Miller Christopher, Lundy Paige, Woodrow Sarah
1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and.
2Department of Neurological Surgery, Cleveland Clinic, Akron, Ohio.
J Neurosurg. 2020 Jul 10;134(6):1967-1973. doi: 10.3171/2020.4.JNS20618. Print 2021 Jun 1.
The burden of neurosurgical disease in low- and middle-income countries (LMICs) has emerged as a significant factor in global health. Additionally, calls have been growing for first-world neurosurgeons to find ways to help address the international need. Allowing residents to pursue international elective opportunities in LMICs can help alleviate the burden while also providing unique educational opportunities. However, pursuing international work while in residency requires overcoming significant logistical and regulatory barriers. To better understand the general perspectives, perceived barriers, and current availability of international rotations, a survey was sent out to program directors at Accreditation Council for Graduate Medical Education (ACGME)-approved residencies.
An anonymous survey was sent to all program directors at ACGME-approved residencies. The survey included branch points designed to separate programs into program directors with an existing international rotation, those interested in starting an international rotation, and those not interested in starting an international rotation. All participants were asked about the perceived value of international training and whether residents should be encouraged to train internationally on a 5-point Likert scale. The survey ended with open-response fields, encouraging thoughts on international rotations and overcoming barriers.
Forty-four percent of recipients (50/113) responded; of the 50 programs, 13 had an established international elective. Of programs without a rotation, 54% (20/37) noted that they were interested in starting an international elective. Key barriers to starting international training included funding, the Residency Review Committee approval process, call conflicts, and the establishment of international partners. Perceived learning opportunities included cultural awareness, unique pathology, ingenuity, physical examination skills, and diagnosis skills. The majority of respondents thought that international rotations were valuable (74%, 37/50) and that residents should be encouraged to pursue international educational opportunities (70%, 35/50). Program directors who maintained an existing international rotation or were interested in starting an international elective were more likely to perceive international rotations as valuable.
Recent calls from The Lancet Commission on Global Surgery for increased surgical interventions in the developing world have been expanded by neurosurgical leadership to include neurosurgical diseases. Resident involvement in international electives represents an opportunity to increase treatment of neurosurgical disease in LMICs and develop the next generation of international neurosurgeons. To increase opportunities for residents at international sites, attention should be focused on overcoming the practical and regulatory barriers at a local and national level.
低收入和中等收入国家（LMICs）的神经外科疾病负担已成为全球健康的一个重要因素。此外，呼吁第一世界的神经外科医生设法帮助满足国际需求的声音越来越多。允许住院医师在低收入和中等收入国家寻求国际选修机会有助于减轻负担，同时也提供独特的教育机会。然而，住院医师期间从事国际工作需要克服重大的后勤和监管障碍。为了更好地了解总体观点、感知到的障碍以及国际轮转的当前可用性，向研究生医学教育认证委员会（ACGME）认可的住院医师培训项目主任发送了一份调查问卷。
向ACGME认可的住院医师培训项目的所有项目主任发送了一份匿名调查问卷。该调查包括一些分支问题，旨在将项目分为已有国际轮转的项目主任、有兴趣开展国际轮转的项目主任以及没有兴趣开展国际轮转的项目主任。所有参与者被问及对国际培训的感知价值，以及是否应该鼓励住院医师在国际上进行培训，采用5分制李克特量表。调查以开放式回答字段结束，鼓励对国际轮转和克服障碍发表看法。
44%的收件人（50/113）回复；在这50个项目中，13个有既定的国际选修项目。在没有轮转项目的项目中，54%（20/37）表示有兴趣开展国际选修项目。开展国际培训的主要障碍包括资金、住院医师评审委员会的审批程序、值班冲突以及建立国际合作伙伴。感知到的学习机会包括文化意识培养、独特的病理学、创造力、体格检查技能和诊断技能。大多数受访者认为国际轮转很有价值（74%，37/50），并且应该鼓励住院医师寻求国际教育机会（70%，35/50）。维持现有国际轮转或有兴趣开展国际选修项目的项目主任更有可能认为国际轮转有价值。
《柳叶刀》全球外科委员会最近呼吁在发展中国家增加外科手术干预，神经外科领域的领导层已将其扩展到包括神经外科疾病。住院医师参与国际选修项目是一个增加低收入和中等收入国家神经外科疾病治疗机会以及培养下一代国际神经外科医生的契机。为了增加住院医师在国际机构的机会，应将注意力集中在克服地方和国家层面的实际和监管障碍上。
