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World J Surg. 2017 Aug 4. doi: 10.1007/s00268-017-4137-x. [Epub ahead of print]

Are American Surgical Residents Prepared for Humanitarian Deployment?: A Comparative Analysis of Resident and Humanitarian Case Logs.

Author information

1
Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave, Aurora, CO, 80045, USA. yihan.lin@ucdenver.edu.
2
Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA. yihan.lin@ucdenver.edu.
3
Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA.
4
University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, 53726, WI, USA.
5
Surgeons OverSeas, 99 Avenue B, Suite 5E, New York, 10009, NY, USA.
6
Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, 21205, MD, USA.
7
Maimonides Medical Center, 4802 10th Ave, Brooklyn, 11219, NY, USA.
8
Médecins Sans Frontières (MSF-USA), 333 7th Avenue, New York, 10001, NY, USA.
9
Médecins Sans Frontières (MSF), Operational Center - Brussels, Rue de l'Arbre Bénit 46, 1050, Brussels, Belgium.
10
Department of Surgery, University of Colorado Denver, 12631 E. 17th Ave, Aurora, CO, 80045, USA.

Abstract

BACKGROUND:

Effective humanitarian surgeons require skills in general surgery, OB/GYN, orthopedics, and urology. With increasing specialization, it is unclear whether US general surgery residents are receiving exposure to these disparate fields. We sought to assess the preparedness of graduating American surgical residents for humanitarian deployment.

METHODS:

We retrospectively analyzed cases performed by American College of Graduate Medical Education general surgery graduates from 2009 to 2015 and cases performed at select Médecins Sans Frontières (MSF) facilities from 2008 to 2012. Cases were categorized by specialty (general surgery, orthopedics, OB/GYN, urology) and compared with Chi-squared testing. Non-operative care including basic wound and drain care was excluded from both data sets.

RESULTS:

US general surgery residents performed 41.3% MSF relevant general surgery cases, 1.9% orthopedic cases, 0.1% OB/GYN cases, and 0.3% urology cases; the remaining 56.4% of cases exceeded the standard MSF scope of care. In comparison, MSF cases were 30.1% general surgery, 21.2% orthopedics, 46.8% OB/GYN, and 1.9% urology. US residents performed fewer OB/GYN cases (p < 0.01) and fewer orthopedic cases (p < 0.01). Differences in general surgery and urology caseloads were not statistically significant. Key procedures in which residents lacked experience included cesarean sections, hysterectomies, and external bony fixation.

CONCLUSION:

Current US surgical training is poorly aligned with typical MSF surgical caseloads, particularly in OB/GYN and orthopedics. New mechanisms for obtaining relevant surgical skills should be developed to better prepare American surgical trainees interested in humanitarian work.

PMID:
28779383
DOI:
10.1007/s00268-017-4137-x
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