Advancing equity in global ophthalmology
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LETTER TO THE EDITOR
Advancing equity in global ophthalmology Daniel J. Olivieri 1,2,3
&
Zane Z Yu 1,2
&
Paul B Greenberg 1,2
Received: 28 October 2020 / Revised: 28 October 2020 / Accepted: 4 November 2020 # This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2020
Dear Editor, Recent research in global health equity focuses on low- and middle-income countries (LMIC) versus high-income country (HIC) authorship,1–3 HIC – LMIC partnership reciprocity,4–7 and ethical considerations of international medical-surgical partnerships.8, 9 Global ophthalmology, based on a PubMed search, has not seen an increase in equity research. We propose three strategies for advancing equity in global ophthalmology: implementing ‘sandwich’ training programs, indexing LMIC-driven research opportunities, and reframing stakeholder engagement on coordinating agency websites. First, global surgical training programs can provide structured residency and fellowship opportunities for LMIC trainees. ‘Sandwich’ training programs refer to a hybrid model by which LMIC residents participate in extended, in-person training at HIC academic institutions, bookended by training in their home nation.10 This model not only provides LMIC participants with directly transferrable skills but also facilitates the institutional growth of LMIC surgical departments.10 Further, implementing ‘sandwich’ training programs between HIC – LMIC ophthalmology departments facilitate trainee participation, research collaboration, and ‘reverse innovation’ in clinical skills. Specific strategies include transitioning the over 1021 international ‘observership’ programs listed on the American Academy of Ophthalmology (AAO) website into ‘sandwich’ fellowships and ‘twinning’ specific HIC and LMIC partners. Additionally, we propose requiring HIC * Paul B Greenberg [email protected] 1
Division of Ophthalmology, Alpert Medical School, Brown University, Coro Center West, Suite 200, 1 Hoppin Street, Providence, RI, USA
2
Section of Ophthalmology, Providence VA Medical Center, Providence, RI, USA
3
Watson Institute for International and Public Affairs, Brown University, Providence, RI, USA
collaboration with regional training institutions, such as the College of Surgeons of East, Central, and Southern Africa (COSECA), as a prerequisite to LMIC ophthalmic research. Next, barriers to global surgery research include publication costs and language barriers, which lead to large disparities in LMIC authorship on global surgery publications. 3As a result, global surgery often fails to prioritize the needs, concerns, and research interests of LMIC institutions. Indexing LMIC ophthalmic research foci on online platforms for collaboration can engage medical student-researchers, physicians, and axillary health professionals in both HICs and LMICs. In turn, prioritizing LMIC research foci reorients global health as an LMIC-centric, thereby better aligning global ophthalmology’s end-targets with its end-stakeholders
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