Letter to the Editor: International Survey of Medical Students Exposure to Relevant Global Surgery (ISOMERS): A Cross-Sectional Study.

We read the InciSioN Collaborative’s publication on global surgery exposure among medical students with a lot of interest [1]. This study is impressive for several reasons. First, the collaborative surveyed almost 1,600 final-year medical students from 144 medical schools in 20 countries across all geographical regions and country income categories [1]. The study is the largest of its kind led by medical students in global surgery to date—almost 200 students participated in this study [1]. The coordination and resources necessary to accomplish such a feat are outstanding. This feat is even more impressive because the collaborative accomplished this without institutional funding [1]. It was only fitting that such a publication would be published in a reputable peer-reviewed journal like the World Journal of Surgery. Taken together, it is clear that the future of academic global surgery is bright and here to stay. The global surgery community must support this generation with research funds and greater international global surgery research roles.

The InciSioN Collaborative found that exposure to global surgery was unevenly distributed, following the same distribution as lack of access to care [1, 2]. It is concerning that the regions with the greatest global surgery need are the ones with lesser exposure. The lack of exposure in low- and middle-income countries (LMICs) is primarily due to awareness [3]. Google Trend analyses of global surgery terms have shown that only three of the top 10 countries with high-interest levels are LMICs (India (5.0%), South Africa (2.0%), and Nigeria (1.0%)) [4]. The InciSioN Collaborative found the most popular global surgery exposure means among medical students was social media [1]. Social media and the internet have played important roles in global surgery education and advocacy; however, this great democratizer might be excluding non-English speakers from the discourse. This suspicion is confirmed by the lack of Latin American respondents in the ISOMERS study [1] and low global surgery Google Trends interest levels in this region [4]. We know anecdotally that medical students within this region are as passionate as their colleagues in other regions. For example, InciSioN Columbia hosted the annual InciSioN Global Surgery Symposium at the height of the COVID-19 pandemic. The conference was very successful and saw great participation within the region in part because the organizers arranged for live Spanish and English translations—emphasizing that Global surgery does not belong to the English language. The InciSioN Collaborative understood this and translated their survey into Japanese and French. They were probably limited to these languages based on the availability of volunteer translators in the study group. This situation further emphasizes the need for funding. Organized global surgery groups and other international global surgery stakeholders should encourage grant applications and donations to this group.

We congratulate the InciSioN Collaborative on this wonderful research article [1], and we thank them for leading by example. Finally, we urge action based on their findings and recommendations.