Surgery is more than a set of technical skills—it is a profession that demands a high level of commitment and lifelong dedication. Historically, the education of enthusiastic medical students transcended grand lecture halls and involved observation of master surgeons. In fact, in the early years of formal surgical education, students entered into apprenticeships where they essentially lived with their surgical mentors to learn the intricacies of treating surgical diseases, and they traveled abroad to attain skills and knowledge not taught at their home institutions.
The technological revolution has made the transmission of large volumes of information around the world much simpler. With the click of a mouse, data and audiovisual media can be sent to a recipient within seconds, while video streaming allows for a real-time exchange of information. Although this method of exchanging knowledge may seem more practical and time-efficient, it is much less personal, and the art of surgical care, education, and collaboration is diminished.
For this reason, the conference setting remains a vital and cherished medium for the dissemination of surgical knowledge. Surgeons from around the globe attend these meetings to learn, discuss, and share their experiences in patient care. The American College of Surgeons (ACS) Clinical Congress is a prime example of this format, with thousands of surgeons congregating annually to meet the experts and attend the educational and scientific sessions.
The leadership of the Resident and Associate Society of the College (RAS-ACS) maintains that opportunities for the exchange of scientific knowledge should begin at the trainee level and for this reason has developed an International Exchange Scholarship Program. This program, which began in 2011, is modeled on the ACS International Relations Committee’s (IRC) International Guest Scholarships program.
Program structure and purpose
For more than 40 years, the IRC has offered International Guest Scholarships and international traveling fellowships. Surgeons outside of the U.S. and Canada have actively sought these scholarships, which are contingent upon satisfying the IRC’s requirements. Most notably, the applicant must be a surgeon who has completed formal training and has been practicing for at least one year. Hence, surgical residents were ineligible for these awards.
The RAS-ACS International Exchange Scholarship Program was established with the support of the IRC and the ACS Division of Member Services. The objective of this program is to encourage the international exchange of surgical information concerning training paradigms, health care delivery models, and research opportunities, in addition to establishing and fostering professional and academic collaborations and friendships.
This program is more than a scholarship to fund an international surgical resident’s attendance at the Clinical Congress and RAS-ACS events—it is an exchange. A reciprocal commitment is necessary, which means the nation from which the RAS-ACS accepts its exchange scholar must host a RAS-ACS member at its respective national meeting. The RAS-ACS oversees the International Exchange Scholarship Program, and the RAS-ACS Membership Committee reviews and selects the candidates and coordinates the program’s activities. (The program is partly funded by the IRC.)
Inception and status
The RAS-ACS International Exchange Scholarship Program was initially a joint venture between the ACS and the Royal College of Surgeons in Ireland (RCSI). Through a competitive selection process specified by each institution, a surgical trainee was selected and awarded the opportunity to attend the major surgical meeting by the respective host nation.
By the 2012–2013 academic year, Australia-New Zealand, Italy, and Lebanon had joined Ireland as exchange locations. Consequently, four international guest scholars now travel to the U.S. and four North American surgical residents travel abroad. Efforts are under way to expand this opportunity, with a focus on engaging nations in Africa, South America, and Asia.
The selection process is competitive. Scholarships are awarded to current RAS-ACS members in good standing from North America. At the beginning of the calendar year, a call for applicants is issued through the e-newsletter that all Residents and Associate members receive. Applicants must submit an essay indicating how they will use the scholarships, and a blinded scoring process is employed. Reviewers include senior RAS-ACS Executive Committee members and ACS Fellows. The results are announced toward the end of the academic year (May or June) to allow sufficient time for planning international visits and satisfying international travel requirements.
Scholars have the opportunity to attend an international meeting in the host nation and receive a generous stipend that may be used for airfare, sustenance, and lodging. Scholarship recipients must provide a full written report of their activities and experiences overseas.
For guest scholars visiting from abroad, the program affords them the opportunity to attend the ACS Clinical Congress. They are formally recognized at the RAS-ACS annual business meeting with an award and the scholarship funds. They are automatically enrolled in a variety of RAS-ACS events and lectures, skills courses, and presentations aimed at residents. International scholars are encouraged to become RAS-ACS members, resulting in the waiver of their Clinical Congress registration, and they may avail themselves of the many other benefits of ACS membership. The scholars are also invited to multiple events coordinated by the IRC, including several receptions and the IRC annual business meeting. Future plans that the RAS-ACS Membership Committee is considering include providing assistance in visiting local hospitals in the Clinical Congress host city, as well as a variety of extracurricular activities.
It is too soon to assess the true impact of this exchange program. With increasing exposure through electronic media and the Bulletin, over the last year there was nearly a 400 percent increase in the applications for this RAS-ACS International Exchange Scholarship Program. The RAS-ACS Membership Committee is currently assessing the impact and outcomes of this program.
It is clear that the reaction to the IRC’s International Guest Scholarship program has been positive. A survey conducted in 2003 measured the impact of the IRC’s Guest Scholarships program.* All scholarship recipients from 1968 to 2003 were queried. The response rate was 46 percent, and virtually all of the respondents noted a positive impact from the program, with 47 percent saying it was extremely helpful and 38 percent noting that it afforded them an opportunity not otherwise available.* Most importantly, 86 percent of the respondents noted that they encouraged others to apply for the program.
The current RAS-ACS leadership began investigating the impact of the International Exchange Scholarship Program with its own survey. The survey was sent to the International Exchange participants with a 25 percent response rate. Of those respondents, 75 percent attended the Clinical Congress and 25 percent attended an international meeting. Participants were asked to evaluate the accommodations, the comparative activity of the host country’s meeting, the attitude of those surgeons they encountered, extra costs, and if they would recommend the program to their colleagues. Two subjective questions addressed the experience as well as potential improvements that could be made. Three-quarters felt the accommodations were as expected. All the respondents felt that the host country’s meeting was more active than their home meeting, and the level of collegiality they encountered uniformly exceeded expectations. All respondents would either most likely or definitely recommend the program to their colleagues.
The response from the resident scholars has been overwhelmingly positive. Following are excerpts from some of the participants’ reports:
- Valentina Giaccaglia, MD, a postgraduate year (PGY)-6 resident from La Sapienza University of Rome, Italy, attended the 2012 Clinical Congress. “It was very interesting to share my experience with colleagues from other countries, and I am extraordinarily grateful for the opportunity to get new scientific and clinical knowledge from the best surgeons coming from all over the world. I am very grateful for the hospitality extended to me by so many people during my visit. I look forward to scientific collaboration and friendship with surgical colleagues in the U.S. I thank the American College of Surgeons for this unique opportunity and hope many other colleagues will have the chance to benefit from the International Exchange Program.”
- Leigh Anne Dageforde, MD, a PGY-6 resident at Vanderbilt University Medical Center, Nashville, TN, visited the RCSI and participated in their Millin Symposium in Dublin. “The RCSI had arranged a comprehensive and busy visit for me[…]. The ‘language’ of surgery is universal and provides an instant connection with others working in the field…. [T]he exchange was a great experience. The consultants, registrars, and administrators were extremely welcoming. Furthermore, I appreciated the opportunity to learn about surgery in a different health system, which may have some similarities to our own in the near future…. I would highly recommend this experience to other residents and am thankful for all the RCSI did to welcome and educate me.”
- Alecio Vinci, MD, a PGY-4 resident at San Matteo University in Pavia, Italy, participated in the 2013 Clinical Congress in Washington, DC. “I have personally been exposed to a cutting-edge surgical environment letting me enhance the skills needed to be a proficient and competent surgeon.” In describing the conference, he noted that it “represented an occasion for a mutual exchange of experience, information, and methods between countries with different specialist training program[s] and career paths.” Finally, Dr. Vinci noted that he was “impressed by the organization specifically designed for residents and…pleased to be involved in the majority of educational opportunities offered by [RAS-ACS] during the Clinical Congress.”
- Laura Wang, MD, a PGY-5 resident in general surgery, was the representative surgical trainee of the Royal Australasian College of Surgeons. She “was thoroughly impressed at the size and level of organization of the RAS-ACS committee. Each day [of the 2013 Clinical Congress] was packed with many interesting and [thought-provoking] academic sessions. Many concurrent sessions for each subspecialty were run by the who’s who of international thought leaders of each field. In addition to the academic and scientific sessions, I was struck by the number of sessions on cost-effective health care, leadership, and life-balance…. It was an absolute honor and privilege to be awarded the John Buckingham Scholarship this year. The ACS meeting was not only academically interesting but also a unique opportunity to meet trainees and consultants from around the world. The academic and social networking events were very well-organized, and I would not hesitate to encourage other Australian general surgery and subspecialty trainees to apply for this grant in the coming years.”
Building on the strong foundation that the IRC provided, the RAS-ACS has successfully implemented an international exchange scholarship program for surgical trainees that the RAS-ACS would like to expand in future years. To achieve this goal, the RAS-ACS has focused on establishing an annual timeline to allow for proper planning for residents. Support from program directors and the institutions of selected scholars is important and continued funding through the ACS, the IRC, and support groups is imperative to allow for fruitful progress of the program. Finally, international chapter involvement and identification of mentors to host surgical trainees are paramount.
*Fong Y, Early K, Deane SA, Johnson FE, Nogueras JJ, Finley RJ, Hoballah JJ, Michelassi F, Villar HV. American College of Surgeons International Scholarship Programs: 40-year history of support for international surgical education. J Am Coll Surg. 2010;211(2):279-284.