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The Benefits of a Surgical Rotation in an International Setting
*Molly J Douglas, Michael Curci
Maine Medical Center, Portland, ME

Objective: Provide a surgical residency immersion rotation in an international, resource-limited environment. Design: Western medicine’s involvement in low and middle income countries (LMICs) has historically included short term visits delivering “bursts” of needed care, while some longer duration exchange programs have sought a more integrated contribution to the healthcare system. To better understand these issues, a 4-week immersion rotation was created for a US-based 3rd year surgical resident on a pediatric surgery service alongside Rwandan faculty and residents including night call. Setting: Rwanda’s University Teaching Hospital of Kigali, the main referral hospital for the nation’s public health system. Significant institutional resource constraints included limited staffing, limited ICU capacity, and variable availability of antibiotics, suture material, radiologic and laboratory studies. Interventions: A 3rd year general surgical resident, mentored by a US board certified surgeon, rotating for 4 weeks in Kigali, Rwanda. Main Outcome Measures: Comparisons of case diversity, proportion of time spent on non-clinical tasks, and cultural and educational observations of the resident. Results: The case mix in Rwanda was more diverse. Less time was spent on “indirect care” including documentation and chart review; a paper record system encouraged economy of words. Cultural observations included a Rwandan emphasis on operative independence earlier in training and less emphasis on precise perioperative care. Environmental austerity coupled with a language barrier also improved reliance on physical exam and honed the ability to make decisions with limited information. Conclusions: An international immersion rotation increases understanding of LMICs health systems, provides a unique surgical education pertinent to the ACGME’s six competencies, and may foster an ongoing interest in global health.

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