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

Heather J Roberts; Patrick D Albright; David W Shearer; Nae Won; Madeline C MacKechnie; R Richard Coughlin; Theodore Miclau 3rd; Saam Morshed; Sanjeev Sabharwal; COACT Resident Rotation Study Group

doi:10.1016/j.amjsurg.2020.08.046

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

Am J Surg. 2021 Feb;221(2):245-253. doi: 10.1016/j.amjsurg.2020.08.046. Epub 2020 Sep 12.

Authors

Heather J Roberts¹, Patrick D Albright², David W Shearer³, Nae Won⁴, Madeline C MacKechnie⁵, R Richard Coughlin⁶, Theodore Miclau 3rd⁷, Saam Morshed⁸, Sanjeev Sabharwal⁹; COACT Resident Rotation Study Group

Collaborators

COACT Resident Rotation Study Group:
John Dawson¹⁰, Brian Davis¹¹, Alan Daniels¹², Milton Little¹³, John Garlich¹⁴, Chad Coles¹⁵, Ross Leighton¹⁶, Michael Maceroli¹⁷, Sandra Hobson¹⁸, Chris Bray¹⁹, Duretti Fufa²⁰, Sariah Khormaee²¹, Brian Mullis²², Roman M Natoli²³, Babar Shafiq²⁴, Jimmy Mackenzie²⁵, Danny Wongworawat²⁶, Lee Zuckerman²⁷, Joshua Speirs²⁸, Charles F Carr²⁹, Michael Mackechnie³⁰, George Dyer³¹, Melvin Makhni³², Kiran Agarwal-Harding³³, Brandon Yuan³⁴, Matt Beal³⁵, Danielle Chun³⁶, Andrew Furey³⁷, Brad Petrisor³⁸, Yongjung Kim³⁹, Ken Egol⁴⁰, Christian Pean⁴¹, Blake Schultz⁴², Darin Friess⁴³, Zach Working⁴⁴, Grant Sun⁴⁵, Henry Boateng⁴⁶, Michael Gardner⁴⁷, Malcolm DeBaun⁴⁸, Blake Schultz⁴⁹, Saquib Rehman⁵⁰, Eric Gokcen⁵¹, J Milo Sewards⁵², Nicholas Bernthal⁵³, Zachary Burke⁵⁴, Alex Upfill Brown⁵⁵, Melissa Esparza⁵⁶, Peter O'Brien⁵⁷, David Stockton⁵⁸, Kevin Neal⁵⁹, Nathan O'Hara⁶⁰, Arun Hariharan⁶¹, Peter Cole⁶², Ann Van Heest⁶³, Patrick Horst⁶⁴, Brandon Kelly⁶⁵, Mauricio Kfuri⁶⁶, Karl Lalonde⁶⁷, Jaimo Ahn⁶⁸, Samir Mehta⁶⁹, Matt Winterton⁷⁰, Luke Lopas⁷¹, James Kellam⁷², Thomas Higgins⁷³, Iain Elliot⁷⁴, Paul Whiting⁷⁵, Jordan T Shaw⁷⁶, Nathaniel M Wilson⁷⁶, William Obremskey⁷⁷, Cassandra A Lee⁷⁸, Keith Kenter⁷⁹, Joseph Weistroffer⁸⁰, Josh Veenstra⁸¹, David Knowles⁸², Devin Conway⁸³, Aung Thein Htay⁸⁴, Myat Thu Wynn⁸⁵, Dr Peter Smitham⁸⁶, Dr Dino Aguilar⁸⁷, Amanda J McCoy⁸⁸, Kiprono Koech⁸⁸, Ian Orwa⁸⁸, Marvin Wekesa⁸⁸, Francis Mbugua⁸⁹, Daniel D Galat⁸⁹, John Mandela⁸⁹, David Jomo⁸⁹, James Kinyua⁹⁰, Mbonisi Malaba⁹⁰, Felix Kuguru⁹⁰, Fasto Yugusuk⁹⁰, Pierre Woolley⁹¹, Marc-Alain Pean⁹², Billy Haonga⁹³, Edmund Eliezer⁹⁴, Samuel Hailu⁹⁵, Fre Alemseged⁹⁶, Linda Chokotho⁹⁷, Allman Tinoco⁹⁸, Bibek Banskota⁹⁹, Scott Nelson¹⁰⁰, Francisco Alberto Hernandez Vargas¹⁰¹

Affiliations

¹ University of California, Department of Orthopaedic Surgery, 500 Parnassus Ave MU320-W, San Francisco, CA, USA, 94143. Electronic address: heather.roberts@ucsf.edu.
² University of California, Department of Orthopaedic Surgery, 500 Parnassus Ave MU320-W, San Francisco, CA, USA, 94143; University of Minnesota Medical School, Department of Orthopedic Surgery, 2512 S 7th St, Suite R200, Minneapolis, MN, USA, 55455. Electronic address: patrick.d.albright@gmail.com.
³ University of California, Department of Orthopaedic Surgery, 500 Parnassus Ave MU320-W, San Francisco, CA, USA, 94143. Electronic address: david.shearer@ucsf.edu.
⁴ University of California, Department of Orthopaedic Surgery, 500 Parnassus Ave MU320-W, San Francisco, CA, USA, 94143. Electronic address: nae.won@ucsf.edu.
⁵ University of California, Department of Orthopaedic Surgery, 500 Parnassus Ave MU320-W, San Francisco, CA, USA, 94143. Electronic address: madeline.mackechnie@ucsf.edu.
⁶ University of California, Department of Orthopaedic Surgery, 500 Parnassus Ave MU320-W, San Francisco, CA, USA, 94143. Electronic address: richard.coughlin@ucsf.edu.
⁷ University of California, Department of Orthopaedic Surgery, 500 Parnassus Ave MU320-W, San Francisco, CA, USA, 94143. Electronic address: theodore.miclau@ucsf.edu.
⁸ University of California, Department of Orthopaedic Surgery, 500 Parnassus Ave MU320-W, San Francisco, CA, USA, 94143. Electronic address: saam.morshed@ucsf.edu.
⁹ University of California, Department of Orthopaedic Surgery, 500 Parnassus Ave MU320-W, San Francisco, CA, USA, 94143. Electronic address: sanjeev.sabharwal@ucsf.edu.
¹⁰ Baylor College of Medicine Program. Electronic address: John.Dawson@bcm.edu.
¹¹ Baylor College of Medicine Program. Electronic address: Brian.Davis2@bcm.edu.
¹² Brown University Program. Electronic address: alandanielsmd@gmail.com.
¹³ Cedars-Sinai Medical Center Program. Electronic address: Milton.Little@cshs.org.
¹⁴ Cedars-Sinai Medical Center Program. Electronic address: john.garlich@cshs.org.
¹⁵ Dalhousie University. Electronic address: coles@dal.ca.
¹⁶ Dalhousie University. Electronic address: r.k.leighton@ns.sympatico.ca.
¹⁷ Emory University School of Medicine Program. Electronic address: mmacerol@gmail.com.
¹⁸ Emory University School of Medicine Program. Electronic address: sandralhobson@gmail.com.
¹⁹ Greenville Health System/University of South Carolina Program. Electronic address: Christopher.Bray@prismahealth.org.
²⁰ Hospital for Special Surgery/Cornell Medical Center Program. Electronic address: FufaD@hss.edu.
²¹ Hospital for Special Surgery/Cornell Medical Center Program. Electronic address: sariah.khormaee@gmail.com.
²² Indiana University School of Medicine Program. Electronic address: bmullis@iupui.edu.
²³ Indiana University School of Medicine Program. Electronic address: rnatoli@IUHealth.org.
²⁴ Johns Hopkins University Program. Electronic address: bshafiq2@jhmi.edu.
²⁵ Johns Hopkins University Program. Electronic address: jmacken6@jhmi.edu.
²⁶ Loma Linda University Health Education Consortium Program. Electronic address: dwongworawat@llu.edu.
²⁷ Loma Linda University Health Education Consortium Program. Electronic address: lzuckerman@llu.edu.
²⁸ Loma Linda University Health Education Consortium Program. Electronic address: Jspeirs@llu.edu.
²⁹ Mary Hitchcock Memorial Hospital/DartmouthHitchcock Program. Electronic address: charles.f.carr@hitchcock.org.
³⁰ Mary Hitchcock Memorial Hospital/DartmouthHitchcock Program. Electronic address: michael.mackechnie@gmail.com.
³¹ Massachusetts General Hospital/Brigham and Women's Hospital/Harvard Medical School Program. Electronic address: gdyer@mgh.harvard.edu.
³² Massachusetts General Hospital/Brigham and Women's Hospital/Harvard Medical School Program. Electronic address: mmakhni@bwh.harvard.edu.
³³ Massachusetts General Hospital/Brigham and Women's Hospital/Harvard Medical School Program. Electronic address: kiran.agarwalharding@gmail.com.
³⁴ Mayo Clinic College of Medicine and Science (Rochester) Program. Electronic address: Yuan.Brandon@mayo.edu.
³⁵ McGaw Medical Center of Northwestern University Program. Electronic address: mbeal@nm.org.
³⁶ McGaw Medical Center of Northwestern University Program. Electronic address: Danielle-Chun@northwestern.edu.
³⁷ Memorial University of Newfoundland. Electronic address: afurey99@gmail.com.
³⁸ McMaster University. Electronic address: petrisb@mcmaster.ca.
³⁹ New York Presbyterian Hospital (Columbia Campus) Program. Electronic address: yk2299@cumc.columbia.edu.
⁴⁰ New York University School of Medicine/NYU Langone Orthopedic Hospital Program. Electronic address: Kenneth.Egol@nyulangone.org.
⁴¹ New York University School of Medicine/NYU Langone Orthopedic Hospital Program. Electronic address: christian.pean@nyulangone.org.
⁴² New York University School of Medicine/NYU Langone Orthopedic Hospital Program. Electronic address: blakeschultzmd@gmail.com.
⁴³ Oregon Health & Science University Program. Electronic address: friessd@ohsu.edu.
⁴⁴ Oregon Health & Science University Program. Electronic address: workingz@ohsu.edu.
⁴⁵ Oregon Health & Science University Program. Electronic address: grant.s.sun@gmail.com.
⁴⁶ Penn State Milton S Hershey Medical Center Program. Electronic address: hboateng@pennstatehealth.psu.edu.
⁴⁷ Stanford Health CareSponsored Stanford University Program. Electronic address: michaelgardner@stanford.edu.
⁴⁸ Stanford Health CareSponsored Stanford University Program. Electronic address: mdebaun@stanford.edu.
⁴⁹ Stanford Health CareSponsored Stanford University Program. Electronic address: blakeschultzmd@gmail.com.
⁵⁰ Temple University Hospital Program. Electronic address: Saqib.Rehman@tuhs.temple.edu.
⁵¹ Temple University Hospital Program. Electronic address: Eric.Gokcen@tuhs.temple.edu.
⁵² Temple University Hospital Program. Electronic address: jmilo.sewards@tuhs.temple.edu.
⁵³ UCLA David Geffen School of Medicine/UCLA Medical Center Program. Electronic address: NBernthal@mednet.ucla.edu.
⁵⁴ UCLA David Geffen School of Medicine/UCLA Medical Center Program. Electronic address: ZBurke@mednet.ucla.edu.
⁵⁵ UCLA David Geffen School of Medicine/UCLA Medical Center Program. Electronic address: AUpfillBrown@mednet.ucla.edu.
⁵⁶ University of Arizona College of Medicine-Phoenix Program (Banner). Electronic address: melissa.esparza@gmail.com.
⁵⁷ University of British Columbia. Electronic address: peter.obrien@vch.ca.
⁵⁸ University of British Columbia. Electronic address: djstockton@telus.net.
⁵⁹ University of Florida College of Medicine Jacksonville Program. Electronic address: Kevin.Neal@nemours.org.
⁶⁰ University of Maryland Program. Electronic address: NO'Hara@som.umaryland.edu.
⁶¹ University of Maryland Program. Electronic address: ahariharan@som.umaryland.edu.
⁶² University of Minnesota Program. Electronic address: peter.a.cole@healthpartners.com.
⁶³ University of Minnesota Program. Electronic address: vanhe003@umn.edu.
⁶⁴ University of Minnesota Program. Electronic address: horst.patrick@gmail.com.
⁶⁵ University of Minnesota Program. Electronic address: kell1401@umn.edu.
⁶⁶ University of Missouri-Columbia Program. Electronic address: kfurim@health.missouri.edu.
⁶⁷ University of Ottawa. Electronic address: karllalonde@toh.ca.
⁶⁸ University of Pennsylvania Health System Program. Electronic address: Jaimo.Ahn@pennmedicine.upenn.edu.
⁶⁹ University of Pennsylvania Health System Program. Electronic address: Samir.Mehta@uphs.upenn.edu.
⁷⁰ University of Pennsylvania Health System Program. Electronic address: mattwinterton@gmail.com.
⁷¹ University of Pennsylvania Health System Program. Electronic address: lalopas04@gmail.com.
⁷² University of Texas Health Science Center at Houston Program. Electronic address: james.f.kellam@uth.tmc.edu.
⁷³ University of Utah Program. Electronic address: thomas.higgins@hsc.utah.edu.
⁷⁴ University of Utah Program. Electronic address: elliott.iain@gmail.com.
⁷⁵ University of Wisconsin Hospitals and Clinics Program. Electronic address: Whiting@ortho.wisc.edu.
⁷⁶ University of Wisconsin Hospitals and Clinics Program.
⁷⁷ Vanderbilt University Medical Center Program. Electronic address: william.obremskey@vumc.org.
⁷⁸ Wake Forest University School of Medicine Program. Electronic address: casslee@ucdavis.edu.
⁷⁹ Western Michigan University Homer Stryker MD School of Medicine Program. Electronic address: keith.kenter@med.wmich.edu.
⁸⁰ Western Michigan University Homer Stryker MD School of Medicine Program. Electronic address: joseph.weistroffer@med.wmich.edu.
⁸¹ Western Michigan University Homer Stryker MD School of Medicine Program. Electronic address: joshua.veenstra@med.wmich.edu.
⁸² Western Michigan University Homer Stryker MD School of Medicine Program. Electronic address: david.knowles@med.wmich.edu.
⁸³ Yale-New Haven Medical Center Program. Electronic address: Devin.conway@yale.edu.
⁸⁴ Yangon Orthopedic Hospital. Electronic address: dr.ath.ypa@gmail.com.
⁸⁵ Yangon Orthopedic Hospital. Electronic address: myatthuwynn@icloud.com.
⁸⁶ Royal Adelaide Hospital.
⁸⁷ Hospital Antonio Lenín Fonseca de Managua.
⁸⁸ Tenwek Mission Hospital.
⁸⁹ AIC Kijabe Hospital.
⁹⁰ CURE International Hospital Kenya.
⁹¹ La Paix Hospital. Electronic address: pmwoolley06@icloud.com.
⁹² La Paix Hospital. Electronic address: marcalainpean@hotmail.com.
⁹³ Muhimbili Orthopaedic Institute. Electronic address: bhaonga@gmail.com.
⁹⁴ Muhimbili Orthopaedic Institute. Electronic address: ndalama@yahoo.com.
⁹⁵ Tikur Anbessa Teaching Hospital. Electronic address: samiethio@gmail.com.
⁹⁶ Tikur Anbessa Teaching Hospital. Electronic address: friyatom@gmail.com.
⁹⁷ Beit Cure International Hospital (Malawi). Electronic address: lindachokotho@gmail.com.
⁹⁸ Hospital San Juan de Dios. Electronic address: allmantinocolukez@gmail.com.
⁹⁹ Hospital and Rehabilitation Centre for Disabled Children.
¹⁰⁰ Hospital Adventiste d'Haiti. Electronic address: scottnelsonmd@gmail.com.
¹⁰¹ Hospital Escuela Antonio Lenin Fonseca. Electronic address: franckohv@gmail.com.

PMID: 33092782
DOI: 10.1016/j.amjsurg.2020.08.046

Abstract

Background: Despite interest among North American orthopaedic residents to pursue rotations in resource-limited settings, little is known regarding resident motivations and impact on host surgeons.

Methods: Surveys were distributed to North American orthopaedic surgeons and trainees who participated in international rotations during residency to assess motivations for participation and to orthopaedic surgeons at partnering low- and middle-income country (LMIC) institutions to assess impact of visiting trainees.

Results: Responses were received from 136 North American resident rotators and 51 LMIC host surgeons and trainees. North American respondents were motivated by a desire to increase surgical capacity at the LMIC while host surgeons reported a greater impact from learning from residents than on surgical capacity. Negative aspects reported by hosts included selfishness, lack of reciprocity, racial discrimination, competition for surgical experience, and resource burdens.

Conclusions: The motivations and impact of orthopaedic resident rotations in LMICs need to be aligned. Host perceptions and bidirectional educational exchange should be incorporated into partnership guidelines.

Keywords: Education; Global surgery; International rotation; Low- and middle-income country; Orthopaedic residency.

MeSH terms

Adult
Developing Countries
Female
Humans
International Cooperation*
Internship and Residency / organization & administration*
Internship and Residency / statistics & numerical data
Male
Middle Aged
Motivation*
North America
Orthopedic Procedures / education
Orthopedics / education*
Orthopedics / statistics & numerical data
Surgeons / psychology*
Surgeons / statistics & numerical data
Surveys and Questionnaires