J. F. Vance1, N. Rao1, B. Burns1, D. Walters1 1East Tennessee State University – Quillen College Of Medicine,Department Of Surgery,Johnson City, TN, USA
Introduction:
While many surgeons choose to use their skills in under-resourced settings, there had been few formal opportunities to cultivate volunteerism within general surgery residency training until recently. Since 2011, when the American Board of Surgery (ABS) and Accreditation Council for Graduate Medical Education (ACGME) released guidelines for international surgical rotations (ISRs) there has been an explosion of interest in the developing field of global surgery. Many institutions, such as our own, have developed ISRs. We will discuss necessary components for cultivation of an international surgical rotation, briefly discuss benefits and challenges of such a program and discuss our clinical experience in Belize.
Methods:
International surgery rotations have defined guidelines and requirements. ACGME mandates having a sponsoring institution and letter of agreement. Many factors are important selecting a site for an ISR: community resources and needs, safety, educational materials, food and lodging. Rotations must be optional for trainees and a minimum of two weeks in length. They are restricted to post-graduate years two through four. Perhaps one of the most time consuming steps is to acquire the medical license for the US faculty surgeon. It goes without saying that this person must be dedicated to initiating and sustaining partnerships. In addition, programs must provide the resident’s salary, travel, health and evacuation insurance. Paramount to development of ISRs are strong department backing and donor support. In the years we have worked in Belize we have gathered some basic data to detail types of clinical encounters, disease states treated as well as procedures and surgeries performed.
Results:
In just over two years our department has provided global surgery training to six residents in as any months. We have provided medical and surgical consults and trained a local surgeon in laparoscopy. Four different faculty mentors have shared their time and expertise in general, trauma, and vascular surgery. While providing general surgical coverage at the facility we assist local surgeons with obstetric, orthopedic and urologic cases. Approximately 75% of cases logged by residents comprise a mixture of general surgery while the other fourth is a mixture of urology, OG/GYN, and Orthopedics.
Conclusion:
Global surgery as a field is expanding rapidly. ISRs are a growing interest among applicants and residents. There are as many as 25 such ACGME-approved programs. The partnership between LLL Hospital and ETSU is one of many possible models for international engagement and surgical education. As we gather more data and clinical experience, ETSU is developing cross-department collaborative partnerships with the hospital to expand opportunities for students and to provide other needed services. We hope that this serves as an example to other programs who wish to serve and provide surgical care around the globe.