Background: The term ‘last mile’ has been used across disciplines to refer to populations who are farthest away, most difficult to reach, or last to benefit from a program or service. However, last mile research lacks a shared understanding around its conceptualization. Objectives: This project used a concept mapping process to answer the questions: what is last mile research in global health and, how can it be used to make positive change for health equity in the last mile? Methods: Between July and December 2019, a five-stage concept mapping exercise was undertaken using online concept mapping software and an in-person consensus meeting. The stages were: establishment of an expert group and focus prompt; idea generation; sorting and rating; initial analysis and final consensus meeting. Results: A group of 15 health researchers with experience working with populations in last mile contexts and who were based at the Matariki Network institutions of Queen’s University, CAN and Dartmouth College, USA took part. The resulting concept map had 64 unique idea statements and the process resulted in a map with five clusters. These included: (1) Last mile populations; (2) Research methods and approaches; (3) Structural and systemic factors; (4) Health system factors, and (5) Broader environmental factors. Central to the map were the ideas of equity, human rights, health systems, and contextual sensitivity. Conclusion: This is the first time ‘last mile research’ has been the focus of a formal concept mapping exercise. The resulting map showed consensus about who last mile populations are, how research should be undertaken in the last mile and why last mile health disparities exist. The map can be used to inform research training programs, however, repeating this process with researchers and members from different last mile populations would also add further insight.

This study examined the lived experiences of Syrian refugee child brides to understand their needs as they navigate new social roles after marriage. A cross-sectional study was conducted in Lebanon using SenseMaker^® to collect narratives from married Syrian girls age 13 and older and from their parents. Thematic analysis using inductive coding was performed. Identified themes were organized according to an adaptation of Bronfenbrenner’s socioecological theory of human development to present experiences across all levels of the girls’ interactions and potential influences. Themes at the microsystem level included overwhelming domestic expectations and worry about their own children in the girls’ roles as young mothers. Experiences of intimate partner violence and family conflict were common. At the exosystem level, participants described safety concerns and financial and legal system challenges. The macrosystem level highlighted social expectations around married girls discontinuing education and around separation or divorce. As efforts continue to prevent child marriage within the Syrian crisis and globally, understanding experiences of already married girls is critical to providing support for mitigating harm to child brides. Programs might consider safety planning, parenting supports, access to skills training and education, peer-to-peer social networking, and engaging husbands or families of child brides.

ObjectivesThe objective of the CAEP Global Emergency Medicine (EM) panel was to identify successes, challenges, and barriers to engaging in global health in Canadian academic emergency departments, formulate recommendations for increasing engagement of faculty, and guide departments in developing a Global EM program.MethodsA panel of academic Global EM practitioners and residents met regularly via teleconference in the year leading up to the CAEP 2018 Academic Symposium. Recommendations were drafted based on a literature review, three mixed methods surveys (CAEP general members, Canadian Global EM practitioners, and Canadian academic emergency department leaders), and panel members’ experience. Recommendations were presented at the CAEP 2018 Academic Symposium in Calgary and further refined based on feedback from the Academic Section.ResultsA total of nine recommendations are presented here. Seven of these are directed towards Canadian academic departments and divisions and intend to increase their engagement in Global EM by recognizing it as an integral part of the practice of emergency medicine, deliberately incorporating it into strategic plans, identifying local leaders, providing tangible supports (i.e., research, administration or financial support, shift flexibility), mitigating barriers, encouraging collaboration, and promoting academic deliverables. The final two recommendations pertain to CAEP increasing its own engagement and support of Global EM.ConclusionsThese recommendations serve as guidance for Canadian academic emergency departments and divisions to increase their engagement in Global EM.

Objective: The Global Emergency Medicine Literature Review (GEMLR) identifies impactful research in global emergency care. This 20th annual edition reviews GEM literature published in 2024 and highlights the growth of GEMLR over the years. Methods: We conducted a scoping review of 2024 GEM articles through structured PubMed and gray literature searches. Reviewers and editors from 10 countries screened abstracts using predefined criteria for three domains: disaster and humanitarian response (DHR), emergency care in limited‐resource settings (ECLRS), and emergency medicine development (EMD). Duplicates and articles lacking authorship equity or ethical oversight were excluded. Remaining publications were scored using tailored rubrics for original research (OR), review articles (RE), and gray literature (GRAY). The top 5% in each category were selected for critical appraisal. A retrospective summary of 20 years of GEMLR reviews was also completed. Results: The search identified 46,714 PubMed and 12,575 gray literature articles. A total of 473 met inclusion criteria and were scored; 33 were selected as the top 5%, a decrease from 55 in 2023. Although the search string was unchanged, 2024 yielded ~10,000 fewer articles. Common themes included trauma, pediatrics, and clinical/triage protocols, with a new focus on mental health among clinicians and disaster victims. Over 20 years, 230 individuals have contributed 810 service‐years to GEMLR. Nearly 75% of members were from the USA, while 32 (13.9%) were from LMICs and 27 (11.7%) from non‐USA high‐income countries. In total, 398,904 articles have been screened, 8476 scored, and 517 top articles narratively reviewed since 2005. Conclusions: Over two decades, GEMLR has evolved into a large‐scale, multinational, methodologically rigorous initiative, highlighting more than 500 high‐impact GEM publications. In 2024, despite fewer articles screened, 33 top studies were identified across key domains. GEMLR emphasizes equitable LMIC representation, rigorous quality standards, and authorship equity, aiming to help shape the future of emergency care research.

Introduction: Global Emergency Medicine (Global EM) is growing rapidly as an academic niche in Canada. An increasing number of Canadian emergency physicians work internationally as part of their practice, and trainees consistently seek out international projects and electives. For the most part however, residents have had to create their own training opportunities as formal Global EM fellowship training has been lacking in Canada. To address this identified need, Queens University established a Global EM fellowship, the first of its kind in the country. Methods: The fellowship is designed to provide the skills necessary for an academic career in Global Emergency Medicine. Curriculum and objectives are modeled on similar well-established fellowships in the United States. Areas of expertise include emergency medicine systems development, humanitarian medicine, disaster response, public health, tropical medicine, research, administration and education. Fellows have the opportunity to tailor their training according to their specific interests within these domains. Importantly, the fellowship provides direct mentorship from academic global EM and public health physicians, and networking opportunities within the global health sphere. Results: The two-year fellowship curriculum is divided between: 1) coursework to complete a Master of Public Health (MPH) Degree 2) fieldwork 3) relevant international emergency medicine training courses and 4) clinical work in the emergency departments at the Kingston Health Sciences Center. The Queens Global EM fellowship admitted its first fellow in August 2017. To date, the inaugural fellow has completed the MissionCraft Leadership in Disaster Relief course as well as a Humanitarian U Disaster and Response course, in addition to submitting a research grant as a co-principal investigator, starting coursework for an MPH degree and giving several invited lectures on humanitarian medicine. The fellow also travelled to Lebanon to support research in collaboration with aid organizations responding to the Syrian crisis. Upcoming fieldwork involves teaching at a newly established emergency medicine residency program in Haiti as well as a humanitarian crisis deployment. Conclusion: In response to a lack of formal international emergency medicine training opportunities in Canada, Queens University has established a Global Emergency Medicine fellowship. The fellowship aims to provide protected time, access to field opportunities and dedicated mentorship to develop the skills necessary to succeed as an academic Global EM physician. We believe it provides a unique opportunity to significantly expand fellows experiences in global health fieldwork, education and research while continuing to practice in a Canadian tertiary emergency department.