SPECIAL EDITORIAL
Obtaining Accreditation Council for Graduate Medical Education Approval for International Rotations During Plastic Surgery Residency Training Donald R. Mackay, MD Abstract: Global medicine and international rotations are becoming increasingly popular and relevant in training the next generation of Plastic Surgeons. The Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties have started to address the issues that will ensure our residents are protected as well as ensuring that they gain a valuable educational experience. The principles and the process for getting an International Rotation approved by the Plastic Surgery Residency Review Committee are outlined in this article. Key Words: Global health, international rotation, residency education, residency review committee (J Craniofac Surg 2015;26: 1086–1087)
O
ne of the truly noble features of our profession is the willingness of our colleagues to provide care to people suffering in poor countries around the world. Many of us felt inspired to become plastic surgeons by witnessing this altruism. Plastic surgeons have been prominent in providing this care because of our ability to treat children with cleft lip and palate. This is one of the commonest congenital anomalies, and the surgical repair can be safely performed even in resource poor environments. In North America, large nongovermental organizations, such as Operation Smile, ReSurg International (formally Interplast), and Smile Train, provide cleft and other reconstructive care globally. Residents in plastic surgery have volunteered for years on their mission trips. An increasing number of universities and other local organizations are also active in global medical care and have provided residents the opportunity to participate in their efforts. Increasingly, residents are seeking out residency programs that provide an international experience. Residents who have had the opportunity to participate in international missions have consistently rated the experience the most meaningful of their training. Campbell et al1 also demonstrated that these missions are important educational experiences that are consistent with the Accreditation Council for Graduate Medical Education competencies. From the Department of Plastic Surgery, Penn State Hershey College of Medicine, Hershey, PA. Received December 12, 2014. Accepted for publication December 20, 2014. Address correspondence and reprint requests to Donald R. Mackay, MD, Department of Plastic Surgery, Penn State Hershey College of Medicine Hershey, PA; E-mail: [email protected] The author reports no conflicts of interest. Copyright # 2015 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000001679
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Our colleagues on the American Board of Surgery, recognizing the educational value, led the way in establishing guidelines for formal approval of international rotations. The Plastic Surgery Residency Review Committee after a lengthy, thoughtful debate approved a process for recognizing international rotations (Table 1). The principles embodied in the requirements address issues of patient and resident safety, the nature of the site, and the educational structure of the rotation.
RESIDENT PROTECTION The RRC has the responsibility of ensuring that residents are educated in a safe environment. There are many areas where a crying need for our services are in the dangerous parts of the world. Many of our colleagues are willing to put themselves in harm’s way in these areas, but the RRC unanimously agreed that it is absolutely imperative that the resident’s safety be not compromised. Avoiding areas that have a State Department travel advisory was the best way we had to assure safety. Additional requirements that protect the residents include ensuring adequate living conditions, health and evacuation insurance, and transportation. We also felt that it is important that rotation had to be completely voluntary.
THE SITE The RRC needs to ensure that the rotation takes place in a setting conducive to an educational experience. We felt that it is important for the international site to have an established relationship with the resident’s home (sponsoring) institution. The requirement thus includes the need for a program letter of agreement just as we do for additional sites in the United States. Additional requirements were designed to ensure that the site as appropriate educational resources, such as an Internet connection and the necessary patient support services to perform surgery safely.
THE EDUCATIONAL EXPERIENCE As with any rotation, the RRC requires competency-based goals and objectives for these rotations. There is a temptation to focus solely on the operative experience. The RRC wanted to ensure that the resident had a holistic experience that included an outpatient experience. The requirements for an explanation of the long-term follow-up of the patients’ specific information on the outcomes of the patients they were involved with ensures that the resident clearly understands that the patients cannot be abandoned and that the outcomes need to be held to same standards we apply at home. We also felt that it is important to have the program director explain what is unique about the rotation, which would not be provided at the home institution. The surgeon responsible for the resident at the site must be appropriately qualified either with
The Journal of Craniofacial Surgery
Volume 26, Number 4, June 2015
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery
Volume 26, Number 4, June 2015
Special Editorial
TABLE 1. The Plastic Surgery Residency Review Committee Application3 International Rotation Application Process Review Committee for Plastic Surgery To apply for an international rotation in plastic surgery, at least 30 days before the start of the rotation, the program director must submit a letter, cosigned by the DIO and addressed to the executive director of the Review Committee for Plastic Surgery, including the following information and documentation: Provide the name and location of the international site Provide the name and PGY level of the resident for whom the rotation is requested Provide a copy of a properly executed PLA between the ACGME-accredited program and the international site at which the rotation will take place Provide a letter of support from the DIO of the ACGME-accredited program’s sponsoring institution Provide the dates of the rotation, a minimum of seven days at the site is required Provide a description of the site that includes: type of center (governmental, nongovernmental, private) evidence that there is local authority approval for the site demonstration of the requirement that the center must have an established ongoing relationship with the program (at least 2 previous visits to the center before any resident involvement) a statement of the center’s operative volume and type a statement about the adequacy of the supportive anesthetic, radiologic, laboratory, and critical care infrastructure a description of the educational resources available, including reliable access to web-based educational materials Provide an educational rationale (a statement describing what educational experience the international rotation provides for the resident that the primary institution or affiliates do not) Describe the rotation: Explain how the rotation will provide continuity of care (preoperative, perioperative, and postoperative care) Explain how patients will be followed by local staff members after the resident has completed the rotation, and how the resident will receive feedback about the individual patient outcomes Provide verification that the rotation is an elective Provide competency-based goals and objectives for the rotation Provide verification that the experience will include an outpatient experience Provide verification that the resident will enter operative experiences in the ACGME Case Log System Provide confirmation that the program has an accreditation status of ‘‘Continued Accreditation’’ Provide a statement that ABMS-certified full-time or clinical faculty members (or non-ABMS-certified clinical faculty members with qualifications deemed acceptable in advance by the Review Committee) will supervise the resident during the rotation and evaluate the resident at the end of the rotation; these faculty members must have a relationship with the home institution Provide samples of the end-of-rotation evaluations that will be used Provide verification that salary, travel expenses, health insurance, and evacuation insurance are provided by the sponsoring institution and/or program Provide a statement addressing physical environmental issues, including housing, transportation, communication, safety, and language The review committee will not approve proposed international rotations to countries or areas in countries that have U.S. State Department travel warnings at the time of application. It is the responsibility of the applying program to confirm that a U.S. State Department travel warning is not in effect for the site at the time of the planned rotation. ABMS indicates American Board of Medical Specialties; DIO, designated intuitional official; PLA, program letter of agreement.
American Board of Medical Specialties certification or qualifications deemed appropriate by the RRC. Program directors must also be aware that after they have received RRC approval, they still need to get approval from the American Board of Plastic Surgery for these rotations to be a recognized part of the resident’s training. The Global Health Committee of the American Council of Academic Plastic Surgeons has a lot of useful information on their website to help program directors with the approval process.2 Many of us view the international care efforts we are involved in as some of the most important work we do. Our residents are generally idealistic, altruistic, and just as eager to help. It is essential that we model these experiences in such a way that the residents understand our role. We are guests in the countries we visit. We have to be partners with our hosts in looking after their patients. The residents must understand that they are not there to practice independently. We have to perform these services with the same rigorous standards and oversight that we do at home. We
#
2015 Mutaz B. Habal, MD
should be striving to educate and help our hosts grow their local programs so that ultimately our services are no longer needed. The Accreditation Council for Graduate Medical Education through the Plastic Surgery RRC and the American Board of Plastic Surgery recognize and support the increasing importance of International rotations in residency training. The approval process will hopefully encourage more young Plastic Surgeons to participate in these noble efforts.
REFERENCES 1. Alex Campbell, Randy Sherman, Magee William P. The role of humanitarian missions in modern surgical training. Plast Reconstr Surg 2010;126:295 2. Academic Council of Academic Plastic Surgeons (ACAPS) http://www.acaplasticsurgeons.org 3. Bentz M, Chang J, Chung K, et al Criteria for Approved International Rotations. Accreditation Council for Graduate Medical Education (ACGME) Plastic Surgery Website. http://www.acgme.org
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Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Obtaining Accreditation Council for Graduate Medical Education Approval for International Rotations During Plastic Surgery Residency Training Donald R. Mackay, MD Abstract: Global medicine and international rotations are becoming increasingly popular and relevant in training the next generation of Plastic Surgeons. The Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties have started to address the issues that will ensure our residents are protected as well as ensuring that they gain a valuable educational experience. The principles and the process for getting an International Rotation approved by the Plastic Surgery Residency Review Committee are outlined in this article. Key Words: Global health, international rotation, residency education, residency review committee (J Craniofac Surg 2015;26: 1086–1087)
O
ne of the truly noble features of our profession is the willingness of our colleagues to provide care to people suffering in poor countries around the world. Many of us felt inspired to become plastic surgeons by witnessing this altruism. Plastic surgeons have been prominent in providing this care because of our ability to treat children with cleft lip and palate. This is one of the commonest congenital anomalies, and the surgical repair can be safely performed even in resource poor environments. In North America, large nongovermental organizations, such as Operation Smile, ReSurg International (formally Interplast), and Smile Train, provide cleft and other reconstructive care globally. Residents in plastic surgery have volunteered for years on their mission trips. An increasing number of universities and other local organizations are also active in global medical care and have provided residents the opportunity to participate in their efforts. Increasingly, residents are seeking out residency programs that provide an international experience. Residents who have had the opportunity to participate in international missions have consistently rated the experience the most meaningful of their training. Campbell et al1 also demonstrated that these missions are important educational experiences that are consistent with the Accreditation Council for Graduate Medical Education competencies. From the Department of Plastic Surgery, Penn State Hershey College of Medicine, Hershey, PA. Received December 12, 2014. Accepted for publication December 20, 2014. Address correspondence and reprint requests to Donald R. Mackay, MD, Department of Plastic Surgery, Penn State Hershey College of Medicine Hershey, PA; E-mail: [email protected] The author reports no conflicts of interest. Copyright # 2015 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000001679
1086
Our colleagues on the American Board of Surgery, recognizing the educational value, led the way in establishing guidelines for formal approval of international rotations. The Plastic Surgery Residency Review Committee after a lengthy, thoughtful debate approved a process for recognizing international rotations (Table 1). The principles embodied in the requirements address issues of patient and resident safety, the nature of the site, and the educational structure of the rotation.
RESIDENT PROTECTION The RRC has the responsibility of ensuring that residents are educated in a safe environment. There are many areas where a crying need for our services are in the dangerous parts of the world. Many of our colleagues are willing to put themselves in harm’s way in these areas, but the RRC unanimously agreed that it is absolutely imperative that the resident’s safety be not compromised. Avoiding areas that have a State Department travel advisory was the best way we had to assure safety. Additional requirements that protect the residents include ensuring adequate living conditions, health and evacuation insurance, and transportation. We also felt that it is important that rotation had to be completely voluntary.
THE SITE The RRC needs to ensure that the rotation takes place in a setting conducive to an educational experience. We felt that it is important for the international site to have an established relationship with the resident’s home (sponsoring) institution. The requirement thus includes the need for a program letter of agreement just as we do for additional sites in the United States. Additional requirements were designed to ensure that the site as appropriate educational resources, such as an Internet connection and the necessary patient support services to perform surgery safely.
THE EDUCATIONAL EXPERIENCE As with any rotation, the RRC requires competency-based goals and objectives for these rotations. There is a temptation to focus solely on the operative experience. The RRC wanted to ensure that the resident had a holistic experience that included an outpatient experience. The requirements for an explanation of the long-term follow-up of the patients’ specific information on the outcomes of the patients they were involved with ensures that the resident clearly understands that the patients cannot be abandoned and that the outcomes need to be held to same standards we apply at home. We also felt that it is important to have the program director explain what is unique about the rotation, which would not be provided at the home institution. The surgeon responsible for the resident at the site must be appropriately qualified either with
The Journal of Craniofacial Surgery
Volume 26, Number 4, June 2015
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery
Volume 26, Number 4, June 2015
Special Editorial
TABLE 1. The Plastic Surgery Residency Review Committee Application3 International Rotation Application Process Review Committee for Plastic Surgery To apply for an international rotation in plastic surgery, at least 30 days before the start of the rotation, the program director must submit a letter, cosigned by the DIO and addressed to the executive director of the Review Committee for Plastic Surgery, including the following information and documentation: Provide the name and location of the international site Provide the name and PGY level of the resident for whom the rotation is requested Provide a copy of a properly executed PLA between the ACGME-accredited program and the international site at which the rotation will take place Provide a letter of support from the DIO of the ACGME-accredited program’s sponsoring institution Provide the dates of the rotation, a minimum of seven days at the site is required Provide a description of the site that includes: type of center (governmental, nongovernmental, private) evidence that there is local authority approval for the site demonstration of the requirement that the center must have an established ongoing relationship with the program (at least 2 previous visits to the center before any resident involvement) a statement of the center’s operative volume and type a statement about the adequacy of the supportive anesthetic, radiologic, laboratory, and critical care infrastructure a description of the educational resources available, including reliable access to web-based educational materials Provide an educational rationale (a statement describing what educational experience the international rotation provides for the resident that the primary institution or affiliates do not) Describe the rotation: Explain how the rotation will provide continuity of care (preoperative, perioperative, and postoperative care) Explain how patients will be followed by local staff members after the resident has completed the rotation, and how the resident will receive feedback about the individual patient outcomes Provide verification that the rotation is an elective Provide competency-based goals and objectives for the rotation Provide verification that the experience will include an outpatient experience Provide verification that the resident will enter operative experiences in the ACGME Case Log System Provide confirmation that the program has an accreditation status of ‘‘Continued Accreditation’’ Provide a statement that ABMS-certified full-time or clinical faculty members (or non-ABMS-certified clinical faculty members with qualifications deemed acceptable in advance by the Review Committee) will supervise the resident during the rotation and evaluate the resident at the end of the rotation; these faculty members must have a relationship with the home institution Provide samples of the end-of-rotation evaluations that will be used Provide verification that salary, travel expenses, health insurance, and evacuation insurance are provided by the sponsoring institution and/or program Provide a statement addressing physical environmental issues, including housing, transportation, communication, safety, and language The review committee will not approve proposed international rotations to countries or areas in countries that have U.S. State Department travel warnings at the time of application. It is the responsibility of the applying program to confirm that a U.S. State Department travel warning is not in effect for the site at the time of the planned rotation. ABMS indicates American Board of Medical Specialties; DIO, designated intuitional official; PLA, program letter of agreement.
American Board of Medical Specialties certification or qualifications deemed appropriate by the RRC. Program directors must also be aware that after they have received RRC approval, they still need to get approval from the American Board of Plastic Surgery for these rotations to be a recognized part of the resident’s training. The Global Health Committee of the American Council of Academic Plastic Surgeons has a lot of useful information on their website to help program directors with the approval process.2 Many of us view the international care efforts we are involved in as some of the most important work we do. Our residents are generally idealistic, altruistic, and just as eager to help. It is essential that we model these experiences in such a way that the residents understand our role. We are guests in the countries we visit. We have to be partners with our hosts in looking after their patients. The residents must understand that they are not there to practice independently. We have to perform these services with the same rigorous standards and oversight that we do at home. We
#
2015 Mutaz B. Habal, MD
should be striving to educate and help our hosts grow their local programs so that ultimately our services are no longer needed. The Accreditation Council for Graduate Medical Education through the Plastic Surgery RRC and the American Board of Plastic Surgery recognize and support the increasing importance of International rotations in residency training. The approval process will hopefully encourage more young Plastic Surgeons to participate in these noble efforts.
REFERENCES 1. Alex Campbell, Randy Sherman, Magee William P. The role of humanitarian missions in modern surgical training. Plast Reconstr Surg 2010;126:295 2. Academic Council of Academic Plastic Surgeons (ACAPS) http://www.acaplasticsurgeons.org 3. Bentz M, Chang J, Chung K, et al Criteria for Approved International Rotations. Accreditation Council for Graduate Medical Education (ACGME) Plastic Surgery Website. http://www.acgme.org
1087
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
