Emergency Surgery Workshop Davos 2011: Presentation by Prof Frederick Burkle, MD, Senior Fellow & Scientist, the Harvard Humanitarian Initiative, Harvard School of Public Health, Kailua, HI, USA

1. ACCOUNTABILTY &
ACCREDITATION OF EMERGENCY
SURGERY PROVIDERS
FREDERICK M. BURKLE, JR., MD, MPH, DTM,
FAAP, FACEP
PROFESSOR
&
WOODROW WILSON SENIOR INTERNATIONAL PUBLIC POLICY SCHOLAR
SENIOR FELLOW & SCIENTIST
HARVARD SCHOOL OF PUBLIC HEALTH

2. Harvard
THE PROBLEM* Humanitarian
Initiative
• “Unacceptable practices” & questions about
clinical competencies of some Foreign
Medical/Surgical teams (FMTs/FSTs)
• Current FMT guidelines “limited in scope”
• Need for “greater accountability, stringent
oversight, better coordination”
*Global Health Cluster CONCEPT PAPER 2011

3. Harvard
2 STEP PROCESS Humanitarian
Initiative
I: Internal quality improvement of services &
standards of performance of FMTs
II: Professionalize the education, training &
certification of Emergency Surgery
humanitarian providers & accreditation of their
academic training centers & trainers

4. STEP I: FMT REQUIREMENTS
Professional & ethical standards Team composition by services & bed
capacity
Accelerate deployments Standardized data collection &
reporting
Match services with supply & demand Procedures performed only by those
licensed/accredited to do so
Create register of FMT provider FMTs staffed by personnel with
organizations experience in humanitarian settings
Team composition by specialty, Process to supervise less experienced
experience
*Global Health Cluster CONCEPT PAPER 2011

5. STEP II: RECOGNIZING THAT ….
• The global and regional blueprint for
professionalization of humanitarian assistance is
moving forward rapidly*
• Humanitarian assistance is a multidisciplinary
discipline with specific obligations discipline-to-
discipline; disciplines are highly integrated
• A system of “accountability, quality control,
reporting, registration, certification & coordination”
is inevitable
*Walker, P, Hein K. Health Affairs, 2010

6. PROFESSIONALIZATION:
Yes or NO?

7. ELRHA– Enhancing Learning and Research
for Humanitarian Assistance
• ELRHA: a collaborative network dedicated to
supporting partnerships between higher education
institutions and humanitarian organizations and
partners around the world
• ELHRA Project: moves the professionalization of
the humanitarian aid workforce from discussion to
action
• Encourage similar “actions” to take place between
existing, and developing, academic training centers

8. REGIONAL HUBS

9. STEP II: RECOGNIZING THAT…
• Expectations are that each „discipline‟ will
demonstrate:
> competency-based education & training
> regional standards as a global HUB/Regional sub-
group
• Argue that this goal is best reached as an association of
like-minded academic & academic affiliated centers
who have an established track record in the discipline
of Emergency Surgery in humanitarian settings

10. BLUEPRINT RECOMMENDATIONS
Establish Certified Training Programs:
• Regional & internationally recognized academic
training programs
• Standardized system of competency-based
certification
• Work with members, academics & training institutions
to devise certification criteria for entry-, mid-
level, & higher levels

11. BLUEPRINT RECOMMENDATIONS
Identify Core Competencies:
• Appropriate for a Regional Hub to accept a set of core
competencies on which to base training, a way of
certifying training courses, and accrediting
training institutions
• Provide accredited trainers from accredited training
centers around the world:
> via training provided by accredited training
institutions
> &/or supervised experience

12. BLUEPRINT RECOMMENDATIONS
Create Standard Routes to Certification:
• Presupposes that recognized regional HUB organizations will:
> Create a list of competencies
> Do the training
> Accredit the training institution & its trainers
• 3 Common routes:
> Completing a curriculum
> Demonstrating competency through examination or
experience
> Producing a portfolio to document the acquisition of
competency

13. BLUEPRINT RECOMMENDATIONS
Seek recognition from stakeholders:
• Bring NGOs, IOs, Donors on board in whose
interest it is to support the professionalization
process of the FMTs & Emergency Surgery
• They should recognize the association and accept the
certification it provides
• Lobby for a “Global authority for crises”…similar to
that provided by the International Health
Regulations Treaty for pandemics*
*Burkle FM, Redmond, AD, McCardle D. Lancet, Nov, 2011

14. EXAMPLE
• 12 established Academic Training Centers in North America
that have provided 2-17 years of education and training in
humanitarian health for the general health care provider
• Survey tool completed & joint meeting held November, 2011
• Building an Association of Academic Training Centers for
Humanitarian Health in support of the work of
the North American regional HUB of ELHRA
• Recognize that a similar approach is needed for health
specialists (i.e., emergency surgery)

15. SUMMARY: AN ACADEMIC ASSOCIATION FOR
INDIVIDUAL DISCIPLINE PROFESSIONALS
• Independent „discipline-specific‟ Professional Academic
Associations
• Forum for Core and Sub-group competencies
• Sets standards: Professional & Ethical
• Accredits training centers and trainers
• Establishes discipline-specific routes to certification
• Push the research to build content & standards
• Internationalize the field