Research Voices from the Field is a new feature that showcases cutting-edge research that breaks barriers and promotes inclusion in medicine. Each edition spotlights a research publication and includes insights directly from the authors—revealing their motivations, the significance of their findings, and why the research matters for healthcare professionals everywhere.
In this edition, Faizal Haji, a pediatric neurosurgeon at the BC Children’s Hospital, Scholar at the Centre for Health Education Scholarship (CHES), and Assistant Professor in the Department of Surgery, reflects on why he co-authored “Defining a Framework and Evaluation Metrics for Sustainable Global Surgical Partnerships” with colleagues in the Branch for Global Surgical Care — a piece relevant to anyone interested in decolonization and global health equity.
In this edition, Faizal Haji, a pediatric neurosurgeon at the BC Children’s Hospital, Scholar at the Centre for Health Education Scholarship (CHES), and Assistant Professor in the Department of Surgery, reflects on why he co-authored “Defining a Framework and Evaluation Metrics for Sustainable Global Surgical Partnerships” with colleagues in the Branch for Global Surgical Care — a piece relevant to anyone interested in decolonization and global health equity.
Read Faizal Haji‘s bio
Faizal Haji, MD, PhD, FRCSC
Dr. Faizal Haji is a pediatric neurosurgeon at the BC Children’s Hospital and an Assistant Professor in the Department of Surgery at the University of British Columbia. Dr. Haji is also co-lead for the Surgical Education Research Interest Group, Graduate Program Advisor for the Masters and Certificate Program in Global Surgical Care, and Associate Director of the Global Surgery Lab within the Department of Surgery at UBC.
Dr. Haji completed undergraduate studies followed by medical training at McMaster University. After graduating from medical school in 2008, he completed his neurosurgical residency at Western University in London, Ontario, Canada. During residency, Dr. Haji obtained a PhD from the Institute of Medical Science at the University of Toronto, alongside completing research fellowships at the Ronald R. Wilson Centre for Research in Education at UHN and the Learning Institute at the Hospital for Sick Children. His dissertation focused on the effect of fidelity, complexity and cognitive load on learning and transfer of procedural skills for novices engaged in simulation-based education. Upon completing neurosurgical residency and becoming a fellow of the Royal College of Physicians and Surgeons of Canada in 2018, Dr. Haji completed a postgraduate fellowship in pediatric neurological surgery at the Children’s Hospital of Alabama and the University of Alabama at Birmingham (UAB), where his research focused on capacity development for postgraduate surgical training in resource-limited settings. After training, Dr. Haji spent two years as a pediatric and adult neurosurgeon at the Kingston Health Sciences Centre and Medical Education Scholar at Queen’s University. Dr. Haji’s academic interest is in health professions education, with his program of research focusing on three areas: (i) surgical education, including clinical reasoning, the integration of basic and clinical sciences in surgical training, and entrustment; (ii) the globalization of health professions education, including its implications for international medical graduates (IMGs) and learners, educational policy (e.g. related to admissions, certification, and accreditation), international collaborations, and the migration of pedagogical and assessment approaches (e.g, CBME); and (iii) optimizing the design of simulation-based education for medical and surgical skills training with particular focus on cognitive load and learner engagement.
Together with over 70 students and faculty from around the world who are members of the Global Surgery Lab at UBC, we conducted this study to provide guidelines for the development of ethical and sustainable global surgery partnerships (GSPs). Global Surgery has grown substantially since the publication of the 2015 Lancet Commission, which demonstrated that over two-thirds of the world’s population lack access to safe and affordable surgical and anesthetic care, the majority of whom live in the poorest and most resource-limited regions of the globe. The associated World Health Assembly Declarations 68.15 and 76.2 recognize access to safe, timely, and affordable surgical care as a critical component of Universal Health Coverage, and the integration of emergency, obstetric, and anesthetic care is essential to building resilient health systems.
In response to this unmet need, historically surgical care providers engaged in short-term “missions” to provide care in resource-constrained (often international) settings. Unfortunately, these activities are rooted in a colonial framework, where surgical providers from high-resource settings engage in short-term missions to provide surgical care to populations without adequate consideration of the ethics and sustainability of such work, particularly with respect to local culture, needs, and context. More recently, efforts to scale up surgical care in resource-constrained settings have focused on reciprocal, bidirectional partnerships between institutions and teams in High-Income Countries (HICs) and Low- and Low-Middle-Income Countries (LICs/LMICs) that centre around education and training, capacity development, and health systems strengthening. In an ongoing effort to decolonize Global Surgery, our lab engaged in this study in hopes of initiating a conversation around what ethical, sustainable GSPs look like.
Using a modified Delphi technique, we recruited 50 global surgery experts from 34 countries representing all six WHO regions to iteratively establish consensus around the definitions and evaluation metrics for six “pillars” of sustainable GSPs: Stakeholder Engagement, Multidisciplinary Collaboration, Context-Relevant Education and Training, Bilateral Authorship, Multisource Funding, and Outcome Measurement. The associated 47-item checklist achieved full consensus among the expert panel over three rounds of the Delphi process and can serve as a self-auditing tool and benchmark to ensure accountability for those funding and engaging in GSPs. Importantly, this work also furthered an important conversation among panelists, within our lab, and in the literature about knowledge-sharing, co-creation, and decolonization by working in solidarity with, and uplifting, local and Indigenous providers, knowledge, and healthcare practices around the world.
In an ongoing effort to further this work, we are actively involved in pilot testing and iteratively revising this framework with Global Surgery groups engaged in GSPs within Canada and around the world.
Defining a Framework and Evaluation Metrics for Sustainable Global Surgical Partnerships
Authors: Catherine J Binda, Jayd Adams, Rachel Livergant, Sheila Lam, Kapilan Panchendrabose, Shahrzad Joharifard, Faizal Haji & Emilie Joos
Abstract
Objective: The aim of this study was to use expert consensus to build a concrete and realistic framework and checklist to evaluate sustainability in global surgery partnerships (GSPs).
Background: Partnerships between high-resourced and low-resourced settings are often created to address the burden of unmet surgical need. Reflecting on the negative, unintended consequences of asymmetrical partnerships, global surgery community members have proposed frameworks and best practices to promote sustainable engagement between partners, though these frameworks lack consensus. This project proposes a cohesive, consensus-driven framework with accompanying evaluation metrics to guide sustainability in GSPs.
Methods: A modified Delphi technique with purposive sampling was used to build consensus on the definitions and associated evaluation metrics of previously proposed pillars (Stakeholder Engagement, Multidisciplinary Collaboration, Context-Relevant Education and Training, Bilateral Authorship, Multisource Funding, Outcome Measurement) of sustainable GSPs.
Results: Fifty global surgery experts from 34 countries with a median of 9.5 years of experience in the field of global surgery participated in 3 Delphi rounds. Consensus was achieved on the identity, definitions, and a 47-item checklist for the evaluation of the 6 pillars of sustainability in GSPs. In all, 29% of items achieved consensus in the first round, whereas 100% achieved consensus in the second and third rounds.
Conclusions: We present the first framework for building sustainable GSPs using the input of experts from all World Health Organization regions. We hope this tool will help the global surgery community to find noncolonial solutions to addressing the gap in access to quality surgical care in low-resource settings.
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