Advertisement

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

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.

Notes

Acknowledgements

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.

References

  1. 1.
    Leow JJ, Kingham TP, Casey KM et al (2010) Global surgery: thoughts on an emerging surgical subspecialty for students and residents. J Surg Educ 67(3):143–148CrossRefPubMedGoogle Scholar
  2. 2.
    Powell AC, Casey K, Liewehr DJ et al (2009) Results of a national survey of surgical resident interest in international experience, electives, and volunteerism. J Am Coll Surg 208(2):304–312CrossRefPubMedGoogle Scholar
  3. 3.
    Meara JG, Leather AJM, Hagander L et al (2015) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 386:569–624CrossRefPubMedGoogle Scholar
  4. 4.
    Chu K, Rosseel R, Trelles M et al (2010) Surgeons Without borders: a brief history of surgery at Medecins Sans Frontieres. World J Surg 34:411–414. doi: 10.1007/s00268-009-0187-z CrossRefPubMedGoogle Scholar
  5. 5.
    Drake FT, Horvath KD, Goldin AB et al (2013) The general surgery chief resident operative experience: 23 years of national ACGME Case logs. JAMA Surg 148(9):841–847CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Accreditation Council for Graduate Medical Education (ACGME) ACGME Case Log Statistical Reports. Chicago. http://www.acgme.org/Data-Collection-Systems/Case-Logs-Statistical-Reports. Accessed Aug 1 2016
  7. 7.
    Wong EG, Trelles M, Dominguez L et al (2014) Surgical skills needed for humanitarian missions in resource-limited settings: common operative procedures performed at Medecins Sans Frontieres facilities. Surgery 156(3):642–649CrossRefPubMedGoogle Scholar
  8. 8.
    Merchant A, Valenzuela JY, Lyon C et al (2016) Creating a Global acute care surgery fellowship to meet international need. JACS 223(4):e120–e121Google Scholar
  9. 9.
    Knudson MM, Tarpley MJ, Numann PJ (2015) Global surgery opportunities for U.S. surgical residents: an interim report. J Surg Educ 72(4):e60–e65CrossRefPubMedGoogle Scholar
  10. 10.
  11. 11.
    Nygaard RM, Daly SR, Van Camp JM (2015) General surgery resident case logs: do they accurately reflect resident experience? J Surg Educ 72(6):e178–e183CrossRefPubMedGoogle Scholar
  12. 12.
    Nickerson JW, Chackungal S, Knowlton L et al (2012) Surgical care during humanitarian crises: a systematic review of published surgical caseload data from foreign medical teams. Prehospital Disaster Med 27(2):184–189CrossRefPubMedGoogle Scholar
  13. 13.
    Peoples GE, Gerlinger T, Craig R et al (2005) Combat casualties in afghanistan cared for by a single forward surgical team during the initial phases of operation enduring freedom. Mil Med 170(6):462CrossRefPubMedGoogle Scholar
  14. 14.
    Mock CN, Donkor P, Gawande A et al (2015). Essential surgery: key messages from Disease Control Priorities, 3rd edition. Lancet 385(9983):2209–2219CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Yihan Lin
    • 1
    • 2
  • 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

Personalised recommendations