Surgical Training for Civilian Surgeons Interested in Humanitarian Surgery: A Scoping Review

Jonathan Mitchell; Ahmad Zeineddin; LaDonna Kearse; Katherine D Downton; Adam L Kushner; Shailvi Gupta

doi:10.1016/j.jss.2022.10.068

Surgical Training for Civilian Surgeons Interested in Humanitarian Surgery: A Scoping Review

J Surg Res. 2023 Mar:283:282-287. doi: 10.1016/j.jss.2022.10.068. Epub 2022 Nov 21.

Authors

Jonathan Mitchell¹, Ahmad Zeineddin², LaDonna Kearse³, Katherine D Downton⁴, Adam L Kushner⁵, Shailvi Gupta⁶

Affiliations

¹ Howard University College of Medicine, Department of Surgery, Washington, District of Columbia; Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, Maryland. Electronic address: jonathanmitchell5@me.com.
² Howard University College of Medicine, Department of Surgery, Washington, District of Columbia.
³ Stanford University, Department of Surgery, Palo Alto, California.
⁴ Health Sciences and Human Services Library, University of Maryland, Baltimore, Maryland.
⁵ Surgeons OverSeas, New York, New York.
⁶ Surgeons OverSeas, New York, New York; R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland.

PMID: 36423477
DOI: 10.1016/j.jss.2022.10.068

Abstract

Introduction: Humanitarian surgery is essential to surgical care in limited resource settings. The difficulties associated with resource constraints necessitate special training for civilian surgeons to provide care in these situations. Specific training or curricula for humanitarian surgeons are not well described in the literature. This scoping review summarizes the existing literature and identifies areas for potential improvement.

Methods: A review of articles describing established courses for civilian surgeons interested in humanitarian surgery, as well as those describing training of civilian surgeons in conflict zones, was performed. A total of 4808 abstracts were screened by two independent reviewers, and 257 abstracts were selected for full-text review. Articles describing prehospital care and military experience were excluded from the full-text review.

Results: Of the eight relevant full texts, 10 established courses for civilian surgeons were identified. Cadaver-based teaching combined with didactics were the most common course themes. Courses provided technical education focused on the management of trauma and burns as well as emergencies in orthopedics, neurosurgery, obstetrics, and gynecology. Other courses were in specialty surgery, mainly orthopedics. Two fellowship programs were identified, and these provide a different model for training humanitarian surgeons.

Conclusions: Humanitarian surgery is often practiced in austere environments, and civilian surgeons must be adequately trained to first do no harm. Current programs include cadaver-based courses focused on enhancing trauma surgery and surgical subspecialty skills, with adjunctive didactics covering resource allocation in austere environments. Fellowships programs may serve as an avenue to provide a more standardized education and a reliable pipeline of global surgeons.

Keywords: Courses; Global surgery; Humanitarian surgery; Training.

Publication types

Review

MeSH terms

Cadaver
Humans
Medical Missions*
Obstetrics*
Orthopedics* / education
Surgeons*