Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Training to Serve the Unmet Surgical Needs Worldwide
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5. A curriculum based on “task achievement” outcome works better than a
“time in service” approach.
Interplast was established as a foundation in order to meet the training needs of
Stanford University residents and evolved to meet the surgical needs of developing
countries but with humanitarian motivation. The program then began to provide
role models for trainees of both American and the developing countries involved.
The final evolution was to mount educational programs. The educational programs
flowed from the motivation of a surgeon (a) to help people and (b) to teach. Powerful
psychic income occurs in fulfillment of the reason why we became physicians in
the first place—the “doctor instinct”. A professional is one who applies his/her skills
for the benefit of others. The good feeling that this produces is the psychic income
which becomes the motor driving the programs.
In this model, there are two primary teaching goals: (1) to develop psychomotor
skills, i.e., how to do surgery. This takes 2 years. (2) to develop an attitudinal behavior
change which takes place over 5 years. Two additional benefits occur: recipients
become providers and teachers and life-long professional relationships are developed.
There are two models: one for teaching in the University hospitals and the other
model for district hospital level surgery. The following will outline the district hospital
model.
The basic outline includes the following:
1. Intermittent trips, monthly or quarterly rotations depending on the specialty.
2. A team of four to twelve visiting professionals, each with a counterpart
from the host country.
3. The curriculum is a serious commitment on the part of all.
Intermittent trips allow participation of busy professionals. The team achieves
more than a single surgeon could do. Moreover the team reaches a high level of
achievement similar to that of an athletic team accomplishing what they have not
done before. The experience of working in a team is greatly appreciated by the participants
along with the satisfaction of achieving something worthwhile.
An advantage of the Foundation-University relationship is the ability of the foundation
to provide liability insurance, community support and background funds.
The University provides the staff and skills as well as the young, idealistic trainees. It
is possible to acquire team members from several countries bringing a wealth of
additional experience and widening each member’s friendships. Moreover, the teams
are multi-professional including nurses, anesthesiologists, pediatricians, surgeons in
various specialties, technicians, and so forth.
The curriculum of the district surgeon consists of parts from many specialties.
The curriculum is divided into tasks or operations as needed and requested by the
trainee hosts. These tasks are filtered and selected depending upon whether a particular
task is considered to be teachable by the providers.
The following is a brief outline of the District Surgery Curriculum:
• General Surgery: Trauma; Laparoscopy; Wound care; Secondary level
General Surgery
• Orthopedics: Fractures; Club foot; Bone healing
• Plastic Surgery: Burns; Repair of lacerations; Cleft lip repair
• ObGyn: Child birth; D&C; Infections;
• Community Health: principles
• ENT: facial fractures
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