Scholars discuss their experience
The authors interviewed seven current and past U.S. scholars about their experience. Though they ranged in training level and specialty, many common themes were noted in their experiences.
Most scholars wanted to learn more about how their host country’s health system tackled problems in their specialty of interest. Leigh Anne Dageforde, MD, FACS, assistant professor of surgery, Massachusetts General Hospital, Boston, traveled to Ireland in 2013 as a research resident because she had an interest in multi-visceral transplant. When she arrived, Dr. Dageforde was surprised by how consolidated the transplant system was compared with the U.S. system.
“They only have one transplant center hospital for each organ, and it’s the size of Indiana,” Dr. Dageforde said. “If you think about one hospital to the whole country, that’s so different than us. In New England, we have 14 kidney transplant centers.”
David Hampton, MD, FACS, assistant professor of trauma and acute care surgery, the University of Chicago, IL, chose to travel to Beirut, Lebanon, because he had never been to the Middle East. “The biggest goal was just seeing how things were done somewhere else. I knew it wasn’t a resource difference, but rather seeing different cultural attitudes and how that interfered with or accelerated patient care,” he said.
Dr. Hampton noticed some differences in practice but overall didn’t see any difference in outcomes, illustrating that there are many ways to deliver quality medical care. The biggest surprise while observing a surgical service was that the operating rooms were located in the basement to keep staff and patients safe in case of an attack, and armed security guards were at the door to the operating rooms, he said.
Alejandra M. Casar Berazaluce, MD, a postgraduate year three (PGY-3) resident in general surgery at the University of Texas Health Science Center at San Antonio, was inspired by her experience as a medical student in Mexico to explore surgical training at the Royal Australasian College of Surgeons (RACS).
In Australia, “It’s not just like here where you’ve matched and then you’re expected to graduate,” she said. “In Australia, there’s a lot of randomness with respect to advancing forward and ultimately finishing a training program.”
Dr. Casar Berazaluce said she was struck by “how much organization and power the trainees had in creating real change for surgical training. They were actually developing their own life skills and competency-based curriculum to streamline their training.”
Rebecca Williams-Karnesky, MD, PhD, MEdPsych, a PGY-4 in general surgery at the University of New Mexico, Albuquerque, is looking forward to her experience at the RACS—on hold at press time because of the coronavirus pandemic—“because they’ve done a lot of work on bullying and diversity, equity, and inclusivity (DEI). I’d love to build some collaborations and talk to the content experts…it would be really cool to import some of their ideas to the U.S.”
As a past traveler to one of the RACS meetings, Dr. Williams-Karnesky said she enjoyed the “refreshing forward-thinking ‘meeting of the minds’ over there” on issues related to DEI and health care disparities. She recalled listening to an expert at the meeting who had “so much breadth of knowledge on disparities in health care delivery, across so many ranges of race, ethnicity, socioeconomic status diversity, and a lot sociological theories for health care. And I think that those types of things were just reaching the U.S.”
Katy Flynn-O’Brien, MD, a senior pediatric surgery fellow at the Medical College of Wisconsin, Milwaukee, was interested in learning about variations in the surgical training system: “I was able to talk a lot with both trainees [and faculty] about the differences between the American system and the system in Ireland. I learned a lot about their system, but also shared a lot about our system. So, it felt like it was mutually beneficial,” she said.
Many of the scholars had the opportunity to meet some of the “big names” in surgery and make serendipitous connections with surgeons in their specialty. At the conferences, Dr. Flynn-O’Brien met a world-renowned pediatric surgeon who mentored her mentor, and Dr. Casar Berazaluce was grateful to have the opportunity to speak with Barbara L. Bass, MD, FACS, FRCSI(Hon), FRCSEd(Hon), FCOSECSA(Hon), and Adil Haider, MD, FACS.
During her time in the hospital, Dr. Dageforde spent a day with a prominent transplant surgeon in Ireland before applying to fellowship. One of his former mentees, Maria B. Majella Doyle, MD, FACS, is now an attending at Washington University, St. Louis, MO, where Dr. Dageforde went on to complete her fellowship. She recalls, “I actually do think there was some kind of fun networking that happened [because Dr. Doyle] is a mentor for me now.”
Sharven Taghavi, MD, FACS, assistant professor of surgery, Tulane University, New Orleans, LA, traveled to Australia to explore the differences in rural and urban trauma care. He said being part of the exchange program “provided a great opportunity for me to advance my career because of the connections I made both within the College and by going to the meeting in Australia. It was a great career development value and a great career development opportunity.”
The ACS also has been mindful about maximizing the impact of the exchange beyond intercultural exchange and relationships. Dr. Dageforde appreciated the opportunity to provide a written piece on her experience. “I think as a resident it’s really nice…when I got back, [the College] asked me to write something up [for the Bulletin], which gave me a non–peer-reviewed publication. I think it added nicely to my CV [curriculum vitae].”
