title: Early experience in establishing and evaluating an ACGME-approved international general surgery rotation.
abstract: BACKGROUND
  In 2011, the Accreditation Council for Graduate Medical Education Surgery Residency Review Committee first provided guidelines for elective international general surgery rotations. The Vanderbilt general surgery residency program received Surgery Residency Review Committee approval for a fourth-year elective in Kenya beginning in the 2011-2012 academic year. Because this rotation would break ground culturally and geographically, and as an educational partnership, a briefing and debriefing process was developed for this ground-breaking year.
  
  
  OBJECTIVE
  Our objectives were to prepare residents to maximize the experience without competing for cases with local trainees or overburdening the host institution and to perform continuous quality assessment and improvement as each resident returned back.
  
  
  METHODS
  Briefing included health protection strategies, a procedures manual containing step-by-step preparation activities, and cultural-sensitivity training. Institutional Review Board exemption approval was obtained to administer a questionnaire created for returning residents concerning educational value, relations with local trainees, physical environment, and personal perceptions that would provide the scaffold for the debriefing conference.
  
  
  RESULTS
  The questionnaire coupled with the debriefing discussion for the first 9 participants revealed overall satisfaction with the rotation and the briefing process, good health, and no duty hours or days-off issues. Other findings include the following: (1) emotional effect of observing African families weigh cost in medical decision making; (2) satisfactory access to educational resources; (3) significant exposure to specialties such as urology and radiology; and (4) toleration of 4 weeks as a single and expressed need for leisure activity materials such as books, DVDs, or games. The responses triggered adjustments in the briefing sessions and travel preparation. The host institution invited the residents to return for the 2012-2013 year as well as 2013-2014.
  
  
  CONCLUSIONS
  Detailed preparation and the follow-up evaluation for assessment and improvement of this nascent international surgery experience are associated with resident satisfaction and the host institution has agreed to continue the rotation.
authors.affiliation: Surgery Education Office, Vanderbilt University, Nashville, Tennessee. Electronic address: margaret.tarpley@vanderbilt.edu.
authors.forename: Margaret
authors.initials: M
authors.lastname: Tarpley
authors.forename: Erik
authors.initials: E
authors.lastname: Hansen
authors.forename: John L
authors.initials: JL
authors.lastname: Tarpley
mesh_terms: D000068:Accreditation; D000328:Adult; D002983:Clinical Competence; D003162:Competency-Based Education; D004503:Education, Medical, Graduate / Q000458:organization & administration; D005260:Female; D013502:General Surgery / Q000193:education*; D017408:Guidelines as Topic; D006801:Humans; D033183:Interdisciplinary Communication; D007393:International Educational Exchange; D007396:Internship and Residency / Q000458:organization & administration*; D007630:Kenya; D008297:Male; D015397:Program Evaluation; D012955:Societies, Medical; D013997:Time Factors; D014481:United States
keywords: Interpersonal and Communications Skills; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; general surgery education; global surgery; international rotation; surgery education; surgical RRC