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J Surg Educ. 2015 Jul-Aug;72(4):e33-45. doi: 10.1016/j.jsurg.2015.01.004. Epub 2015 Apr 14.

Distributed learning or medical tourism? A Canadian residency program's experience in global health.

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Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario. Electronic address:
Department of Medicine, University of Ottawa, Ottawa, Ontario.
Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario.



Global health experiences (GHEs) are becoming increasingly prevalent in surgical residency education. Although it may seem intuitive that participation in GHEs develops CanMEDS competencies, this has not been studied in depth in surgery. The purpose of this study is (1) to explore if and how otolaryngology-head and neck surgery (OHNS) resident participation in GHEs facilitates the development of CanMEDS competencies and (2) to develop an OHNS GHE tool to facilitate the integration of CanMEDS into GHE participation and evaluation.


An online survey explored the GHEs of current and past OHNS residents in Canada. Based on the data collected and a literature review, a foundational tool was then created to (1) enable OHNS residents to structure their GHEs into CanMEDS-related learning objectives and (2) enable OHNS program directors to more effectively evaluate residents' GHEs with respect to CanMEDS competencies.


Participants' GHEs varied widely. These experiences often contributed informally to the development of several CanMEDS competencies. However, few residents had concrete objectives, rarely were CanMEDS roles clearly incorporated, and most residents were not formally evaluated during their experience. Residents felt they achieved greater learning when predeparture objectives and postexperience reflections were integrated into their GHEs.


Although GHEs vary widely, they can serve as valuable forums for developing CanMEDS competencies among participating residents. Without clear objectives that adhere to the CanMEDS framework or formal assessment methods however, residents in GHEs risk becoming medical tourists. The use of an objective and evaluation tool may facilitate the creation of predeparture learning objectives, encourage self-reflection on their GHE, and better enable program directors to evaluate residents participating in GHEs.


CanMEDS; Interpersonal and Communication Skills; Medical Knowledge; Practice-Based Learning and Improvement; Systems-Based Practice; assessment; global health; medical education; objectives; otolaryngology; residency

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