Purpose: Canada's Royal College of Physicians and Surgeons established a competency-based medical education (CBME) training in pediatric surgery in 2021. Specialty-specific Entrustable Professional Activities (EPAs), foundational to CBME, were created within this framework as tools to assess fellow progression. We aimed to determine which of these EPAs were appropriate for assessment of international medical graduates (IMGs) from Low and Lower-Middle-Income Countries (LMICs) training in pediatric surgery in Canada. Methods: Subject matter experts (SMEs) were defined as surgeons with experience in global pediatric surgical education. SMEs were invited to complete a survey tool to assess the relevance of the EPAs for IMG fellows. Each item was rated on a 5-point Likert scale, and narrative comments were collected along with demographic data from respondents. An EPA was determined to be relevant if more than 80 % of SMEs rated it at 4 or higher. Results: Six SMEs completed the survey. The average duration of experience training pediatric surgery fellows was 13 years, and all SMEs had previously used EPAs for fellow assessment. The average duration of experience supporting LMIC environments was 16 years. Relevance criteria were met for 20 of the 38 EPAs. EPAs not meeting relevance criteria included redundant EPAs, activities not applicable to the LMIC environment, and non-technical skills. Conclusion: EPAs remain a valuable tool for fellow assessment. However, not all the EPAs seem relevant for IMGs training in Canada. Context-relevant education and training programs for LMIC trainees in pediatric surgery are critical to fortifying the global surgical workforce. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

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.

Background: Family physicians with enhanced surgical skills/obstetric surgical skills contribute significantly to surgical care delivery in rural British Columbia. This environmental scan documents their practice locations and procedural scope. Methods: Practice locations of enhanced surgical skills physicians/obstetric surgical skills physicians were identified using public data and professional networks. These data were collected between January 2022 and April 2023. Numbers of surgical procedures performed were determined using MSP billing data for fiscal year 2021-2022. Results: Overall, 11 enhanced surgical skills physicians and 21 obstetric surgical skills physicians were practising in 17 of the 45 rural communities. Five communities had enhanced surgical skills physicians/obstetric surgical skills physicians as the sole surgical providers. Common procedures billed by these physicians included colonoscopies (n = 559), C -sections (n = 404), and inguinal/femoral hernia repairs (n = 52). Conclusions: A number of family physicians provide core surgical services in rural BC, sometimes as the only surgical providers at their hospital. Despite the limitations of the data collected, due mostly to a high turnover of surgical providers in rural sites, our study shows that enhanced surgical skills physicians and obstetric surgical skills physicians are integral to the well-being of rural patients and the health care systems they access. Concerted efforts should be made to recruit and retain these key surgical providers in our province.

Mounting evidence suggests that childhood health is an important predictor of wellness as an adult. Indigenous peoples worldwide suffer worse health outcomes compared to settler populations. No study comprehensively evaluates surgical outcomes for Indigenous pediatric patients. This review evaluates inequities between Indigenous and non-Indigenous children globally for postoperative complications, morbidities, and mortality. Nine databases were searched for relevant subject headings including “pediatric”, “Indigenous”, “postoperative”, “complications”, and related terms. Main outcomes included postoperative complications, mortality, reoperations, and hospital readmission. A random-effects model was used for statistical analysis. The Newcastle Ottawa Scale was used for quality assessment. Fourteen studies were included in this review, and 12 met inclusion criteria for meta-analysis, representing 4793 Indigenous and 83,592 non-Indigenous patients. Indigenous pediatric patients had a greater than twofold overall (OR 2.0.6, 95% CI 1.23–3.46) and 30-day postoperative mortality (OR 2.23, 95% CI 1.23–4.05) than non-Indigenous populations. Surgical site infections (OR 1.05, 95% CI 0.73–1.50), reoperations (OR 0.75, 95% CI 0.51–1.11), and length of hospital stay (SMD = 0.55, 95% CI − 0.55–1.65) were similar between the two groups. There was a non-significant increase in hospital readmissions (OR 6.09, 95% CI 0.32–116.41, p = 0.23) and overall morbidity (OR 1.13, 95% CI 0.91–1.40) for Indigenous children. Indigenous children worldwide experience increased postoperative mortality. It is necessary to collaborate with Indigenous communities to promote solutions for more equitable and culturally appropriate pediatric surgical care.

Abstract Background The UNCRC outlines the rights of children and youth to develop their greatest potential. These rights provide a framework for a child-centred approach in paediatric clinical practice and are associated with improved patient outcomes and experiences. While these rights are increasingly acknowledged globally, more work is needed within clinical settings to adopt this rights-based approach. A pilot survey was developed in partnership with an equity-deserving urban youth recreation centre and youth with chronic health conditions from a provincial paediatric tertiary care teaching hospital’s Youth Advisory Committee (YAC) regarding their knowledge of, and access to, the UNCRC. Objectives 1) To identify urban community youth knowledge of, and access to, UNCRC; 2) To identify and compare YAC knowledge of, and access to, UNCRC. Design/Methods Ethics approval was obtained. A survey developed to facilitate UNCRC discussions was presented to the urban community youth, iteratively from 2020 to 2021. Participants were recruited using convenience snowball sampling. Zoom dialogues between the research team and YAC members were held to adapt the survey to YAC context. The survey was completed by YAC members on Qualtrics from May to August 2022. Demographic information and survey results were analyzed using descriptive statistics. Results 57 participants completed the survey, including 18 youth, 16 caregivers, and 11 staff members from the community, and 11 youth and 1 staff member from YAC. The median ages of urban and YAC youth were 16.4 years and 23 years respectively. Prior to the study, 70% of youth participants did not know, or only sort of knew that the UNCRC existed. Both urban youth and YAC reported that children aged 0 to10 and 11 to 14 have the most access to article 31 (rest and play). However, urban youth reported that 15 to24-year-olds have the most access to article 24 (health and health services), whereas YAC reported article 12 (respect for children’s views) for this age group. Both youth groups reported that children and youth of all ages have the least access to articles 28 and 29 (education), article 12 (respect for children’s views), and article 23 (support for children with disabilities). Conclusion A lack of knowledge of the UNCRC was prevalent in youth from both an urban community and tertiary care hospital, indicating a need for increased dialogue among this community, clinicians, and the healthcare system. These results will also inform patient advocacy communities on gaps in knowledge and access to empower advocacy around child rights.

Abstract Rationale and Objectives The University of British Columbia provides medical students in years 1, 2, and 4 with protected time to explore the CanMEDs competencies in student-directed service, education, and research through the Flexible and Enhanced Learning (FLEX) program. Six FLEX students in the past three years have engaged in reciprocal partnerships with the Responsive, Intersectoral Community Child Health Education and Research group (RICHER). RICHER is a consortium of interdisciplinary healthcare providers, resource centres, and community members working across sectors and systems who serve equity-deserving children, youth, and families in Vancouver’s inner-city. Students develop leadership, health advocacy, and collaboration competencies through mentorship and co-learning with the RICHER team and community partners. For example, students have partnered to promote and amplify vaccine equity, knowledge of children’s and youth’s rights, food security, and social-emotional learning. Project Description For each FLEX project, community members identify local priorities. They conduct needs assessments and environmental scans. Students complete project proposals, ethics board and grant applications, and elicit iterative community feedback. Students collect data and communicate findings to stakeholders, including community members and RICHER clinicians. RICHER further amplifies community voices by sharing FLEX project results with local and provincial decision-makers, resulting in policy change and resource mobilization. Projects are evaluated qualitatively by stakeholders. For example, during the COVID-19 lockdown, many inner-city families faced barriers accessing COVID vaccines. The Downtown Eastside neighbourhood had some of the lowest vaccination rates in the province. Outcomes FLEX students surveyed 122 community members and found that 89 (73%) community members experienced a significant barrier to accessing COVID vaccines, such as: no access to technology or ID required to register or book an appointment, no access to transportation to a vaccine clinic, or trauma associated with accessing healthcare or injections. The RICHER team was able to respond to these findings by authoring a letter to the local health authority, who mobilized a pop-up vaccine clinic at an accessible, local community centre using the principles of brokered trust. Discussion/Future Directions This vaccine equity project has set a precedence for accessible care and created a model for future vaccine clinics to provide protection against viruses like influenza. FLEX students and hospital staff learned from Indigenous Elders and community members how to use the medicine wheel in the context of wholistic healthcare. As health advocates, FLEX students learned to ask, “who are we not seeing and why?” and learned how to write motivational letters to changemakers.

Indigenous Peoples across North America and Oceania experience worse health outcomes compared to non-Indigenous people, including increased post-operative mortality. Several gaps in data exist regarding global differences in surgical morbidity and mortality for Indigenous populations based on geographic locations and across surgical specialties. The aim of this study is to evaluate disparities in post-operative outcomes between Indigenous and non-Indigenous populations. This systematic review and meta-analysis was conducted in accordance with PRISMA and MOOSE guidelines. Eight electronic databases were searched with no language restriction. Studies reporting on Indigenous populations outside of Canada, the USA, New Zealand, or Australia, or on interventional procedures were excluded. Primary outcomes were post-operative morbidity and mortality. Secondary outcomes included reoperations, readmission rates, and length of hospital stay. The Newcastle Ottawa Scale was used for quality assessment. Eighty-four unique observational studies were included in this review. Of these, 67 studies were included in the meta-analysis (Oceania n = 31, North America n = 36). Extensive heterogeneity existed among studies and 50% were of poor quality. Indigenous patients had 1.26 times odds of post-operative morbidity (OR = 1.26, 95% CI: 1.10–1.44, p<0.01) and 1.34 times odds of post-operative infection (OR = 1.34, 95% CI: 1.12–1.59, p<0.01) than non-Indigenous patients. Indigenous patients also had 1.33 times odds of reoperation (OR = 1.33, 95% CI: 1.02–1.74, p = 0.04). In conclusion, we found that Indigenous patients in North American and Oceania experience significantly poorer surgical outcomes than their non-Indigenous counterparts. Additionally, there is a low proportion of high-quality research focusing on assessing surgical equity for Indigenous patients in these regions, despite multiple international and national calls to action for reconciliation and decolonization to improve quality surgical care for Indigenous populations.

# Overcoming barriers to pediatric trauma education in low-and middle-income countries {#article-title-2} Trauma remains a leading cause of child mortality and disability worldwide, taking the lives of 1 million children annually. Of all deaths from pediatric trauma, 95% occur in low- and middle-

Objectives The relationship between visual function and social determinants of health in pediatric ophthalmology patients is unclear. Our study evaluated the feasibility of screening for social determinants of health in ophthalmology clinics, assess the prevalence of these risk factors, and to clarify the relationship between social determinants of health and visual function. Methods An institution approved survey on social determinants of health risk factors was completed by 145 patients from five pediatric ophthalmology outpatient clinics in British Columbia. Medical charts of survey participants were reviewed to determine diagnoses and level of visual function. Descriptive statistics, univariate, and multivariate analysis were performed. Results Socioeconomic risk factors were present in all pediatric ophthalmology settings. 56% (n=81) of participants reported having at least one risk factor. Characteristics of poverty, including annual household income, size of support network, adverse childhood experiences, and level of parental education, were not associated with level of visual function. Food insecurity, housing instability, low income, and lack of social support were all associated with a higher adverse event scores (p<0.05). Patients who experienced food insecurity were more likely (OR 7.14, 95% CI 1.47-38.44) to have an adverse childhood experience score of four or more compared to patients who did not have any risk factors. Conclusions Our study found no relationship between the level of visual function and social determinants of health risk factors. Given that all pediatric ophthalmology populations experience socioeconomic poverty, the need to establish social screening and social work support is pertinent in all pediatric ophthalmology clinics.

Children who experience socioeconomic poverty and/or significant adverse childhood experiences (ACEs) are more likely to develop poorer health outcomes in adulthood. Little is known however on the relationship between the level of visual function and social determinants of health (SDOH) in pediatric ophthalmology patients.

Background In 2015, the Lancet Commission on Global Surgery published six global surgery goals, one of which was to provide 80% of the world's population with timely access to the Bellwether Surgical procedures. Little is known about the prevalence or efficacy of subsequent interventions implemented in under-resourced countries to increase timely access to Bellwether surgical procedures. Methods A systematic review of articles and grey literature published in MEDLINE, Embase, Cochrane, CINAHL, and Web of Science databases was conducted. Two independent reviewers evaluated 1923 captured abstracts using explicit inclusion and exclusion criteria. Following a thematic analysis, two reviewers conducted data extraction on the eleven manuscripts included in the final review. Results The studied innovations, sparse in number, centred on improved educational resources, the development of orthopaedic devices, and models for assessing surgical access disparity. Eight papers were centred around timely access to caesarean sections, three around open fracture reduction, and three around laparotomy; all focused on adult populations. Five papers addressed innovations in West Africa, two in East Africa, two in South Asia, and one in Southeast Asia. Common outcome metrics were not used to assess improvements to timely surgical access. Conclusions Few published interventions have been implemented since the publication of the 2015 Lancet Commission on Global Surgery goals that have or will longitudinally increase the availability of timely surgical access in Low and Middle-Income Countries (LMIC). Tangible outcome measures in existing literature are lacking. An up-scaling and wider adoption of successful strategies is necessary and possible.