Global health equity education in U.S. anesthesiology residencies is gaining attention due to major global disparities in access to safe anesthesia care. The field focuses on ensuring fair access to safe effective anesthesia—especially in resource-limited settings—while addressing the social and structural factors driving inequities. Although anesthesia providers play a key role in patient safety and surgical outcomes, many U.S. programs still lack formal global health equity curricula 1. Integrating this training equips residents to work in diverse and resource-limited environments and to provide culturally responsive care. These experiences build empathy, humility, and a deeper understanding of health equity 2. As healthcare becomes increasingly interconnected, global health expertise is essential for a resilient perioperative workforce. Importantly for the global surgery community, anesthesia capacity is a cornerstone of safe surgical systems. The Lancet Commission on Global Surgery, as well as National Surgical, Obstetric, and Anesthesia Plans (NSOAPs), highlight that global surgery cannot advance without parallel strengthening of anesthesia education, workforce development, and leadership 3. Therefore, structured global health equity training in anesthesiology is directly aligned with global surgical system strengthening efforts. Amid efforts to defund health equity initiatives, integrating formal global health equity training into U.S. anesthesiology residencies has become increasingly urgent. As institutions face political and financial pressure to scale back, creating durable well-structured curricula are essential to sustaining progress in reducing global health disparities. A clear roadmap for developing, implementing, and evaluating such programs can ensure consistency, quality, and long-term impact. Although focused on anesthesiology, the proposed framework can serve as a scalable model for other surgical and perioperative programs aiming to build ethical, sustainable, and equity-centered global health education pathways. Decolonizing global health education means examining and addressing the historical and systemic inequities reinforced by Western-centric medical practices. In medical training, this involves elevating the perspectives of local providers in low- and middle-income countries (LMICs), integrating their input into curriculum design, and ensuring they play an active role in shaping collaborations 4. It also requires dismantling power imbalances so partnerships are equitable and truly shared. Expanding Global Health Curricula: Incorporate courses on the history of colonial medicine and its effects on specific healthcare contexts, emphasizing the structural impacts of colonialism on LMIC healthcare systems. Deemphasizing Short-Term Engagements: Transition from short-term, unidirectional global health engagements to extended, reciprocal experiences that foster equitable partnerships. Defining Roles and Providing Preparation: Establish previsit assessment with clearly defined roles and responsibilities. Include site-specific training and supervision to ensure trainees do not engage in activities beyond their level of training. Building Long-Term Collaborations: Recruit faculty dedicated to fostering equitable sustainable global health partnerships and align institutional promotion criteria to recognize this work. Bidirectionality of initiatives: Ensure the bidirectionality of work by engaging the local providers in equal access to grant funding and/or allowing them to be on site in high income countries for learning. By embedding these strategies into global health training programs, US anesthesiology residency education can shift from transactional engagements to drivers of transformational equity-focused practices. The Consortium of Universities for Global Health (CUGH) Competency Subcommittee created the Global Health Education Competencies Tool Kit, outlining key domains for global health training 7. Although not all domains apply directly to anesthesiology, they offer a strong foundation for building comprehensive relevant global health curricula. The most applicable competencies are highlighted below. The proportion of U.S. anesthesiology residencies offering global health electives is like other specialties, but programs vary widely in structure, goals, curriculum, and funding 8. Therefore, developing a global health training program requires a clear stepwise approach. Drawing on existing and emerging initiatives, we outline key steps for creating a context-sensitive, up-to-date, and decolonized global health curriculum. Map LMIC sites for capacity for partnership. Build relationships with existing and current anesthesiologists (involved in or responsible for educational advancement) who can help lead, mentor, and drive priorities on the ground. Secure buy-in from local stakeholders to ensure relevance and sustainability. Use interviews, surveys, or site visits with anesthesiology providers in LMICs to understand challenges in medication access, equipment availability, and training gaps. Analyze the existing anesthesia landscape, including scope of practice, provider training programs, and healthcare system limitations. Collaborate with universities and training institutions to facilitate trainee exchanges and bidirectional hosting. Review available literature (e.g., WHO and WFSA) for existing material or work already done. Develop core lecture topics, such as: Principles of global health equity and key players in global health. Anesthesiology and the global burden of surgical disease. Anesthesiology practices for resource-limited settings. Cultural competence and ethical considerations. Pain and analgesia in the global context. Share learning objectives and materials across institutions to streamline implementation. Deliver training using diverse methods, such as: Lectures, interactive workshops, case-based discussions, and simulation-based training. Virtual and in-person mentorship programs. Collaborative research projects with local providers. Establish a dedicated team of faculty members with global health experience. Assign specific responsibilities, including curriculum oversight, travel logistics, resident support, and project mentorship. Regularly assess the program's quality and impact through resident feedback and partner evaluations. Resident knowledge acquisition (pre/postassessments). Cultural competence surveys. Obtain LMIC partner satisfaction/feedback similar to previous studies 9, 10. Number of publications, QI projects, or research outputs. Use evaluation findings to make iterative improvements to the program. Develop a long-term sustainability plan that includes funding (e.g., NIH/Fogarty grants and hospital-supported fellowships), faculty support (including protected time and promotion incentives), and material resources (such as grant writing support). Seek funding from grants, institutional support, or external donors. Build partnerships with global health organizations for additional support and expertise. Encourage residents to engage in global health research from study design to data collection and analysis. Pair residents with experienced global health mentors to guide their professional development. There are several US anesthesiology residency training programs that have aligned their curriculum to best match the CUGH toolkit (Table 1); however, this list is not exhaustive. This table was created utilizing information provided on program websites and author knowledge. CA-3 onsite rotation up to 3 months of dedicated research and project time either locally or internationally. Option to participate in the health equity curriculum. Option for global health equity fellowship with a 50% clinical commitment and 50% commitment to research, policy, and education University of Rwanda, Foundation for African Medicine and Education (FAME) in Karatu, Tanzania. Hue University Medical and Pharmacy (HUMP) in Vietnam. Global health - professional equity and exchange program (GH-PEEP), which brings visiting observers from international partnership sites to interact locally with Stanford's faculty, trainees, and students Global health equity and perioperative disparities Global surgical disease burden and anesthesia Pain and analgesia in the global context Anesthesia in resource-limited settings Cultural humility and ethical considerations 2–4 weeks teaching rotations in CA-3 years Option for residency global health track Option for global health fellowship Creating a global health equity training program for U.S. anesthesiology residencies requires commitment, collaboration, and a clear equity-focused vision. By following this roadmap, programs can build a sustainable curriculum that prepares interested residents to navigate complex global health challenges locally and abroad. Prioritizing a decolonized inclusive approach promotes culturally responsive care and equitable partnerships. This is an opportunity to train anesthesiologists who are both technically skilled and deeply committed to improving health outcomes worldwide. Betelehem M. Asnake: conceptualization, writing – original draft, writing – review and editing. Maziar M Nourian: conceptualization, writing – original draft, writing – review and editing. Ana M. Crawford: supervision. Bantayehu Sileshi: supervision. Sheida Tabaie: writing– review and editing. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
Asnake et al. (Tue,) studied this question.