Competency of Ultrasound Knowledge of Laos Emergency Medicine Residents during International Elective Rotation in Thailand

Background: International rotations for EM residents are becoming increasingly popular. However, there is a dearth of evidence to demonstrate that these rotations can be performed utilizing the POCUS training and that residents have appropriate training, which could assist them in improving their point-of-care ultrasound (POCUS) knowledge. Objective: The researchers aimed at evaluating the POCUS knowledge of the international EM residents after the POCUS training during an international elective rotation. Materials and Methods: A curriculum was developed in the form of a 4-week rotation in the Laos EM residency program at the Department of Emergency Medicine at Khon Kaen University’s Srinagarind Hospital. It consisted of didactic lectures, bedside ultrasound trainings, the journal club, and the process of reviewing the images. Tools were developed, which included a knowledge exam, which was designed to test the residents’ image interpretation abilities and their clinical decision-making processes. The assessments were administered before and after each resident’s rotation. Results: Eight Laos EM residents completed their rotations and the tests. The average Pre-training scores and Post-training scores were 11.13+1.27 and 17.75+1.30, respectively. The average knowledge test score was found to have significantly improved from 55.63% to 88.75%. Conclusion: A POCUS training for the Laos EM residency program in the international elective rotation was able to be developed. Through participating in this training, the residents had been able to improve their basic POCUS knowledge, which will aid the emergency physicians to better care for their patients. Keywords: Ultrasound, POCUS, Emergency medicine, International cooperation

International electives in neurological surgery training: a survey of program directors from Accreditation Council for Graduate Medical Education–approved neurological surgery programs

OBJECTIVEThe burden of neurosurgical disease in low- and middle-income countries (LMICs) has emerged as a significant factor in global health. Additionally, calls have been growing for first-world neurosurgeons to find ways to help address the international need. Allowing residents to pursue international elective opportunities in LMICs can help alleviate the burden while also providing unique educational opportunities. However, pursuing international work while in residency requires overcoming significant logistical and regulatory barriers. To better understand the general perspectives, perceived barriers, and current availability of international rotations, a survey was sent out to program directors at Accreditation Council for Graduate Medical Education (ACGME)–approved residencies.METHODSAn anonymous survey was sent to all program directors at ACGME-approved residencies. The survey included branch points designed to separate programs into program directors with an existing international rotation, those interested in starting an international rotation, and those not interested in starting an international rotation. All participants were asked about the perceived value of international training and whether residents should be encouraged to train internationally on a 5-point Likert scale. The survey ended with open-response fields, encouraging thoughts on international rotations and overcoming barriers.RESULTSForty-four percent of recipients (50/113) responded; of the 50 programs, 13 had an established international elective. Of programs without a rotation, 54% (20/37) noted that they were interested in starting an international elective. Key barriers to starting international training included funding, the Residency Review Committee approval process, call conflicts, and the establishment of international partners. Perceived learning opportunities included cultural awareness, unique pathology, ingenuity, physical examination skills, and diagnosis skills. The majority of respondents thought that international rotations were valuable (74%, 37/50) and that residents should be encouraged to pursue international educational opportunities (70%, 35/50). Program directors who maintained an existing international rotation or were interested in starting an international elective were more likely to perceive international rotations as valuable.CONCLUSIONSRecent calls from The Lancet Commission on Global Surgery for increased surgical interventions in the developing world have been expanded by neurosurgical leadership to include neurosurgical diseases. Resident involvement in international electives represents an opportunity to increase treatment of neurosurgical disease in LMICs and develop the next generation of international neurosurgeons. To increase opportunities for residents at international sites, attention should be focused on overcoming the practical and regulatory barriers at a local and national level.

When Healthcare Systems Collide: An International Elective Student’s Perspective

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