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CAGS INTERNATIONAL SURGERY COMMITTEE
 
 
 
Information for Residents
 
Specialty Training Requirements:
See the Objectives of Training and Specialty Training Requirements.
The Royal College allows up to three months training abroad during a general surgery residency provided the proposed training is acceptable to your local Program Director and Residency Committee. Such approval is not automatic and you should approach your program director early in your training to seek his or her approval and advice.
These specialty training requirements apply to those who begin training on or after 1 June 2003. Please also see the 1996 requirements pertaining to those who begin training before 1 June 2003.
Five years of approved residency training. Training should incorporate the principle of graded increasing responsibility. This must include at least 36 months of General Surgery rotations, of which at least one year must be spent as a senior or chief resident. This period must include:
  1. two (2) years of core training in surgery (please see the Objectives attached to this document).
  2. thirty (30) months of approved residency training in general surgery, one continuous year of which must be at a senior resident position;
  3. six (6) months of approved residency training that may include:

    i. further approved residency in general surgery or in one or more branches of general surgery such as pediatric surgery, vascular surgery, thoracic surgery, surgical oncology, or colorectal surgery;
    ii. clinical or basic research in a department approved by the Program Director, Residency Committee, and the Royal College (see "Policies and Procedures" Section IV);
    iii. up to six (6) months of training in other areas which are relevant to the resident's career goals and which are acceptable to the Residency Committee of his or her medical school; this period may include up to three months in an institution that is not approved for residency training by the Royal College of Physicians and Surgeons of Canada.
This period may include:
  • further approved residency in another surgical discipline such as plastic surgery, gynecology or urology;
  • further residency in an approved program in a non-surgical specialty such as critical care, pathology, y or internal medicine, infectious disease, transplantation or interventional radiology;
  • rural or remote general surgery.

Check List for Residents Going Overseas on Medical Missions
        Academic and regulatory
        Personal and safety
        Medical
        Upon returning
       HIV exposure
  
Academic & Regulatory
1.      Consult with your home Program Director.
2.      Consult with a CAGS Faculty Advisor regarding your interests. Please send an up-to-date copy of your cv and a covering letter explaining what you would do, what skills you have to offer, where you would like to go and when you are available. Then arrange either a telephone call or a personal meeting.
3.      Resident electives should be an absolute minimum of 6 weeks. There is no point going for three weeks as you will hardly be settled before its time to leave.
4.      If you are going to a Missionary Hospital ensure their beliefs jibe with your own.
5.      Identify your chosen elective and make contact with the on-site supervisor. Ideally you will get an introduction from a Canadian Surgeon then send a nice letter with your CV to the on site supervisor.
6.      Determine local licensing and malpractice insurance regulations (applying for a license may be very time consuming and require notarized copies of all your foundation documents – just like here).
7.      CMPA generally does offer coverage for Teaching/research/missionary/charitable work abroad but it is essential that you write to them beforehand.
8.      Establish if this will be a clinical or research elective.
9.      Research involving Human subjects should be ideally be cleared by your own institutional REB as well as by that of the host institution.
10.  Find funding. Some Universities (eg U of T) offer scholarships for overseas work.
 
 
Personal & Safety
1.      Read government travel advisories about your destination.
2.      The University of Toronto Safety Abroad program has lots of useful information on their website and all Toronto students including residents are expected to attend pre-departure student workshops.
3.      Talk to someone who has been where you are going. Consider your dietary restrictions in relation to the local menu or you may starve.
4.      Figure out in conjunction with your on-site supervisor where you will stay and what it will cost.
5.      In General, plan not to take your partner, children and cat unless they are heath professionals too.
6.      Assess the risk of occupational exposure to HIV, Hepatitis and other hazards. If you are going where HIV testing and PEP drugs may not be readily available consider taking your own. Know the CDC recommendations for occupational PEP[1]. Perry manufactures “cut-proof”, re-usable glove liners which you may consider if you expect to be doing lots of orthopedics or trauma and slicing your gloves on bone fragments.
7.      Visit a travel medicine specialist. Some vaccination programs take a month to complete. Take adequate supplies of your own prescription medications.
8.      Get travel insurance that covers medical evacuation to home in case of serious illness or injury. You may lose your Provincial Health insurance coverage if you are out of the Province longer than three months.
9.      Note that in some regions, especially those considered war zones, your existing life or disability insurance may not apply. Check with your insurer.
10.  If you do not already have life and disability insurance consider getting some. Rates are typically low for residents.
11.  Identify your emergency contacts at home and give them a complete list of your contact and flight information.
12.  Make arrangements for someone to pay monthly bills while you are away.
13.  Respect local customs particularly regarding dress. Shorts and nose-rings may be acceptable for ward rounds in Canada but they are NOT in most developing countries. Doctors there expect their colleagues to look like doctors.
14.  Learn a bit of the language.
15.  Find out which Embassy is responsible for you in-country (usually the Brits or Americans if the are no Canadian reps) and let them know you are there. If you are nice, sometimes you even get invited to dinner with the Ambassador.
16.  Road traffic injuries are the most common way travelers die. Wear a seatbelt or motorcycle helmet and avoid dangerous vehicles, especially public busses and matatus.
17.  Psychological stress related to some of the awful things you may encounter is more common than physical illness. Understand this and that the best way to de-brief after a traumatic experience is with someone who has been through similar situations and understands. Talk to your CAGS Faculty Advisor.
18.  Regardless of whether you are planning to have sex while away take a packet of suitable prophylactics.
19.  Most Institutions like the Office of International Surgery will ask for a complete list of your emergency contacts and some may ask you to sign a waiver absolving them of responsibility in case of your untimely demise.
 
 
Medical
1.      Get an idea of your clinical responsibilities and brush-up on relevant topics.
2.      Three books that will see you through just about anything are: Maurice King’s Primary Surgery (Vols I & II are both currently available from TALC in the UK); The Merck Manual and a good anatomy book. Many useful textbooks are now available on CD-ROM. Do not count on fast internet access.
3.      Find out from your hosts what you can bring. Up-to-date texts, cautery machines, and skin-grafting knives are popular items. Check with your hosts regarding what they need.  Novopharm houses the Canadian Medical Aid Program (CanMAP) which has a long history of providing Canadian Doctors with parcels of free medicine for poor countries. (Carol Day at 1-800-268-4127)
4.      Do not carry narcotics through customs.
5.      If you are going to take lots of digital photographs (which you certainly should) you will need to decide if you will take a laptop or some other storage device such as an “i-pod”. Make sure expensive equipment is insured and if it is lost get a police report. Do back up your files before you set out.
6.      Pack light. A hockey bag with a few clothes and a lot of medical supplies can be re-filled with souvenirs on your return.
7.      Take a short holiday. It’s good for you.
 
 
 
Upon Returning
1.      Expect some re-adjustment issues. Know who you can talk to.
2.      Plan to write-up your experience for others to share.
 
 
[updated by MB August08]
   
   
   
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Canadian Association of General Surgeons • Station B Box 1428 • Ottawa, ON • K1P 5R4
Tel: 613-882-6510 • Email: cags@cags-accg.ca
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