Fallah Parisa Nicole, Bernstein Mark
1Harvard Medical School, Boston, Massachusetts.
2Division of Neurosurgery, Department of Surgery, University of Toronto; and.
J Neurosurg. 2018 Apr 6;130(4):1157-1165. doi: 10.3171/2017.10.JNS17435. Print 2019 Apr 1.
There is a global lack of access to surgical care, and this issue disproportionately affects those in low- and middle-income countries. Global surgery academic collaborations (GSACs) between surgeons in high-income countries and those in low- and middle-income countries are one possible sustainable way to address the global surgical need. The objective of this study was to examine the barriers to participation in GSACs and to suggest ways to increase involvement.
A convenience sample of 86 surgeons, anesthesiologists, other physicians, residents, fellows, and nurses from the US, Canada, and Norway was used. Participants were all health care providers from multiple specialties and multiple academic centers with varied involvement in GSACs. More than half of the participants were neurosurgeons. Participants were interviewed in person or over Skype in Toronto over the course of 2 months by using a predetermined set of open-ended questions. Thematic content analysis was used to evaluate the participants' responses.
Based on the data, 3 main themes arose that pointed to individual, community, and system barriers for involvement in GSACs. Individual barriers included loss of income, family commitments, young career, responsibility to local patients, skepticism of global surgery efforts, ethical concerns, and safety concerns. Community barriers included insufficient mentorship and lack of support from colleagues. System barriers included lack of time, minimal academic recognition, insufficient awareness, insufficient administrative support and organization, and low political and funding support.
Steps can be taken to address some of these barriers and to increase the involvement of surgeons from high-income countries in GSACs. This could lead to a necessary scale-up of global surgery efforts that may help increase worldwide access to surgical care.
全球范围内外科治疗的可及性不足，且这一问题对低收入和中等收入国家人群的影响尤为严重。高收入国家与低收入和中等收入国家的外科医生之间开展全球外科手术学术合作（GSACs）是满足全球外科手术需求的一种可持续途径。本研究的目的是探讨参与GSACs的障碍，并提出增加参与度的方法。
选取了来自美国、加拿大和挪威的86名外科医生、麻醉师、其他医生、住院医师、研究员和护士作为便利样本。参与者均为来自多个专业和多个学术中心的医疗服务提供者，参与GSACs的程度各不相同。超过半数的参与者为神经外科医生。在2个月的时间里，通过使用一组预先确定的开放式问题，对参与者进行了面对面访谈或在多伦多通过Skype进行访谈。采用主题内容分析法对参与者的回答进行评估。
基于数据，出现了3个主要主题，指出了参与GSACs的个人、社区和系统障碍。个人障碍包括收入损失、家庭责任、职业生涯初期、对当地患者的责任、对全球外科手术努力的怀疑、伦理问题和安全问题。社区障碍包括指导不足和同事支持缺乏。系统障碍包括时间不足、学术认可度低、认识不足、行政支持和组织不足，以及政治和资金支持低。
可以采取措施解决其中一些障碍，并增加高收入国家外科医生参与GSACs的程度。这可能会促使全球外科手术努力进行必要的扩大，有助于增加全球范围内外科治疗的可及性。
