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J Surg Educ. 2015 Jul-Aug;72(4):e60-5. doi: 10.1016/j.jsurg.2015.03.010. Epub 2015 Apr 25.

Global surgery opportunities for U.S. surgical residents: an interim report.

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Department of Surgery, University of California, San Francisco General Hospital and Trauma Center, San Francisco, California.
Department of Surgery, Vanderbilt University, Nashville, Tennessee. Electronic address:
Department of Surgery Emerita, SUNY Upstate Medical University, Syracuse, New York.



In 2011, the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Surgery developed guidelines that allowed time spent and cases performed outside of the United States by surgical residents from ACGME-accredited training programs to be applied toward program completion. We hypothesized that the number of programs with global surgical rotations would have increased after that important development. We also sought to determine the characteristics that led to sustainment of such programs.


An Institutional Review Board-approved electronic survey was sent to all 253 program directors of ACGME-approved general surgery residencies requesting information on international rotations available to residents. Responses were requested from program directors with extant rotations. Survey questions focused on locations, funding, nature of the rotations, faculty involvement, keys to success, and the barriers to overcome during program development and sustainment.


The survey reported 34 surgery residency programs offering global surgery rotations, up from 23 just 5 years previously. Of these reporting programs, 25 have been approved by the ACGME. Most rotations occur in the postgraduate year 3 or 4 and are primarily clinical rotations. Africa is the main destination. Resident supervision is provided by a mixture of host and home surgeons. A dedicated faculty is considered to be the most important element for success while funding remains a major impediment.


The interest in global surgery continues to increase, and general surgical programs will strive to meet the expectations of residents looking for international exposure. Collaboration could facilitate resident opportunities and potentially be more cost-effective.


Interpersonal and Communication Skills; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; global surgery; graduate medical education; international medical education; international surgical rotations; surgery education; surgery electives

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