Discussion: Modeling the Lifetime Impact of Reconstructive Plastic Surgery Training: Implications for Building Capacity in Global Surgery
Year: 2025
Type: article
Abstract: Cai et al1 evaluated the impact of a single surgeon educator on the potential for relieving the burden of surgical disease among a community across generations of trainees. The authors subsequently distributed a survey to the US-based and international plastic surgeons and developed a formula to calculate the attributable surgical impact of various plastic surgery index cases by combining each surgeon’s individual impact factor, lifetime number of trainees, and lifetime number of cases done by those trainees. Among the eight index cases chosen, there were differences in the lifetime impact between procedures performed in high-income countries compared with low- and middle-income countries (LMICs). For example, breast reduction and carpal tunnel release showed higher lifetime impact among high-income countries, likely due to differences in patient population demand and the elective nature of these procedures. In comparison, LMICs saw tremendous lifetime impact among procedures such as cleft lip repair and correction of syndactyly. This result may be due to the high disease burden of congenital malformations combined with the smaller workforce of plastic surgeons covering larger geographic areas. Overall, the lifetime impact predicted is profound and clearly demonstrates how training and education dramatically improve capacity building for a community. As a limitation, the results from the LMIC group may be overly generalized. There were fewer plastic surgeons among the LMIC group surveyed (19 in total, compared with 28 US-based plastic surgeons) and no specification of the proportion of geographic distribution among the LMIC providers. Regardless, the survey results offer an overall glimpse of the plastic surgery needs around the world. Should the survey be applied to a larger population of plastic surgeons across the globe, the results may demonstrate which pathologies or disparities are specific to certain regions of the globe, and provide opportunities for bidirectional partnership, collaboration, and innovative solutions for commonly encountered problems.2 It is estimated that there are 5 billion people without adequate access to surgical care, with the majority of these individuals living in LMICs.3 To illustrate, 25% of the global burden for surgical disease exists solely on the continent of Africa, where there is only 2% of the global medical workforce.4 Although delivery of general surgery capacity has grown over the past years in many areas, plastic surgery capacity remains low.5 However, since the publication of the Lancet Commission in 2015, research on global health education by plastic surgeons has increased 7-fold, demonstrating efforts by plastic surgeons to improve global capacity.3,6 Few studies have demonstrated concrete outcomes of the impact of education. By modeling the lifetime impact of training and education, this article clearly shows that teaching provides a positive impact well beyond the learner, and more importantly, on a community, with an exponentially greater return on the investment required to conduct the teaching.7 Traditionally, healthcare delivery to low-resourced communities has primarily existed as short-term medical trips where large volumes of patients are treated. Although these trips treat large numbers of patients, they create an unsustainable dependency on the visiting surgeons and teams without investment into the local healthcare economy. Becoming more commonplace, organizations and institutions are seeking to improve global surgery delivery by creating sustainable solutions within diagonal development of care models, with education as a primary centerpiece.8 Over the years, plastic surgeons have demonstrated the strong impact of education on various methods of delivery. Several plastic surgeons who have focused their work on plastic surgery education and delivering care in LMICs. Dr. Jerome Pierce Webster has been described as the Father of Plastic Surgery Education in the United States while serving as a medical missionary to China.9 Dr. Sam Noordhoff dedicated his life-long career to the education of numerous physicians in Taiwan and serving to facilitate establishment of the Chang Gung Memorial Hospital, which has become one of the top institutions for plastic surgery training in the world.10 Several nongovernmental organizations have developed short-term medical trips and used these high-volume caseloads as opportunities for repetitive instruction to train local surgeons and providers.11 By training local surgeons to perform and manage the high-volume cases existing within a community, the focus can be on providing surgery for complex conditions that local surgeons are unable to provide.12 Additionally, teaching direct surgical care also allows for potential research collaborations and improvement in data collection models such as national health records, improved patient follow-up with better outcomes predictions, and more accurate understanding of surgical volumes in the respective regions.13 Academic institutions and plastic surgery departments have recently joined in the global surgery effort and have created relationships with universities in LMICs, creating a cross-cultural relationship and dedication to teaching with bilateral exchange of trainees.14 Academic centers may comprise the institutions best-positioned to provide diagonal development of care to serve LMICs by enhancing research, education, and service in the respective regions, resulting in both advancement of education and developing a sustainable approach to the delivery of global surgery.8,15 The COVID-19 pandemic provided an opportunity to capitalize and improve virtual and hybrid learning and has allowed training programs domestically and abroad to have access to education that otherwise may not exist in their current curriculum.16 Virtual curricula facilitating the transfer of knowledge and surgical skills are being demonstrated by implementing live-stream surgery,16 formalized virtual courses,17 and simulated surgical models.18 These examples are a limited sampling of the efforts championed by passionate individuals and groups seeking to improve the global delivery of plastic surgery and demonstrate the real ways expertise is being passed to the next generation. Whether or not a plastic surgery educator’s clinical practice is tied to an academic institution, long-term educational commitment to a community is the foundation to the sustainable delivery of global plastic surgery. Continuing this investment in training, even 1 trainee at a time, will continue to benefit the global community both immediately and in the long-term through the multiplier effect that each resident can have on future global health trainees, as illustrated by Cai et al.1 DISCLOSURE The authors have no financial or other conflicts of interest to disclose in relation to the content of this article.
Authors: Ariel E. Figueroa, Arun K. Gosain
Institution: Lurie Children's Hospital
Language: English
Topic: Global Health and Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,195
OpenAlex ID: W4406305014