It is estimated that 5 billion people worldwide lack access to safe, affordable surgical care when needed, and inadequate access and mortality from surgically treatable diseases disproportionately impacts low- and middle-income countries (LMICs).^1,2 Urologists in the US have a unique opportunity to expand their reach and use their skills to close this gap by participating in global surgical education. By transferring skills to local surgeons, urologists can help to build capacity, strengthen health systems, and improve access to care.

Partnering with International Volunteers in Urology (IVUmed), we recently led a weeklong urologic oncology workshop at King Faisal Hospital in Kigali, Rwanda. We had the fortune of working with fantastic local partners focused on developing capacity in a few key areas of urologic oncology. The following are takeaways that urologists participating in global surgical education should consider.

Capacity-Building to Expand Equitable Access and Build Sustainable Bilateral Partnerships

Historically, short-term surgical missions—whereby a skilled surgeon visits an LMIC to provide surgical services over a limited time frame—and one-time equipment donations have been the mainstay of US surgeon participation in global health. While there may be opportunities to help individual patients in certain scenarios through these efforts, evidence of sustainable value and capacity growth from these short-term missions is lacking.³ There has thus been an effort in the global health community to shift toward long-term partnerships built with the intention to train local providers, thereby building capacity in the local health care system. Urologists from the US can help build capacity for urologic care in LMICs by providing training, mentoring, and technical assistance to local surgeons through these sustainable partnerships. Working with an established local or international nongovernment organization dedicated to this work, such as IVUmed, is one way to get involved while ensuring your contribution is sustainable.

Our trip to Kigali was one of many in a growing partnership between the urology group at King Faisal Hospital and IVUmed. Through recurring visits by dedicated groups of urologists representing key training and subspecialty areas, we hope to grow the technical skill base and capability of the local team. By strengthening the capacity of local surgeons, urologists can help to expand access to the high-quality surgical care sorely needed around the world. These partnerships must also be bilateral in nature, and visiting educators stand to learn as much as, if not more, from their hosts as what they can impart.

Identify Local Community Needs

A critical first step in developing a worthwhile global surgical education program is identifying the needs of the community you intend to serve. The field of global health has a history riddled with failed missions led by ostensibly well-intentioned physicians seeking to bring a skill set to a community that simply needed something different. Working with local partners from the outset to identify areas of greatest need ensures that education programs are responsive to the needs of the surgeons they serve.

In Kigali, our local partners identified their rapidly expanding program of community PSA screening and associated rise in localized prostate cancer detection as an area of focus and need. With more men being identified with elevated PSA, there was a great need to develop skills in transrectal ultrasonography (TRUS) and prostate biopsy. Given the increase in incidence of localized prostate cancer that comes with early detection, local urologists also wanted more opportunities to perform radical prostatectomies with skilled educators. We therefore worked with the local team to identify candidate patients for radical prostatectomy during our visit and coordinated a TRUS workshop with patients identified to have elevated PSA in need of prostate biopsy. Furthermore, the urologists in Kigali cited an interest in further training in major open retroperitoneal and pelvic oncologic surgery. We therefore coordinated our visit in conjunction with their surgical schedule to focus on these cases.

Real-Time, In-Person Training Is Critical to Success

In a shrinking globalized world in which we can reach anyone instantaneously via internet-based video chatting, there is a reasonable desire to transition or expand virtual global surgical education to reduce costs and expand reach. Undoubtedly, virtual education platforms will provide additional opportunities to hone local skills. However, we argue that in-person, hands-on, real-time education is the most impactful way to transfer skills to local surgeons on an individual level.

In Kigali, our local partners had recently procured equipment for TRUS in anticipation of a growing need for TRUS-guided prostate biopsies. With most prostate cancer in the country previously diagnosed by digital rectal exam and finger-guided biopsies, there was a great need to develop skill with TRUS among the staff urologists and trainees in the area. As such, we organized a focused TRUS and prostate biopsy clinic in coordination with our local partners to give them opportunities to hone their TRUS skill set with direct supervision and guidance. This clinic was accompanied by lectures focused on early prostate cancer detection and technical aspects of TRUS. As any urologist knows from their training, hands-on guidance from an experienced mentor with repetition is critical to developing proficiency.

Moreover, in the operating room, we performed radical prostatectomies and nephrectomies in concert with our local partners, encouraging active participation in the identification of relevant anatomy, key surgical steps, and common pitfalls from the local team of urology attending surgeons and resident trainees. This type of hands-on direct feedback intraoperatively would be difficult or impossible to achieve with current virtual platforms.

As a urologist or urology trainee, you have spent many years honing a highly specialized skill set with the goal of alleviating suffering. Moreover, many of us were interested in medicine in the first place as an opportunity to make a difference for the most vulnerable populations. Transferring skills to local surgeons through global surgical education is one way that you can contribute to shrinking global inequities and reaching your personal and professional goals. We encourage anyone interested in health disparities and global health to participate and volunteer time and expertise with a reputable organization dedicated to global surgical education. As the IVUmed motto states, “Teach One, Reach Many.”⁴