Factors influencing anesthesia residency selection: impact of global health opportunities

What Is the Current Status of Global Health Training for US Postgraduate Trainees in Anesthesiology? What Are Possible Visions for the Future?

Purpose of Review

There is a great deal of interest in global health at all levels of educational attainment. Many residency programs wish to offer a global health opportunity (GHO) but lack the resources to create one de novo. This review will look at the prevalence of global health education in residency and consider the fellowships available. It will summarize the existing recommendations about a curriculum in global health and how best to prepare trainees for a GHO.

Recent Findings

While approximately 45% of residency programs make GHOs available to their residents, there is a lack of standardization of curriculum. Logistical and ethical challenges, funding, and the lack of international partners are all barriers to offering a GHO. Residents and fellows can benefit from a GHO as it helps achieve their ACGME core competencies, among other benefits.

Summary

We make the recommendation for more robust training and education with the investment of fewer resources by aligning with existing global health participation opportunities. We also recommend the use of the Consortium of Universities for Global Health (CUGH) which provided curriculum for creating a context in global health for trainees regardless of discipline.

Development of an Open-Access Webinar Series on Pathways for Global Surgery Engagement for Applicants to US Residency Programs

BACKGROUND

Global surgery (GS) training pathways in residency are unclear and vary by specialty and program. Furthermore, information on these pathways is not always accessible. To address this gap, we produced a collection of open-access webinars for senior medical students focused on identifying GS training pathways during residency.

METHODS

The Global Surgery Student Alliance (GSSA) is a national nonprofit that engages US students and trainees in GS education, research, and advocacy. GSSA organized nine one-hour, specialty-specific webinars featuring residents of surgical specialties, anesthesia, and OBGYN programs. Live webinars were produced via Zoom from August to October 2020, and all recordings were posted to the GSSA YouTube channel. Medical students moderated webinars with predetermined standardized questions and live questions submitted by attendees. Participant data were collected in mandatory registration forms.

RESULTS

A total of 539 people were registered for 9 webinars. Among registrants, 189 institutions and 36 countries were represented. Registrants reported education/training levels from less than undergraduate education to attending physicians, while medical students represented the majority of registrants. Following the live webinars, YouTube recordings of the events were viewed 839 times. Webinars featuring otolaryngology and general surgery residents accrued the greatest number of registrations, while anesthesia accrued the least.

CONCLUSIONS

Medical students at all levels demonstrated interest in both the live and recorded specialty-specific webinars on GS in residency. To address the gap in developing global surgery practitioners, additional online, open-access education materials and mentorship opportunities are needed for students applying to US residencies.

The Preparing Residents for International Medical Experiences (PRIME) Simulation Workshop: Equipping Surgery and Anesthesia Trainees for International Rotations

INTRODUCTION

Although global health training expands clinical and sociocultural expertise for graduate medical trainees and is increasingly in demand, evidence-based courses are limited. To improve self-assessed competence for clinical scenarios encountered during international rotations, we developed and assessed a simulation-based workshop called Preparing Residents for International Medical Experiences.

METHODS

High-fidelity simulation activities for anesthesiology, surgery, and OB/GYN trainees involved three scenarios. The first was a mass casualty in a low-resource setting requiring distribution of human and material resources. In the second, learners managed a septic operative patient and coordinated postoperative care without an ICU bed available. The final scenario had learners evaluate a non-English-speaking patient with pre-eclampsia. We paired simulation with small-group discussion to address sociobehavioral factors, stress, and teaching skills. Participants evaluated the quality of the teaching provided. In addition, we measured anesthesiology trainees' self-assessed competence before and after the workshop.

RESULTS

The workshop included 23 learners over two iterations. Fifteen trainees (65%) completed the course evaluation, 93% of whom strongly agreed that the training met the stated objectives. Thirteen out of 15 (87%) anesthesiology trainees completed the competence survey. After the training, more trainees indicated confidence in providing clinical care with indirect supervision or independently. Mean self-assessed competency scores on a scale of 1-5 increased for all areas, with a mean competency increase of 0.3 (95% CI, 0.2-0.5).

DISCUSSION

Including simulation in a pretravel workshop can improve trainees' self-assessed competence for a variety of scenarios involving clinical care in limited-resource settings.

General Surgery Applicants are Interested in Global Surgery, but Does It Affect Their Rank List?

BACKGROUND

The interest of medical students and surgery residents in global surgery continues to grow. Few studies have examined how the presence of global surgery opportunities influences an applicant's decision to choose a surgical training program. We designed a survey to examine the interest in global surgery among general surgery residency applicants and the influence of a global surgery rotation on a general surgery residency applicant's rank list.

METHODS

In March 2019, an online 20-question qualitative survey was administered to all general surgery applicants to a single academic institution. Results were stratified into two applicant groups; applicants from domestic or international medical schools. The survey was designed to capture demographic information, previous global rotations or experiences, future interest in global surgery opportunities, and the importance of global surgery in choosing a residency program.

RESULT

s: A total of 179 (21% response rate) applicants completed the entire survey. Of the respondents 81% were interested in a global surgery rotation during residency, 56% considered a global surgery opportunity as moderately to extremely important to their residency rankings, 71% said they would rank a residency higher if it had a funded global surgery program compared to one without funding and 58% of the surveyed applicants were interested in incorporating global surgery into their future career.

CONCLUSIONS

Global surgery opportunities are important to some general surgery residency applicants. A majority of applicants believe a funded global surgery would positively influence their rank list. As residency programs train residents for their future careers greater consideration needs to be given to developing global surgery opportunities.

Host perspective on academic supervision, health care provision and institutional partnership during short-term electives in global health

CONTEXT

Studies about the impact of global health electives on host institutions are scarce and often made from the perspective of institutions that send students. The present research examined the impact of short-term electives in global health (STEGHs) from the under-represented perspective of host institutions in Benin.

METHODS

The authors conducted 30 semi-structured interviews from a convenience sample of Beninese health care professionals who had hosted Canadian medical students. Interviewees had previously supervised STEGHs in one of the five different institutions. A subsequent qualitative thematic analysis methodology was used to compilate codes and generate themes.

RESULTS

Hosting STEGH students motivated respondents to increase their medical knowledge through self-driven learning. They perceived an improvement in the quality of their care and felt a negligible impact on patient safety. They negatively commented on the lack of clear pedagogic objectives that they could rely on. Interviewees think current STEGH partnerships do not advantage them because institutions that send students offer little support during the electives. Furthermore, sending institutions do not offer the same opportunity for local medical students or professionals to take part in such electives outside of Benin.

CONCLUSIONS

Although host health care professionals evaluated global health electives positively overall, specific improvements could mitigate their negative impacts and help create a more balanced partnership between sending and host institutions. Sending institutions could involve host institutions in curriculum planning. They could invest in building reciprocal elective programmes to receive students from elsewhere. Meanwhile they can maximise the transfer of relevant medical knowledge, and provide expertise, resources and support during the electives.

The Impact of an International Elective on Anesthesiology Residents as Assessed by a Longitudinal Study

INTRODUCTION

Participation of anesthesiology residents in international electives may lead to the acquisition of skills as described in the Accreditation Council for Graduate Medical Education (ACGME) competencies. There is great interest in participating in such electives, but it is not clear there are educational or professional benefits. The purpose of this study was to evaluate the educational benefits of participating in overseas electives among anesthesiology residents.

METHODS

A longitudinal study design was used between 2010 and 2015 to survey all anesthesiology residents selected to participate in the nationally competitive Society for Education in Anesthesia-Health Volunteers Overseas (SEA-HVO) Traveling Fellowship Program in which third-year residents receive scholarships and ABA credit for 1-month teaching electives in a low-resource country. Pre-elective and post-elective surveys were sent via de-identified e-mails during the third year of residency. We investigated residents' expectations, plans, and comfort level with teaching techniques prior to the elective and after and asked about perceived benefits.

RESULTS

The response rate was 68.8% of the 45 residents who received the survey. Participants were motivated by professional and humanitarian goals. Residents reported improved comfort with teaching techniques, especially lecturing and giving feedback. Participants acquired better skills in assessing the learning needs of students. There was a slight but nonsignificant increased comfort dealing with cultural and language barriers. The major self-perceived unique benefit of international electives was improvement in intercultural communication. The systems' changes reported by residents as the most important to improve were those that affected patient safety.

CONCLUSION

Global health electives have a small positive effect on teaching, cultural proficiency, and systems assessment skills. Residents improve in their ability to identify educational needs and to give feedback. Patient safety during anesthetic care is appreciated as the most important systems' need.