Author(s): Carrillo, Laura A; Segarra, Borja; Sabharwal, Sanjeev | Abstract: BackgroundAlthough efforts have been made to address the inequities of surgical care globally, to our knowledge, there has been no comprehensive analysis of orthopaedic clinical observerships in North America that are available for international surgeons.MethodsTwo investigators performed a systematic online search to identify orthopaedic clinical observerships that are available in the United States and Canada for international surgeons. Variables such as host type, geographic location of host site, program type, eligibility criteria, subspecialty focus, application and participation fees, availability of funding, duration of observership, and the quality of online information that is available based on an online content (OC) score were collected.ResultsOf the 113 available observership sponsors in North America, 36 (32%) were professional-society-based, 69 (61%) were academic/institution-based, and 8 (7%) were private-practice-based. Most observerships were located in the U.S. (n = 85) and, of these, the Northeast was the most common U.S. region (n = 29, p = 0.008). Of the observerships with a focus, pediatrics was the most frequent orthopaedic subspecialty (p l 0.0001), followed by spine and trauma. Professional-society-sponsored observerships offered funding to international surgeons more often than academic/institution-based and privately sponsored programs (p l 0.0001). The average OC score for the entire cohort was 2.35 and was similar among the 3 host types (p = 0.954). The program structure and requirements such as applicant eligibility, application and participation fees, and duration of observership varied widely.ConclusionsThere are opportunities for international orthopaedic surgeons to participate in clinical observerships in North America. Given the greater funding support and lack of fees for professional-society-sponsored observerships, these observerships may pose fewer financial barriers for surgeons from low and middle-income countries (LMICs). The quality of online information was similar among the 3 different host types and can be improved.Clinical relevanceThe relevance and impact of a clinical observership experience in North America for a practicing orthopaedic surgeon from an LMIC need to be explored further.

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Clinical Observership Opportunities in North America for International Orthopaedic Surgeons.

Background There is substantial disparity in access to surgical care worldwide that largely impacts children in resource-limited environments. Although it has been suggested that surgeons in high-income countries work alongside their overseas peers to bridge this gap, there is limited information regarding the impact of pediatric orthopaedic observerships that are available to international surgeons. This study aimed to assess the perceived impact of such visitations on overseas surgeons, including their professional development and clinical practice. Methods A survey was distributed to overseas surgeons who participated in a pediatric orthopaedic observership in North America in the years 2009 to 2019. Details were collected regarding each respondent's demographics and observership program, and the impact of this short-term clinical experience as perceived by the visiting surgeon. Results Of the 181 international surgeons from 56 countries who participated in a pediatric orthopaedic observership, most were young male surgeons residing in a middle-income nation. The majority of surgeons observed in outpatient clinics (98%) and in the operating room (96%) and attended educational in-house conferences (92%). Most observers (75%) acknowledged gaining relevant orthopaedic knowledge and clinical skills that improved local patient care, and nearly all (99%) shared the newly acquired knowledge with their peers and trainees. Most (97%) were still living and working in the country that had been their residence at the time of their observership. No noteworthy trends were identified between the income classification of the surgeons' country of residence and their ability to incorporate the acquired skills into their practice. Conclusions Participating in a North American pediatric orthopaedic observership has a positive perceived impact on the majority of visiting surgeons, with potential gains in clinical skills and knowledge that likely benefit their patients, peers, and trainees. Such participation does not contribute to substantial brain drain and may assist with local capacity building. Identifying ways to increase access to such educational opportunities, particularly for surgeons from lower-income countries, should be explored further.

Pediatric Orthopaedic Observerships in North America for International Surgeons: The Visitor's Perspective.

International observerships are one of many efforts aimed at addressing disparities in orthopaedic trauma care globally. However, their impact on visiting surgeons and their home countries, as well as the challenges faced by participating surgeons, are not well-documented.A survey was distributed to overseas surgeons who participated in an orthopaedic trauma observership from 2009 to 2020. Surgeons were identified through North American institutions previously recognized by the authors as having hosted international observerships. Information gathered included participant demographics, details of and perceived impact of the observership, and barriers faced before, during, and after the program. Responses from 148 international surgeons (ISs) from 49 countries were analyzed.Sixty percent of observerships were at academic programs, 57% lasted 1-3 months, and 60% were self-funded. Participants identified cost and housing as primary barriers. After completing their observership, lack of funding, equipment and support staff, and excessive workload prevented participants from implementing changes at their clinical practice. Most observers believed that they gained relevant clinical (89%) and surgical knowledge (67%) and developed a professional network of North American hosts (63%). The most common suggested changes to the observership were greater hands-on experience in the operating room and structured goal setting relevant to the visiting surgeon.Visiting surgeons find North American orthopaedic trauma observerships helpful in improving their surgical and clinical skills. However, financial constraints and resource limitations at their clinical practice and limited operative experience during the observership present barriers to maximizing this clinical experience. To enhance the relevance of clinical observerships for ISs and impact global orthopaedic trauma care, the unique needs and challenges facing ISs must be addressed.IV-Cross-Sectional Study. 

Orthopaedic trauma observerships in North America for international surgeons: the visitors' perspective

Supplemental Digital Content is Available in the Text. Objective: International observerships are one of many efforts aimed at addressing disparities in orthopaedic trauma care globally. However, their impact on visiting surgeons and their home countries, as well as the challenges faced by participating surgeons, are not well-documented. Methods: A survey was distributed to overseas surgeons who participated in an orthopaedic trauma observership from 2009 to 2020. Surgeons were identified through North American institutions previously recognized by the authors as having hosted international observerships. Information gathered included participant demographics, details of and perceived impact of the observership, and barriers faced before, during, and after the program. Responses from 148 international surgeons (ISs) from 49 countries were analyzed. Results: Sixty percent of observerships were at academic programs, 57% lasted 1–3 months, and 60% were self-funded. Participants identified cost and housing as primary barriers. After completing their observership, lack of funding, equipment and support staff, and excessive workload prevented participants from implementing changes at their clinical practice. Most observers believed that they gained relevant clinical (89%) and surgical knowledge (67%) and developed a professional network of North American hosts (63%). The most common suggested changes to the observership were greater hands-on experience in the operating room and structured goal setting relevant to the visiting surgeon. Conclusions: Visiting surgeons find North American orthopaedic trauma observerships helpful in improving their surgical and clinical skills. However, financial constraints and resource limitations at their clinical practice and limited operative experience during the observership present barriers to maximizing this clinical experience. To enhance the relevance of clinical observerships for ISs and impact global orthopaedic trauma care, the unique needs and challenges facing ISs must be addressed. Level of Evidence: IV—Cross-Sectional Study.

Introduction: The AAOS International Scholars Program was launched in 2002 with the goal of enhancing the knowledge and skills of orthopaedic surgeons in underserved regions. The goals of this study were to 1) characterize the professional and practice profile of scholarship recipients, 2) assess the perceived impact of this short term educational experience on their clinical practice, 3) if/how the knowledge and skills have been disseminated to students and/or colleagues, and 4) assess career development in a subset of scholarship recipients. Method: The AAOS international scholar database was accessed to review the scholarship applications and all available follow-up questionnaires for 103 scholarship recipients. Results: Respondents generally practiced in an academic institution, incorporated the knowledge and skills learned during the short term educational experience in their practices, and introduced the information acquired to medical students, residents, and colleagues alike. In general, the recipients demonstrated a substantial progress in their career development. Conclusions: Our impression is that this short term educational experience was successful in imparting new knowledge and skills to the scholarship recipients who then shared these experiences with their peers and trainees. Further study will be required to understand the impact of this program on the long-term professional development of the recipients and enhanced health care of the region.

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William B. Stetson

Papers

A Review of the AAOS International Scholars Program after 14 Years: Professional Development and Education of the Recipients