The Impact of Regulation on Resident International Experiences: A Multispecialty Review of Current ACGME and RRC Standards for International Electives

Partnerships between industrialized and nonindustrialized institutions have accelerated the growth of surgery and surgical subspecialties in the developing world. The results of these partnerships include qualitive and quantitative clinical benefits as well as unique opportunities for the development of resident clinical and surgical skills. Surveys demonstrate surgical residents have a strong interest in international humanitarian work. Ultimately, the opportunities for residents to participate in international work as a program elective are subject to the regulations of the Accreditation Council of Graduate Medical Education (ACGME) and the Residency Review Committees (RRC) that govern residency accreditation. The regulations from accreditation bodies serve to ensure resident safety and educational value; however, excessive regulation can be a major hurdle to programs initiating international electives. Though the regulations are publicly available there is no comparison of various subspecialty standards in the literature. Nor is there a review of how standards affect resident education and safety or the ability for individual residencies to initiate international electives. The regulations as defined by the ACGME and RRC of 7 surgical specialties (general, plastics, neurological, otolaryngology, ophthalmology, orthopedics, and urology) were reviewed from the available data on the ACGME website. The regulations demonstrate a great deal of diversity in how the specialties regulate international work. On one end of spectrum, 2 programs have robust guidelines and an approval process that ultimately allows residents to claim credit for cases performed internationally. On the other end, the regulations for some programs make little mention of international rotations other than to deny that cases be counted for credit. ACGME regulations have a strong effect on resident experiences while training internationally. Ideally, regulations should ensure resident safety and education without being overly cumbersome and preventing smaller programs from developing international electives. This would allow more residents access to the educational benefits available through meaningful international electives. Beyond the educational benefits, resident participation in international training creates a foundation for continued international work throughout their career. This could, in turn, increase the number of surgeons willing to travel internationally and bolster the dev