The world of surgery is rapidly evolving, and many of our obstacles in delivery of surgical care are shared across international borders. Finding solutions to our challenges and improving the quality of care can be better facilitated and augmented through international collaboration. I was honored to receive the 2017 American College of Surgeons International Exchange Scholarship to travel to the Royal College of Surgeons in Ireland (RCSI), where I learned how the Irish have developed innovative approaches to delivering quality patient care domestically and establishing symbiotic partnerships with surgical organizations internationally.
Though small in size, Ireland is a country vast in the depth of its surgical history and international surgical influence. Founded in 1784, RCSI has produced multiple globally renowned surgeons, and is one of the most reputable training programs in the world. Interestingly, the history of the college has also been closely intertwined with the history of the country itself. During the Irish revolutionary period, Irish republicans used the building as a defense fortress from British fire, and columns along the front entrance steps retain bullet holes to this day. I was fascinated by the centuries-old anatomy lab and lecture halls. Although the college has deep historical roots, it has taken bold leaps into the future with a new world-class medical education building that has put RCSI at the international forefront of surgical training. I was impressed to tour the new surgical education building, learn about its environmentally responsible design, and to experience its new cutting edge surgical simulation center.
RCSI is extensively involved internationally as a leader in global surgery. It has formed a unique partnership with the College of Surgeons of East, Central, and Southern Africa—one of the largest surgical training institutions in Sub-Saharan Africa. Through this collaboration, RCSI has assisted African surgeons in increasing surgical and emergency care at the district level in regions of Africa with dire shortages of surgical services. I enjoyed establishing contact with residents and instructors from COSECSA who attended the Millin Meeting. I admire Ireland’s approach to international surgical aid—RCSI focuses on augmenting existing healthcare delivery infrastructure and training systems in Africa. It fosters a culture of sustainable international collaboration rather than an imposing vertical approach. Along with its global involvement through Irish Aid, RCSI also has a strong international academic presence with schools in Malaysia, Dubai, and Bahrain. I was impressed to witness the large diverse student body while attending a multidisciplinary medical student lecture on breast cancer at Beaumont Hospital, which is the designated teaching hospital for RCSI.
I enjoyed learning about surgical training in Ireland and recognizing parallels to the system we have in the United States. At RCSI, students pursue a 6-year medical school education, followed by an eight-year surgical training. The first year is intern year, followed by two years of basic surgical training as senior house officers (junior residents), and concluding with 6 years of training as specialist registrars (senior residents/fellows). Surgical trainees in Ireland rotate around the country every several months. Although this system poses unique challenges to registrars, I admire how it provides all trainees with a similar and diverse surgical training experience. I appreciated the opportunity to meet multiple specialist registrars at different stages in their surgical training, and to learn that despite our ocean of distance between each other, we share common motivations in caring for the physically ill and that our governing educational bodies cultivate a mutual interest in the betterment of our national healthcare systems through efficient, evidence-based surgical care.
Attending the Millin Meeting provided me with unique insight into the current state of surgical affairs in Ireland. The largest topics covered during the national symposium included providing uniform quality specialty and pediatric surgical care throughout Ireland, and improving the efficiency of Ireland’s public hospital system. It was inspiring to listen as Irish surgeons discussed creative approaches to their health care challenges. I found that there were many similarities between the experience of Irish registrars training in public hospitals around Dublin to my own experience training at Cook County Hospital in Chicago. We had much to share and to learn from each other. The Irish are a very kindhearted and embracing people, and their caring nature is made manifest in the warmth of their bedside manner. It was a pleasure making multiple acquaintances within the college during my visit.
I am grateful to the American College of Surgeons and the Royal College of Surgeons in Ireland for making this exchange a possibility. Through this experience I have gained insight into a foreign health care system with similar training paradigms. The Royal College of Surgeons in Ireland is setting an example of excellence in surgical care and training for the world to follow. I intend to use this experience to nurture future international collaboration in improving surgical care both domestically and globally.
