Elsevier

Journal of Surgical Education

Volume 72, Issue 4, July–August 2015, Pages e88-e93
Journal of Surgical Education

Global Health Initiatives
Integrating Global Health Into Surgery Residency in the United States

https://doi.org/10.1016/j.jsurg.2014.05.005Get rights and content

Introduction

The increasing influence of globalization on health care has resulted in a greater awareness of health disparities within the millennial generation, some of who strive to ensure equity in the provision of health care services. Interest in global health among the surgical residency applicant pool is increasing.1 The ability to offer a global health opportunity is now considered a marker of a competitive surgical training program that improves resident recruitment. Furthermore, it motivates residents to serve local vulnerable communities and prepares them for a future career in global health.

In 2011, the General Surgery Residency Review Committee (RRC) of the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Surgery approved international electives for credit toward residency graduation requirements. After extensive debate on the ways in which international electives could be standardized to ensure consistent educational experience for residents, the surgery RRC approved a set of requirements for such electives.2, 3

Surgical training institutions (academic and community based) are beginning to explore ways to actualize international surgical rotations. We discuss inherent practicalities, challenges, and opportunities and emphasize that any such program must be bidirectional and fall within the educational pillars and the core competencies prescribed by the ACGME. All the authors are surgeons who are actively involved with a global surgical program, with resident participation at their respective institutions.

Section snippets

Finding a Global Institutional Partner

Although the integration of global health into a surgery residency program may be focused on enhancing the experience of the surgery resident, it must fit into the overall global health mission of the institutions involved—the home institution and the host institution. There are a variety of reasons why an institution may be committed to global health, and the mechanism by which these efforts are actualized can be broadly categorized into clinical care, education, capacity building, and

Financial and Logistical Aspects of the Elective International Surgical Rotation

In a time of shrinking revenue from governmental and other sources, funding the international surgical elective for a surgery resident presents some challenges. Approval by the surgery RRC-ACGME is contingent on the educational environment that requires the presence of a board-certified (or equivalent) surgeon to provide supervision, appropriate clinical experience, and safe living conditions. A highly recommended first expense might be a site visit by the program director or surgery education

Global Health as an Academic Surgical Career

One of the greatest limitations of global surgery within a surgical training environment, which has hitherto been driven by the desires of surgery residents, is the lack of a clear career path for surgical faculty. A stipulation of the ACGME surgery RRC is the involvement of preferably an American Board of Surgery-certified surgeon with faculty appointment at a US program to provide oversight for the residents during their time abroad.

As the field of academic global surgery evolves, it is

Conclusion

As surgical residency programs contemplate the integration of global health partnerships, it must be recognized that the winds of change within global public health are now blowing in the direction of noncommunicable diseases, of which surgical diseases are prominent. For surgical departments, prepositioning and addressing the global surgical burden through institutional partnerships built on a platform of clinical care, education and capacity building, and research are strongly encouraged. The

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