title: An International Surgical Rotation as a Systems-Based Elective: The Botswana-University of Pennsylvania Surgical Experience.
abstract: OBJECTIVE
  There is a growing need to address the global burden of surgical disease along with increasing interest in international surgical practice, necessitating an understanding of the challenges and issues that arise on a systems level when practicing abroad.
  
  
  METHODS
  This elective is a month-long rotation in which senior surgical residents participate in patient care as part of a surgical team in the main tertiary and teaching hospital in Gaborone, the capital city of Botswana. Clinical experience is combined with formal readings and educational sessions, with the attending surgeon supervising the program to develop a systems-based curriculum that contextualizes the clinical experience. A formal debriefing and written reflections by the residents at the conclusion of the rotation are used to qualitatively assess resident development and insight into systems-based international surgical practice.
  
  
  METHODS
  Princess Marina Hospital, Gaborone, Botswana.
  
  
  METHODS
  General surgery residents in their fourth clinical year of training.
  
  
  RESULTS
  Our elective met important requirements outlined in the literature for foreign practice, including adequate supervision of the American trainees and care to not detract from local trainees' educational experience. Residents' debriefing and written reflections demonstrated an increased understanding of systems-based practice and awareness of issues important to successful international surgical practice and collaboration.
  
  
  CONCLUSIONS
  Our global surgery elective with a focus on systems-based practice sensitizes residents to the challenges and issues they must be aware of when practicing internationally.
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: jessica.cintolo@gmail.com.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Cintolo-Gonzalez
authors.affiliation: Department of Surgery, Princess Marina Hospital, Gaborone, Botswana.
authors.forename: Alemayehu Ginbo
authors.initials: AG
authors.lastname: Bedada
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jon
authors.initials: J
authors.lastname: Morris
authors.affiliation: Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Georges
authors.initials: G
authors.lastname: Azzie
mesh_terms: D001902:Botswana; D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate; D013502:General Surgery / Q000193:education*; D006801:Humans; D007393:International Educational Exchange; D007396:Internship and Residency; D010414:Pennsylvania
keywords: Interpersonal and Communication Skills; Patient Care; Professionalism; Systems-Based Practice; global health; global surgery; international electives; systems-based practice