UCSF Benioff Children's Hospital of Oakland, Oakland, California.
University of California San Francisco, San Francisco, California.
J Bone Joint Surg Am. 2020 Jun 17;102(12):e60. doi: 10.2106/JBJS.19.01150.
Although efforts have been made to address the inequities of surgical care globally, to our knowledge, there has been no comprehensive analysis of orthopaedic clinical observerships in North America that are available for international surgeons.
Two investigators performed a systematic online search to identify orthopaedic clinical observerships that are available in the United States and Canada for international surgeons. Variables such as host type, geographic location of host site, program type, eligibility criteria, subspecialty focus, application and participation fees, availability of funding, duration of observership, and the quality of online information that is available based on an online content (OC) score were collected.
Of the 113 available observership sponsors in North America, 36 (32%) were professional-society-based, 69 (61%) were academic/institution-based, and 8 (7%) were private-practice-based. Most observerships were located in the U.S. (n = 85) and, of these, the Northeast was the most common U.S. region (n = 29, p = 0.008). Of the observerships with a focus, pediatrics was the most frequent orthopaedic subspecialty (p < 0.0001), followed by spine and trauma. Professional-society-sponsored observerships offered funding to international surgeons more often than academic/institution-based and privately sponsored programs (p < 0.0001). The average OC score for the entire cohort was 2.35 and was similar among the 3 host types (p = 0.954). The program structure and requirements such as applicant eligibility, application and participation fees, and duration of observership varied widely.
There are opportunities for international orthopaedic surgeons to participate in clinical observerships in North America. Given the greater funding support and lack of fees for professional-society-sponsored observerships, these observerships may pose fewer financial barriers for surgeons from low and middle-income countries (LMICs). The quality of online information was similar among the 3 different host types and can be improved.
The relevance and impact of a clinical observership experience in North America for a practicing orthopaedic surgeon from an LMIC need to be explored further.
尽管全球已经在努力解决外科护理方面的不平等问题，但据我们所知，目前还没有对北美可供国际外科医生参加的骨科临床观摩课程进行全面分析。
两名调查员进行了系统的在线搜索，以确定美国和加拿大为国际外科医生提供的骨科临床观摩课程。收集的变量包括主办方类型、主办地点的地理位置、项目类型、资格标准、专业重点、申请和参与费用、资金可用性、观摩期限以及基于在线内容（OC）评分的在线可用信息质量。
在北美 113 个可供选择的观摩课程中，有 36 个（32%）是专业协会主办的，69 个（61%）是学术/机构主办的，8 个（7%）是私人诊所主办的。大多数观摩课程都位于美国（n=85），其中东北部是最常见的美国地区（n=29，p=0.008）。在以重点关注为特色的观摩课程中，儿科是最常见的骨科亚专业（p<0.0001），其次是脊柱和创伤。专业协会主办的观摩课程比学术/机构主办和私人赞助的课程更经常为国际外科医生提供资金（p<0.0001）。整个队列的平均 OC 评分为 2.35，在 3 种主办方类型中相似（p=0.954）。课程结构和要求，如申请人资格、申请和参与费用以及观摩期限，差异很大。
国际骨科外科医生有机会参加北美的临床观摩课程。鉴于专业协会主办的观摩课程提供更多的资金支持且不收取费用，这些观摩课程可能对来自低收入和中等收入国家（LMIC）的外科医生来说，财务障碍较小。3 种不同主办方类型的在线信息质量相似，可以进一步提高。
需要进一步探讨北美临床观摩经历对来自 LMIC 的执业骨科外科医生的相关性和影响。
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