Surgery and Healing in the Developing World - Dartmouth-Hitchcock

International Surgical Education
oped world unless there is an encroaching threat—such as an epidemic—or unless
fear or fascination arouse curiosity about our neighbors.
To better understand the problems faced globally and the educational resources
adapted to meet these challenges in several different systems, surgical educators from
several continents were assembled and addressed the issues of international surgical
education in order to respond to rising demands in quantity and quality of surgical
services in an era of perceived resource restrictions.
Africa
Nigeria has the largest population in black Africa with as much as one-fifth of
the continent’s people. For a population of over 100 million people, located mostly
in the rural countryside, there are fewer than 10,000 medical doctors, most of whom
live and practice in large cities. Before 1948, most Nigerian doctors were trained in
Europe and North America. Today there are 13 medical schools throughout Nigeria,
nine of them in the nation’s southern sections.
To improve the health of the Nigerian population, the medical schools have
planned curricula to respond to the health care problems of that nation, even though
the medical schools themselves were patterned after educational systems originating
in quite different environments.
Admission to a medical school is through join-matriculation examination; classes
of 50 students in the newer medical schools and over 200 in the longer established
schools are common. These students spend two years in basic science and three years
in clinical rotations. Although the government is exerting a lot of pressure to increase
the intake of students, the limiting factor has been the infrastructure of facilities
to accommodate the students. Surgery plays an important role in the education
of all undergraduate medical students, since at the end of training they must be able
to apply the surgical skills demanded of a general duty medical officer in a developing
tropical country. Exposure to surgical illnesses and the development of fundamental
surgical skills take place in general surgery and specialty rotations at different
times in the curriculum for a total up to nine months of the medical school experience.
The undergraduate examination in surgery was modeled on the British system
until more recently, when experiments in objective grading of multiple choice questions
and clinical papers were begun. There currently is a very strong emphasis on a
well-structured clinical examination. Because of a growing public concern about the
length of the training program and the perceived need to produce more doctors at a
reduced commitment in time, there is pressure to de-emphasize of basic medical
science subjects. This public pressure for a devaluation of quality surgical education
in exchange for immediate increase in physicians is an especially vexing problem in
Africa. The urgency of public demand may be depreciating medical expertise in
parts of the developed world as well. A story is told about Charles Elliot, the famed
educator and past president of Harvard University (1869-1909), who was asked
why Harvard had gained a reputation as the greatest storehouse of knowledge in the
country. He replied, “In all likelihood, it is because the freshmen bring to us so
much knowledge while the seniors take away so little of it.”
South America
Disease patterns vary around the world according to geographic conditions, ethnic
patterns, and socioeconomic development. Colombia is experiencing an increase
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