Clinical Observership Opportunities in North America for International Orthopaedic Surgeons

Although efforts have been made to address the inequities of surgical care globally, to our knowledge, there has been no comprehensive analysis of orthopaedic clinical observerships in North America that are available for international surgeons.

Two investigators performed a systematic online search to identify orthopaedic clinical observerships that are available in the United States and Canada for international surgeons. Variables such as host type, geographic location of host site, program type, eligibility criteria, subspecialty focus, application and participation fees, availability of funding, duration of observership, and the quality of online information that is available based on an online content (OC) score were collected.

Of the 113 available observership sponsors in North America, 36 (32%) were professional-society-based, 69 (61%) were academic/institution-based, and 8 (7%) were private-practice-based. Most observerships were located in the U.S. (n = 85) and, of these, the Northeast was the most common U.S. region (n = 29, p = 0.008). Of the observerships with a focus, pediatrics was the most frequent orthopaedic subspecialty (p < 0.0001), followed by spine and trauma. Professional-society-sponsored observerships offered funding to international surgeons more often than academic/institution-based and privately sponsored programs (p < 0.0001). The average OC score for the entire cohort was 2.35 and was similar among the 3 host types (p = 0.954). The program structure and requirements such as applicant eligibility, application and participation fees, and duration of observership varied widely.

There are opportunities for international orthopaedic surgeons to participate in clinical observerships in North America. Given the greater funding support and lack of fees for professional-society-sponsored observerships, these observerships may pose fewer financial barriers for surgeons from low and middle-income countries (LMICs). The quality of online information was similar among the 3 different host types and can be improved.

The relevance and impact of a clinical observership experience in North America for a practicing orthopaedic surgeon from an LMIC need to be explored further.