World Journal of Surgery

, Volume 42, Issue 1, pp 32–39 | Cite as

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

  • Yihan LinEmail author
  • James S. Dahm
  • Adam L. Kushner
  • John P. Lawrence
  • Miguel Trelles
  • Lynette B. Dominguez
  • David P. Kuwayama
Original Scientific Report



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.


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.


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.


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.



The following individuals participated in a previously published paper on MSF case volumes. This analysis relied heavily upon their prior work: Evan Wong MD, Shailvi Gupta MD, and Gilbert Burnham MD PhD.

Compliance with ethical standards

Conflicts of interest

There are no financial or personal relationships which could potentially and inappropriately influence this work and conclusions.


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Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Yihan Lin
    • 1
    • 2
    Email author
  • James S. Dahm
    • 2
    • 3
  • Adam L. Kushner
    • 4
    • 5
  • John P. Lawrence
    • 6
    • 7
  • Miguel Trelles
    • 8
  • Lynette B. Dominguez
    • 8
  • David P. Kuwayama
    • 1
  1. 1.Department of SurgeryUniversity of Colorado DenverAuroraUSA
  2. 2.Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUSA
  3. 3.University of Wisconsin School of Medicine and Public HealthMadisonUSA
  4. 4.Surgeons OverSeasNew YorkUSA
  5. 5.Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  6. 6.Maimonides Medical CenterBrooklynUSA
  7. 7.Médecins Sans Frontières (MSF-USA)New YorkUSA
  8. 8.Médecins Sans Frontières (MSF), Operational Center - BrusselsBrusselsBelgium

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