American surgeons, residents and medical students are increasingly interested in global health, but a recent study published in the World Journal of Surgery suggests U.S. general surgery residents are ill-prepared for humanitarian medical work abroad.
The study compares the cases performed by Accreditation Council for Graduate Medical Education general surgery graduates to those performed at Doctors Without Borders facilities. Researchers found less than half — 43.6 percent — of the cases ACGME graduates had performed were relevant to the work of Doctors Without Borders.
The bulk of U.S. general surgery residents' training was outside of the Doctors Without Borders scope of care. However, the residents also had little training in some of the most in-demand procedures in environments dealing with war, epidemic or natural disaster. Just 2 percent of the cases performed by ACGME graduates were orthopedic and less than 1 percent were OB/GYN — two of the most commonly needed types of surgeries at Doctors Without Borders facilities. The researchers "most striking" finding was that the average American general surgery resident has never participated in a Cesarean section, which is the most common procedure performed in Doctors Without Borders projects.
The researchers also found surgical residents often did not know how to perform some surgeries in a low-technology environment, without the tools and diagnostic capabilities typically available in U.S. hospitals.
"Our study raises serious questions about the ability of current U.S. surgical training to adequately prepare graduates to be effective in such environments," the authors conclude. "Graduates of U.S. general surgical training programs spend a majority of their time in advanced general surgery and specialty care impractical in most humanitarian settings. U.S. trainees are also critically deficient in exposure to basic and essential obstetrical, gynecological and orthopedic care."
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Editor's note: This article was updated Aug. 25, 2017 at 11:50 a.m. CT to correct an error in the name of the Accreditation Council for Graduate Medical Education. It incorrectly named the organization as the American College of Graduate Medical Education. We regret this error.
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