Globalization in Pediatric Surgical Training: The Benefit of an International Fellowship in a Low-to-Middle–Income Country Academic Hospital

Abstract

Objective A relative oversupply of pediatric surgeons led to increasing difficulties in surgical training in high-income countries (HIC), popularizing international fellowships in low-to-middle–income countries (LMIC). The aim of this study was to evaluate the benefit of an international fellowship in an LMIC for the training of pediatric surgery trainees from HICs. Methods We retrospectively reviewed and compared the prospectively maintained surgical logbooks of international pediatric surgical trainees who completed a fellowship at Chris Hani Baragwanath Academic Hospital in the last 10 years. We analyzed the number of surgeries, type of involvement, and level of supervision in the operations. Data are provided in mean differences between South Africa and the respective home country. Results Seven fellows were included. Operative experience was higher in South Africa in general (Δx̅ = 381; 95% confidence interval [CI]: 236–656; p < 0.0001) and index cases (Δx̅ = 178; 95% CI: 109–279; p < 0.0001). In South Africa, fellows performed more index cases unsupervised (Δx̅ = 71; 95% CI: 42–111; p < 0.0001), but a similar number under supervision (Δx̅ = –1; 95% CI: –25–24; p = 0.901). Fellows were exposed to more surgical procedures in each pediatric surgical subspecialty. Conclusion An international fellowship in a high-volume subspecialized unit in an LMIC can be highly beneficial for HIC trainees, allowing exposure to higher caseload, opportunity to operate independently, and to receive a wider exposure to the different fields of pediatric surgery. The associated benefit for the local trainees is some reduction in their clinical responsibilities due to the additional workforce, providing them with the opportunity for protected academic and research time.

Responding to the need: An evaluation of the subspecialty units in a pediatric surgical department in a limited resource setting using selected optimal resources for children's surgery strategies

“…Zanini et al in 2021 demonstrated that of the European surgical trainees (both pre and postqualification) who visited the DPS, operative experience was higher in South Africa for all general and index pediatric surgical cases than in their country of origin, except for minimally invasive surgery. 31 The results of this study demonstrate that resources are available for the selected OReCS strategies for quality improvement in the subspecialty units of the DPS.…”

“…The contribution of the visiting trainees and surgeons to the workforce, surgeries performed, and research is regarded as invaluable by the DPS. Zanini et al in 2021 demonstrated that of the European surgical trainees (both pre and postqualification) who visited the DPS, operative experience was higher in South Africa for all general and index pediatric surgical cases than in their country of origin, except for minimally invasive surgery 31 …”