Meet our First Global Engagement Grand Rounds guest speaker: Dr. Kristin L. Long

On May 7th, Global Engagement hosted Dr. Kristin L. Long, the 2024 Society of University Surgeons (SUS) Global Surgery Scholarship awardee who delivered a talk entitled “Turbulence: Bumps in the Road of Hybrid Global Surgery Efforts.”

Dr. Kristin Long is an associate professor of surgery at the University of Wisconsin (UW) School of Medicine and Public Health in the Division of Endocrine Surgery. She completed her general surgery training at the University of Kentucky (UK) and her endocrine surgery fellowship at MD Anderson Cancer Center in Houston, Texas, prior to joining the faculty at UW. Once at UW, she also earned a master’s degree in public health. Her clinical practice focuses primarily on thyroid and parathyroid surgery, and she is the associate program director for UW’s Endocrine Surgery Fellowship Program. Her academic focus is global surgery, and she has projects in Kenya, Ethiopia, and Palestine. Additionally, she is a fellow of the College of Surgeons of Eastern, Central and Southern Africa (COSECSA) and serves on the executive committee of the Association of Academic Global Surgery. She was awarded the 2019 AAS Visiting Professorship to the West African College of Surgeons and has given invited talks on six continents. Her SUS Global Surgery Scholar proposal focused on the challenges of adapting to a hybrid virtual world in education and capacity-building for global surgery. 

How did your passion for Global Surgery develop? And what are your visions and goals in that regards, as a US surgeon and faculty member?

Since I was a little child, I always felt a passion to be part of international work and I had a long-standing interest in Africa specifically. In my undergraduate stage, I thought that I was going to do biomedical research, then my interest transitioned into pediatric infectious disease. But when I did my surgery rotation, which was halfway through medical school, I fell in love with it, especially with the amazing influence I had from my mentors in the surgery rotation. Dr. Donald Maier, a pediatric surgeon at Texas Tech in El Paso, who spent the majority of his career operating in Nigeria, was such an inspiration to me.  He showed me that it could be a wonderful opportunity for a surgeon and explained to me what it would look like, and that was what started my interest in surgery, specifically.

My real hands-on experience began when I was a resident at UK and had the chance to go work and live in Kenya during my research year. In Kenya, I met some of the collaborators whom I worked with after that, and some I still work with today.

That’s where it all started, and since that time I always do my best to say “yes” whenever a Global Surgery opportunity comes my way.

I must say that I’m so lucky that the UW has always supported me as a faculty member doing international work, beginning just a few weeks after I started there in 2016.

Your SUS Global Surgery Scholar proposal focused on the challenges of adapting to a hybrid virtual world in education and capacity-building for global surgery. Tell us about the award, the selection criteria, and what it personally meant to you.

It was a great honor to receive the SUS Global Surgery Scholar award of 2024. It’s a relatively new award and a few other people have won it before me. One of them was Dr. Weiser at Stanford Surgery.

The award is designed to sponsor faculty who are interested in global surgery to go and give invited talks at universities such as Stanford to talk about their academic endeavors. For the longest time those of us who were involved in academic global surgery felt like it was not necessarily getting equal attention compared to other more traditional academic endeavors in academic surgery,  and this is really showing that the field of global surgery has come a long way in the last couple of decades and it really is as valued and as important as all of the other academic pursuits that we have. I find it very forward- thinking from the SUS as a society to support that.

For me personally, I feel like I’m in my early-mid career, and it was nice to see SUS supporting younger faculty in their organization. It felt really great, and I was tremendously humbled by it.

The SUS award is an application process where you submit a proposal of what you would talk about if you were invited to give these talks as the global surgery scholar. It’s mostly designed to highlight what your research efforts and academic work have been. It also shows you the scope of global surgery work as a whole because everyone does something a little bit different and unique, and I think it’s very motivating to see that there’s so many different opportunities of involvement.

Can you tell us about American College of Surgeons (ACS) training hubs that you participated in, such as HOPE in Lusaka, Zambia and Hawassa in Ethiopia. What is your role, and how do you see those hubs contributing in improving surgical skills in the COSECSA region?

ACS training hubs are a new model on how to involve multiple organizations. For many years, Global surgery was operated in silos for individual institutions that had partnerships and it was a lot of resource duplication to a lot of unnecessary extra work sometimes.

The ACS hubs that HOPE started are actually making it much more collaborative in terms of having multiple institutions working together.

I’ve been involved directly with the hub in Hawassa since or even prior to COVID, and I worked together with some of the local surgeons there on research quality improvement and education, as we had a lot of work directly with their trainees.

In the last five years or so, research has become a requirement for a lot of the surgical trainees in the COSECSA region, they are required to do that as part of their training, and I feel like it’s something that not all of their faculty are necessarily comfortable teaching, so we were able to get involved to help in that aspect.

Similarly in Lusaka hub, the universities that are involved there are doing almost the same work and I believe that it is allowing a lot of cross pollination; multiple different universities with different people interested in global surgery working together and building communities.

 I hope that it stays as a successful model and that there are more hubs to come in the future.

What do you believe are the indications of success for these ACS training hubs?

The majority of the scholarship awardees at this year’s COSECSA annual meeting were from the Hawassa program. Trainees who submitted work to that meeting were also funded to attend the meeting because they had some of the highest quality research presented. That’s a tremendous success.

Also, the local faculty in Hawassa became more engaged with what we’re doing and are really driving the program forward to the point that we are now in the passenger seat, and they are telling us what and how they want it. This—in my opinion—is the end goal that you want to achieve from any bidirectional partnership; it’s becoming locally driven by the champions who are on the ground.

Training settings and clinical services may vary between the US and other countries such as LMICs; how do you address that gap when you travel, and how do you create the common ground to achieve the maximum benefit, to both sides? 

As a faculty member, I think that you need to go to any new site in a partnership very openminded and humble and learn from the local faculty how they do things. Then after that start trying to develop ways of improvement for things that you can do better.

The worst sort of culture clashes and unsuccessful partnerships I’ve seen were when  somebody comes in with the mentality of dictating how things should be done to solve their problem.

I always talk to the young trainees who come with me in my trips to places with limited resources, and I tell them that they will be seeing things that are done in a different way from what they have been used to here in the US. I tell them that its OK ,and it is their way, and its what they are comfortable with. I also tell my trainees that they must adapt to the environment and respect the culture.

 I believe that this is one of the greatest benefits that our young trainees gain in these kinds of exposures: they learn to adapt to a setting where the resources they are used to be having do not always exist.

We should allow the developing of plans and initiatives to be locally driven because our role is primarily giving suggestions and recommendations. We should listen to them tell us what they need rather than telling them this is how we’re going to do it. It’s important to brief our delegation members about the system and the culture prior to the trip, as well to debrief after they return to assess what went well and what didn’t.

It’s a learning experience, and we should patiently try to make it better each time.

In my opinion, the most important thing that our young trainees who travel with us learn is how to adapt to these different settings of work, rather than focusing on gaining technical skills.

They will learn how to handle things when they don’t have the needed equipment or instruments, how to manage patients who do not have access to a medication that would easily be available to patients in United States hospitals, or even how to work when there is no electricity.

I found that these kinds of things had a great deal of influence on the way our trainees will operate and provide care to their patients in the future, they are lessons for life and it will change their perspective and make them think outside the box.

Even here in the United States, we went through difficult circumstances during COVID when resources became more limited and rarer than usual. We also see that in some of the rural or underserved locations here in America.

A good doctor should be creative and well-trained to work in all circumstances. Even when you are on the receiving side and get a call telling you that a patient is being transferred to your hospital from a rural hospital, you won’t be frustrated and you’ll know why they are sending the patient to you and trust that they had already exhausted all possible options to do it there without having the patient and the family travel to a different place.

Do you find virtual educational programs with LMICs to be an effective as a means of overcoming in-person challenges, such as funding to cover travel expenses, VISA restrictions and other obstacles?

I think the virtual educational programs are definitely growing as an alternative in terms of initiating relationships and building bridges of trust between the institutions, but they remain a partial solution, because it’s difficult to maintain these relationships and push them forward in meaningful way without in-person interactions.

Virtual programs allow us to optimize so that we are good stewards of our resources in terms of travel. It’s no secret that the time spent in travel is a premium challenge to academic surgeons; it’s not easy to be gone for two weeks and then come back and try to catch up with my other responsibilities and commitments. It is even harder to bring colleagues from low resource settings to our universities to have meaningful experiences. Even assuming they get a VISA, which is a very low-rate possibility as I mentioned in my talk, they would still be restricted from having a comprehensive hands-on experience and be limited to shadowing , which I think is not ideal and not fair.

You mentioned ENTRUST in your talk! How do you see programs like ENTRUST helping in educational methodologies in COSECSA region?

We are just starting to see the impact that it’s going to bring to the assessment and educational systems the region. Dr. [Dana] Lin and Dr. [Cara] Liebert did such good work on integrating it into to the education system in COSECSA, and I’m excited to see how much impact it will have in the near future.

Using it in giving the board exams was phenomenal to see. It’s a virtual platform that is so specific and easily applicable to multiple settings.

Part of the struggle with the COSECSA region is that it consists of 14 countries, so imagine the difficulty of travelling as a trainee. Even our trainees here in the US struggle to travel for their fellowship interviews for example, but travelling in a low-income setting just to take your exams can be extremely difficult.

I see ENTRUST as a successful way to ease that burden as well on the number of standardization examiners. There is tremendous variability in the skills of examiners and in the biases that a person may bring to the examination, so I think that the ENTRUST system is a really nice way to mitigate some of that.

I expect it to have an impact even beyond COSECSA region.

Can you tell us about Association for Academic Global Surgery (AAGS) and your role within the organization?

AAGS is an independent society focusing on global surgery and I think that one of the things we’re hoping to do with that organization is to develop an institutional packages/ memberships, things that entities who have obvious interest and infrastructures for global surgery like Stanford could join and help us build a platform for what we’d like global surgery look like , what are our best practices defining bidirectional partnerships, how do we get value for our international partners, what kind of educational criteria defines a good educational partnership. Those are the things that we’re working on, and obviously the University of Wisconsin is building our Center for Global Surgery as well, so I think that we’re all building together.

It’s teamwork, and we learned the hard way that you cannot do really successful academic global surgery partnerships in a silo.

Tell us about your visit to Stanford Surgery.

My visit was fantastic! Before coming I expected that the focus of the trip was to give a talk about the things that I love, but at the end of the day it was meeting with almost all the faculty and seeing everyone’s different interest and involvement in global surgery and projects they are working on. We were able to find commonality in every one of the 10 or 12 meetings that I had that day.

To see that many people are enthusiastic about global surgery is truly heartwarming, yet at the same time exciting for the work we could do together in the future. Everyone I met was so kind and generous with their time, and I wish that I had more time to discuss all these brilliant ideas.

I am deeply impressed with the global engagements at Stanford Surgery; you really set a high bar for other institutions to follow.

Thanks to everyone who was involved in this visit from Dr. [Mary] Hawn and her support from the department level, Dr. [Tom] Weiser and his team who kindly created this opportunity for me to come and visit Stanford and see the wonders what can be. You are a model in terms of global surgery.

I’m honored and humbled and ready to return at any time!