Abstract: Despite the good-natured intent of the volunteers that embark on humanitarian mission trips, the intent of the missions trips have at times been criticized for being training grounds for young physicians and surgeons. This commentary describes the role of the resident surgeon on mission trips from the perspective of a current otolaryngology resident surgeon. With clearly defined roles and responsibilities, surgical care can be delivered safely with resident participation on mission trips.
Medical and surgical humanitarian mission trips are a way
physicians, medical students, nurses and support staff can join
together as a team, and donate their time and skills to serve those
with limited access to health care. Despite the good-natured
intent of the volunteers that embark on humanitarian mission
trips, the intent of the missions trips have at times been criticized
for being training grounds for young physicians and surgeons
[1,2]. This, in turn has been documented to be a potential source
of apprehension among local physicians. For instance, one review
of short term mission trips papers published over a 25-year
period revealed that local doctors felt resentment that a trainee
surgeon might not be as adequately supervised as in their home
country . There was also a feeling that inadequate supervision
may lead to complications.
While formal international rotations within United States surgical residency programs are established at certain institutions,  residents may also find opportunities and travel with third party humanitarian groups. Resident regulations set forth by the Accreditation.
Council for Graduate Medical Education (ACGME) and American Osteopathic Association (AOA) for training programs in the United States might not necessarily apply to humanitarian service abroad. As a result, the role of the resident physician team member on humanitarian mission trips is not well defined in protocols. The training and supervision relationship between residents and attending surgeons must continue during overseas work. In a discussion about global surgery as a component of surgical education training, the authors insist that a qualified surgeon always be available to “supervise any treatment attempted to prevent any inappropriate harm to patients” . This sentiment has been echoed in guideline reports produced by Board of the American Society of Plastic Surgeons and the Plastic Surgery Foundation . By sharing personal experience, this commentary aims to clarify the role of the resident mission team member, from the perspective of a current otolaryngology resident surgeon who recently completed his first mission trip.
During formal otolaryngology residency training, the author
participated in a weeklong humanitarian mission trip to Antigua,
Guatemala. The author travelled with a third party humanitarian
mission group in order to contribute as a volunteer resident
surgeon. The trip was dedicated to microtia repair, and cleft
lip and palate repair. Beginning with early morning rounds, the
resident was responsible for assisting the attending surgeons
during rounds. Materials were gathered for rounds, including
dressing materials, extra drains, tape, and scissors, and were
brought to the bedside. Patients were evaluated in unison with
attending physicians, drains and dressings were changed, and
the daily plan for each patient was determined at morning
rounds. After the patients had been rounded on, preoperative
evaluations were conducted (in which the patients were seen
and evaluated), the surgical site was marked, and any remaining
pre-operative questions were answered.
The involvement of the resident during each case closely resembles the operating room experience in the United States. How to cite this article: Kieliszak CR. Reconstructive Facial Plastic Surgery on Humanitarian Mission Trips: Role of the Resident Surgeon Team Member. Glob J Otolaryngol. 2015;1(1): 555552. 002 The resident mostly participated as an assistant to the primary surgeon. Since there were several rooms operating at once, the resident often shuffled between rooms when needed for certain tasks such as harvesting skin grafts.
There was adequate supervision from attending surgeons at all times during the case. Post-operatively, the resident rounded on all patients on the wards before leaving for the evening.
A potential method of lessening the resentment and apprehension of having trainees on mission trips might be to establish guidelines for international humanitarian trips, outlining the role of the resident team member. For instance, guidelines for the delivery of plastic surgery care were created and approved by both the American Society of Plastic Surgeons and the Society of Pediatric Anesthesia [5,6]. These reports include general comments about resident participation. More specific roles and responsibilities of the residents through the phases of care on facial plastic surgery mission trips are presented here (Table 1). This basic information could be custom-tailored to the individual mission trip in order to describe the resident’s team member’s exact role and could be provided to the facility in the host country to provide full disclosure and transparency.
The future for resident involvement in mission trips looks bright. Dr. Mary Ann Hopkins, in her presidential address for Association for Surgical Education, described the importance of resident participation in global health initiatives, stating that the experience “not only imparts the importance of global health but will also show them (the residents) the value of education and training local doctors” . Residents have been shown to perceive benefits in “cultural competency, communication skills, adaptability and desire for service” . In fact, recent studies have shown that resident participation in mission trips is more likely to lead to participation in trips after residency . Organizations such as “Operation Giving Back”, sponsored by the American College of Surgeons, have provided a portal for which physicians and surgeons, including residents and medical students can find opportunities to perform humanitarian work.
Humanitarian mission trips can be life changing, not only for the children and their families in the countries that are served, but for the team members on the mission. A mission trip experience can help reaffirm one’s passion for medicine, and serve as a reminder that providing support to those with limited access is a critical component to being a doctor. With clearly defined roles and responsibilities, the resident may function as an integral team member and should be considered as an asset, and not a liability.
Thank you to the American Osteopathic Foundation who
provided funding to support expenses on the mission trip.
Thank you to the New York Institute of Technology - College of Osteopathic Medicine (NYIT-COM) and the Center for Global Health who provided funding to support expenses on the mission trip.
Thank you to the Help Us Give Smiles (HUGS) foundation for including the author as a surgical team member on the mission trip to Antigua, Guatemala, in 2014.
- Hadlock TA, Sabini P, Quatela V, Cheney ML (2008) Multistaged reconstructive efforts via medical missions: keys to optimizing outcome. Arch Facial Plast Surgery 10(5): 350-352.
- Dupuis CC (2004) Humanitarian missions in the third world: a polite dissent. Plast Reconstr Surg 113(1): 433-435.
- Martiniuk AL, Manouchehrian M, Negin JA, Zwi AB (2012) Brain Gains: a literature review of medical missions to low and middle-income countries. BMC health Serv Res 12: 134.
- Leow JJ, Kingham TP, Casey KM, Kushner AL (2010) Global surgery: thoughts on an emerging surgical subspecialty for students and residents. J Surg Educ 67(3): 143-148.
- Schneider WJ, Migliori MR, Gosain AK, Gregory G, Flick R, et al. (2011) Volunteers in plastic surgery guidelines for providing surgical care for children in the less developed world: part II. Ethical considerations. Plast Reconstr Surg 128(3): 216e-222e.
- Schneider WJ, Politis GD, Gosain AK, Migliori MR, Cullington JR, et al. (2011) Volunteers in plastic surgery guidelines for providing surgical care for children in the less developed world. Plast Reconstr Surg 127(6): 2477-2486.
- Hopkins MA (2015) Surgical education and global health: call to action. Am J Surg 209(1): 1-7.
- Vu MT, Johnson TR, Francois R, Simms-Cendan J (2014) Sustained impact of short- term international medical mission trips: resident perspectives. Med Teacher 36(12): 1057-1063.
- Tannan SC, Gampper TJ (2015) Resident Participation in International Surgical Missions is Predictive of Future Volunteerism in Practice. Arch Plast Surgery 42(2): 159-163.
- Operation Giving Back.
Table 1: Resident Objectives, Responsibilities and Participation Roles through Phases of Care.