A Call to Action: The Case for Surgical Log Credit for International Rotations and Further Action by the Academic Urology Leadership
David E. Rapp, MD
Originally published July 2022 in Urology Practice
A Call to Action
Important international initiatives have brought attention to providing surgical care to 5 billion people worldwide who lack access. As one of many opportunities to help, given vast resident interest in international rotations, the urological community is ideally positioned to harness this interest and foster the next generation of global surgery leaders needed to meet this challenge. Unfortunately, barriers such as lack of institutional support, time off and funding impede trainee participation and, perhaps, an educational experience that might stimulate a career-long interest in global surgery. Notably, the lack of case log credit for international surgeries serves as an important message to devalue the importance of these international experiences. Allowing international cases to be counted for surgical log credit exists as an immediate action that the urological leadership should take to demonstrate its commitment to this global effort and its trainees.
In 2015, the Lancet Commission on Global Surgery was purposed to promote widespread access to safe and high-quality surgical care.1 The Commission reported that, in contrast to other notable gains seen across other health care initiatives, the development of surgical care infrastructure in low and middle income countries (LMICs) had received little attention. And, as a result, LMICs were unable to meet the significant and growing burden of surgical disease. Specifically, the Commission concluded that 5 billion people lack access to safe and affordable surgical care and that 143 million additional surgeries are needed to save lives and prevent disability due to surgical disease. Further, it noted that “surgical and anesthesia care should be an integral component of a national health system in countries at all levels of development.”
Fortunately, the urological community is well positioned to help lead within this global effort. This is critical given the significant portion of the global surgical burden that is urological and the cost-effective nature of providing surgical care.2 Specific to the United States, numerous organizations have created robust infrastructure to help provide urological and urogynecologic care in LMICs. Such nongovernmental organizations (NGOs) include GSE (Global Surgical Expedition), IVUmed and IOWD (International Organization for Women and Development). These and other efforts are supported by many additional organizations focused on fund- ing and advocacy, including the GPC (Global Philanthropic Committee), the G4 Alliance and, more recently, the Urology Care Foundation.
Most importantly, resident interest for international training is vast and growing. Numerous studies demonstrate a significant interest in global surgery experience in the majority of residents across varied surgical subspecialties.3-7 This interest is notable across urology trainees, who perceive international training as being of significant importance to their education and report a commitment to volunteer not only during residency but throughout their career.4,6,7 This is arguably the most critical component of the global surgery movement as we must seek to identify not just urologists willing to participate sporadically on a week-long surgical trip, but rather to foster the next generation of global surgery leadership.
Certainly, there are many steps needed to support the development of a formalized and robust training effort for international global urological surgery. Present barriers include the lack of formal curricula to provide global surgery training and the absence of organized platforms to help trainees identify international opportunities, as well as the lack of institutional support or the need to use personal funding and vacation time to pursue global surgery training.4,7 Much like global efforts to combat surgical disease, such steps will take time, leadership and commitment. However, allowing international cases to be counted for surgical log credit exists as an immediate action that the urological leadership can take to demonstrate its commitment to this global effort and its trainees.1 (continued)