September 2017 #PRSJournalClub Wrap-Up: “Predictors, Quality Markers, and Economics of Volunteering Internationally: Results from a Comprehensive Survey of American Society of Plastic Surgeons Members”

by Kyle Sanniec, MD, MHA (@drkylesanniec)

The September edition of #PRSJournalClub provided a fantastic opportunity to discuss the PRS article “Predictors, Quality Markers, and Economics of Volunteering Internationally: Results from a Comprehensive Survey of American Society of Plastic Surgeon Members” by McIntyre J (@joycemcintyremd), Schoenbrunner A (@aschoenbrunner), Kelley K, and Gosman AA (@amandatory_v).  The article can be found here.

The goal of the study was to evaluate quality of clinical care provided on international volunteer trips as well as demographic and economic information on volunteers with the goal of improving quality of care delivered. A validated email survey was sent to ASPS surgeons with 746 respondents (15% response rate). They further divided the respondents into surgeons who never volunteered (253), surgeon who volunteered but not in the past 5 years (210), and surgeons who volunteered within the past 5 years (283). In the subset of respondents who volunteered in the past 5 years, questions regarding quality, resient and attending participation, and death or major complications were evaluated. Lastly the economic impact and opportunity cost of surgeons volunteering abroad was evaluated.

A total of 283 surgeons volunteered a total of 2368 surgery days in the past 5 years and a majority (61.7%) were not fellowship trained. Cleft surgery (50.9%) followed by general recontruction (19.7%) and burn reconstruction (7.6%) were the most comon category of surgery performed. The use of quality metrics and guidelines showed that 98.9% of respondents utilzied medical records with 98.2% reporting follow-up care.  However, only 38.5% utilized safe surgery guidelines and only 36.7% of participants operated within their scope of pracitce at their home institution.

Predictors of a major complication or death were found to be use of general anesthetic (OR 4.8; p<0.036) as well as the type of surgery performed as respondents who performed general reconstructions (OR 0.5; p=0.042) and hand surgery (OR 0.3;p=0.044) less likely to report a death or major complication.

The most important predictor of volunteering was previous expereince volunteering in medical school (OR 6.1; p<0.01) or in residency (OR 22.3; p<0.001). The study also found no difference in fellowship trained surgeon and non-fellowship trained surgeons with regards to volunteering. The most common reasons that surgeons did not volunteer was an inability to take time away from their practice (59.3%), unable to find a group to travel with (18.3%), and not believing their skills were needed (15.9%).

The cost of volunteering demonstrated that 34.7% of surgeons contributed more than $2000 with 25% contributing between $1000-$2000.  The monetary value of international work performed by the volunteering surgeons was valued at approximately $8.2 million.  The opportunity cost incurred on the volunteers from absence at their home institution was $43 million.

The authors concluded that there is wide variability in the quality of care on international mission trips and that many surgeons are operating outside of their scope of practice on mission trips.  Additionally, the importance of volunteer experience in medical school and residency cannot be overstated as those experiences early in a young surgeon’s education are formitive in creating an attending surgeon who will volunteer internationally in the future.

This article was first discussed by the current Resident Ambassadors to the PRS Editorial Board Jordan Frey (@JordanFreyMD), Shuja Shafqat (@shujashafqatmd), and Chad Purnell (@ChadPurnellMD), and the special guest moderator Dr. Amy Colwell. Listen to the podcast discussion below:


This was followed by a robust discussion during the #PRSJournalClub.  Some of the excerpts are found below as the authors provided an interactive discussion of their research and tangible goals for the future of international volunteering. Click on each excerpt to see each discussion in its entirety.

Enjoy reviewing the article and the interactive discussion, and as always follow the journal (@PRSJournal), the PRS Resident Ambassadors: Jordan Frey (@JordanFreyMD), Shuja Shafqat (@shujashafqatmd), and Chad Purnell (@ChadPurnellMD), or myself (@DrKyleSanniec) for information on the next #PRSJournalClub.

 

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References:

  1. McIntyre J, Schoenbrunner A, Kelley K, Gosman AA. Predictors, Quality Markers, and Economics of Volunteering Internationally: Results from a Comprehensive Survey of American Society of Plastic Surgeons Members. Plast Reconstr Surg. 2017;140(3):617-626.

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