title: International health electives in orthopaedic surgery residency training.
abstract: BACKGROUND
  Residents in surgical training programs today demonstrate an increasingly strong interest in global health. Given the considerable need for specialists in underserved areas, some surgical residency programs offer international health electives in resource-poor settings to augment resident training. This study aims to quantify and to characterize international health elective opportunities among orthopaedic surgery residency programs across the United States.
  
  
  METHODS
  A web-based survey was distributed to program directors and program coordinators of the 154 U.S. orthopaedic surgery residency programs accredited by the Accreditation Council for Graduate Medical Education. Questions assessed the availability and characteristics of international health electives, the barriers to offering opportunities, and the opinions of program directors regarding the value of international health electives in orthopaedic surgery training.
  
  
  RESULTS
  Seventy-three orthopaedic surgery residency programs (47.4% response rate) responded to the survey, with twenty-four responses from program directors and forty-nine responses from program coordinators. Nineteen programs (26.0%) offer international elective training opportunities. Fifty programs had notable barriers to offering international electives. These barriers included lack of training time (thirty-seven programs [74%]), lack of funding (thirty-five programs [70%]), and lack of an international partner to facilitate an international health elective (seventeen programs [34%]). Directors of programs that offer international health electives compared with directors of programs that do not offer these electives felt more strongly that international health electives are important in residency training (mean Likert scale score of 4.2 compared with 2.65; p = 0.00195), that international health electives are valuable for residents (mean Likert scale score of 4.6 compared with 3.53; p = 0.0265), and that exposure to international health care should be required during residency training (mean Likert scale score of 3.0 compared with 1.65; p = 0.0194).
  
  
  CONCLUSIONS
  A minority of the orthopaedic surgery residency programs that participated in this study offers international health elective opportunities to trainees. Barriers such as time parameters and funding limit their availability. Our results characterize international health electives and highlight potential areas of intervention that could increase their availability to a greater number of residents.
authors: University of Chicago Medicine, 5841 South Maryland Avenue, MC3079, Chicago, IL 60637. E-mail address: paul.shultz@uchospitals.edu.
authors: Paul A
authors: PA
authors: Shultz
authors: Warren Alpert Medical School, Brown University, 2 Dudley Street, Providence, RI 02905. E-mail address for R.N. Kamal: Robin_kamal@brown.edu. E-mail address for A.H. Daniels: Alan_daniels@brown.edu. E-mail address for E. Akelman: Edward_akelman@brown.edu.
authors: Robin N
authors: RN
authors: Kamal
authors: Warren Alpert Medical School, Brown University, 2 Dudley Street, Providence, RI 02905. E-mail address for R.N. Kamal: Robin_kamal@brown.edu. E-mail address for A.H. Daniels: Alan_daniels@brown.edu. E-mail address for E. Akelman: Edward_akelman@brown.edu.
authors: Alan H
authors: AH
authors: Daniels
authors: Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center for Outpatient Care, Building 3F, Suite 3300, Boston, MA 02114. E-mail address: cwdigiovanni@partners.org.
authors: Christopher W
authors: CW
authors: DiGiovanni
authors: Warren Alpert Medical School, Brown University, 2 Dudley Street, Providence, RI 02905. E-mail address for R.N. Kamal: Robin_kamal@brown.edu. E-mail address for A.H. Daniels: Alan_daniels@brown.edu. E-mail address for E. Akelman: Edward_akelman@brown.edu.
authors: Edward
authors: E
authors: Akelman
mesh_terms: D003625:Data Collection; D004503:Education, Medical, Graduate / Q000592:standards; D014943:Global Health / Q000193:education*; D006801:Humans; D038622:Internationality; D020407:Internet; D007396:Internship and Residency / Q000592:standards; D009985:Orthopedics / Q000193:education* / Q000592:standards; D012959:Socioeconomic Factors; D014481:United States