Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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402 Surgery and Healing in the Developing World
Requirements for Promotion and Yearly Certificates
A Resident’s Promotion to the Next Level Should Depend on
Three Criteria:
1. ethical and subordinate conduct
2. academic performance
3. the development of clinical and surgical skills
A resident who frequently behaves unethically or who is insubordinate to either
his Director or the hospital authorities should not be promoted and should probably
be dismissed.
Academic performance should be measured by the results of the yearly in-service
examination, by the quality of the resident’s monthly written reports or research
projects, by his completion of assigned reading, and by his level of participation in
teaching conferences. A resident who fails in one or several of these areas and is
marginal in the others should not be promoted. He could either be given the opportunity
to repeat the year or dismissed.
Clinical and surgical skills may be more difficult to judge, but if a resident is
clearly lagging or repeating again and again the same clinical or operating room
mistakes, he should probably be given the opportunity to repeat the year.
When a resident is promoted he should receive an attractive, signed certificate of
achievement certifying that he has completed that level of surgical training. Ideally a
high official from the Ministry of Health or Education should sign the certificate
along with the Program Director, but if these officials are not interested in issuing or
signing such a certificate or it if the request could create problems for the training
program, the certificate should be signed by the highest officials within the institution.
Whenever possible certification should fall under the auspices of an international
medical or surgical society to provide additional credibility.
When a resident completes all four or five years of residency training the same
holds true for the diploma he is awarded. It should not be a simple certificate, but
should be a high-quality document that reflects the significance of his achievement
to anyone who sees it.
To protect the residents and the institutions that train them, the requirements
for promotion and graduation should be included in the signed, yearly contract and
the Resident’s Manual.
The Importance of English
It is an inescapable fact of life that the majority of the surgical literature in the
world is in English. Most medical conferences are held in English, and most visiting
faculty speak only English. Program Directors should do everything possible to provide
for their residents at least their major surgical textbook in a language with
which they are comfortable. But unless their residents are already fluent in English
they should provide an opportunity for them to learn English and should probably
insist that they develop fluency in English. This will help them immensely to be able
to communicate directly with visiting faculty, read English textbooks and journals,
read articles on the Internet, and understand what is said during medical conferences
where English is the primary language.