Abstract
Since 2017, the Global Anaesthesia Surgery and Obstetric Collaboration (GASOC) has been hosting journal clubs to promote critical appraisal of global surgery publications. The COVID-19 pandemic has prompted a transition to an online-only journal club format. Attendees have rated the online GASOC journal clubs highly in terms of relevance for their learning and development, and the ability to engage with discussions. This transition has allowed more trainees in low- and middle-income countries (LMICs) to register for journal clubs, but barriers have continued to restrict their participation. Feedback submitted by participants has allowed GASOC to identify and address these barriers in order to promote bidirectional partnerships between high-income country and LMIC trainees.
The Global Anaesthesia, Surgery and Obstetric Collaboration (GASOC) is a trainee-led organisation aiming to promote impactful trainee involvement in global surgery initiatives. Since 2017, GASOC has hosted bi- to tri-monthly virtual journal clubs to discuss a variety of published global surgery research. This article reflects on GASOC’s changing experience of running journal clubs and highlights the growing importance of its use in building collaborations.
The first documented journal club is thought to have occurred sometime in the 1800s. 1 Since then, the advantages of holding such meetings for evaluating and disseminating research have been well established. Journal clubs are useful for developing skills in critical appraisal, research design and medical statistics with subsequent translation from knowledge into clinical practice, 2 and have been employed for these purposes within global surgery academia. The Lancet Commission on Global Surgery has highlighted the paucity of global surgery research arising from low- and middle-income countries (LMICs) and the need for LMIC research capacity building. 3 Journal clubs are a vital part of capacity building, but local-level conversations among LMIC clinicians are not currently connected to the global academic discourse. 4 At GASOC, we have attempted to address these issues to foster meaningful collaboration through our technology-assisted journal clubs. We have aimed to facilitate the involvement of LMIC colleagues in (1) setting research priorities, (2) critically assessing the relevance of global surgery papers in local contexts and (3) openly discussing inequity in global surgery academia.
The first GASOC journal club in 2017 was hosted across three host sites in London, Oxford and Glasgow, later expanding to sites in Leeds, Edinburgh, South Africa and Ireland. Journal club attendees were invited to attend in person, and all sites communicated with each other in real-time via a video conference application. Authors of chosen articles were invited to present and discuss their research, either in person or remotely. Participants were encouraged to engage by posing questions to the author(s), and taking part in a free-form discussion. Sessions were recorded live, to allow playback for those unable to attend.
Since the COVID-19 pandemic, live streaming has been the sole medium for GASOC journal club. This has allowed us to widen participation, particularly amongst LMIC trainees, through dissemination of the video link via our partner organisations, including the Oxford University Global Surgery Group, G4 Alliance, the RCSI-COSECSA partnership and our colleagues in LMICs. For our July and October journal clubs in 2020, 38% and 47% of those registered were from LMICs, respectively. In addition to gaining insight into the research priorities of LMIC trainees, the international links fostered through the journal club have resulted in fruitful collaborations, such as a COVIDpod podcast episode with a surgeon from the South African Global Surgical Society.
Journal club participants have been varied in their experience and clinical background. Papers have covered a range of surgical, anaesthetic and obstetric topics such as surgical referral systems in LMICs, 5 the burden of maternal peri-partum infections worldwide 6 and the training of non-physician anaesthetists in sub-Saharan Africa, 7 thus highlighting the breadth of research methodologies being used to address global surgical research priorities. Discussions of studies with the authors have allowed participants to appreciate the challenges faced during study design and conduct, including data collection, analysis and interpretation, thereby outlining essential considerations for those wishing to undertake global surgical research. This has been particularly beneficial for students and early career researchers, who have been motivated by GASOC journal clubs to seek mentorship from more experienced global surgery academics.
Over the five journal clubs that have taken place since switching to a virtual-only format in April 2020, attendees gave speaker presentations an average rating of 4.4/5. On average, the online journal club format was rated 4.5; attendees’ ability to engage with the journal club 4.3 and the relevance of the journal club for their learning and development 4.5. A greater number of LMIC participants registered for our journal clubs in July 2020, December 2020 and April 2021, when speakers from LMICs presented (Figure 1). However, despite interest during registration, a significant proportion of participants were unable to attend our journal clubs (Figure 1). Our focus has therefore shifted to identifying barriers to participation in order to enable us to address them (Table 1).
Number of participants that registered and provided feedback after journal clubs, separated by institutional affiliation. Barriers to journal club attendance highlighted in feedback forms and proposed solutions. LMIC: low- or middle income country; GASOC: Global Anaesthesia Surgery and Obstetric Collaboration.
For GASOC, hosting a technology-assisted international journal club has been a process of continued learning, given the varied target audience and the evolving e-learning landscape. Although piloted within UK institutions to begin with, there is undoubtedly a pressing need for greater international participation and empowerment of colleagues from LMICs. As the focus of the GASOC journal club has shifted from research dissemination to mitigation of inequity in global surgery academia, we have reflected as an organisation to ensure more meaningful steps to facilitate LMIC participation are taken. These reflections have stemmed from candid discussions with LMIC clinicians during journal clubs about a lack of opportunities for, or disproportionate challenges faced by LMIC researchers in global surgery. As part of the long-term vision for GASOC, the aim is to support trainees in LMICs to form national and regional trainee-led global surgical organisations, and use the ‘global classroom’ 8 of a technology-assisted journal club to maintain bidirectional relationships with these groups. In addition to HIC–LMIC collaborations, these journal clubs may eventually facilitate research partnerships between LMIC researchers, thereby promoting the involvement of LMIC colleagues in shaping global surgical research priorities.
Footnotes
Acknowledgements
GASOC wishes to thank the speakers and attendees for their contributions during our journal clubs. We are grateful for the support of our partner organisations, including RCSI-COSECSA, the G4 Alliance and the South African Global Surgery Society.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
