title: Perspectives of South American physicians hosting foreign rotators in emergency medicine.
abstract: BACKGROUND
  Emergency Medicine (EM) is increasingly becoming an international field. The number of fellowships in International EM in the USA is growing along with opportunities to complete international health electives (IHEs) during residency training. The impact on host institutions, however, has not been adequately investigated. The objective of this study is to assess the experience of several South American hospitals hosting foreign EM residents completing IHEs.
  
  
  METHODS
  Anonymous, semi-structured one-on-one interviews were conducted with physicians working in Emergency Departments in three hospitals in Lima, Peru and one hospital in Buenos Aires, Argentina. All participants reported previously working with EM foreign rotators. Interviews were analyzed qualitatively and coded for common themes.
  
  
  RESULTS
  Three department chairs, six residents, and 15 attending physicians were interviewed (total = 24). After qualitative analysis of interviews, two broad theme categories emerged: Benefits and Challenges. Most commonly reported benefits were knowledge sharing about emergency medical systems (78%), medical knowledge transfer (58%), and long-term relationship formation (42%). Top challenges included rotator Spanish language proficiency (70%) lack of reciprocity (58%), and level of training and rotation length (25%). Spanish proficiency related directly to how involved rotators became in patient care (e.g., taking a history, participating in rounds) but was not completely prohibitive, as a majority of physicians interviewed felt comfortable speaking in English. Lack of reciprocity refers to the difficulty of sending host physicians abroad as well as failed attempts at building long-lasting relationships with foreign institutions. Lastly, 25% preferred rotators to stay for at least 1 month and rotate in the last year of EM residency. This latter preference increased knowledge transfer from rotator to host.
  
  
  CONCLUSIONS
  Our research identified benefits and challenges of IHEs in Emergency Medicine from the perspective of physician hosts in several hospitals in South America. Our results suggest that IHEs function best when EM residents rotate later in residency training and when relationships are maintained and deepened among those involved including host physicians, rotators, and institutions. This leads to future rotators, project collaboration, research, and publications which not only benefit individuals involved but also the wider field of Emergency Medicine.
authors: Department of Neurology, University of Utah Health Sciences Center, Salt Lake City 84132, UT, USA.
authors: Steve
authors: S
authors: O'Donnell
authors: Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester 14642, NY, USA.
authors: David H
authors: DH
authors: Adler
authors: Department of Emergency Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City 64110, MO, USA.
authors: Pholaphat Charles
authors: PC
authors: Inboriboon
authors: Clínica San Pablo, Av. El Polo 789-Monterrico, Perú
authors: Hermenegildo
authors: H
authors: Alvarado
authors: Department of Emergency Medicine, Cayetano Heredia University, Av. Honorio Delgado 350 Urb. Ingeniería, S.M.P Lima 31, Perú
authors: Raul
authors: R
authors: Acosta
authors: Trauma and Orthopedics, Hospital Italiano, Buenos Aires C1181ACH, Argentina.
authors: Daniel
authors: D
authors: Godoy-Monzon
keywords: Emergency medicine; Global health; International Emergency Medicine; International Health Elective; Residency education
references: Acad Med. 2003 Mar;78(3):342-7
references: 12634222
references: Acad Emerg Med. 2007 Nov;14(11):1047-51
references: 17967967
references: Mayo Clin Proc. 2010 Aug;85(8):734-41
references: 20675512
references: Int J Emerg Med. 2012 Nov 13;5(1):43
references: 23148459