Surgery in developing countries. Essential training in residency

Hypothesis: A surgical elective in a developing country setting is an essential new component of academic residency training. Design: A survey of residents and faculty within the Department of Surgery at the University of California, San Francisco, and a collaborative program piloted between the Department of Surgery at the University of California, San Francisco, and Makerere University in Kampala, Uganda, including a 6-week clinical elective. Setting: Mulago and Nsambya hospitals in Kampala, Uganda. Participants: Two residents and 3 faculty advisors at the University of California, San Francisco. Intervention: Development of a 6-week pilot clinical surgical elective. Main Outcome Measures: Assessment of the level of interest in international health in an academic surgery program; pathology and case variety, diagnostic methods, and surgical and anesthetic resources and techniques in a pilot developing country. Results: Forty percent of residents enter residency with prior international health experience whereas 90% express interest in a developing country elective. Twentyfive percent of faculty participate in voluntary international surgical service and research projects. As a result of the survey and the level of interest in our program, 2 visits to Uganda were made and a residency elective rotation was successfully created. This resulted in exposure of residents to the educational benefits of learning in a resource-constrained setting: a broader scope of surgical conditions and pathology, greater reliance on history-taking and physical examination skills in a lowtechnology environment, and sociocultural aspects of care provision. Greater questions about global health equity, access to information, and the role of surgery in public health are raised along with potential challenges in international collaboration. Conclusions: A developing country surgical experience complements the academic mission of service, training, and research and should be an essential component of surgical training programs. There is interest among residents and faculty in such a program as well as a need for greater commitment to north-south collaborations among academic surgical institutions and societies, as has been successfully implemented abroad. More generally, surgery is an integral part of public health and health systems development worldwide.