Creating an International Surgical Residency Rotation


In the United States surgical residents are complaining that on completion of training they do not feel adequately trained with the confidence to practice surgery in private practice. The American College of Surgeons has gone so far as to suggest adding an additional two years to an already five year program, a surgical preceptorship to get more responsibility. Whether this approach will work remains to be seen.

In Cambodia there are lots of cases but not enough surgeons,  Also there is a lack of incentive as surgeons are salaried.

So.  No brainer.

Rotate our American Surgical Residents to Cambodia. The rotation would be one month. The surgical resident would have a surgical clinic, see and schedule patients, do ER & trauma call, and essentially would totally be in charge. Let’s also rotate a senior surgeon, someone either retired or near retirement age, with significant experience. Many are fed up with malpractice, billings, collections, electronic records, etc. They just want to practice surgery. The senior attending would be there to assist, consult, proctor and mentor the resident.

A win – win for everybody.

So how does one accomplish this? The Residency Review Committee (RRC), a division of the American Board of Surgery (ABS) has strict regulations and a formal application process. The resident must be fully funded (which is why until now sponsorships were from individual residency programs). What this means is we must provide international airfare, local transportation (tuk-tuk personal driver), accommodations in a safe neighborhood, health insurance, and evacuation insurance. 

We have made arrangements with the G Mekong Hotel www.gmekonghotel.com which is air-conditioned, free Wi-Fi, free buffet breakfast, pool, & even a gym.

A supervising physician is required who is approved by the ABS to monitor and proctor. Full documentation of the experience must be kept to meet requirements by the American College of Surgeons (ACS), the ABS, and the RRC.

On the Cambodian side, a Memorandum of Understanding will be worked out with the involved hospital. The MOU will specify where, when, and what we plan to provide, i.e. cover clinics, operate in the OR, integrate into the existing system with ER backup, trauma call, etc., teaching and conference participation.

I envision the resident will arrive, get settled in, meet with the supervising physicians, and start in surgery clinic. All cases will be his or hers to treat appropriately which means going to the OR and operating where appropriate. The resident will integrate into ER/trauma call and provide support alongside Cambodian surgeons. The rotating resident and the attending would bring in donations so a continued supply of needed materials could be obtained.

We will use primarily Khmer Soviet Friendship Hospital in Phnom Penh.  We are looking to provide a volume of 60 cases/month which would be a combination of both major and minor cases.  If we cannot achieve enough volume at KSFH we will try to make arrangements with additional hospitals.  We will have an  MOU in place with every hospital used.  The resident would be responsible for maintaining activity logs to include clinic experience, cases seen, diagnosis, operation, operative report, and post-op follow-up.  The attending would be responsible for verifying the accuracy of the logs,

Surgeons for Cambodia, Inc. will provide both the resident and the attending with local cellphones for communication.  A  driver will be available for transportation to the hospital & back to the hotel.  

Signing in - Signing Out.  On arrival you will be met at the airport, cleared thru customs, and taken to you hotel.  IMPORTANT - you must have with you a 2x2 passport type photo that will be a part of your visa application.  Do NOT forget the picture.  At your hotel you will meet the team that will be leaving (except for the first time).  The departing surgeons will sign over their cases and turn over the cellphones to the arriving surgeons.  This provides continuity of care.

American surgical residents get cases and confidence, Cambodia gets quality care on a continuous basis.

 The Resident's Role Fact Sheet




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