title: Do international rotations make surgical residents more resource-efficient? A preliminary study.
abstract: OBJECTIVE
  Interest in international surgery among general surgery residents in the United States has been shown in several publications. Several general surgery residency programs have reported their experiences with international surgery rotations (ISRs). Learning to use limited resources more efficiently is often cited as a benefit of such rotations. We hypothesized that general surgery residents become more resource efficient after they have completed an ISR.
  
  
  METHODS
  Laboratory, radiologic, and diagnostic studies ordered on 2900 patients by 21 general surgery residents over 65 months at a single institution were analyzed retrospectively. The patient populations they wrote orders on were assessed for similarity in age, gender, and diagnoses. The outcomes in those patient populations were assessed by duration of stay and in-hospital mortality. Six (29%) of these residents (ISR residents) completed a 1-month ISR during their third year of residency. Their orders were compared with their classmates who did not participate in an ISR (NISR residents). The results were compared between the 2 cohorts from both before and after their international rotations. An analysis focused on comparing the changes from pre-ISR to post-ISR. A survey was also sent after objective data were collected to all residents and alumni involved in the study to assess their subjective perception of changes in their resource efficiency and to characterize their ISRs.
  
  
  RESULTS
  Patient populations were similar in terms of demographics and diagnoses. ISR residents generated an average of $122 less in orders per patient per month after their ISR compared with before. NISR residents generated an average of $338 more in orders per patient per month after the ISRs compared with before (p = 0.04). Pre-ISR order charges were statistically similar. Similar results were observed when radiologic/diagnostic study orders were analyzed independently. Differences in outcomes were statistically insignificant. The survey revealed that most of the ISR residents perceived that their attitude toward ordering tests and laboratories was influenced greatly by their ISR, and all the ISR residents perceived that they became more resource efficient than their peers after their ISRs.
  
  
  CONCLUSIONS
  These preliminary findings seem to indicate increased resource efficiency among general surgery residents who completed an ISR. However, the sample size of residents was small, and we could not establish conclusively a causal relationship to their ISRs. A more extensive study is needed if reliable conclusions are to be drawn regarding the effect of ISRs on the resource efficiency of residents.
authors.affiliation: Department of Surgery, Christ Community Health Services, Memphis, Tennessee 38104, USA. jason.oliphant@christchs.org
authors.forename: Jason L
authors.initials: JL
authors.lastname: Oliphant
authors.forename: Ronell R
authors.initials: RR
authors.lastname: Ruhlandt
authors.forename: Stanley R
authors.initials: SR
authors.lastname: Sherman
authors.forename: Marc G
authors.initials: MG
authors.lastname: Schlatter
authors.forename: Joel A
authors.initials: JA
authors.lastname: Green
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003162:Competency-Based Education; D016001:Confidence Intervals; D017046:Cost Savings; D003430:Cross-Sectional Studies; D004503:Education, Medical, Graduate / Q000191:economics* / Q000379:methods; D005260:Female; D013502:General Surgery / Q000191:economics / Q000193:education*; D006801:Humans; D007391:International Cooperation; D007393:International Educational Exchange / Q000191:economics* / Q000706:statistics & numerical data; D007396:Internship and Residency / Q000191:economics*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D040841:Resource Allocation; D012189:Retrospective Studies; D014481:United States