Global health engagement in the Scottish health service: A journey towards global citizenship.

For most of its history, the contribution of the Scottish health service towards health needs outside of Scotland has been informal, ad hoc, and viewed as incidental to its core functions. A more globalised view is emerging, and in recent years, NHS Scotland has begun formalising the principles and mechanisms by which it will contribute towards health and human flourishing around the world. This article provides a brief historical overview of how Scottish medical personnel became involved in the introduction of Western medicine and public health in less developed countries, originally in parallel with colonial expansion and Christian mission outreaches. Following devolution in 1999 of many political powers from the UK Parliament to a newly-formed Scottish Parliament, Scotland's own international development strategy has been evolving. In 2016, the Scottish Government articulated a commitment to 'global citizenship', a pan-governmental, pan-societal engagement towards domestic and international achievement of the UN's Sustainable Development Goals. Following a consideration of the risks and benefits of international volunteering to the Scottish health service, an NHS Scotland Global Citizenship Programme was established, which has catalysed policy development, created networking opportunities, the promulgation of best practice in international health work and the development of novel contracts which facilitate global health work in tandem with a Scottish employment contract. This article also outlines the various benefits of global health engagement for a health service in a high income country such as Scotland.

Remote and rural surgery training and recruitment: a national attitudinal survey of Scottish surgical trainees.

INTRODUCTION: Scotland's healthcare system includes six rural general hospitals (RGHs) which provide a full surgical service to the most remote and rural populations. Constraints of geography and finance, and population need, mean that local delivery of surgical services will be required for the foreseeable future. These RGHs face difficulties in recruiting suitably trained general surgeons. This study aimed to describe Scottish surgical trainees' attitudes towards training and working in remote and rural surgery, perceived barriers to recruitment and potential solutions. METHODS: A survey was distributed in paper and electronic forms to all Scottish trainees in core surgery (early-stage trainees) and general surgery (later-stage trainees). The survey collected data describing demographics, life and career experiences, and attitudes towards training in remote and rural environments. Univariate and multivariate analyses of influences on interest in rural training and recruitment were carried out, and thematic analysis of free-text responses. RESULTS: There were 152 respondents (response rate 59%). Most (81%) felt that surgical training should be offered in rural environments and 43% were personally interested in some rural training. On multivariate analysis, interest in rural training was associated with being a core trainee (odds ratio (OR) 7.54, 95% confidence interval (CI) 2.79-22.76), and rural work experience following graduation (OR 5.12, 95%CI 1.85-15.39). Respondents stating that they were likely to work in a rural environment (9.2%), were more likely on multivariate analysis to be core trainees (OR 5.70, 95%CI 1.37-28.99) and to have previously lived in a rural location (OR 5.49, 95%CI 1.33-25.93). When trainees were asked for their views on how RGH jobs could be made more attractive, themes identified were as follows: increasing and improving training opportunities in RGHs, increasing the breadth of surgical training, optimising links with referral centres, and improving pay and conditions. CONCLUSION: This is the first study in a UK setting to describe the views of surgical trainees towards training and working in rural environments. There is substantial support and interest for rural surgical training among Scottish surgical trainees. A minority are interested in a rural surgical career, with interest more likely in core trainees and in those who have lived rurally. Increasing surgical training opportunities in rural environments and maximising medical school intake from rural areas may be important in addressing recruitment concerns.

The Basic Surgical Skills Course in Sub-Saharan Africa: An Observational Study of Effectiveness.

BACKGROUND: The Basic Surgical Skills (BSS) course is a common component of postgraduate surgical training programmes in sub-Saharan Africa, but was originally designed in a UK context, and its efficacy and relevance have not been formally assessed in Africa. METHODS: An observational study was carried out during a BSS course delivered to early-stage surgical trainees from Rwanda and the Democratic Republic of the Congo. Technical skill in a basic wound closure task was assessed in a formal Objective Structured Assessment of Technical Skills (OSAT) before and after course completion. Participants completed a pre-course questionnaire documenting existing surgical experience and self-perceived confidence levels in surgical skills which were to be taught during the course. Participants repeated confidence ratings and completed course evaluation following course delivery. RESULTS: A cohort of 17 participants had completed a pre-course median of 150 Caesarean sections as primary operator. Performance on the OSAT improved from a mean of 10.5/17 pre-course to 14.2/17 post-course (mean of paired differences 3.7, p < 0.001). Improvements were seen in 15/17 components of wound closure. Pre-course, only 47% of candidates were forming hand-tied knots correctly and 38% were appropriately crossing hands with each throw, improving to 88 and 76%, respectively, following the course (p = 0.01 for both components). Confidence levels improved significantly in all technical skills taught, and the course was assessed as highly relevant by trainees. CONCLUSION: The Basic Surgical Skills course is effective in improving the basic surgical technique of surgical trainees from sub-Saharan Africa and their confidence in key technical skills.

Examining the impact of audience response systems on student performance in anatomy education: a randomised controlled trial.

Background and aims Electronic audience response systems offer the potential to enhance learning and improve performance. However, objective research investigating the use of audience response systems in undergraduate education has so far produced mixed, inconclusive results. We investigated the impact of audience response systems on short- and long-term test performance, as well as student perceptions of the educational experience, when integrated into undergraduate anatomy teaching. Methods and results A cohort of 70 undergraduate medical students was randomly allocated to one of the two groups. Both groups received the same anatomy lecture, but one group experienced the addition of audience response systems. Multiple-choice tests were conducted before, immediately after the lecture and again 10 weeks later. Self-perceived post-lecture subject knowledge, confidence and enjoyment ratings did not differ between groups. Test performance immediately following the lecture improved when compared against baseline and was modestly but significantly superior in the group taught with audience response systems (mean test score of 17.3/20 versus 15.6/20 in the control group, p = 0.01). Tests conducted 10 weeks after the lecture showed no difference between groups (p = 0.61), although overall a small improvement from the baseline test was maintained (p = 0.02). Conclusions Whilst audience response systems offer opportunities to deliver novel education experiences to students, an initial superiority over standard methods does not necessarily translate into longer term gains in student performance when employed in the context of anatomy education.