International Elective During Orthopaedic Residency in North America: Perceived Barriers and Opportunities

Fan, Bensen; Zhao, Chen; Sabharwal, Sanjeev

doi:10.2106/jbjs.n.00012

Cited by 13 publications

(17 citation statements)

References 25 publications

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“…O rthopaedic resident interest in LMIC rotations continues to grow 2,3,8 , an unsurprising trend considering the opportunities it affords HIC residents to honor their humanitarian ideals through immersive exposure to a new pathology and surgical technique. This article highlights several points on HIC surgical resident rotations in LMICs and the need for future orthopaedic research on this topic, particularly from the LMIC perspective.…”

Section: Resultsmentioning

confidence: 99%

“…To our knowledge, this is the first systematic review to interpret data on surgical resident rotations in LMICs. Despite strong interest in these rotations from orthopaedic programs 2,3,8 , literature reporting their motivations and impact is sparse. Thus, for this analysis, we included surgical resident rotations beyond orthopaedics to identify practices that minimize harm and share benefits with LMIC partners 43,44 .…”

Section: Discussionmentioning

confidence: 99%

“…Although lack of funding has long been considered prohibitive to implementing such orthopaedic rotations 4 , new models of orthopaedic partnerships within LMICs 5,6 and evidence for the cost-effectiveness of global orthopaedic care 7 have increased LMIC orthopaedic access. Today, over 25% of North American orthopaedic residency programs offer some form of international training 2,[8][9][10][11] .…”

mentioning

confidence: 99%

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Clinical Observership Opportunities in North America for International Orthopaedic Surgeons

Carrillo

Segarra

Sabharwal

2020

Journal of Bone and Joint Surgery

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Introduction: Interest in clinical rotations in low-and middle-income countries (LMICs) has grown among high-income country (HIC) orthopaedic residents. This study addresses the following questions: (1) What motivates HIC surgical residents to rotate in LMICs? (2) What is the impact of rotations on HIC residents? (3) What are the LMIC partner perceptions of HIC collaboration? Materials and Methods: A search strategy of multiple databases returned 3,740 unique articles pertaining to HIC surgical resident motivations for participating in rotations in LMICs or the LMIC host perspective. Data extraction was dually performed using meta-ethnography, the qualitative equivalent of meta-analysis. Results: Twenty-one studies were included in the final analysis. HIC residents were primarily motivated to rotate in LMICs by altruistic intent, with greatest impact on professional development. LMIC partners mostly valued HIC sustained investment and educational opportunities for LMIC partners. From LMIC's perspective, potential harm from collaboration arose from system-level and individual-level discordance between HIC and LMIC expectations and priorities. HIC priorities included the following: (1) adequate operative time, (2) exposure to varied pathology, and (3) mentorship. LMIC priorities included the following: (1) avoiding competition with HIC residents for surgical cases, (2) that HIC groups not undermine LMIC internal authority, (3) that HIC initiatives address local LMIC needs, and (4) that LMIC partners be included as authors on HIC research initiatives. Both HIC and LMIC partners raised ethical concerns regarding collaboration and perceived HIC residents to be underprepared for their LMIC rotation. Discussion: This study synthesizes the available literature on HIC surgical resident motivations for and impact of rotating in LMICs and the LMIC host perception of collaboration. Three improvement categories emerged: that residents (1) receive site-specific preparation before departure, (2) remain in country long enough to develop site-specific skills, and (3) cultivate flexibility and cultural humility. Specific suggestions based on synthesized data are offered for each concept and can serve as a foundation for mutually beneficial international electives in LMICs for HIC orthopaedic trainees.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical Observership Opportunities in North America for International Orthopaedic Surgeons

Carrillo

Segarra

Sabharwal

2020

Journal of Bone and Joint Surgery

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“…Our survey indicates that there are limited opportunities for international health electives during fellowship training among North American paediatric orthopaedic fellowship programmes. Compared with orthopaedic residency programmes, paediatric orthopaedic fellowships have fewer structured global health programmes (11.5% versus 12% to 32%) 6,10,11 and lower rates of IHE participation (42.3% versus 61%). 6 This is surprising given the fact that paediatric orthopaedics is often identified as the most prevalent subspecialty for international volunteerism within orthopaedics.…”

Section: Discussionmentioning

confidence: 99%

“…16 Nearly all other IHE studies have shown funding to be a major concern, with 90% of programmes believing finances are at least a moderate barrier. 6,10,11 Orthopaedic department funding is often the primary funding source, with donations and private grants commonly listed as additional sources of support. 6 Despite 59% of programmes offering at least some financial support, many residents often pay a portion or the entire cost of their experience abroad.…”

Section: Discussionmentioning

confidence: 99%

Availability of global health opportunities in North American Paediatric Orthopaedic Fellowship Programmes

Siy

Lins

Dahm

et al. 2018

Journal of Children's Orthopaedics

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PurposeOrthopaedic residents are increasingly seeking international health electives (IHEs) during training, many of which involve providing paediatric orthopaedic care. However, little is known about the availability of IHEs during orthopaedic fellowship training. Our study sought to assess the global health opportunities available to North American paediatric orthopaedic fellows.MethodsWe conducted an online, REDCap-based survey of paediatric orthopaedic fellowship programme directors (PDs) in the United States and Canada. The survey link was sent by the Pediatric Orthopaedic Society of North America (POSNA) Evidence-Based Medicine Committee to all POSNA-approved paediatric orthopaedic fellowship PDs. Follow-up reminder emails were delivered at set time intervals.ResultsThe overall response rate was 55% (26/47). Only three of 26 responding programmes (11.5%) offered a structured global health programme but 42.3% of programmes (11/26) reported fellow IHE participation within the last ten years. In all, 91% of PDs reported that fellows were extremely satisfied with their IHE, and 91% agreed that IHEs are valuable for trainees. Perceived barriers to fellow participation in IHEs included lack of funding, lack of established partner sites, lack of interest among fellows and concerns related to time away compromising clinical/call coverage. In all, 65.4% of PDs agree that IHE participation during training plays a major role in shaping fellows’ future volunteer activities.ConclusionThere are limited global health opportunities among North American paediatric orthopaedic fellowship programmes, with only 11.5% offering a structured global health programme. Greater efforts to establish sustainable funding and international partnerships may increase opportunities for IHEs during paediatric orthopaedic fellowship training.Level of EvidenceLevel II

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Motivations and impact of international rotations in low- and middle-income countries for orthopaedic surgery residents: Are we on the same page?

Roberts

Albright²,

Shearer

et al. 2021

The American Journal of Surgery

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International Elective During Orthopaedic Residency in North America: Perceived Barriers and Opportunities

Cited by 13 publications

References 25 publications

Clinical Observership Opportunities in North America for International Orthopaedic Surgeons

Clinical Observership Opportunities in North America for International Orthopaedic Surgeons

Availability of global health opportunities in North American Paediatric Orthopaedic Fellowship Programmes

Motivations and impact of international rotations in low- and middle-income countries for orthopaedic surgery residents: Are we on the same page?

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