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

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.

Assessment of Local Health Worker Attitudes toward International Medical Volunteers in Low- and Middle-income Countries: A Global Survey

“…However, targeted subspecialty practitioners were more often requested, notably OB/GYN and Emergency Medicine. This reflects existing literature on surgical caseloads from humanitarian organizations, showing frequent OB/GYN and orthopedic cases [ 16 ].…”

Australasian general surgical training and emergency medical teams: a review

“…Lin et al . conducted a comparative analysis between the logbooks of general surgical trainees in USA between 2009 and 2015 and the procedures performed by MSF between 2008 and 2012.…”

“…39,40 Non-operative management of penetrating abdominal trauma in patients who meet strict criteria is also gaining popularity. 41 Lin et al 6 conducted a comparative analysis between the logbooks of general surgical trainees in USA between 2009 and 2015 and the procedures performed by MSF between 2008 and 2012. The authors found that the US general surgical trainees had minimal experience in orthopaedic and obstetric surgery, while both featured prominently in the logbooks of MSF surgeons.…”

“…Emergency medical teams (EMTs) have been an established option to provide surgical care in many recent sudden‐onset disasters (SODs), particularly in low‐ and middle‐income countries (LMICs) where chronic deficiencies in health infrastructure often exist . The versatility of general surgeons are well suited to a central role in EMTs, but with the increasing subspecialization in general surgical training in both Australia and other high‐income countries (HICs), concerns have been raised about where general surgeons with the appropriate skillset will be found . This review explores the importance of general surgeons in EMTs and outlines some of the challenges facing the suitable training of general surgeons in Australasia for this role.…”

Health Care Providers in War and Armed Conflict: Operational and Educational Challenges in International Humanitarian Law and the Geneva Conventions, Part II. Educational and Training Initiatives

“…New mechanisms for obtaining relevant surgical skills should be developed to better prepare surgical trainees from industrialized countries interested in humanitarian work. 61 As such, knowledge of the surgical skills required to adequately respond to humanitarian emergencies is essential to prepare surgeons and plan for interventions. MSF's review of required surgical skills urgently called for a basic skill set that any aspiring volunteer surgeon needs to be familiar with in resource-limited humanitarian emergency settings, 62 and much of that basic skill set is also the basis for the ICRC War Surgery Seminar.…”