Establishing collaborations in global neurosurgery: The role of InterSurgeon

The global deficiency in surgical care has been highlighted in the past several years, through the publication of the Lancet Commission on Global Surgery in 2015, the passage of WHA Resolution 68.15, and concerted efforts by advocacy organizations such as the G4 Alliance. Approximately 23,300 additional neurosurgeons are estimated to be needed to address the greater than 5 million essential neurosurgical cases that are not performed annually, most in low- and middle-income countries (LMICs).

However, increasing recognition of the ease and feasibility of virtual technology prompted a shift towards virtual modes of communication. InterSurgeon (https://www.intersurgeon.org/), an independent, internet-based social network platform, has allowed for formal connection between global surgery advocates who may have complementary needs and resources. This manuscript aims to: 1) characterize the current progress of InterSurgeon, 2) describe lessons learned from the creation and use of InterSurgeon, and 3) discuss future directions for InterSurgeon.

Equitable, well-designed collaborations are central to progress in global neurosurgery. InterSurgeon has catalyzed collaborations within global neurosurgery across world regions and country income status. In addition to its role in facilitating traditional in person collaborations, InterSurgeon will become an increasingly important tool for connecting surgeons worldwide as virtual collaboration and augmented reality training paradigms become important components of global surgery capacity building.

Confidence and knowledge in emergency management among medical students across Colombia: A role for the WHO basic emergency care course

Introduction
Globally, medical students have demonstrated knowledge gaps in emergency care and acute stabilization. In Colombia, new graduates provide care for vulnerable populations. The World Health Organization (WHO) Basic Emergency Care (BEC) course trains frontline providers with limited resources in the management of acute illness and injury. While this course may serve medical students as adjunct to current curriculum, its utility in this learner group has not been investigated. This study performs a baseline assessment of knowledge and confidence in emergency management taught in the BEC amongst medical students in Colombia.

Methods
A validated, cross-sectional survey assessing knowledge and confidence of emergency care congruent with BEC content was electronically administered to graduating medical students across Colombia. Knowledge was evaluated via 15 multiple choice questions and confidence via 13 questions using 100 mm visual analog scales. Mean knowledge and confidence scores were compared across demographics, geography and prior training using Chi-Squared or one-way ANOVA analyses.

Results
Data were gathered from 468 graduating medical students at 36 institutions. The mean knowledge score was 59.9% ± 23% (95% CI 57.8–62.0%); the mean confidence score was 59.6 mm ±16.7 mm (95% CI 58.1–61.2). Increasing knowledge and confidence scores were associated with prior completion of emergency management training courses (p<0.0001).

Conclusion
Knowledge and confidence levels of emergency care management for graduating medical students across Colombia demonstrated room for additional, specialized training. Higher scores were seen in groups that had completed emergency care courses. Implementation of the BEC as an adjunct to current curriculum may serve a valuable addition.

Low-cost peer-taught virtual research workshops for medical students in Pakistan: a creative, scalable, and sustainable solution for student research

Background
Pakistan has not been a major contributor to medical research, mainly because of the lack of learning opportunities to medical students. With the increase in online learning systems during COVID-19, research related skills can be taught to medical students via low-cost peer taught virtual research workshops.

Aim of the Study
To assess the effectiveness of a comprehensive low-cost peer-taught virtual research workshops amongst medical students in Pakistan.

Methods
This quasi-experimental study assessed the effectiveness of five virtual research workshops (RWs) in improving core research skills. RWs for medical students from across Pakistan were conducted over Zoom by medical students (peer-teachers) at the Aga Khan University, Pakistan, with minimal associated costs. The content of the workshops included types of research, ethical approval and research protocols, data collection and analysis, manuscript writing, and improving networking skills for research. Improvement was assessed via pre-and post-quizzes for each RW, self-efficacy scores across 16 domains, and feedback forms. Minimum criteria for completion of the RW series was attending at least 4/5 RWs and filling the post-RW series feedback form. A 6-month post-RW series follow-up survey was also emailed to the participants.

Results
Four hundred medical students from 36 (/117; 30.8%) different medical colleges in Pakistan were enrolled in the RWs. However, only 307/400 (76.75%) medical students met the minimum requirement for completion of the RW series. 56.4% of the participants belonged to the pre-clinical years while the rest were currently to clinical years. The cohort demonstrated significant improvement in pre-and post-quiz scores for all 5 RWs (p <  0.001) with the greatest improvement in Data Collection and Analysis (+ 34.65%), and in self-efficacy scores across all domains (p <  0.001). 166/307 (54.1%) participants responded to the 6 months post-RWs follow-up survey. Compared to pre-RWs, Research involvement increased from 40.4 to 62.8% (p <  0.001) while proportion of participants with peer-reviewed publications increased from 8.4 to 15.8% (p = 0.043).

Conclusion
Virtual RWs allow for a wide outreach while effectively improving research-related knowledge and skills, with minimal associated costs. In lower-middle-income countries, virtual RWs are a creative and cost-effective use of web-based technologies to facilitate medical students to contribute to the local and global healthcare research community.

Medical Students in Global Neurosurgery: Rationale and Role

Global neurosurgery aims to build equity in neurosurgical care worldwide. The active involvement of early-career general practitioners, neurosurgical residents, and medical students in global neurosurgery is critical for the development of sustainable strategies to address inequalities. However, the rationale for medical student involvement in global neurosurgery and strategies to increase medical student involvement have not been described previously. We characterize why medical students are fundamental to the success of global neurosurgery initiatives, outline existing opportunities for medical students in the global neurosurgery space, and delineatehow to incorporate medical students into various global neurosurgery initiatives

Survey of Social Media Use for Surgical Education During Covid-19

Objective: To evaluate the use of social media platforms by medical students, surgical trainees, and practicing surgeons for surgical education during the Covid-19 pandemic.

Methods: An online, 15-question survey was developed and posted on Facebook and WhatsApp closed surgeon groups.

Results: The online survey was completed by 219 participants from South America (87%), North America (7%), Europe (5%), Central America, and Asia. Respondents included medical students (6.4%), surgical residents/fellows (24.2%), and practicing surgeons (69.4%). The most common age group was 35-44 years. When asked which social media platforms they preferred, the video sharing site YouTube (33.3%), the messaging app WhatsApp (21%), and “other” (including videoconferencing sites) (22.3%) were most popular. Respondents reported using social media for surgical education either daily (38.4%) or weekly (45.2%), for an average of 1-5 hours/week. Most (85%) opined that surgical conferences that were cancelled during the pandemic should be made available online, with live discussions.

Conclusion: Social media use for surgical education during Covid-19 appears to be increasing and evolving.

Exploring the knowledge and attitudes of Cameroonian medical students towards global surgery: A web-based survey

Introduction: Global surgery is a growing field studying the determinants of safe and affordable surgical care and advocating to gain the global health community’s attention. In Cameroon, little is known about the level of knowledge and attitudes of students. Our survey aimed to describe the knowledge and attitudes of Cameroonian medical students towards global surgery.

Materials and methods: We performed an anonymous online survey of final-year Cameroonian medical students. Mann-Whitney U test and Spearman correlation analysis were used for bivariate analysis, and the alpha value was set at 0.05. Odds ratios and their 95% confidence intervals were calculated.

Results: 204 respondents with a mean age of 24.7 years (±2.0) participated in this study. 58.3% were male, 41.6% had previously heard or read about global surgery, 36.3% had taken part in a global surgery study, and 10.8% had attended a global surgery event. Mercy Ships was well known (46.5%), and most students believed that surgical interventions were more costly than medical treatments (75.0%). The mean score of the global surgery evaluation was 47.4% (±29.6%), and being able to recognize more global surgery organizations was correlated with having assumed multiple roles during global surgery studies (p = 0.008) and identifying more global surgery indicators (p = 0.04). Workforce, infrastructure, and funding were highlighted as the top priorities for the development of global surgery in Cameroon.

Conclusion: Medical students are conscious of the importance of surgical care. They lack the opportunities to nurture their interest and should be taught global surgery concepts and skills.

Barriers to Women Entering Surgical Careers: A Global Study into Medical Student Perceptions

Background: Barriers to female surgeons entering the field are well documented in Australia, the USA and the UK, but how generalizable these problems are to other regions remains unknown.

Methods: A cross-sectional survey was developed by the International Federation of Medical Students’ Associations (IFMSA)’s Global Surgery Working Group assessing medical students’ desire to pursue a surgical career at different stages of their medical degree. The questionnaire also included questions on students’ perceptions of their education, resources and professional life. The survey was distributed via IFMSA mailing lists, conferences and social media. Univariate analysis was performed, and statistically significant exposures were added to a multivariate model. This model was then tested in male and female medical students, before a further subset analysis by country World Bank income strata.

Results: 639 medical students from 75 countries completed the survey. Mentorship [OR 3.42 (CI 2.29-5.12) p = 0.00], the acute element of the surgical specialties [OR 2.22 (CI 1.49-3.29) p = 0.00], academic competitiveness [OR 1.61 (CI 1.07-2.42) p = 0.02] and being from a high or upper-middle-income country (HIC and UMIC) [OR 1.56 (CI 1.021-2.369) p = 0.04] all increased likelihood to be considering a surgical career, whereas perceived access to postgraduate training [OR 0.63 (CI 0.417-0.943) p = 0.03], increased year of study [OR 0.68 (CI 0.57-0.81) p = 0.00] and perceived heavy workload [OR 0.47 (CI 0.31-0.73) p = 0.00] all decreased likelihood to consider a surgical career. Perceived quality of surgical teaching and quality of surgical services in country overall did not affect students’ decision to pursue surgery. On subset analysis, perceived poor access to postgraduate training made women 60% less likely to consider a surgical career [OR 0.381 (CI 0.217-0.671) p = 0.00], whilst not showing an effect in the men [OR 1.13 (CI 0.61-2.12) p = 0.70. Concerns about high cost of training halve the likelihood of students from low and low-middle-income countries (LICs and LMICs) considering a surgical career [OR 0.45 (CI 0.25-0.82) p = 0.00] whilst not demonstrating a significant relationship in HIC or UMIC countries. Women from LICs and LMICs were 40% less likely to consider surgical careers than men, when controlling for other factors [OR 0.59 CI (0.342-1.01 p = 0.053].

Conclusion: Perceived poor access to postgraduate training and heavy workload dissuade students worldwide from considering surgical careers. Postgraduate training in particular appears to be most significant for women and cost of training an additional factor in both women and men from LMICs and LICs. Mentorship remains an important and modifiable factor in influencing student’s decision to pursue surgery. Quality of surgical education showed no effect on student decision-making.