Abstract
BackgroundThe hierarchical nature of medical education has been thought necessary for the safe care of patients. In this setting, medical students in particular have limited opportunities for experiential learning. We report on a student-faculty collaboration that has successfully operated an annual, short-term surgical intervention in Haiti for the last three years. Medical students were responsible for logistics and were overseen by faculty members for patient care. Substantial planning with local partners ensured that trip activities supplemented existing surgical services. A case review was performed hypothesizing that such trips could provide effective surgical care while also providing a suitable educational experience.FindingsOver three week-long trips, 64 cases were performed without any reported complications, and no immediate perioperative morbidity or mortality. A plurality of cases were complex urological procedures that required surgical skills that were locally unavailable (43%). Surgical productivity was twice that of comparable peer institutions in the region. Student roles in patient care were greatly expanded in comparison to those at U.S. academic medical centers and appropriate supervision was maintained.DiscussionThis demonstration project suggests that a properly designed surgical trip model can effectively balance the surgical needs of the community with an opportunity to expose young trainees to a clinical and cross-cultural experience rarely provided at this early stage of medical education. Few formalized programs currently exist although the experience above suggests the rewarding potential for broad-based adoption.
Highlights
The hierarchical nature of medical education has been thought necessary for the safe care of patients
When taken in aggregate, the data above is an example of an effort to provide top-quality surgical care to a population in dire need while adhering to the principles of medical education embraced in U.S academic medical centers
Short-term humanitarian surgical interventions commonly focus narrowly on bringing a “crack-team” of experienced clinicians to perform a set of highly specialized procedures for a community in need
Summary
The hierarchical nature of medical education has been thought necessary for the safe care of patients. In this setting, medical students in particular have limited opportunities for experiential learning. The hierarchical nature of medical education with step-wise progression to greater abilities and responsibilities has been thought necessary for the safe and efficient practice of medical care within the academic learning environment. Such a system has advantages, one cost of this well-established hierarchy is that experiential learning only minimally reaches those further down the chain of command. Given the intrinsic importance of technical acumen and repetition-based learning for surgery,[4] any hierarchy that limits practice of clinical skills may further distance the medical student from the proven ideal form of surgical skill acquisition - routine reiteration [5,6]
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