M. A. Boeck1,3,4, Y. Woo1, A. L. Kushner1,3,4, T. D. Arnell1, M. A. Hardy1,4 1Columbia University Medical Center,Department Of Surgery,New York, NY, USA 3Johns Hopkins Bloomberg School Of Public Health,Baltimore, MD, USA 4Surgeons OverSeas (SOS),New York, NY, USA
Introduction: General surgical care is critical for adequate healthcare delivery around the world. With training in North America increasingly focused on surgical specialization, international electives during residency enable future surgical leaders to return to the foundations of general surgery. The validation of international rotations by the American Board of Surgery (ABS) and ACGME Residency Review Committee (RRC) in 2011 formalized this effort. Despite this, and ample evidence of resident and program director interest, the number of such electives remains relatively limited. Here we present the evolving international surgical elective experience at New York Presbyterian Hospital-Columbia.
Methods: From 2008 – 2013 categorical senior general surgery residents participated in non-ACGME RRC accredited international surgical electives, selected jointly by the program director and participant. Prompt post-rotation analyses, combined with a recent anonymous survey, were reviewed to effectively evaluate and improve the program.
Results: A total of 13 international electives at 8 sites (Brazil, Ethiopia, France, India, Israel, Kenya, S. Korea and Thailand) were completed since 2008, with 0-4/7 (mean=2) residents participating per year, each for a period of 6-8 weeks. The Graduate Medical Education office and the Department covered salaries and other expenses, respectively. Perceived strengths included adaptation to the use of limited resources, open surgeries, significant supervised operative autonomy, advanced disease presentations, honing physical exam skills, and teaching prospects at all levels. Criticisms focused on large variations in case volume, limited operating room involvement, language barriers hindering patient and staff interactions, inadequate guidance on living logistics, and a lack of adequate medical and leisure supplies. 100% (7/7) survey respondents would repeat the experience if given the opportunity, with the same number expressing a continued interest in global surgical work due to the elective.
Conclusion: Some residency programs affiliate with one international location, minimizing the importance of resident preference for site selection. Columbia’s approach, despite challenges in creating multiple, concurrent surgical international electives, is favored by the residents. Site inspections by a faculty member, including evaluation of projected case volume, level of supervision, degree of clinical involvement, language proficiencies, potential for research, and bidirectional exchange, are essential. Further reflection is needed to ensure educational, mutually beneficial, sustainable, standardized rotations. The potential returns and effects on career trajectories are undeniable, providing incentive for program directors to strongly consider making international rotations available to trainees.