Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Training Surgeons in the Developing World
Table 1. Surgical experience of trainees
Rotation % of Training Times Months*
• General & thoracic surgery 38.6% 17
• Gynecology 14.6% 6
• Urology 13.6% 6
• Orthopedics 13.6% 6
• Pediatric surgery 5.7% 2.5
• Neurosurgery 5.0% 2.5
• Plastic surgery 4.5% 2
• Anesthesia 2.2% 1
• ENT/ophthalmology 2.2% 1
• Vacation (1 month/yr) - -
TOTAL: 100% 44 months
*percentage of 44 months of training
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who is able to competently and safely administer an appropriate anesthetic who will
be able to perform a required operation anywhere at any time.
The following is a suggested breakdown of surgical training for general surgery
residents in the developing world:
Making the Model Work
The Length of Surgical Training
How long should it take to train a surgeon? There is no absolute answer because
residents learn at different speeds. Nevertheless, if the goal is to train qualified general
surgeons to an internationally recognized level of competence, the process will
require a minimum of four to five years. This is as true in the developing world as in
the West.
The Teaching Environment
The teaching environment needs to include an adequate operating room with
autoclave capabilities, a recovery room, a surgical ward, an outpatient clinic with
emergency management capability (or an emergency room), a conference room,
and a surgical library.
Although a surgical training center should have the skills and equipment necessary
to perform general, inhalational anesthesia whenever indicated, the operating
room does not need to be equipped with a wide array of the latest in instrumentation
or sophisticated equipment to serve well. Nor does it need a large staff of support
personnel. Most operations requiring only a spinal anesthetic where blood loss
is minimal and where the operating time is under 90 minutes can be carried out
with three people: a circulating nurse who monitors the pulse and blood pressure, a
resident or surgical assistant, and the surgeon. While a pulse oximeter and automatic
blood pressure monitor are helpful, they are not absolutely essential. Many
surgeons have their circulating nurses monitor the patient’s pulse and blood pressure
manually, chart the results and announce them loudly every five minutes. If
patients develop problems a fourth person can be added to the team in minutes.
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