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PRS Resident Chronicles
Monday, May 12, 2014
Have you asked about Global Surgery?
by Harry Nayar, MD, MBE
 
I recently had the opportunity to attend the spring retreat of the American Council of Academic Plastic Surgeons (ACAPS) in Miami, Florida.  The subject of this years meeting was global health opportunities in plastic surgery residency.  I listened as chairmen and program directors recounted their experiences with global surgery.  Whether they were presenting epidemiologic data, offering ideas on finding time in busy clinical schedules to travel abroad, describing philanthropic efforts to secure funding, or simply sharing their life stories in international service, the tone was positive and the gaze was decidedly forward.  However, amid this spirited exchange between the academic leaders of our field, I couldn’t help but think that the one voice missing from the room was the catalyst for the entire movement- the resident. 
 
Formal global surgery training, both for domestic and foreign practitioners, is gaining momentum in the academic community, although it has traditionally been considered as a post-residency pursuit.  The Paul Farmer fellowship in Global Surgery, through a trinity of education, research, and clinical care is often held up as the standard of structured training in underserved settings.  The American Association for Hand Surgery (AAHS) supports a reverse fellowship program in Kumasi, Ghana, whereby U.S. hand surgeons travel abroad to train foreign providers, thus advancing local capabilities and infrastructure.  While these programs have undoubtedly moved us towards addressing many of the unmet needs of the world’s indigent by producing culturally competent, capable global surgeons, formal global surgery training during residency has thus far been lacking. 
 
There are three major obstacles to implementing global health training in residency: time, money, and accreditation.  There were plenty of creative strategies presented at the retreat to overcoming issues of time and money, but the latter, the issue of accreditation, was effectively solved.  The process of applying for accreditation of cases performed abroad was once considered too daunting and cumbersome to even consider, but it has been streamlined and demystified by Dr. Rohrich and the rest of the residency review committee (RRC).  Furthermore, the ACGME, which was also represented at the meeting, considers these initiatives to be unique and important components of resident surgical education.  What does this all mean for you?  Your time abroad is not taken from vacation time and the cases you perform can count towards your plastic surgery operative log.  Facilitating the pathway to accreditation is a necessary incentive to pursue global health curricula, but to maximize the uptake of global surgery programs the motivation must come from the resident body.
 
Every year for more than a decade, the chief residents at my program, the University of Wisconsin, have travelled to Nicaragua.  There, they collaborate with local practitioners to provide surgical services including clinics and didactics to one of the world’s poorest populations.  However, our training to think globally starts long before we arrive to the hospitals of Nicaragua.  Our chairman, Michael Bentz, has fostered an environment of mindful resource conservation.  Pans are left closed until it is absolutely necessary to open them, operating room time is minimized, and every suture is used to the hilt, not only because we know that what we save could be utilized abroad, but also to challenge us to operate outside of our comfort zone. This pervasive philosophy has left us as better surgeons, domestically and abroad.
 
I feel confident in saying that all plastic surgeons, in some form or the other, have an affinity to global health.  Whether that is participating in humanitarian missions or forging a career in academic global surgery, we could all benefit from structured training.  Our chairmen, program directors, and regulatory commissions have made laudable strides to making these experiences possible, but it all starts with us, the residents.  So, have you asked about global surgery?

References:
1. Campbell, A., Sherman, R., Magee, W. P. The role of humanitarian missions in modern surgical training. Plast Reconstr Surg. 2010; 126: 295-302.
2. Farmer, P. E., Kim, J. Y. Surgery and global health: a view from beyond the OR. World Journal Surg. 2008; 32: 533-536.
3. Hughes, C. D., Babigian, A., McCormack, S., et al. The clinical and economic impact of a sustained program in global plastic surgery: valuing cleft care in resource-poor settings. Plast Reconstr Surg. 2012; 87e-94e.
 
About the Blog

Plastic and Reconstructive Surgery

PRS Resident Chronicles” is the official Resident blog of Plastic and Reconstructive Surgery, the journal of the American Society of Plastic Surgeons. Visit this blog to follow the unique journeys of several young doctors as they go through residency in their respective Plastic Surgery Programs across the country.

We want to hear from Plastic Surgery Residents across the globe as well: how do you use PRS in your residency? What are some of the challenges you’ve faced and successes you’ve had? Join the on-going conversation by commenting, and if you think you have a potentially interesting-enough entry to be a unique blog post, email us at prs@plasticsurgery.org.

Bookmark the “PRS Resident Chronicles,” subscribe to the RSS feed and join in the on-going conversation with Plastic and Reconstructive Surgery. This is your journal; have fun, be respectful, get engaged and interact with the PRS community.

Keep in mind that the views and recommendations presented in this blog do not necessarily indicate official endorsements or opinions of the Publisher, PRS, or the ASPS. All views are those of the authors and the authors alone.

Rod J Rohrich, MD
Editor-in-Chief

Contributors

Andre Alcon is a fourth-year medical student at Yale University where he is starting a one year research fellowship in tissue engineering with the department of plastic and reconstructive surgery.

Ashley Amalfi is currently a fifth year Plastic Surgery Resident at Southern Illinois University School of Medicine. She attended the George Washington University and received dual degrees in Fine Arts and Art History. She returned home to attend The University of Rochester School of Medicine and Dentistry in Rochester, NY. Ashley met her husband, a urologist, during her training at SIU. She enjoys yoga, reading, travel and cooking in her free time.

Jordan Ireton is in her first of six years at the University of Texas Southwestern Plastic Surgery residency program.

 

 Anup Patel, MD, MBA, is a resident in the Yale Plastic and Reconstructive Surgery Program. He co-founded Cents of Relief, a 501(c)3 nonprofit, that empowers victims of human trafficking through health and educational initiatives including those related to reconstructive surgery. Along those lines, he has interest in surgical burden of disease and healthcare policy. He has been selected to serve on the American Society of Plastic Surgeons Board of Directors as resident representative.

 

Justin Perez is a fourth-year medical student at Weill Cornell Medical College. Born and raised in Reading, Pennsylvania, Justin moved to New York City to attend Fordham University, where he graduated summa cum laude with degrees in Biology and Spanish Literature. His academic interests include tissue engineering and wound healing, the topics of his current research. His hobbies include theater and biking.

 

Raj Sawh-Martinez, MD is a current resident at the Yale Plastic and Reconstructive Surgery program.  He grew up in Yonkers, NY and completed his undergraduate work in Neural Science at New York University.  He graduated from the Yale School of Medicine in 2011.

Ajul Shah, MD is a graduate of University of Texas Southwestern Medical School and is now a resident in his second of six years at the Yale Plastic Surgery residency program.

Jacob Unger, MD was raised in New Jersey on the shore. He attended Tulane University for his undergraduate work where he rowed on the Tulane Crew Team and majored in Philosophy. He graduated Phi Beta Kappa, Summa cum Laude with honors and then attended New York University School of Medicine. When not working, he enjoys traveling with his wife, surfing, and skiing.

Former Resident Chronicle contributors

Eamon O’Reilly, MD LCDR USN is an active duty US Navy full-time outservice resident in his second of three years at the University of Texas Southwestern Plastic Surgery residency program in Dallas, TX.