Surgical training in the UK since the Second World War has developed into a world class education programme. However, with the dramatic increase in the number of doctors and surgeons, combined with the improvement in access to health care, pathologies are now being treated earlier, and trainee exposure to advanced pathology has consequentially reduced. Not all countries are as privileged as the UK to have 3 doctors per 1000 head of population; South Africa has approximately 1/3rd of this number, Cambodia 1/10. th. , and Malawi 1/100. th. Many of these countries have difficulty filling posts for medical professionals within their own hospitals. The publication of the CRISP report and Lord Crisp's subsequent book ‘Turning the world upside down’ in 2010, highlighted, and tried to produce evidence of the mutual benefit of international health links to both the developed and the developing countries. It cited the bilateral transfer of skills and ideas, development of management skills, and improved workforce morale as beneficial effects of such links. The Department for International Development has prioritised the formation of these international partnerships. The Tropical Health Education Trust has been given the task of distributing grant funds. There are over 100 currently established and funded different health links across the UK. Some local links already exist such as the Gloucester NHS Trust Kambia, Sierra Leone link which focuses on maternal health, NHS South Centrals leadership programme which has a broader remit and works in conjunction with the ministries of health in certain areas of Tanzania and Cambodia and UHB/BRI link with Mbarara, Uganda in obstetrics, child health, ophthalmology. Over the last 4 years, a series of South West Trainees have spent 1 year working in hospitals in Malawi and South Africa. The positive feedback that they have given, the dramatic increase in the surgical exposure as documented in their log books, and the number of high quality research projects that they have published as a result, has led to the programme director looking favourably on future requests. We feel it would be mutually beneficial to formalise these links, with a regular stream of surgeons from this region spending time in these hospitals. Benefits for the recipient hospital would be a dependable and regular supply of staff, who could be incorporated into more long scale programmes, aimed at improving regional health care. Benefits to the donor institution and surgeon would be streamlined application process, simpler living logistics, car house etc, continuity of research projects, and the possibility to apply for funding for local research staff

The World Health Organisation (WHO) has recently identified musculoskeletal care as a major global health issue in the developing world. However, little is known about the quality and trends of orthopaedic research in resource-poor settings. The purpose of this study was to perform a systematic review of orthopaedic research in low-income countries (LIC). The primary objective was to determine the quality and publication parameters of studies performed in LIC. Secondary objectives sought to provide recommendations for successful strategies to implement research endeavors in LIC. A systematic review of the literature was performed by searching MEDLINE (1966-November 2014), EMBASE and the Cochrane Library to identify peer-reviewed orthopaedic research conducted in LICs. The PRISMA guidelines for performing a systematic review were followed. LIC were defined by the WHO and by the World Bank as countries with gross national income per capita equal or less than 1045US$. Inclusion criteria were (1) studies performed in a LIC, (2) conducted on patients afflicted by an orthopaedic condition, and (3) evaluated either an orthopaedic intervention or outcome. The Oxford Centre for Evidence-Based Medicine Levels of Evidence, and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used to objectively rate the overall methodological quality of each study. Additional data collected from these studies included the publication year, journal demographics, orthopaedic subspecialty and authors' country of origin. A total of 1,809 articles were screened and 277 studies met our inclusion criteria. Eighty-eight percent of studies conducted in LIC were of lower quality evidence according to the GRADE score and consisted mostly of small case series or case reports. Bangladesh and Nepal were the only two LIC with national journals and produced the highest level of research evidence. Foreign researchers produced over 70% of the studies with no collaboration with local LIC researchers. The most common subspecialties were trauma (42%) and paediatrics (14%). The 3 most frequent countries where the research originated were the United States (42%), United Kingdom (11%), and Canada (8%). The 3 most common locations where research was conducted were Haiti (18%), Afghanistan (14%), and Malawi (7%). The majority of orthopaedic studies conducted in LIC were of lower quality and performed by foreign researchers with little local collaboration. In order to promote the development of global orthopaedic surgery and research in LIC, we recommend (1) improving the collaboration between researchers in developed and LIC, (2) promoting the teaching of higher-quality and more rigorous research methodology through shared partnerships, (3) improving the capacity of orthopaedic research in developing nations through national peer-reviewed journals, and (4) dedicated subsections in international orthopaedic journals to global healthcare research

Aims

Tuberculosis (TB) is one of the biggest communicable causes of mortality worldwide. While incidence in the UK has continued to fall since 2011, Bradford retains one of the highest TB rates in the UK. This study aims to examine the local disease burden of musculoskeletal (MSK) TB, by analyzing common presenting factors within the famously diverse population of Bradford.

Aims

The ongoing COVID-19 pandemic has disrupted and delayed medical and surgical examinations where attendance is required in person. Our article aims to outline the validity of online assessment, the range of benefits to both candidate and assessor, and the challenges to its implementation. In addition, we propose pragmatic suggestions for its introduction into medical assessment.