient education digital interventions. Conclusion: The implementation of this tool is feasible and presents patients with easier access to appropriate and engaging information, allowing better surgical preparation and recovery. It can be offered online, allowing it to be sustainable while creating the foundations for a modern patient education culture in LMICs

Global Neurosurgery and the Congress of Neurological Surgeons: Collaboration, Innovation, and Opportunity to Improve Care, Education, and Access.

Global neurosurgery encompasses the neurosurgical care and public health efforts to ensure timely and safe neurosurgical care access for all who need it (1). Over the past several decades, global neurosurgery has been championed by many individuals, which has led to a broader interest in developing larger collaborative, sustainable neurosurgical care efforts. On a national level, neurosurgical educational opportunities have grown through courses, online education, and fellowships. Given the growing global burden of neurosurgical disease, there is a significant opportunity and need for worldwide neurosurgery and neurosurgical education worldwide, especially in low- and middle-income countries (LMICs).
To advance global neurosurgery from an educational standpoint, the Congress of Neurological Surgeons (CNS), American Association of Neurological Surgeons (AANS), World Federation of Neurological Surgeons (WFNS), and other international neurosurgical societies have successfully developed programming. The CNS has led with a robust educational platform and offerings for neurosurgeons through in-person courses, fellowships, webinars, online case databases (2), publications, guidelines, and virtual grand rounds. SANS online education and questions modules offer neurosurgeons the ability to learn and self-test to advance their fund of knowledge, education, and continuing education