Gaps in surgical competencies of general surgeons deployed on humanitarian missions in disaster settings

Introduction:As the access to surgery differs geographically, its disparity is even more pronounced in disaster settings. With the increasing interest of surgeons from high-income countries (HIC) to respond to these surgical disparities, non-governmental organizations (NGOs) often send teams of health practitioners to provide healthcare aid to the most unstable regions of the world. However, surgeons participating in these missions rarely get the medical training necessary to face the large scope of procedures they can encounter in humanitarian settings. This research aims to create a framework of the necessary skills needed for surgeons to provide proper surgical care in disaster settings.Methodology:This is a descriptive qualitative study to outline the differences between the surgical procedures general surgeons in HICs are being trained on during their surgical training with the surgical procedures required in disaster settings. After identifying the main surgical procedures general surgeons are expected to be trained on before their deployment to a disaster setting in an LMICs, a survey was sent to participants to assess their competency level in these procedures and the likelihood of them performing these procedures in their home country compared to on the mission.Results:Participants indicated the high frequency of performing several surgical procedures from different surgical specialties on humanitarian missions. The most common of these procedures are cesarean section, fracture reduction, skeletal retraction, wound debridement, burn dressing, application of skin and graft, and performing emergency laparotomies. However, only wound debridement and emergency laparotomy were performed more than 10-20 times/ year by the participants in their daily practice in the past 5 years. The rest of the procedures in this list were never performed by the participants in their daily practice. Obstetrical and orthopedic procedures are amongst the most common procedures a general surgeon must perform when deployed on a mission in a disaster setting. However, they are rarely, if ever, performed by the surgeons in their daily practice. Looking at the requirements to complete general surgery training in most HICs, it is clear that the focus has shifted to training in advanced procedures and away from surgical training in other specialty procedures such as obstetrics, plastic surgery, orthopedic, and neurosurgery. Discussion:This study proves the perception that there is a gap in the training of surgeons who engage in health missions abroad compared to the scope of practice expected of them during these missions. This gap is more present in subspecialties such as obstetrics, orthopedics, urology, and neurosurgery. This shows the importance of surgeons who participate in these missions to have broad-based training that includes the most encountered surgical procedures in disaster settings. Acquiring skills in these life-saving procedures before being deployed on a surgical mission will improve the mortality and morbidity outcomes of these missions and create an ethical space where surgeons from high-income countries only perform procedures they have been adequately trained on