The advent of video-assisted thoracoscopic surgery in Mongolia has faced funding and accessibility challenges, leading to languid adoption. A Mongolian-Canadian collaboration was inaugurated to support the development of a self-sustainable, self-governed minimally invasive thoracic surgery (MITS) program in Mongolia. A multidisciplinary Canadian thoracic surgery team collaborated with the National Cancer Center of Mongolia Thoracic Surgery service from 2016 to 2023. The team engaged in patient rounds, MITS procedures, and service education. Program and patient outcomes were reviewed. Thirty-four patients underwent MITS procedures as part of the Mongolian-Canadian collaboration. Median age was 51 years (range, 16-76 years), and 41% (14 out of 34) were men. Lung, esophageal, and mediastinal procedures composed 50% (17 out of 34), 21% (7 out of 34), and 21% (7 out of 34) of procedures, respectively. Conversion rate, median operative time, and hospital length of stay were 0%, 172.5 minutes, and 8 days, respectively. The complication rate was 9% (3 out of 34) with 3% (1 out of 34) being Clavien-Dindo >3 requiring re-operation. Thirty-day mortality was 0%. Mongolia's thoracic surgery team progressed from surgical assists to primary operators and a self-governed program. In 2023, the National Cancer Center of Mongolia's thoracic surgery service independently conducted 72% (50 out of 69) of esophagectomies and 91% (48 out of 53) of pulmonary resections via minimally invasive technique compared with 0% in 2015. The Mongolian-Canadian collaboration demonstrated successful transfer of MITS proficiency through global noncolonialist surgical partnership, consequentially shifting the national thoracic surgical paradigm. Continued collaboration will focus on sustainability and supporting local surgeons in regional dissemination of MITS proficiency with the aim of globalizing thoracic surgical excellence.

Background: non-small cell lung cancer (NSCLC) outcomes remain suboptimal for early-stage disease despite emerging advances in systemic therapy for the peri-operative period. Next-generation sequencing (NGS) identifies driver mutations for which targeted therapies have been developed that improve survival. The BC lung cancer screening program, which was initiated in May 2022, is expected to identify people with early and late stages of NSCLC. It is crucial to first understand the molecular epidemiology and patterns of time to initiate treatment across its five health authorities (HA) to optimize the delivery of care for NSCLC in BC. In this way, we may harness the benefits of targeted therapy for more people with NSCLC as novel advances in therapy continue to emerge. Objective: to compare (a) the frequency of actionable NSCLC molecular alterations among HAs and (b) the time to treatment initiation. Methods: a retrospective observational study was conducted with prospectively collected data from the BC CGL Database. Adults with late stage NSCLC who underwent targeted NGS were included for the time period from May 2020 to June 2021. Demographics, actionable molecular alterations, PDL-1 expression, and time to treatment across HAs were examined. Using appropriate statistical tests for comparison among HAs, p>0.05 was deemed significant. Results: 582 patients underwent NGS/IHC and analysis during the study period. The mean age was 71 (10.1), and 326 (56%) patients were female. A significantly higher proportion of all EGFRm+ were identified within Vancouver Coastal Health (VCHA) and Fraser Health Authority (FHA) compared to the other health authorities (p < 0.001). This also holds true for common sensitizing EGFRm+ alone (p < 0.001) and for sensitizing EGFRm+ when adjusted for females and smoker status (OR 0.75; 95% CI 0.62, 0.92; p = 0.005). Patients residing within the Northern, Interior, and Island HAs were less likely to receive treatment at the same rate as those in VCHA and FHA HAs. Conclusion: actionable NSCLC driver mutations are present in all regional HAs, with disparity noted in time to initiate treatment between HAs. This provides evidence for the importance of molecular testing for patients in all BC HAs to guide personalized and timely NSCLC treatment.

Objective: This project aimed to achieve international consensus on core learning objectives for global surgery education. Background: As global surgery emerges as an academic field, there is a growing need for consensus-driven learning objectives to guide education and training. Existing curricula vary widely and lack multidisciplinary input. Methods: A modified Delphi consensus was conducted with an international panel of global surgery experts. A scoping review informed an initial list of learning objectives, categorized into 14 domains based on the Consortium of Universities for Global Health framework. Panelists rated objectives over three iterative survey rounds, with consensus defined as ≥80% agreement within ±1 Likert point of the median. Results: Sixty-one experts from 26 countries across all World Health Organization (WHO) regions participated, representing surgery (40.1%), anesthesia (14.8%), obstetrics and gynecology (14.8%), general practitioners with and without enhanced surgical skills (16.4%), and allied health fields (6.6%). The majority (57.4%) had over 10 years of experience in global surgery. Across three Delphi rounds, 120 learning objectives reached consensus, covering key domains such as the global burden of surgical disease, surgical system strengthening, ethics and equity, health policy, and sustainable development. A total of 25 (20.8%) objectives were designated for introductory learners, 55 (45.8%) for advanced learners, and 40 (33.3%) for both levels. Conclusion: This Delphi consensus provides a structured, globally relevant framework for global surgery education, supporting curriculum development and competency-based training. These findings underscore the importance of aligning global surgery education with evolving healthcare priorities while ensuring adaptability across diverse surgical contexts.

Thoracic pathologies pose a substantial health burden in low- and middle-income countries. Compounding the high incidence of these conditions, a global shortage and unequal distribution of surgical professionals exacerbate morbidity, mortality, and disability-adjusted life years in these regions. Global thoracic surgery aims to address these disparities. This study explores the interest, engagement, and perceived importance of global surgical care among Canadian thoracic surgeons. A self-administered electronic survey was distributed to members of the Canadian Association of Thoracic Surgery. The survey assessed perceptions of global surgery, willingness to engage in international collaborations, institutional resources, and barriers to participation. Thirty-three practicing thoracic surgeons participated, most of whom worked in academic centers (23 out of 33 [69.7%]). A majority (30 out of 33 [90.9%]) believed international collaboration enhances thoracic surgery. Although 48.5% (16 out of 33) were willing to travel abroad to support surgical capacity in low- and middle-income countries, and an equal percentage expressed interest in research addressing low- and middle-income countries’ needs, only 21.2% (7 out of 33) had prior involvement in global thoracic surgery. Key barriers included a lack of institutional support (26 out of 33 [78.8%]), limited formal collaborative opportunities (26 out of 33 [78.8%]), inadequate funding (30 out of 33 [90.9%]), and an absence of recognized pathways for career development in global surgery (29 out of 33 [87.9%]). Canadian thoracic surgeons have a keen interest in global surgical initiatives; however, they face significant barriers in institutional support, resources, and accessibility of collaborative opportunities. Tackling these challenges through strengthened institutional policies, directed funding, and the establishment of a dedicated national network may enhance engagement in global thoracic surgical care.

Despite calls from various global organizations for increased attention to global surgery, guidance on developing effective curricula is lacking. In this scoping review, we aimed to outline the necessary learning objectives and competencies for establishing sustainable, equitable, and noncolonialist academic global surgery programs. This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews. We used key terms to search 5 electronic databases and conducted a comprehensive grey literature search to identify universities, medical programs, and organizations offering academic global surgery programs. We categorized curricular objectives extracted from these sources into the 11 domains of global health defined by the Consortium of Universities on Global Health. We employed thematic analysis to further categorize these objectives into unique themes within each domain. We found a total of 43 studies and 61 programs through database and grey literature searches, respectively. These sources yielded 333 unique curricular objectives, which we analyzed thematically, revealing 41 unique themes spanning various neglected areas in global surgery, such as Indigenous health, environments, chronic diseases, technology, and underserved populations like refugees, urban populations of low socioeconomic status, and racial and ethnic minority groups. This review outlines essential skills for effective engagement in modern global surgical care, emphasizing the emergence of nontraditional themes like bidirectional partnerships, sustainability, and self-governance over mission-based approaches. Integrating these forward-looking themes into global surgery curricula is vital for improving global surgical care standards and fostering a skilled, globally aware workforce.