Teaching Surgery in Foreign Countries

Teaching surgery in foreign countries is the key to expand French surgery’s influence at a worldwide level. We are currently facing a problem to decide which training method is best suited from efficiency and costs perspectives. My own experience contributed to improve reflexions in this respect.Cooperation. At the end of the 1960s, the French government under General dee Gaulle’s impulse created a medical cooperation system consisting of, notably, the appointment of University Professors for four-year periods in foreign countries. Therefore from 1974 to 1978 I have run the surgical unit of Constantine University Hospital (Algeria). The first young surgeons of Eastern Algeria were trained during this period of time. They are today in charge of surgical units in Constantine, Annaba, Batna, Setif and Khenchela. Back then we were nine French medical professors, and this important number improved teaching quality. Others surgeons also followed the same path, as Denis Gallot in Morocco, Daniel Jaeck in Laos, and Oscar Nusseaume in Senegal. At the end of this foreign teaching experience, the French surgeons would be attributed a permanent position in a university hospital in France. Due to its high costs, this type of cooperation was abandoned despite the very impressive results.Training of foreign surgeons in France. Laparoscopic surgery was proved to be a fantastic vehicle to increase the influence of French surgery through training workshops including training sessions with boxes, animal laparoscopic surgery and theoretical course. After performing the first worldwide laparoscopic splenectomy in 1991, I was invited as from 1992 to teach these skills and methods in many countries (Maghreb, Middle East, Vietnam, Latin America and Ukraine). As a consequence, many young foreign surgeons attended training sessions in French hospitals. Thanks to an agreement with the French foreign Office, we have obtained six half-year grants which allowed receiving every year during three years (from 1997 to 1999) each time for six-month periods two Peruvians surgeons in the surgery unit of Cochin hospital (Paris). The choice of the candidates was made in Peru with the help of the French embassy based notably on knowledge of French language, motivation and medical knowledge. These surgeons are now heads of surgery units in Arequipa, Huancayo, Trujillo and Piura. A similar recruitment process was made in Ecuador where six surgeons were offered to complete their training at Jean Verdier hospital near Paris. This kind of training is satisfactory to the extent that candidates are young, motivated and has a good knowledge of French language. It also requires a good cooperation with the local French embassy regarding the choice of the candidates and the teaching of French language, as well as a significant financial commitment. We can also mention a similar experience in Vietnam where young surgeons were provided training courses for a two-week period before being invited by the French government as residents in medical or surgical units. Inter-University degree (“DIU”). With the help of Professors Jean-Luc Bouillot, Denis Collet and Doctor Jean-Charles Berthou, we organised for five years (1996 to 2000) a DIU in digestive surgery by laparoscopic approach at Saint Joseph University of Beirut (Lebanon) under a framework agreement entered into with Paris V and Bordeaux universities. This diploma consisted in two eight-day yearly sessions with each morning a live retransmission of a laparoscopic operation followed by a theoretical lecture, and each afternoon a training session on box or animals and a theoretical lecture. Knowledge was tested at the end of the last session. Forty-one Lebanese, Syrians and Jordanians surgeons followed this training course with success. This teaching method is particularly adapted to French-speaking countries. Teaching by video conference. Since 2008 we have organized with the same colleagues a laparoscopic surgery training course by Video-Conference as part of a Lebanon University Degree organized by Saint-Joseph University of Beirut. The retransmission is handled by the audio-visual department of Paris-Descartes University. This interactive teaching has allowed the live broadcast of surgical procedures, movies and technical reports. The practical works were realized in Beirut. Paris-Descartes University invoiced in 2008 €1,500 for each video-conference (each time two days).Today video conference seems to be particularly adapted for interactive teaching and live surgeries broadcasting. However training periods in French surgery units remain very good complements to video-conference even though they entail important costs.Si chacun s’accorde à souligner l’importance de l’enseignement à l’étranger pour le rayonnement de la chirurgie Française, le choix du mode d’enseignement reste controversé. Je rapporte ici au travers de ma pratique l’expérience de quatre types d’enseignement en essayant d’en tirer un certain nombre de conclusions.