R. A. Tessler1, S. Gupta1,2, B. T. Stewart3, E. G. Wong2,4, T. McIntyre5, R. S. Godfrey1, R. R. Price6, A. D. Fox7, A. L. Kushner2,8,9, K. N. Remick10 1University Of California – San Francisco , East Bay,Surgery,Oakland, CA, USA 2Surgeons OverSeas,New York, NY, USA 3University Of Washington,Surgery,Seattle, WA, USA 4McGill University,Surgery,Montreal, QC, Canada 5State University Of New York, Downstate,Surgery,Brooklyn, NY, USA 6University Of Utah,Surgery,Salt Lake City, UT, USA 7University Of Medicine And Dentistry Of New Jersey,Surgery,Newark, NJ, USA 8Columbia University College Of Physicians And Surgeons,Surgery,New York, NY, USA 9Johns Hopkins Bloomberg School Of Public Health,International Health,Baltimore, MD, USA 10Walter Reed Army Medical Center,Trauma Surgery And Critical Care,Washington, DC, USA
Introduction: Injury affects nearly 5.8 million people each year and causes 10% of the world’s deaths; 90% of which occur in low-and-middle-income countries. Increasingly, general surgery residents in the US are eager to confront this burden early in their career. However, formal programs are sparse. Our objective was to define the criteria for an optimal international trauma rotation for US surgical residents.
Methods: A modified Delphi technique was used to solicit consensus from a panel of global surgery program directors, academic surgeons, surgical residents, and surgeons with humanitarian surgery experience. Three rounds of questionnaires were used to create a list of criteria for an optimal international trauma rotation for US general surgical residents. Content analysis of responses was used to generate categories from the criteria.
Results: Consensus responses generated 37 criteria that could be organized into four categories. The most common criterion reported was safety in the host country (78%). The top three most commonly noted criteria for each category are: 1) host nation requirements: sustainability/long-term commitment (56%); strong local champion/mentor (56%); local residency training program and educational curriculum (67%); 2) sponsoring US institution requirements: bi-directional training (44%); strong/supportive mentorship (44%); support and credit approved by American Board of Surgery (44%); 3) surgery resident requirements: required research with scholarly work including both US/host nation authors (33%); participation in ongoing advocacy projects in host nation (22%); commitment to participate in global surgery journal club and/or grand rounds in both institutions (33%); and 4) rotation specific requirements: minimum length of 4 weeks (67%); safe and accessible accommodation/daily living (78%); exposure to breadth of injury care in resource limited settings (67%).
Conclusion: The top responses indicate that safety, minimum length of 4 weeks, exposure to breadth of injury care in resource limited settings and a local educational curriculum are the most important features of an international trauma rotation. With increasing interest among US surgical residents and programs to participate in global surgery endeavors, criteria to establish an optimal surgery resident international trauma experience were created. US institutional leadership and surgery program directors must ensure safety and an optimal educational experience for surgery residents, as well as demonstrate long-term commitment to trauma care in the resource-limited setting. A broader consensus document should be created that gives an acceptable standard for international trauma surgery rotations.