Advancing Equity in Global Surgery Education: Lessons from a Student-Led International Hybrid Conference

INTRODUCTION

The field of global surgery has evolved considerably since the 2015 Lancet Commission on Global Surgery brought attention to the inequities in surgical access worldwide. Yet, an estimated 4.8 billion people still lack access to essential surgical services, a burden disproportionately carried by the world’s most marginalized populations: those living in remote regions, facing systemic discrimination, or experiencing the aftermath of conflict and disaster. Only 6.3% of surgical procedures worldwide are performed in very-low-expenditure countries, which together host 36.8% of the global population [1,2].

When billions remain without access to basic surgical care, this reflects not only a lack of infrastructure but a broader systemic failure. Access to surgery should not depend on birthplace or socioeconomic status, but be recognized as a core component of health care. Addressing these inequities is a shared responsibility that extends across the entire surgical ecosystem, from policymakers and hospital administrators who shape access, to surgeons, anesthetists, nurses, allied health professionals, community health workers, and rehabilitation specialists who deliver care, alongside the trainees, educators, and researchers who sustain the field. This responsibility is shared through education, mentorship, advocacy, and by setting up equitable partnerships at every level of the surgical care continuum.

Founded in 2018, the Canadian Global Surgery Trainees’ Alliance (CGSTA) has become a leading platform for trainee advocacy and education in global surgery [3]. The CGSTA McGill Chapter, in collaboration with the McGill University Health Centre and Centre for Global Surgery (CGS), organizes an annual Global Surgery Conference gathering trainees, clinicians, surgeons, researchers, advocates, and curious minds from around the world to engage with some of the most pressing issues in global surgery.

Originally established in 2012, the conference has transitioned into a student-led initiative following the creation of the CGSTA, marking a shift toward trainee-driven leadership in the field. It now functions not only as an academic forum but also as a space for critical dialogue and collective engagement on advancing safe, accessible, and timely surgical care. The 13th edition centered on the theme of Equity in Global Surgery.

This conference serves as a proof-of-concept model for equitable, trainee-led global surgery education, demonstrating how hybrid, low-cost, and collaborative approaches can expand access, foster engagement, and promote shared leadership across diverse global contexts.

A GLOBAL GATHERING

The 13th Annual Global Surgery Conference was held on May 3rd, 2025, welcoming 158 registered participants from 23 countries from multiple WHO regions. Represented countries included Brazil, Canada, Ecuador, and the United States (Region of the Americas); Ghana and Nigeria (African Region); Italy, Turkey, and Ukraine (European Region); and India and Nepal (South-East Asia Region). While Canadian trainees made up the majority, participation from Africa, South Asia, Latin America, and Europe highlighted the international resonance of the equity theme (Figure 1). The hybrid format of the conference allowed participants to join in person or virtually. The conference ran from 08:30 to 17:00 Eastern Daylight Time (12:30–21:00 UTC) on a single day, with all sessions delivered in English. Attendance was free of charge for all registrants, removing financial barriers to participation. While conference sessions were not recorded, certificates of attendance were issued to all participants who completed the program, supporting recognition of their professional engagement.

The Annual Global Surgery Conference has several key objectives. These include highlighting the importance of global surgery, educating participants on high-impact approaches, providing opportunities to present relevant research, fostering collaboration and networking, and exposing students to opportunities in the field.

The program of the 13th edition featured keynote speakers, trainee research presentations, and an interactive disaster case competition. Keynote lectures provided insights into disaster response, decolonial practices, and sustainable capacity building, anchored by the main lecture titled “Global Surgery: Changing Priorities and Challenges.” Research presentations showcased trainee work from Canada, Kenya, Nigeria, India, and beyond, highlighting diversity in geographic representation, diversity in surgical specialties, and equitable opportunities for trainee participation and contribution.

The conference was co-organized by CGSTA and CGS through a collaborative model that combined trainee leadership with institutional mentorship. CGSTA led the coordination and program development, reflecting its mission to empower trainees in global surgery through education, advocacy, and research engagement. CGS provided institutional support, clinical expertise, and mentorship, ensuring academic rigor and alignment with ongoing global surgery initiatives. Speakers and program content were selected collaboratively, integrating trainee perspectives with faculty guidance.

A novel key feature of the conference for this 13th edition was the disaster-response case competition. The objective of the case competition was to provide participants with a hands-on learning experience that represents a real-world global surgery challenge. The case scenario was a simulated mass casualty explosion of a power station in a flood-prone district of Malawi with limited resources. It was written by medical students and then reviewed by CGS trauma surgeons to ensure clinical relevance and adequate educational value. Through this simulated case, participants were required to manage resource constraints, ethical dilemmas, and system limitations as a team. Participants were forced to decide, in real time, which patient would receive the only available ventilator while others deteriorated around them. The scenario highlighted the complexities of surgical care delivery in a setting with inadequate resources. This learning experience allowed participants to reinforce core competencies such as leadership, advocacy, critical thinking, and collaboration. In addition, learners had the opportunity to translate theoretical knowledge into practical solutions. A detailed description of the case scenario and evaluation framework is provided in Supplementary Material 1.

EVALUATING THE IMPACT

A pre-conference survey was distributed to in-person and virtual attendees via QR-code, and a post-conference survey was administered by QR-code and follow-up email. Data was collected using Google Forms, and participation was voluntary and anonymous. As the surveys were administered as part of an internal program evaluation to inform future iterations of the conference, formal research ethics board approval was not sought. Participants were presented with a written information statement on the survey landing page describing the purpose of the survey, the voluntary and anonymous nature of participation, and the absence of personal identifiers. Submission of the survey was taken to indicate informed consent. Twenty participants completed the pre-conference survey, and 25 participants completed the post-conference survey. Although 158 people registered for the event, the exact number of attendees who received each survey cannot be confirmed, given the hybrid nature of the conference. A total of 45 responses were analyzed. Respondent demographics (Table 1) highlight the reach of the conference.

Both surveys consisted of twelve identical 5-point Likert-scale items (1 = Strongly Disagree to 5 = Strongly Agree) assessing self-reported knowledge (e.g., “I understand what global surgery is”), confidence (e.g., “I feel confident in finding opportunities to get involved in global surgery (e.g., electives, research)”), and awareness (e.g., “I am aware of how colonialism and historical power dynamics have shaped global health and surgery”) related to global surgery.

The post-conference survey included three additional items assessing learning objectives (“Did the conference help you better understand the importance of equity in global surgery?”), attitude (“Did the conference change your attitude towards pursuing a career in global surgery?”), and interest (“Are you interested in joining any of the following activities in the near future?”). Survey items are provided in full in Supplementary Material 2. Responses were collected anonymously, without participant identifiers. Thus, responses were not paired between samples. The analyses conducted were purely exploratory and descriptive.

Post-conference responses demonstrated higher mean scores across all items compared to pre-conference responses (Figure 2). The largest increases were observed in participants’ confidence applying for global surgery-related opportunities (+1.23), familiarity with global surgery programs and organizations (+1.17), and awareness of strategies to improve equity in surgical care globally (+1.08).

The three additional items in the post-conference survey assessed self-reported change in knowledge and interest. Of note, 36% of respondents reported an increased interest in global surgery after attending, while 52% maintained their existing interest. Only 12% reported no change or decrease in engagement. An overwhelming 92% expressed interest in attending the conference again, with the remaining 8% indicating they would consider returning depending on the theme or format; no respondents indicated they would not return. Additionally, 80% of attendees expressed interest in participating in future CGSTA events, 88% were eager to engage in global surgery research projects, 68% were interested in advocacy initiatives, 64% in mentorship programs, and 68% expressed a desire to volunteer abroad. Given the independent samples, causal inferences cannot be drawn, but the observed trends suggest that participation in the conference was associated with increased self-reported engagement and awareness.

LESSONS ON THE 13th ANNUAL CONFERENCE

The descriptive findings of this study and the conference design highlight several practical lessons for advancing global surgery education.

1. Global surgery education requires shared leadership and partnership.
   The purpose of a hybrid format allows broad international participation. This translates to increased accessibility for participants from geographical regions experiencing limitations in surgical care. This is crucial as it allows main stakeholders to partake in global surgery discussions. However, the limited involvement of partners from low- and middle-income countries (LMICs) in organizing the design and delivery of the 13th edition of the conference showcases an important gap. To decolonize global health education, it is important to promote shared leadership efforts, allowing a bidirectional exchange with local collaborations [4,5]. Future conference iterations or initiatives should therefore prioritize co-development with international partners to move beyond participation toward true partnership and shared ownership.
   
2. Simulation learning enhances competency development in global surgery.
   The interactive disaster-response case competition allowed participants to engage in a real-world scenario. This exercise was a chance to put into practice the key competencies promoted in global surgery education such as ethical reasoning, systems thinking, and collaborative decision-making. This opportunity allowed trainees to strengthen learning objectives from traditional didactic teaching. Moreover, it has already been established that simulation-based and interactive educational models improve engagement and knowledge acquisition in global surgery training [6].
   
3. Trainee involvement can be scalable and impactful.
   The conference structure, with trainee involvement at its core, is an example of the capacity of trainees to develop low-cost and scalable global surgery educational initiatives. With appropriate mentorship supporting trainees, such conference models can deliver meaningful and accessible learning experiences. Furthermore, these models foster innovation among early-career trainees, promote inclusivity, and support sustained engagement. Hybrid and internationally accessible conference models have also been shown to increase participation and engagement across diverse learner populations, supporting their role in expanding global surgery education [6-7].
   

LIMITATIONS

The reported findings should be interpreted in the context of several limitations. The sample size was modest, with 45 responses across both surveys. Participation was voluntary, introducing potential response bias. Further, the analyses conducted were purely descriptive. Data enabling the calculation of the percentage of participants who completed both pre- and post-conference surveys was not collected. As the samples were unpaired, inferential statistical analysis could not be conducted, thus conclusions cannot be drawn about the significance of the conference’s impact. Additionally, outcomes were based on short-term, self-reported measures, which may not reflect sustained engagement or objective learning. However, this initiative may serve as a model for future student-led, low-cost, and accessible global surgery opportunities.

MOVING FORWARD

This conference model demonstrates the potential of trainee-led, hybrid educational initiatives in global surgery. Future iterations should aim to strengthen evaluation methods through paired data collection and improved response tracking. Expanding collaboration with LMIC partners in both design and implementation will be essential to advancing equity in practice. Broader representation across surgical specialties may further enrich the educational experience.

CONCLUSION

The 13th Annual Global Surgery Conference is an example of how a trainee-led, hybrid, low-cost model can support engagement and learning in global surgery. While findings are exploratory, this initiative provides a practical framework for designing inclusive and scalable educational programs. Advancing equity in global surgery requires continued collaboration, reflection, and innovation across all levels of training and practice.