Global Surgery Presentation (December 4, 2024)

Introduction

This summary outlines the key aspects of the Global Surgery Program at Baylor College of Medicine, as presented by Dr. Rachel Davis, and highlights Dr. Anandasabapathy's insights into global health innovation, particularly in the field of gastroenterology. The audio recording provides a comprehensive overview of the program's history, its mission to address the global burden of surgical disease, and its multifaceted approach through education, collaboration, advocacy, and research. Additionally, it delves into innovative technological solutions and the potential of artificial intelligence and digital twins in advancing global health equity.

Baylor Global Surgery Program: A Decade of Progress

Dr. Rachel Davis, who initiated the Global Surgery Program at Baylor College of Medicine almost a decade ago, provided an overview of the program's development and achievements. She emphasized the critical problem of access to safe, timely, and affordable surgical care, with five billion people worldwide lacking such access. This lack of access disproportionately affects impoverished individuals, immigrants, refugees, and children, trapping them in a cycle of poverty and representing a significant economic and societal issue.

Dr. Davis highlighted that the core challenge lies in aligning the global capacity to provide surgery with the immense need. While increasing the surgical workforce is crucial, it is a time-intensive process. Therefore, the Baylor College of Medicine program focuses on three key areas to bridge this gap: improving the surgical workforce, enhancing the efficiency of existing systems, and working to decrease the overall surgical need.

In pursuit of these goals, Baylor established the Center for Global Surgery, with a mission to improve access to safe, timely, and quality surgical care through education, collaboration, advocacy, and research. The center acts as a hub for various programs tackling the problem from different angles.

Key Programmatic Areas and Initiatives

• Collaboration: The program fosters extensive collaborations across nine Baylor College of Medicine departments, Baylor College of Medicine Global Programs, Texas Children's Global Network, the National School of Tropical Medicine, the Baker Institute for Public Policy, and increasingly with global organizations like the World Health Organization (WHO), Global Surgery Foundation, and the UN Institute for Training and Research.
• Education: The program offers educational opportunities at all levels, including students, residents, fellows, and practicing surgeons.
  • Residency Track: The integrated clinical global surgery residency training program is a unique and highly competitive seven-year program aimed at training surgeons for resource-variable settings like humanitarian aid, conflict zones, and rural areas. The curriculum includes broad clinical content (general surgery, anesthesia, urology, orthopedics, ultrasound), research, and global/rural experiences. Didactics cover clinical and non-technical content such as capacity building, ethics, finance, advocacy, and diplomacy. The program has successfully matriculated ten residents over the past decade.
  • Fellowships and Electives: The program includes a Global Surgery Advocacy and Policy Fellowship in collaboration with Rice's Baker Institute, focusing on policy development and advocacy at national and international levels. A medical student research elective is also available.
  • Training for Practicing Surgeons: The program offers the Essential Surgery Skills Conference, the Global Trauma Collaboration, and the Casablanca Cardiothoracic Case Series to provide additional skills and knowledge for surgeons working in low-resource settings or those involved in humanitarian aid. The Essential Surgery Skills conference focuses on a wide variety of skills relevant to resource-limited environments. The Global Trauma Collaboration provides virtual education for surgeons in conflict zones, currently engaging with participants from Myanmar, Haiti, Gaza, and Ukraine. The Casablanca Cardiothoracic Case Series facilitates international learning and discussion in cardiothoracic surgery. Many educational programs are also being made virtual and asynchronous for wider global access.
• Advocacy: The program is actively engaged in advocacy efforts, particularly through its growing partnership with the World Health Organization (WHO). Baylor is in the process of formalizing designation as a WHO Collaborating Center to enhance collaboration in areas of emergency, critical, and operative care. Current collaborative projects with WHO include developing educational modules for the WHO Academy and working on the service package delivery and implementation platform to assist countries in developing their surgical systems. The program is also involved in the development of a global strategic action plan for global surgery.
• Research: Residents and faculty are actively involved in global surgery-related research, with numerous publications, abstracts, and grants.

Global Health Innovation and Technology

Dr. Anandasabapathy, Vice President and Senior Associate Dean for Global Programs at Baylor College of Medicine, highlighted the importance of research and innovation in addressing global health challenges. She emphasized the need to adapt and make healthcare technologies accessible and feasible for resource-limited settings. Her presentation focused on innovations in low-cost GI cancer detection technologies, the use of artificial intelligence (AI), and the development of virtual platforms for technology and training.

Innovations in GI Cancer Detection

Dr. Anandasabapathy discussed the limitations of traditional, complex, and costly early cancer detection methods in community-based care. She presented several innovative solutions:

• Low-Cost Capsule Endoscope: A swallowable capsule endoscope with advanced imaging capabilities that can be administered by community health workers for esophageal cancer screening.
• Portable Optical Biopsy Device: A low-cost, portable, and battery-operated confocal micro endoscope that allows for real-time optical biopsies during endoscopy, potentially reducing the need for traditional biopsies and enabling immediate diagnosis. Clinical trials of this device in China and the US have shown promising results, including increased diagnostic yield and a reduction in biopsies.

The Role of Artificial Intelligence (AI)

Dr. Anandasabapathy emphasized the potential of AI to enhance health equity by augmenting clinical performance and overcoming barriers in training and diagnosis. AI-powered image analysis software is being developed to interpret images from the optical biopsy device, with initial results showing comparable or even better performance than novice users and increased confidence among experts. Ongoing research is evaluating clinician confidence and clinical impact of AI-guided approaches in real-world settings.

Digital Twins and Virtual Platforms

Dr. Anandasabapathy introduced the concept of digital twins (computer models) and virtual twins (visual representations) of human organs as a revolutionary approach to research, development, and training. These models, initially developed for aerospace and automotive industries, are now being applied to human anatomy with the goal of replacing animal testing, improving early clinical trials, and ultimately facilitating personalized and population-based care. Baylor College of Medicine is actively involved in developing virtual twins of organs like the esophagus and liver, incorporating diverse population data to ensure global applicability and reduce health disparities. The vision includes creating a virtual twin center for cloud-based clinical research and remote medical education and training.

Conclusion and Future Directions

The presentations highlighted the significant strides made by the BaylorCollege of Medicine Global Surgery Program over the past decade in addressing the global burden of surgical disease through a comprehensive and collaborative approach. The program's commitment to education, advocacy, and research is evident in its diverse initiatives and growing partnerships with global organizations. Furthermore, the focus on global health innovation, particularly in developing low-cost technologies, leveraging the power of AI, and exploring the potential of digital twins, demonstrates a forward-thinking approach to achieving health equity worldwide. The future of the Global Surgery Program and global health initiatives at Baylor College of Medicine appears promising, with ongoing efforts to expand support for trainees in low- and middle-income countries, enhance monitoring and evaluation practices, and actively contribute to the development of a global strategic action plan for surgery.

This executive summary was generated using an AI-powered tool to enhance clarity, efficiency, and readability. While AI assisted in drafting this summary, it has been reviewed and refined to ensure accuracy and alignment with our objectives.