Global Reconstructive Surgery and Global Reconstructive Surgeons
Here we explore the emerging field of global surgery to explain what it involves and what it means to be a global surgeon. In particular we focus on the skills required in different areas of global surgery so that trainees have the opportunity to equip themselves with these skills during their training
What is Global Reconstructive Surgery?
Global surgery is a field that aims to improve health equity (access and quality) for all those who are affected by surgical conditions, with a particular focus on low and middle-income countries (LMIC), but also populations in crisis such as those experiencing conflict, displacement and disaster. Global reconstructive surgery refers to the provision of care to patients who would benefit from surgical reconstruction.
Plastic surgeons have had a long history of involvement with reconstructive surgery in LMIC and there are many organisations currently involved with projects around the world. Since the 2015 Lancet Commission in Global Surgery, the global surgery field is progressing with an emphasis on sustainability, teaching and research.
What does it mean to be a Global Surgeon from a high-income country (HIC)?
A global surgeon originating from a HIC (such as the UK) and involved with a LMIC should be responding to locally identified needs, have well defined goals and be able to assess the outcome of their intervention. Desirable skills and behaviours that a global surgeon should be able to demonstrate are defined here as the 4Cs:
- Competency – a global surgeon offering their skills in a LMIC should be able to demonstrate they have the necessary qualifications and experience. This may be in a number of areas including clinical training, education, research and management.
- Cultural awareness – a global surgeon working in a LMIC should have knowledge and insight into the local culture, customs and needs. This may involve living in a LMIC for a period of time.
- Communicator – a global surgeon should be an excellent communicator on multiple levels from the local team to the wider international global surgery community. Communication will include active listening to ensure any intervention remains relevant and useful.
- Collaborator – a global surgeon should be collaborating with individuals, multidisciplinary teams and organisations globally to help increase the likelihood of effectiveness and sustainability.
To demonstrate skills and experience of global surgery on your CV, an MSc in Public Health provides a good grounding. This will give you skills in epidemiology, health economics and ethics that will enable you to improve health on the global stage more effectively (as these skills are not commonly taught in undergraduate medical training).
Not all surgeons are the same however, and this logic applies to global surgery, as surgeons can be involved in a number of different ways. We have identified 5 key areas of activity where different skills are required by the global surgeon for each activity. Some global surgeons may be involved primarily in only one activity, whereas other global surgeons may be involved in multiple activities.
Operating global reconstructive surgeon
– fly-in surgical safaris and missions have been heavily criticised in recent years and the emphasis now has been on equipping local surgeons with the skills and facilities required to provide a sustainable service. However, there may be circumstances, such as natural disasters (ie earthquakes) and war zones, where a plastic surgeon is needed to provide trauma care and operative reconstruction to a population in acute need. UK Med (www/uk-med.org) have been the leading platform for the UK medical response to natural disaster.
The WHO have created standards for emergency medical teams deployed around the world (available here).
- Clinical ability to manage broad range of advanced trauma and pathology – in an era of subspecialisation, operating global surgeons will need to demonstrate that are sufficiently trained in disaster surgical management. Courses and fellowships in trauma surgery (including the recently developed trauma TIG Fellowship) that would help to provide evidence of these skills.
- Ability to operate in austere and resource-poor environments. In the UK there are number of medical courses targeted in this area (such as the RCS STAE – Surgical Training for Austere Environments). Military experience and courses may also be advantageous.
Educating global reconstructive surgeon
– Educating local reconstructive surgeons is an attractive activity as it potentially leads to improved quality of care in a sustainable way. In BFIRST, the emphasis on activity has been on education. In one of the first projects in Cambodia, an educational curriculum was developed to provide a structured educational programme over many years.
- Ability to teach – you can demonstrate this via teaching courses and qualifications (such as an MSc in Medical Education).
- Access to teaching methods and material appropriate for the LMIC environment – an example of this is BFIRST who have been building an education tool box with resources that can be used by educating global surgeons
- Ability to measure effectiveness and outcome in the LMIC setting – shown by experience in outcome assessment such as exam or work based assessments panels.
Academic global reconstructive surgeon
– The field of academic global surgery is rapidly expanding. The Harvard University Program For Global Surgery and Social Change is well established. In the UK, Kings College has established a Global Health MSc with a global surgery pathway. Most recently the NIHR has awarded significant funding for a global surgery research collaboration between the Universities if Birmingham, Warwick and Edinburgh.
- MSc in Public Health – this will provide valuable research skills such as the ability to synthesis epidemiological statistics
- Higher degree (such as an MD or PhD) – there are opportunities for these degrees to focus on global surgery
Project managing global reconstructive surgeon
– some surgeons are involved in establishing or expanding reconstructive surgical services in LMIC. For example This may well involve operating, educating and research, but will also involve logistical aspects such as securing building space for the service, establishing systems (referral, treatment, follow-up etc.).
- Leadership and management experience – courses in leadership and management will provide skills in leading teams and inspiring others to follow your vision.
- Experience of initiating and developing a health service – this may have been a new clinic or service in a HIC or you may have had the opportunity to develop a service in a LMIC
- Experience of working within various health care systems around the world
Innovative global reconstructive surgeon
– in our era of artificial intelligence and tech innovation there is great potential for innovation to help in LMIC. BFIRST has teamed up with the BAPRAS Innovation Group to try and develop this area.
- Programming and coding skills