Overseas surgical courses and junior trainees

THERE has been considerable literature about the benefits of undertaking overseas fellowship for senior trainees and consultants, and electives for medical students^[1,2,3]. However, short courses outside of Australia are less frequently explored by junior trainees due to perceived higher associated costs, difficulty in facilitating their organisation and a lack of a dedicated platform for the courses that maybe available.

Surgical trainees undertake skills courses for two main reasons, both prior to and during their surgical education and training (SET). The courses are either an essential requirement for their training or they will help teach or augment skills which are difficult to acquire during their current work placement. The challenges that trainees have achieving these goals include finding time during complex rosters to attend courses, limited availabilities, and potential financial burden, at a time when trainees can spend a significant amount of money towards their training during their career^[4].

Several college courses such as the Australia and New Zealand Surgical Skills Education and Training course (ASSET), Care of the Critically Ill Surgical Patient (CCrISP) and Early Management of Severe Trauma (EMST) have equivalent recognised courses overseas. While Australia has a world class health system, there is still a lot to be learnt abroad in different health systems. The EMST (or Advanced Trauma Life Support [ATLS] internationally) and DSTC (Definitive Surgical Trauma Care) are offered in countries abroad at a similar or lower cost than in Australia. If you were to consider taking part in the ATLS within the US for example, it provides Australian trainees the opportunity to learn from clinicians who have greater experience in managing complex trauma cases, as the US has one of the highest road traffic, gunshot and stabbing mortalities of all OECD countries ^[5]. The application process for overseas courses is generally relatively simple, and while waitlists for courses vary, some are more accessible than those locally.

Attending courses overseas at a junior level can also foster an interest and understanding of global health ^[3]. Trainees will benefit from visiting international leading health institutions to learn about novel technologies and techniques such as advances in simulation and robotic surgery^[2].

These courses can also be used as an opportunity to meet peers or mentors from different countries, allowing trainees the chance to take part in projects with international researchers, a cornerstone of the success of local research collaboratives such as QUEST ^[6]. These experiences can also provide opportunities to work abroad in the future, particularly at a time when international fellowships and sabbaticals are becoming more competitive.

Cost and value for money are equally important considerations. The perceived financial burden of travelling overseas may seem like a barrier; however international courses are often significantly cheaper than within Australia. Our experience is that in many cases the costs of flights, accommodation and course fees are equal to or lower than the equivalent course locally. However, a lot of time needs to be spent researching in order to be assured that the effort and money will be worthwhile. Feedback from colleagues is highly sought after but is difficult to source due to the paucity of trainees who attend these overseas courses.

Wellbeing is an important factor in junior doctors’ daily lives. Many trainees should consider electing to use annual leave time to holiday in days around the course, making the trip more enjoyable and allowing them the opportunity to combine study with time to relax and to explore a foreign country.

Finally, it is also important for the prospective student to ensure that the program is accredited by the Australian surgical governing bodies in order to avoid completing the same course twice if it is a prerequisite.

In summary, overseas surgical courses provide junior doctors with opportunities to gain surgical skills and knowledge that they may not easily be exposed to locally, learn about new treatment paradigms in countries with different health systems, enable international networking for future research collaborations, as well as being able to include a holiday with their work experience.

Although there is reliable information for trainees about which Australian courses are available, there is currently no central resource for doctors regarding international courses, with the majority being advertised by word of mouth. We believe that attending short courses overseas is not only beneficial to the individual, but also achievable and essential.

References

1. Nadig A. Surgical trainees should consider taking courses overseas. BMJ. 2016;355:i5809.
2. Abreo N, Sivathasan N. Microsurgery training course, Columbia University, New York. BMJ. 2009;339:b4364.
3. Henry JA, Groen RS, Price RR, Nwomeh BC, Kingham TP, Hardy MA, et al. The benefits of international rotations to resource-limited settings for US surgery residents. Surgery. 2013;153(4):445-54.
4. Stroman L, Weil S, Butler K, McDonald C. The cost of a number: can you afford to become a surgeon? The Bulletin of the Royal College of Surgeons of England. 2015;97(3):107-11.
5. World Health Organization. Global status report on road safety 2018: Summary. World Health Organization; 2018.
6. QUEST Collaboration: www.questcollaboration.org