Since 2011, the American College of Surgeons (ACS) has partnered with surgical societies around the world to foster connections among early-career surgeons. This article describes the College’s Resident and Associate Society (RAS-ACS) International Exchange Program, how scholars are selected, and participants’ experiences.
The program funds ACS Residents and Associate Fellows’ travel to a partnering international surgical conference. This traveling scholarship is reciprocated with exchange scholars from participating host countries. Scholars attend the country or region’s annual conference and, in many cases, participate in exchange activities outside of the conference. The goal of the program is to foster and promote international relations and friendship. Initially established through the ACS International Relations Committee, the program is administered through the RAS-ACS.
Most scholars apply for the program by submitting an essay describing what they would like to learn from the experience. U.S. scholars have traveled to Ireland, Italy, Lebanon, and Australia and New Zealand, and residents and young surgeons from those countries have been able to travel to the U.S. to attend the ACS Clinical Congress and visit institutions in and near the host city. To date, 47 scholars have participated in the program (see Figure 1 for a map of where they currently practice).
In spring 2020, the RAS-ACS surveyed 40 scholars and received 17 responses, finding that approximately half of the responding scholars (53 percent) are currently in residency or fellowship. The group as a whole represented mostly academic surgeons, with only one respondent in an employed setting. The respondents represented a range of surgical specialties; eight are general surgeons and one is an otolaryngologist (see Figure 2).
Respondents were generally active in the ACS: 88 percent already were members before they applied and 71 percent have held a leadership position or are planning to hold a leadership position within the organization in the near future. Every respondent said the exchange was a positive experience, with 82 percent rating it as “extremely positive.” Most scholars felt welcome at the meetings they attended overseas and said they received a tailored experience, but a small number of respondents cited networking as a challenge because of the lack of a contact person in the country or a language barrier.
Scholars discuss their experience
The authors interviewed seven current and past U.S. scholars about their experience. Though they ranged in training level and specialty, many common themes were noted in their experiences.
Most scholars wanted to learn more about how their host country’s health system tackled problems in their specialty of interest. Leigh Anne Dageforde, MD, FACS, assistant professor of surgery, Massachusetts General Hospital, Boston, traveled to Ireland in 2013 as a research resident because she had an interest in multi-visceral transplant. When she arrived, Dr. Dageforde was surprised by how consolidated the transplant system was compared with the U.S. system.
“They only have one transplant center hospital for each organ, and it’s the size of Indiana,” Dr. Dageforde said. “If you think about one hospital to the whole country, that’s so different than us. In New England, we have 14 kidney transplant centers.”
David Hampton, MD, FACS, assistant professor of trauma and acute care surgery, the University of Chicago, IL, chose to travel to Beirut, Lebanon, because he had never been to the Middle East. “The biggest goal was just seeing how things were done somewhere else. I knew it wasn’t a resource difference, but rather seeing different cultural attitudes and how that interfered with or accelerated patient care,” he said.
Dr. Hampton noticed some differences in practice but overall didn’t see any difference in outcomes, illustrating that there are many ways to deliver quality medical care. The biggest surprise while observing a surgical service was that the operating rooms were located in the basement to keep staff and patients safe in case of an attack, and armed security guards were at the door to the operating rooms, he said.
Alejandra M. Casar Berazaluce, MD, a postgraduate year three (PGY-3) resident in general surgery at the University of Texas Health Science Center at San Antonio, was inspired by her experience as a medical student in Mexico to explore surgical training at the Royal Australasian College of Surgeons (RACS).
In Australia, “It’s not just like here where you’ve matched and then you’re expected to graduate,” she said. “In Australia, there’s a lot of randomness with respect to advancing forward and ultimately finishing a training program.”
Dr. Casar Berazaluce said she was struck by “how much organization and power the trainees had in creating real change for surgical training. They were actually developing their own life skills and competency-based curriculum to streamline their training.”
Rebecca Williams-Karnesky, MD, PhD, MEdPsych, a PGY-4 in general surgery at the University of New Mexico, Albuquerque, is looking forward to her experience at the RACS—on hold at press time because of the coronavirus pandemic—“because they’ve done a lot of work on bullying and diversity, equity, and inclusivity (DEI). I’d love to build some collaborations and talk to the content experts…it would be really cool to import some of their ideas to the U.S.”
As a past traveler to one of the RACS meetings, Dr. Williams-Karnesky said she enjoyed the “refreshing forward-thinking ‘meeting of the minds’ over there” on issues related to DEI and health care disparities. She recalled listening to an expert at the meeting who had “so much breadth of knowledge on disparities in health care delivery, across so many ranges of race, ethnicity, socioeconomic status diversity, and a lot sociological theories for health care. And I think that those types of things were just reaching the U.S.”
Katy Flynn-O’Brien, MD, a senior pediatric surgery fellow at the Medical College of Wisconsin, Milwaukee, was interested in learning about variations in the surgical training system: “I was able to talk a lot with both trainees [and faculty] about the differences between the American system and the system in Ireland. I learned a lot about their system, but also shared a lot about our system. So, it felt like it was mutually beneficial,” she said.
Many of the scholars had the opportunity to meet some of the “big names” in surgery and make serendipitous connections with surgeons in their specialty. At the conferences, Dr. Flynn-O’Brien met a world-renowned pediatric surgeon who mentored her mentor, and Dr. Casar Berazaluce was grateful to have the opportunity to speak with Barbara L. Bass, MD, FACS, FRCSI(Hon), FRCSEd(Hon), FCOSECSA(Hon), and Adil Haider, MD, FACS.
During her time in the hospital, Dr. Dageforde spent a day with a prominent transplant surgeon in Ireland before applying to fellowship. One of his former mentees, Maria B. Majella Doyle, MD, FACS, is now an attending at Washington University, St. Louis, MO, where Dr. Dageforde went on to complete her fellowship. She recalls, “I actually do think there was some kind of fun networking that happened [because Dr. Doyle] is a mentor for me now.”
Sharven Taghavi, MD, FACS, assistant professor of surgery, Tulane University, New Orleans, LA, traveled to Australia to explore the differences in rural and urban trauma care. He said being part of the exchange program “provided a great opportunity for me to advance my career because of the connections I made both within the College and by going to the meeting in Australia. It was a great career development value and a great career development opportunity.”
The ACS also has been mindful about maximizing the impact of the exchange beyond intercultural exchange and relationships. Dr. Dageforde appreciated the opportunity to provide a written piece on her experience. “I think as a resident it’s really nice…when I got back, [the College] asked me to write something up [for the Bulletin], which gave me a non–peer-reviewed publication. I think it added nicely to my CV [curriculum vitae].”
Keys to a successful exchange
After reviewing the information gathered from former scholars, we identified three lessons about providing a high-value international exchange program to RAS-ACS members.
Early-career surgeons need financial assistance
All of the scholars had a substantial portion of their program costs covered, and they expressed appreciation to the RAS-ACS for the stipend. Many noted that, as early-career surgeons, it would have been impossible to travel on a resident or fellow salary without significant assistance. To promote an inclusive international exchange at the early-career level, most of the costs need to be covered.
Individual exchanges improve the immersive experience
Dr. Hampton emphasized the importance of traveling by himself, rather than with a group of other American scholars. “When you don’t leave your borders, you kind of pigeonhole yourself. The idea of coming out of the cocoon and getting enveloped in a language and culture where people don’t act like you—the cultural exchange—helped immensely. Going by myself, the safety net goes away. That is part of the learning process and makes it an even more valuable experience.”
The importance of a liaison/contact in the host country
“A good liaison is essential to really put you in touch with the people who are important to you and what your goals are as a visitor,” said Ali Zarrinpar, MD, FACS, associate professor of surgery, University of Florida, Gainesville. “There was a surgeon liaison who is a Fellow of the ACS, but is also an Italian. [He] facilitated a lot of my interactions with the teams there.” For those scholars who had excellent relationships with their liaisons, it was easy to set up observer-ships with a surgical specialty of interest. Others talked about getting invited to the liaison’s house for family dinners. This relationship provided continuity and structure, which enriched the scholar’s experience.
Scholars reflect on the value of ACS membership
Participation in the RAS-ACS International Exchange Program stimulates more active engagement with the College overall, and the scholars discussed why the ACS has been a valuable resource for them. In contrast to specialty societies, which offer targeted benefits to a small community, they appreciate that the ACS spans many specialties and represents a diverse set of surgeon voices.
“It’s nice to have representation in terms of a political voice,” Dr. Zarrinpar said, adding, “I think we have plenty of academic societies, and having a society that involves non-academicians is great.”
In addition to its breadth, Dr. Hampton is grateful that the ACS promotes cross-generational mentorship. It “opens up a lot of doors,” he said. “At the same time, it is an institution where you pay it forward, and you do a reach back and pay it back.”
Residents and fellows are grateful for the professional networking opportunities the RAS-ACS provides, as well as the connections they have fostered across the country in their leadership roles. “Being an ACS member gives me a lot of pride and honor,” Dr. Flynn-O’Brien said. “I’m active and I made close friendships and collaborations through my involvement with the RAS-ACS in particular. So, it’s a great source of inspiration. It’s wonderful hearing about what’s going on in other parts of the country and working on projects together.”
The RAS-ACS International Exchange Program has facilitated intercultural exchange between early career surgeons for a decade. Alumni of the program remember the experience as positive and noted that learning about other health systems was uniquely informative. RAS and College leadership plan to continue the RAS-ACS International Exchange Program and hope to expand it as interest from ACS chapters gains momentum. If you are an individual surgeon or ACS chapter leader interested in getting involved with the exchange program, contact RAS-ACS Leadership at RASnews@facs.org.