Duke Global Surgical Equity Pathway

The Duke Global Surgical Equity Pathway for General Surgery Residents develops academic leaders who work to reduce human suffering caused by surgical disparities. The program focuses on improving surgical outcomes and access to care in low- and middle-income countries and specific regions of North Carolina. Administered by the Department of Surgery, Duke Center for Global Surgery, Hubert-Yeargan Center for Global Health, and Duke Global Health Institute (DGHI), this pathway delivers didactic and practical training leading to a Master’s of Science in Global Health (MSc-GH), clinical experiences in rural North Carolina and global settings, rural and global surgery research opportunities, and research mentorship for surgical residents desiring a career focused on surgical equity. Each resident’s experience is tailored to address her or his career goals.

Program Structure

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All Duke general surgery residents participate in a two-year research fellowship. Residents who elect to participate in the Global Surgical Equity Pathway will begin the research fellowship with a 6-week experience at one of our global or rural partner locations prior to starting Master’s classes at the DGHI in August. The site assessment facilitates the establishment of essential relationships and the identification of the research project focus.

Residents will complete nine months of coursework during the fellowship which will lead to a Master of Science in Global Health (MSc-GH), including construction and defense of a thesis. This program offers trainees opportunities to develop and refine skills in research study design, quantitative and qualitative methods, and to understand key health policy and ethical challenges confronting those engaged in global health careers.

Residents who already have advanced degrees (e.g., MPH, MHSc, or PhD) in relevant fields will work with their global surgery mentor to identify relevant coursework on a flexible basis to further enhance global surgery training. All residents will be expected to participate in GLHLTH 673S Global Surgical Care, a semester-long DGHI seminar and interactive course that explores methods in global surgical research and strategies for national surgical planning.

Residents will complete their Global Health Master's fieldwork and thesis while engaging in mentored clinical and research activities at their global health training site. In addition to a biweekly journal club, there will be ample opportunity to access special events and lectures throughout the training program. Global Surgery Equity Residents will be paired with a Duke Surgery Faculty mentor who will provide mentorship throughout the program.

Rural North Carolina

Rural North Carolina Elective Rotation

Surgical residents may elect to participate in surgical rotations in Robeson County with Duke Surgeons in the specialties of Cardiothoracic and Breast Surgery. Robeson County is home to the Lumbee Indian Tribe, which is the largest Native American Tribe east of the Mississippi River.

Key Deliverables

Key Deliverables

  • Residents will prepare an application to the NIH Fogarty Fellowship and other Global Surgery award opportunities.
  • Residents will be expected to produce three or more global surgery-oriented manuscripts for peer-reviewed publication.
  • Residents participating in the Masters of Science in Global Health will complete a Master’s thesis.
  • Residents will present their work at Duke Surgery departmental conferences, Duke Surgery Resident Research Day, Duke Global Health Institute seminars, and national/international surgical and global health meetings.

Applications

Surgical Residents who have successfully completed PGY1 and have the approval of their Program Director are eligible to apply for entry into the program, which will start in July of PGY3.

Applications are accepted on a rolling basis from July to September 1. Preference will be given to individuals who have already demonstrated a commitment to addressing health disparities and who intend to pursue an academic career in global health. Placements are competitive and contingent upon the qualifications of the applicant, availability, and approval from the Surgery Program Director. For more information including application instructions, visit the Global Health Pathway website.

For more information about this program, please direct inquiries to Dr. Tamara Fitzgerald at Tamara.Fitzgerald@duke.edu.

Awards & Publications in Global Health

Below is a list of awards and publications in global health from faculty, residents, and staff in the Department of Surgery and the General Surgery Residency Program.

  • Sarah Jane Commander – 2019 AAS/AASF Global Surgery Research Fellowship Award

  • Sarah Jane Commander – Recipient of Owen H. Wangensteen Scientific Forum Excellence in Research Awards 2021

  • Commander SJ, Oyania F, Bingana C, Ajidiru L, Ellis DI, Situma M, Fitzgerald TN. Delays in pediatric colorectal care lead to unnecessary healthcare expenditure: A standard of care phase for the implementation of a mobile health program. American College of Surgeons Clinical Congress (oral presentation) 2021.  

  • Rice HE et al. Building a safety culture in global health: lessons from Guatemala. BMJ Glob Health. 2018 Mar 9;3(2)
  • Smith ER et al. Disability Weights for Pediatric Surgical Procedures: A Systematic Review and Analysis. World J Surg. 2018 Sep;42(9):3021-3034.
  • Saxton AT. Economic Analysis of Children's Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis. PLoS One. 2016 Oct 28;11(10):e0165480
  • Concepcion TL et al; Global Initiative for Children’s Surgery. Provision of Surgical Care for Children Across Somaliland: Challenges and Policy Guidance. World J Surg. 2019 Nov;43(11):2934-2944.
  • Concepcion T et al; Global Initiative for Children’s Surgery. JAMA Netw Open. 2019 Jan 4;2(1):e186857
  • Fitzgerald TN, Rice HE. Investing in all of Our Children: Global Pediatric Surgery for the Twenty-First Century.  World J Surg. 2019 Jun;43(6):1401-1403.
  • Taicher BM et al. Implementation of a colour-coded universal protocol safety initiative in Guatemala. BMJ Qual Saf. 2018 Aug;27(8):593-599.
  • Nguyen K et al. Self-reported barriers to pediatric surgical care in Guatemala. Am Surg. 2013 Sep;79(9):885-8.
  • Johnston BE et al. Teaching patient safety in global health: lessons from the Duke Global Health Patient Safety Fellowship. BMJ Glob Health. 2019 Feb 20;4(1):e001220.
  • Truche P et al. Association between government policy and delays in emergent and elective surgical care during the COVID-19 pandemic in Brazil: a modeling study. Lancet Reg Health Am. 2021 Nov;3:100056.
  • COVIDSurg Collaborative. Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study. Lancet Oncol. 2021 Nov;22(11):1507-1517.
  • COVIDSurg Collaborative; GlobalSurg Collaborative. SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study. Anaesthesia. 2022 Jan;77(1):28-39
  • Cotache-Condor CF et al. Geospatial analysis of pediatric surgical need and geographical access to care in Somaliland: a cross-sectional study. BMJ Open. 2021 Jul 21;11(7):e042969.
  • Landrum K et al. Global and regional overview of the inclusion of paediatric surgery in the national health plans of 124 countries: an ecological study. BMJ Open. 2021 Jun 16; 11(6): e045981.
  • Truche P et al. Potentially Avertable Child Mortality Associated with Surgical Workforce Scale-up in Low- and Middle-Income Countries: A Global Study. World J Surg. 2021 Sep;45(9):2643-2652.
  • Fitzgerald TN, Muma NJK, Gallis JA, Reavis G, Ukachukwu A, Smith ER, Ogbuoji O, Rice HE. Development of an Interactive Global Surgery Course for Interdisciplinary Learners. Ann Glob Health. 2021 Mar 31;87(1):33.
  • Muzira A et al.  The socioeconomic impact of a pediatric ostomy in Uganda. Ped Surg Intl 2018 Apr;34(4):457-466.
  • Sico IP et al. Implementation Analysis of a Perioperative Patient Safety Program in Guatemala. World J Surg. 2020 Jul;44(7):2131-2138
  • Vissoci JRN et al. Disparities in surgical care for children across Brazil: Use of geospatial analysis. PLoS One. 2019 Aug 20;14(8):e0220959.
  • Smith ER et al. The contribution of pediatric surgery to poverty trajectories in Somaliland. PLoS One. 2019 Jul 26;14(7):e0219974.
  • Smith ER et al. Waiting Too Long: The Contribution of Delayed Surgical Access to Pediatric Disease Burden in Somaliland. World J Surg. 2020 Mar;44(3):656-664.
  • Kakembo N et al. Burden of Surgical Infections in a Tertiary-Care Pediatric Surgery Service in Uganda. Surg Infect (Larchmt). 2020 Mar; 21(2):130-135.
  • Ullrich SJ et al.  Burden and Outcomes of Neonatal Surgery in Uganda: Results of a Five-Year Prospective Study. J Surg Res. 2019 Sep 25;246:93-99.
  • Reed C et al.  Comparison of Ugandan and North American pediatric surgery fellows’ operative experience: Opportunities for global training exchange.  J Surg Educ May-Jun 2020; 77(3):606-614.
  • Scheiner A et al. Global surgery pro-con debate: A pathway to bilateral academic success or the bold new face of colonialism? J Surg Res 2020 Aug; 252: 272-280.
  • Arivoli M et al.  Multi-Disciplinary Development of a Low-Cost Gastroschisis Silo for Use in Sub-Saharan Africa.  J Surg Res 2020 Nov; 255: 565-574.
  • Commander SJ et al. Predictors of burnout and depression in surgeons practicing in east, central and southern Africa.  J Surg Res 2020 Nov; 255: 536-548.
  • Kakembo N et al. Ugandan medical students career choices relate to foreign funding priorities. World J Surg. 2020 Dec;44(12):3975-3985
  • Commander SJ et al. The hidden mortality of congenital anomalies in Uganda. Surgery 2021 Feb;169(2):311-317.
  • McNee MA et al.  The first six years of the APSA travel fellowship program: Impact and lessons learned. J Pediatr Surg. 2021 May;56(5):862-867.
  • Hubner S et al.  The evolving landscape of medical device regulation in East, Central and Southern Africa. Global Health: Science and Practice. 2021 Apr 1;9(1):136-148.
  • Ellis D, Nakayama D, Fitzgerald TN. Missions, humanitarianism and the evolution of modern global surgery. Am Surgeon. 2021 May;87(5):681-685.
  • Farrow NE et al. Laparoscopic experience and attitudes towards a low-cost laparoscopic system among surgeons in East, Central and Southern Africa. Surg Endoscopy. 2021 Dec;35(12):6539-6548.
  • Ellis D, Fitzgerald TN. The evolving landscape of global surgery: Perspectives on faith-based and academic initiatives. J Relig Health 2021 (in press).
  • Gupta A et al.  KeyLoop: Mechanical retraction of the abdominal wall for gasless laparoscopy.  J Surg Innovation. 2021 (in press)
  • Mueller JL et al. An accessible laparoscope for surgery in low- and middle-income countries. Annals of BME. 2021 2021 Jul;49(7):1657-1669.