Limited Availability of Global Health Opportunities in US Orthopaedic Trauma Fellowship Programs

Overview

Journal OTA Int

Date 2021 May 3

PMID 33937663

Authors

Jordan Shaw

Alexander Siy

James Dahm

Laura Lins

Natasha Simske

Paul Whiting

Affiliations

Soon will be listed here.

Abstract

Purpose: Orthopaedic residents are increasingly seeking international health electives (IHEs) during training, and many such experiences involve providing orthopaedic trauma care. However, little is known about the availability of IHEs during orthopaedic trauma fellowship training. The purpose of our study is to assess the global health opportunities available to US orthopaedic trauma fellows.

Method: We conducted an online, Research Electronic Data Capture (REDCap)-based survey of orthopaedic trauma fellowship program directors (PDs) in the United States. The survey link was sent by the Orthopaedic Trauma Association (OTA) Fellowship Committee to all US OTA-approved orthopaedic trauma fellowship PDs. Follow-up reminder e-mails were delivered at set time intervals from baseline over a period of 4 weeks.

Results: The overall response rate was 80% (43/54). Only 3 of 43 responding programs (7%) offer a structured global health program, but over the last 10 years, 12.5% of the remaining programs (5/40) have had a fellow participate in an IHE during fellowship training. Around 100% of PDs reported fellow satisfaction with their IHEs, and all PDs agreed that the educational experience provided by their fellows' IHE participation was valuable. Among programs with no recent fellow IHE participation and without a structured global health program, 9% of PDs (3/35) expect to institute such a program. Lack of funding, lack of established international partner sites, and fellow time away were the most common perceived barriers to IHE participation. A total of 54% of PDs agree that participation in an IHE during training plays a major role in shaping fellows' future professional and volunteer activities.

Conclusion: There are limited global health opportunities among US orthopaedic trauma fellowship programs, with only 7% (3/43) offering a structured global health program. Perceived barriers include lack of funding, lack of established partner sites, and concerns related to clinical/call coverage. Greater efforts to establish sustainable funding and international partnerships may increase opportunities for IHEs during orthopaedic trauma fellowship training.

References

Spiegel D, Gosselin R, Coughlin R, Joshipura M, Browner B, Dormans J . The burden of musculoskeletal injury in low and middle-income countries: challenges and opportunities. J Bone Joint Surg Am. 2008; 90(4):915-23. DOI: 10.2106/JBJS.G.00637. View

Morshed S, Shearer D, Coughlin R . Collaborative partnerships and the future of global orthopaedics. Clin Orthop Relat Res. 2013; 471(10):3088-92. PMC: 3773130. DOI: 10.1007/s11999-013-3145-x. View

Henry J, Groen R, Price R, Nwomeh B, Kingham T, Hardy M . The benefits of international rotations to resource-limited settings for U.S. surgery residents. Surgery. 2013; 153(4):445-54. DOI: 10.1016/j.surg.2012.10.018. View

Grigorian A, Sicklick J, Kingham T . International surgical residency electives: a collaborative effort from trainees to surgeons working in low- and middle-income countries. J Surg Educ. 2014; 71(5):694-700. PMC: 6082620. DOI: 10.1016/j.jsurg.2014.03.003. View

Klaristenfeld D, Chupp M, Cioffi W, White R . An international volunteer program for general surgery residents at Brown Medical School: the Tenwek Hospital Africa experience. J Am Coll Surg. 2008; 207(1):125-8. DOI: 10.1016/j.jamcollsurg.2008.01.025. View

Disston A, Martinez-Diaz G, Raju S, Rosales M, Berry W, Coughlin R . The international orthopaedic health elective at the University of California at San Francisco: the eight-year experience. J Bone Joint Surg Am. 2009; 91(12):2999-3004. PMC: 2780923. DOI: 10.2106/JBJS.I.00460. View

Zhang S, Shultz P, Daniels A, Ackelman E, Kamal R . High Disparity Between Orthopedic Resident Interest and Participation in International Health Electives. Orthopedics. 2016; 39(4):e680-6. DOI: 10.3928/01477447-20160419-02. View

Haskell A, Rovinsky D, Brown H, Coughlin R . The University of California at San Francisco international orthopaedic elective. Clin Orthop Relat Res. 2002; (396):12-8. DOI: 10.1097/00003086-200203000-00003. View

Shultz P, Kamal R, Daniels A, DiGiovanni C, Akelman E . International health electives in orthopaedic surgery residency training. J Bone Joint Surg Am. 2015; 97(3):e15. DOI: 10.2106/JBJS.M.01189. View

10.

Thompson M, Huntington M, Hunt D, Pinsky L, Brodie J . Educational effects of international health electives on U.S. and Canadian medical students and residents: a literature review. Acad Med. 2003; 78(3):342-7. DOI: 10.1097/00001888-200303000-00023. View

11.

Fan B, Zhao C, Sabharwal S . International elective during orthopaedic residency in North America: perceived barriers and opportunities. J Bone Joint Surg Am. 2015; 97(1):e1. DOI: 10.2106/JBJS.N.00012. View

12.

Coughlin R, Kelly N, Berry W . Nongovernmental organizations in musculoskeletal care: Orthopaedics Overseas. Clin Orthop Relat Res. 2008; 466(10):2438-42. PMC: 2584283. DOI: 10.1007/s11999-008-0412-3. View

13.

Hoehn R, Davis B, Huber N, Edwards M, Lungu D, Logan J . A systematic approach to developing a global surgery elective. J Surg Educ. 2015; 72(4):e15-20. DOI: 10.1016/j.jsurg.2015.01.011. View

14.

Clement R, Ha Y, Clagett B, Holt G, Dormans J . What is the current status of global health activities and opportunities in US orthopaedic residency programs?. Clin Orthop Relat Res. 2013; 471(11):3689-98. PMC: 3792241. DOI: 10.1007/s11999-013-3184-3. View

15.

Jafari A, Tringale K, Campbell B, Husseman J, Cordes S . Impact of Humanitarian Experiences on Otolaryngology Trainees: A Follow-up Study of Travel Grant Recipients. Otolaryngol Head Neck Surg. 2017; 156(6):1084-1087. DOI: 10.1177/0194599817691274. View

16.

Yao C, Swanson J, McCullough M, Taro T, Gutierrez R, Bradshaw A . The Medical Mission and Modern Core Competency Training: A 10-Year Follow-Up of Resident Experiences in Global Plastic Surgery. Plast Reconstr Surg. 2016; 138(3):531e-538e. DOI: 10.1097/PRS.0000000000002484. View

17.

Jense R, Howe C, Bransford R, Wagner T, Dunbar P . University of Washington orthopedic resident experience and interest in developing an international humanitarian rotation. Am J Orthop (Belle Mead NJ). 2009; 38(1):E18-20. View

18.

Matar W, Trottier D, Balaa F, Fairful-Smith R, Moroz P . Surgical residency training and international volunteerism: a national survey of residents from 2 surgical specialties. Can J Surg. 2012; 55(4):S191-9. PMC: 3432249. DOI: 10.1503/cjs.005411. View

19.

Campbell A, Sherman R, Magee W . The role of humanitarian missions in modern surgical training. Plast Reconstr Surg. 2010; 126(1):295-302. DOI: 10.1097/PRS.0b013e3181dab618. View