American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

IEP Scholar Visits ACS-Italy Chapter and Observes Italian Training

Milan Hospital

I was delighted to be a delegate for the ACS-RAS 2015 International Exchange Scholarship program and to attend the 29th Annual ACS-Italy Chapter meeting in Milan. On October 23, 2015, I presented a 10-minute talk: “Global Surgery Program Partnerships,” which outlined a framework for encouraging best practices in global surgery based on the literature and my own experiences. I attended many presentations at the conference—from an update on the treatment of appendicitis and neoadjuvant chemotherapy in pancreatic cancer to a surgical resident research competition. I caught a game of Surgical Jeopardy, which was played in English. I was very impressed—it’s hard to imagine a group of American surgical residents playing such a game in their non-native language.

I also had the opportunity to visit the Ospedale Niguarda Cà Granda with Antonello Forgione, MD, PhD, MBA. My visit was arranged with the kind help of Giuseppe Nigri, MD, PhD, associate professor of surgery at Sapienza University of Rome and director of the exchange. I observed Dr. Forgione perform a roux-en-y gastric bypass in one of the hospital’s many state-of-the-art operating rooms. Through conversations with medical students, residents, and consulting surgeons, I was struck by the differences in the training schema between the U.S. and Italy. In the Italian system, residents generally take a second-assist role during operations, and newly qualified surgeons predominantly function as first-assist surgeons. Only after several years as attending physicians do surgeons become fully independent operators (with residents and new consultants assisting.) Indeed, the bypass I observed was a two-attending case. This is unusual in the U.S., where residents are frequently first assistants and are expected to be fully independent upon graduation, unless they pursue further supervised training in a fellowship. As the percentage of U.S. graduates continuing on to fellowship increases, it may be worthwhile to consider the carefully mentored development model of consultant-as-trainee support used in the Ospedale Niguarda Cà Granda and elsewhere in Italy.

The highlight of my hospital visit was the Advanced International Mini-Invasive Surgery (AIMS) Academy, of which Dr. Forgioni is scientific director. The AIMS Academy opened in 2010, and includes advanced facilities for training surgeons, from UN-style conference rooms that enable 100+ surgeons to have live interactions with remote operating surgeons in real time, to dry labs and wet labs. Efficiency in training and safety in the operating room are enhanced by the services offered at AIMS, and there is the potential to expand this capacity to cover trainees from low- and middle-income countries as well.

I am grateful for an enriching and educational experience as a RAS-ACS delegate to Italy. This exchange fosters international collaboration and collegiality amongst surgeons, and I encourage my fellow residents to participate by applying for this program, and by helping to make international residents who visit the U.S. feel welcome. I will not forget my experience in Milan, and I look forward to continuing to meet and work with my overseas colleagues in the future.