Abstract 14: Going the Distance: A Cross Sectional Study of Embedded Surgical Training Experiences in Low-to-Middle Income Countries

Abstract

Background: Trainees and young surgeons increasingly seek to understand and help address the global burden of surgical disease in low-to-middle income countries (LMICs). Time, program and funding constraints often limit these experiences to 1-2 weeks. However, some surgical trainees and recent graduates have embarked upon longer-term “embedded” global surgery experiences of ≥3 months. There is high potential value in these longer-term experiences, but their common characteristics and significance have not been examined. This study seeks to describe common features of such experiences, their impact on trainees’ learning, and the degree to which they have fostered local partnerships, scholarly achievement, and competency development. Methods: A cross-sectional sample of surgical trainees and recent surgical graduates was surveyed with 25 close- and open-ended questions concerning experience characteristics, self-perceived value, local impact, and professional and scholarly value. Advancement in ACGME competencies during the experience was assessed on a likert scale (1-5) relative to an average year of plastic surgical residency (3). Results: Five young surgeons described experiences that took place in Uganda, India and Nicaragua of average duration 1.8 years (1-2 years). Trainee roles were primarily research-related, graduate roles were a clinical and research hybrid. Resident year at time of experience were ≤PGY4. Funding sources were NGO employment 3/5(80%), grants 2/5(40%), scholarships 1/5(20%), self 1/5(20%). 4/5 (80%) responders found this opportunity via a home institution connection. Top facilitating factors were prior relationships and local mentor support. Top impeding factors were political factors causing delays and cultural/language differences. Aspects that most commonly made the experience valuable to local partners and health systems were serving as additional personnel/resources and establishing self-sufficient processes/policies/partnerships. Scholarly output consisted of scientific presentations (24.4±32.2) and scientific manuscripts (7.8±10.1). ACGME competency growth exceeded that of an average residency year in all domains: interpersonal and communication skills (4.8±0.4), systems-based practice (4.6±0.5), professionalism (4.4±0.5), practice-based learning and improvement (4.4±0.9), medical knowledge (4±0.7), patient care (4±1). Top recommendations were regarding personal attitude and finding a local mentor organization/surgeon. Conclusion: Embedded surgical training experiences in LMICs fostered a high-degree of local health system understanding, ACGME competency acquisition, scholarly output, and enrichment of international partnerships.