Training and delivery of pediatric surgery services in Asia

The purpose of this report is to obtain an overview of pediatric surgery training in Asia and to have a glimpse of its delivery.

A questionnaire survey was conducted, and the returns from 41 (67%) pediatric surgeons from 14 (88%) Asian countries were reviewed.

The number of pediatric surgeons per million population is lowest in Indonesia (0.1) and highest in Japan (25). Two cities in China have 100 or more pediatric surgeons. The number of staff surgeons per center ranges from 1 to 36. Centers with 5 or fewer neonatal surgical operations per staff surgeon per year are located in Cambodia, China, and Japan, and centers with more than 40 neonatal surgical operations per staff surgeon per year are found in India, South Korea, Myanmar, and Thailand. There are centers in which more than 400 postneonatal pediatric surgical operations are performed per staff surgeon each year in Cambodia, India, Indonesia, South Korea, and Myanmar. After general surgery training, pediatric surgery training commonly lasts 2 to 3 years (71%). The shortest training period is 1 year in a center in 1 country to 5 or more years in a few countries. At the end of the training, a variety of exit examinations or assessments (clinicals, orals, written) are conducted in most countries.

Pediatric surgery training programs in Asia are diverse. Clinical cases per trainee surgeon vary greatly. Although some countries have an adequate number of pediatric surgeons to deliver a high quality service, others are severely short staffed, and have huge caseloads, delivering pediatric surgical services under extremely difficult conditions. Governments subsidize the cost of surgical care in most countries (93%): self-payment is common (86%) and insurance is least practiced (64%).