Perspectives of South American physicians hosting foreign rotators in emergency medicine

Abstract

BackgroundEmergency Medicine (EM) is increasingly becoming an international field. The number of fellowships in International EM in the USA is growing along with opportunities to complete international health electives (IHEs) during residency training. The impact on host institutions, however, has not been adequately investigated. The objective of this study is to assess the experience of several South American hospitals hosting foreign EM residents completing IHEs.MethodsAnonymous, semi-structured one-on-one interviews were conducted with physicians working in Emergency Departments in three hospitals in Lima, Peru and one hospital in Buenos Aires, Argentina. All participants reported previously working with EM foreign rotators. Interviews were analyzed qualitatively and coded for common themes.ResultsThree department chairs, six residents, and 15 attending physicians were interviewed (total = 24). After qualitative analysis of interviews, two broad theme categories emerged: Benefits and Challenges. Most commonly reported benefits were knowledge sharing about emergency medical systems (78%), medical knowledge transfer (58%), and long-term relationship formation (42%). Top challenges included rotator Spanish language proficiency (70%) lack of reciprocity (58%), and level of training and rotation length (25%). Spanish proficiency related directly to how involved rotators became in patient care (e.g., taking a history, participating in rounds) but was not completely prohibitive, as a majority of physicians interviewed felt comfortable speaking in English. Lack of reciprocity refers to the difficulty of sending host physicians abroad as well as failed attempts at building long-lasting relationships with foreign institutions. Lastly, 25% preferred rotators to stay for at least 1 month and rotate in the last year of EM residency. This latter preference increased knowledge transfer from rotator to host.ConclusionsOur research identified benefits and challenges of IHEs in Emergency Medicine from the perspective of physician hosts in several hospitals in South America. Our results suggest that IHEs function best when EM residents rotate later in residency training and when relationships are maintained and deepened among those involved including host physicians, rotators, and institutions. This leads to future rotators, project collaboration, research, and publications which not only benefit individuals involved but also the wider field of Emergency Medicine.

Current status of international experiences in general surgery residency programs in the United States

“…While a majority of the literature focuses on benefits to resident education, hosting institutions also receive benefit from international exchanges. O’Donnell et al ( 2014 ) found that hosting institutions for international residents found improvement in knowledge sharing, transfer of medical knowledge, and formation of long-term relationships (Lukolyo et al 2015 ). These benefits were most pronounced when the residents were toward the end of their training and focusing on their future practice and research goals.…”

“…Despite the mutual benefits, trainees do pose some challenges to host institutions including decreased efficiency and negative perceptions of hosting countries held by trainees. These and other challenges can be minimized by preparing residents prior to arrival to a host institution with education on medical, ethical, and cultural challenges that may be encountered during international experiences (O’Donnell et al 2014 ; Kraeker and Chandler 2013 ; Howe et al 2013 ). Overall, these collaborations and partnerships are gateways to facilitate cross-cultural information exchange and enhance worldwide quality of care (Shrime et al 2015 ; Klaristenfeld et al 2008 ).…”

“…These include establishing the initial contact with a foreign program, obtaining sources of funding, planning time for an international experience, and determining the ideal curriculum and length of the experience (Lett 2003 ). A rotation length of at least 4 weeks was seen as more beneficial than a shorter rotation by some host institutions (O’Donnell et al 2014 ). Didactic training prior to international experiences also enhanced the experience for both trainee and hosting institution.…”

Clinical Observership Opportunities in North America for International Orthopaedic Surgeons

“…(2) remain in country long enough to integrate into the environment, and develop a working knowledge of the local system, pathology, and surgical procedures; and (3) cultivate flexibility, particularly in recognizing that despite their training, they will not be local experts 57 . As one LMIC surgeon notes, "…you should not seek to learn how to practice medicine, but instead learn how medicine is practiced in another country" 58 .…”

International Elective Opportunities in United States Anesthesia Residency Programs

“…There are many putative concerns in sending US trainees overseas, including the potential economic effects at the host site, lack of reciprocity, language barriers, safety, and potential lack of supervision. 36 A future comprehensive survey of international partners in anesthesiology programs may clarify these questions.…”