Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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396 Surgery and Healing in the Developing World
• thoracic surgery
• transplant surgery
• trauma
• urology
• vascular surgery
• current atlases of surgery in as many of the above categories as possible
Textbooks in other areas of medicine should also be included for reference:
• cardiology
• EKG interpretation
• gastroenterology
• internal medicine
• oncology
• pediatrics
• pharmacology
Up-to-date library materials should also be included in the library, either through
the Internet or by subscribing to Selected Readings in General Surgery.
Weekly Teaching Conferences
If a Program Director cannot find the time for regular teaching conferences during
the week, something is seriously wrong with his priorities. The best way to deal
with overwork is not to work harder or with greater and greater efficiency, but to get
help. In the developing world, the best way to get that help is to train people to do
your job as well or better than you can do it. Unless one is planning to simply train
surgical technicians, teaching conferences are an absolute necessity.
There should be no less than one hour a week devoted to formal teaching. Two
hours a week are better. When visiting faculty come to teach the residents there
should be three to five one-hour formal teaching sessions a week, depending on how
long the teaching faculty surgeon plans to stay.
The following is a suggested list of the kinds of teaching conferences that should
be held:
• mortality and morbidity: once a month
• oral presentations and discussions of written case reports or research reports:
once a month
• a review of assigned reading with a written quiz: twice a month
• special sessions for problem areas: whenever needed
The residents should actively participate in planning the mortality and morbidity
conferences and in making oral presentations of their written case reports or
research projects.
Direct Supervision in the Preoperative and Postoperative Care of
Surgical Patients
Residents first need to learn how to work up and present them properly. This is
best done in an outpatient or emergency room setting where a resident sees the
patient first, takes a history and does a physical examination on his own before
presenting the case to an attending surgeon. Other learning opportunities occur
when other services request surgical consults. History taking, physical examinations
and presenting skills are taught somewhat vigorously to medical students in North
America but may be neglected in some developing countries.