Journal Article

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

Dahm, James S., Lin, Yihan, Lawrence, John P., Trelles, Miguel, Kushner, Adam L., Dominguez, Lynette B., Kuwayama, David P.

2018

Overview

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.

• Publisher: Springer International Publishing,John Wiley & Sons, Inc
• Subject: Abdominal Surgery / Altruism / Cardiac Surgery / Charities / Clinical Competence / Comparative analysis / Education, Medical, Graduate - organization & administration / Education, Medical, Graduate - standards / Female / General Surgery / General Surgery - education / General Surgery - standards / Graduates / Gynecologic Surgical Procedures - education / Gynecologic Surgical Procedures - standards / Humanitarian aid / Humans / Internship and Residency - standards / Medical Missions / Medical personnel / Medical residencies / Medicine / Medicine & Public Health / Original Scientific Report / Orthopedic Procedures - education / Orthopedic Procedures - standards / Orthopedics / Pregnancy / Relief Work / Retrospective Studies / Skills / Specialization / Statistical analysis / Statistical tests / Surgery / Thoracic Surgery / United States / Urology / Vascular Surgery / Wounds