I read with interest the results of the Association of Program Directors in Surgery (APDS) survey on international electives authored by Mitchell and coworkers in a recent issue of the journal [1]. It is indeed laudable that they have attempted to address the need for surgical trainees in the United States to gain exposure to the ‘‘bigger picture’’ of surgery in less-resourced environments. As someone working in the developing world as an academic surgeon and who supervises trainees, I would like to make a few practical comments that may further assist the authors and the APDS with the design of such educational opportunities for the residents. First, from having hosted a number of international elective trainees over the years (US, UK, German citizens, among others), I would like to recommend to the researchers that the minimum length of time for these elective periods should be 2–3 months. It takes time to settle into a routine, normally about 2 weeks. This should be sufficient time for residents to adjust to the cultural (and potential language) differences and still enable them to effectively benefit from a clinical perspective. This also avoids the ‘‘drop-and-go’’ effect of doing something and not having time to see the final results—something important to surgical trainees. I also found it interesting that the recommendation was for these electives to be done in the third or fourth year of training, as I have previously recommended, preferably after some training in intensive care [2]. As far as curriculum, supervision, and evaluation are concerned, it is important to identify suitable local surgeons, either with FACS or local academic standing (widely published or internationally respected in their field), to provide surrogate supervision rather than relying on direct American supervision, as the nuances of local practice and the adaptation to local resource constraints may otherwise be sacrificed. While no program required research as part of the elective, this is a potential goldmine for the resident, since many developing countries have a wealth of research opportunity but a dearth of local capability to perform it. For the evaluation process, standardized forms could be developed by the Residency Review Committee (RRC) or the American College of Surgeons and used by the local supervisor, thus making the process fair and equitable. Finally, most surgical colleges (American College of Surgeons, Royal College of Surgeons, College of Surgeons of SA, Royal Australasian College of Surgeons, and Pan African Association of Surgeons) hold intercollegiate meetings and combined conferences. There could be formal or informal agreements between the colleges that recognize training undertaken in one country as time served, thus satisfying the RRC that adequate supervision and training of the resident were performed. In conclusion, I wish to support the authors’ contention that a consortium model be adopted to address the requirements for these electives, but I also appeal to the authors and the RRC to include the international partner organizations in the consortium so as to set reasonable and achievable goals for the residents undertaking international electives. T. Hardcastle (&) Trauma Unit, Inkosi Albert Luthuli Central Hospital/ University of Kwa-Zulu Natal, Private Bag X05, PostNet 27, Malvern 4055, South Africa e-mail: timothyhar@ialch.co.za
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Jun 17, 2014
Shaolong Shu + 1
Open Access