Summary:There are still children with cleft lip and/or palate (CLP) in low-resource areas who face social rejection. This stigma disadvantages children in education, employment, marriage, and community, and is exacerbated by barriers to care. Our study objective was to conduct a systematic review of the impact of social stigma of CLP for children in low-resource areas. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A systematic search was conducted of 3 databases: Ovid Embase, Ovid Medline, and the African Journal Online from 2000 to October 5 2018. Common themes were identified using a grounded theory approach and quantitatively summarized. The Joanna Briggs Institute criteria were used to evaluate the risk-of-bias assessments. Four hundred seventy-seven articles were screened; 15 articles were included that focused on the impact of social stigma on CLP in low-resource areas. This was limited to English articles. The majority of studies originated in Nigeria or India. Themes were reported as follows: societal beliefs (n = 9; 60%), social impact (n = 7; 46%), marriage (n = 7; 46%), education (n = 6; 40%), employment (n = 5; 33%), and psychological distress (n = 3; 20%). Causes include the effect of “God’s will,” supernatural forces, evil spirits or ancestral spirits, exposure to an eclipse, black magic, or a contagion. Further, children with CLP may not be worth a full name or considered human and killed. Awareness of the impact of social stigma for children with CLP in low-resource areas generates support toward national education and awareness in low-resource areas.

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Introduction: Today's emergency department sees healthcare system pressures manifest through longer wait times, increased costs, and provider burnout. In the face of questionable sustainability, there is a greater role for training future innovators and entrepreneurs in healthcare. However, there is currently little formal education or mentorship in these areas. The aim of this scoping review was to identify the current and ideal educational practices to foster innovative and entrepreneurial mindsets, with specific interest amongst emergency medicine trainees. Methods: Using a scoping review methodology, the relationship between healthcare and entrepreneurship was explored. OVID, PubMed and Google Scholar were searched using the keywords “entrepreneurship”, “health education” and “health personnel”, on March 8th, 2018. Results were screened by title, abstract and full text by a team of three calibrated researchers, based upon pre-defined exclusion and inclusion criteria. The final list of papers was reviewed using an extraction tool to identify demographics, details of the paper, and its attitudes and perceptions towards entrepreneurship and innovation. Results: After screening, 59 papers were identified for qualitative analysis. These papers ranged from 1970-2018, mainly from the USA (n = 36). Most papers were commentaries/opinions (n = 35); 11 papers described specific innovations. Entrepreneurship was viewed positively in 45 papers, negatively in 2 papers, and mixed in 12 papers. Common specialties discussed were surgery (n = 9), internal medicine (n = 3), and not specified (n = 44). Emergency medicine was described in one paper. Major themes were: entrepreneurial environment (n = 29), funding and capital (n = 12), idea generation (n = 9), and teaching entrepreneurship (n = 6). Of the 11 innovation papers, the discussion was focused on educational (n = 6) or system (n = 5) innovations. These innovations related to surgery (n = 1), public health (n = 1) and palliative care (n = 1). None of these innovations were specific to emergency medicine. Conclusion: This review indicates a small number of programs focused on promoting innovation and entrepreneurship amongst trainees, but no programs specific to the emergency department. There may be benefit for educators in emergency medicine to consider how to foster a greater innovative spirit in our speciality, so our next generation of physicians can help tackle problems affecting patient care.