Surgical residents’ opinions on international surgical residency in Flanders, Belgium

Background International electives benefit training of medical residents due to exposure to an increased scope of pathologies, improved physical examination skills, communication across cultural boundaries and more efficient resource utilization. Currently there is no mechanism for Belgian surgical residents to participate in international training opportunities and little research has addressed the international mobility of Belgian residents. The goal of this study was to examine the attitudes of Belgian residents towards international training among surgical residents. Methods An anonymous, structured electronic questionnaire was sent to a cohort of Belgian residents, including surgical residents, by e-mail and social media. Results In total, 342 respondents filled out the questionnaire out of a total of 5906 Belgian residents. The results showed that 334 of the residents came from Flanders (10.8%) and 8 came from French-speaking Brussels and Wallonia (0.28%). Surgical specialties represented 46% of respondents and included surgical, obstetric and anaesthesiology residents. The majority (98%) were interested in an international rotation, both in low- and middle-income countries (LMICs) and in high-income countries. A total of 84% were willing to conduct an international rotation during holidays and 91% would participate even when their international stay would not be recognised as part of their residency training. A minority (38%) had undertaken an international rotation in the past and, of those, 5% went to an LMIC. Conclusion The majority of surgical residents consider an international rotation as educationally beneficial, even though they are rarely undertaken. Our survey shows that in order to facilitate foreign rotations, Flemish universities and governmental institutions will have to alleviate the regulatory, logistical and financial constraints.

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.

Neurological Surgery Training Abroad as a Progression to the Final Year of Training and Transition to Independent Practice

Background Residents at the University of Virginia spend 1 year abroad at a neurological surgery program prior to their chief year. The Accreditation Council for Graduate Medical Education (ACGME) considers international rotations elective experiences and does not count them toward clinical accreditation. Objective We compared clinical training obtained in New Zealand (NZ) to data from US ACGME-accredited programs to see if it was reasonable to reconsider the former as clinical training. Methods We compared US national average chief case volumes to those performed by University of Virginia residents rotating in NZ over the past 3 years, using case volume comparisons and a survey of the residents' experience. Results The mean number of cases performed in NZ was above the 50th percentile for US averages for adult cranial cases, including the 70th to 90th percentile for aneurysms and 50th to 70th percentile for tumors. The average number of cases performed in 1 year in NZ satisfied the cranial case quota for 4 of 6 adult and 2 of 3 pediatric areas over the entire residency. The rotation doubled the cranial exposure of graduating residents at the chief level without diluting the experience of residents in the core program. All residents reported being “very satisfied” with the experience, noting it facilitated their transition to chief year and independent practice. Conclusions Clinical training obtained during an international rotation in NZ is comparable to that attained in the United States. The international experience in NZ facilitated advancement in all 6 competencies, and should be considered adequate for clinical neurological surgery education.