General surgery residents expand depth and breadth of knowledge during international rotation

November 28, 2018

IR Intern Dr. James Hui and General Surgeon Dr. Irene Wapnir examine a film during Hui's rotation in the breast surgery section.

Choose two: Transplant, Surgical Oncology, Thoracic, Breast Surgery, …or Africa?

While one of those options may seem dissimilar, the International Rotation at the University of Zimbabwe is, in fact, a popular elective for PGY3s in Stanford’s General Surgery Residency Program.

“I saw more perforated duodenal ulcers in one week than I did in five years of residency in the states,” said Dr. Joseph Forrester. “I was also exposed to various rotational flaps that I had not seen before.”

While many residency programs offer the opportunity to study abroad, Dr. Sherry Wren, who manages the international program stateside, says Stanford’s program is unique.

“Many programs around the country have an American surgeon as the onsite supervisor in Africa,” says Dr. Sherry Wren, a general surgeon and director of global surgery for Stanford’s Center for Innovation and Global Health. “We are the only program that has an African trained surgeon as the onsite supervisor allowing our residents to really embed in a different country’s health system with local doctors.”

Meet Professor Godfrey Muguti. Muguti is not only chair of surgery at the University of Zimbabwe, he is also a member of the Stanford Surgery faculty and Stanford’s on-site advisor for the international surgical rotation.

“Stanford residents are fully integrated into our training program during their stay at the University of Zimbabwe,” said Muguti, who founded the international rotation alongside Wren in 2012. “Our main objective is to produce a competent clinician, who is also able to use the available resources efficiently.”

“As residents, we spend the majority of our training with everything at our fingertips—access to a diverse pharmacy of medications, top-of-the-line surgical equipment and highly-trained staff,” said Dr. Cara Liebert, who participated in the program in 2016. “In Zimbabwe, sutures, dressings, and medications are in short supply and often out of stock, so you are more conscious about avoiding waste and utilizing what is available.”

Wren says learning to work in a resources-constrained site is one of her goals for the residents who go to Zimbabwe.

“I want [the residents] to see medicine practiced in a very different environment and construct than they are used to, to compare and contrast two distinct healthcare delivery systems and to see the strengths and weaknesses in both,” said Wren, who supervises the international rotation on the local side. “Most importantly, I want them to think about how the things they learn can be brought back to the U.S.”

Muguti recommends any residents contemplating the program to “polish up on their clinical skills,” especially history taking.

“Upon arrival to Harare, I was impressed with the precision of the local surgeons’ physical exam and the wealth of information they were able to glean from this interaction,” said current PGY3 Dr. Josh Jaramillo, who participated in the program earlier this year. “I definitely developed professional skills and techniques that have helped me to become a better surgeon. But most importantly, this rotation has helped me to grow in my compassion and humanity.”

In addition to the clinical experience, each of the residents interviewed remarked on how the rotation augmented their cultural competency. An education that can extend to the surgeons’ families as well.

“The decision to take my family was easy for me,” said Liebert. “My sons have only ever known growing up in Menlo Park, CA. To allow them a month to experience Zimbabwe culture, play with Zimbabwean children, and see a country very different from their own was a unique and valuable opportunity in their development.”

Liebert was joined by her husband and her two young sons, who were 8 and 1.5 years old at the time.

“For any residents considering the rotation, my advice is to absolutely go—whether alone, with your spouse, or entire family,” said Liebert. “Whether you are considering a career in global surgery or not, there are extremely valuable lessons to learn and experiences to gain from rotating in Zimbabwe.”

In the coming years, Muguti and Wren hope to expand the program by raising the funds to allow University of Zimbabwe residents to rotate at Stanford and establish collaborative research projects at the faculty level.