title: What is the current status of global health activities and opportunities in US orthopaedic residency programs?
abstract: BACKGROUND
  Interest in developing national health care has been increasing in many fields of medicine, including orthopaedics. One manifestation of this interest has been the development of global health opportunities during residency training.
  
  
  OBJECTIVE
  We assessed global health activities and opportunities in orthopaedic residency in terms of resident involvement, program characteristics, sources of funding and support, partner site relationships and geography, and program director opinions on global health participation and the associated barriers.
  
  
  METHODS
  An anonymous 24-question survey was circulated to all US orthopaedic surgery residency program directors (n = 153) by email. Five reminder emails were distributed over the next 7 weeks. A total of 59% (n = 90) program directors responded.
  
  
  RESULTS
  Sixty-one percent of responding orthopaedic residencies facilitated clinical experiences in developing countries. Program characteristics varied, but most used clinical rotation or elective time for travel (76%), which most frequently occurred during Postgraduate Year 4 (57%) and was used to provide pediatric (66%) or trauma (60%) care. The majority of programs (59%) provided at least some funding to traveling residents and sent accompanying attendings on all ventures (56%). Travel was most commonly within North America (85%), and 51% of participating programs have established international partner sites although only 11% have hosted surgeons from those partnerships. Sixty-nine percent of residency directors believed global health experiences during residency shape future volunteer efforts, 39% believed such opportunities help attract residents to a training program, and the major perceived challenges were funding (73%), faculty time (53%), and logistical planning (43%).
  
  
  CONCLUSIONS
  Global health interest and activity are common among orthopaedic residency programs. There is diversity in the characteristics and geographical locations of such activity, although some consensus does exist among program directors around funding and faculty time as the largest challenges.
authors.affiliation: Department of Orthopaedics, University of North Carolina, 3147 Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC, 27514, USA, carter.clement@gmail.com.
authors.forename: R Carter
authors.initials: RC
authors.lastname: Clement
authors.forename: Yoonhee P
authors.initials: YP
authors.lastname: Ha
authors.forename: Bartholt
authors.initials: B
authors.lastname: Clagett
authors.forename: Ginger E
authors.initials: GE
authors.lastname: Holt
authors.forename: John P
authors.initials: JP
authors.lastname: Dormans
mesh_terms: D003299:Cooperative Behavior; D003479:Curriculum; D003906:Developing Countries / Q000191:economics; D014943:Global Health / Q000191:economics; D006801:Humans; D007391:International Cooperation; D007396:Internship and Residency / Q000191:economics; D009313:National Health Programs / Q000191:economics; D009985:Orthopedics / Q000191:economics / Q000193:education*; D011795:Surveys and Questionnaires; D014195:Travel / Q000191:economics; D014481:United States
references.citation: J Bone Joint Surg Am. 2002 Jun;84(6):1086-94
references.pmid: 12063353
references.citation: J Pediatr Surg. 2011 Dec;46(12):2244-9
references.pmid: 22152858
references.citation: Am J Med. 2011 Sep;124(9):881-5
references.pmid: 21658664
references.citation: Clin Orthop Relat Res. 2008 Oct;466(10):2438-42
references.pmid: 18685907
references.citation: J Bone Joint Surg Am. 2000 Mar;82(3):433-6
references.pmid: 10724235
references.citation: Med Educ. 1979 Jan;13(1):28-30
references.pmid: 763179
references.citation: J Otolaryngol Head Neck Surg. 2011 Feb;40(1):81-5
references.pmid: 21303607
references.citation: Clin Orthop Relat Res. 2008 Oct;466(10):2377-84
references.pmid: 18712457
references.citation: J Am Coll Surg. 2008 Jul;207(1):125-8
references.pmid: 18589371
references.citation: Arch Surg. 2008 Sep;143(9):860-5; discussion 865
references.pmid: 18794423
references.citation: Health Serv Res. 2001 Feb;35(6):1347-55
references.pmid: 11221823
references.citation: Clin Orthop Relat Res. 2002 Mar;(396):30-5
references.pmid: 11859219
references.citation: J Grad Med Educ. 2011 Sep;3(3):414-6
references.pmid: 22942976
references.citation: Clin Orthop Relat Res. 2002 Mar;(396):12-8
references.pmid: 11859217
references.citation: Acad Med. 2008 Oct;83(10 Suppl):S53-7
references.pmid: 18820502
references.citation: Can J Surg. 2012 Aug;55(4):S191-9
references.pmid: 22854155
references.citation: Pediatrics. 2008 Jul;122(1):28-33
references.pmid: 18595983
references.citation: J Am Coll Surg. 2009 Mar;208(3):426-33
references.pmid: 19318005
references.citation: Acad Med. 2009 Mar;84(3):320-5
references.pmid: 19240438
references.citation: Clin Orthop Relat Res. 2008 Oct;466(10):2422-7
references.pmid: 18685910
references.citation: Am J Orthop (Belle Mead NJ). 2009 Jan;38(1):E18-20
references.pmid: 19238270
references.citation: Acad Emerg Med. 2002 Jul;9(7):679-83
references.pmid: 12093707
references.citation: J Clin Epidemiol. 1997 Oct;50(10):1129-36
references.pmid: 9368521
references.citation: J Surg Educ. 2007 May-Jun;64(3):143-9
references.pmid: 17574175
references.citation: World J Surg. 2011 Jan;35(1):17-21
references.pmid: 21052998
references.citation: Fam Med. 1998 Jan;30(1):29-33
references.pmid: 9460613
references.citation: J Am Coll Surg. 2007 Jul;205(1):162-8
references.pmid: 17617344
references.citation: Acta Orthop. 2011 Dec;82(6):737-43
references.pmid: 22066554
references.citation: Clin Pediatr (Phila). 2012 Sep;51(9):862-71
references.pmid: 22752293