Roy Avraham Hilzenrat

Despite calls from various global organizations for increased attention to global surgery, guidance on developing effective curricula is lacking. In this scoping review, we aimed to outline the necessary learning objectives and competencies for establishing sustainable, equitable, and noncolonialist academic global surgery programs. This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews. We used key terms to search 5 electronic databases and conducted a comprehensive grey literature search to identify universities, medical programs, and organizations offering academic global surgery programs. We categorized curricular objectives extracted from these sources into the 11 domains of global health defined by the Consortium of Universities on Global Health. We employed thematic analysis to further categorize these objectives into unique themes within each domain. We found a total of 43 studies and 61 programs through database and grey literature searches, respectively. These sources yielded 333 unique curricular objectives, which we analyzed thematically, revealing 41 unique themes spanning various neglected areas in global surgery, such as Indigenous health, environments, chronic diseases, technology, and underserved populations like refugees, urban populations of low socioeconomic status, and racial and ethnic minority groups. This review outlines essential skills for effective engagement in modern global surgical care, emphasizing the emergence of nontraditional themes like bidirectional partnerships, sustainability, and self-governance over mission-based approaches. Integrating these forward-looking themes into global surgery curricula is vital for improving global surgical care standards and fostering a skilled, globally aware workforce.

Objective: This project aimed to achieve international consensus on core learning objectives for global surgery education. Background: As global surgery emerges as an academic field, there is a growing need for consensus-driven learning objectives to guide education and training. Existing curricula vary widely and lack multidisciplinary input. Methods: A modified Delphi consensus was conducted with an international panel of global surgery experts. A scoping review informed an initial list of learning objectives, categorized into 14 domains based on the Consortium of Universities for Global Health framework. Panelists rated objectives over three iterative survey rounds, with consensus defined as ≥80% agreement within ±1 Likert point of the median. Results: Sixty-one experts from 26 countries across all World Health Organization (WHO) regions participated, representing surgery (40.1%), anesthesia (14.8%), obstetrics and gynecology (14.8%), general practitioners with and without enhanced surgical skills (16.4%), and allied health fields (6.6%). The majority (57.4%) had over 10 years of experience in global surgery. Across three Delphi rounds, 120 learning objectives reached consensus, covering key domains such as the global burden of surgical disease, surgical system strengthening, ethics and equity, health policy, and sustainable development. A total of 25 (20.8%) objectives were designated for introductory learners, 55 (45.8%) for advanced learners, and 40 (33.3%) for both levels. Conclusion: This Delphi consensus provides a structured, globally relevant framework for global surgery education, supporting curriculum development and competency-based training. These findings underscore the importance of aligning global surgery education with evolving healthcare priorities while ensuring adaptability across diverse surgical contexts.

Background: non-small cell lung cancer (NSCLC) outcomes remain suboptimal for early-stage disease despite emerging advances in systemic therapy for the peri-operative period. Next-generation sequencing (NGS) identifies driver mutations for which targeted therapies have been developed that improve survival. The BC lung cancer screening program, which was initiated in May 2022, is expected to identify people with early and late stages of NSCLC. It is crucial to first understand the molecular epidemiology and patterns of time to initiate treatment across its five health authorities (HA) to optimize the delivery of care for NSCLC in BC. In this way, we may harness the benefits of targeted therapy for more people with NSCLC as novel advances in therapy continue to emerge. Objective: to compare (a) the frequency of actionable NSCLC molecular alterations among HAs and (b) the time to treatment initiation. Methods: a retrospective observational study was conducted with prospectively collected data from the BC CGL Database. Adults with late stage NSCLC who underwent targeted NGS were included for the time period from May 2020 to June 2021. Demographics, actionable molecular alterations, PDL-1 expression, and time to treatment across HAs were examined. Using appropriate statistical tests for comparison among HAs, p>0.05 was deemed significant. Results: 582 patients underwent NGS/IHC and analysis during the study period. The mean age was 71 (10.1), and 326 (56%) patients were female. A significantly higher proportion of all EGFRm+ were identified within Vancouver Coastal Health (VCHA) and Fraser Health Authority (FHA) compared to the other health authorities (p < 0.001). This also holds true for common sensitizing EGFRm+ alone (p < 0.001) and for sensitizing EGFRm+ when adjusted for females and smoker status (OR 0.75; 95% CI 0.62, 0.92; p = 0.005). Patients residing within the Northern, Interior, and Island HAs were less likely to receive treatment at the same rate as those in VCHA and FHA HAs. Conclusion: actionable NSCLC driver mutations are present in all regional HAs, with disparity noted in time to initiate treatment between HAs. This provides evidence for the importance of molecular testing for patients in all BC HAs to guide personalized and timely NSCLC treatment.