The SEA-HVO Traveling Fellowship Rotation Goals and Objectives


Senior residents or fellows who have been approved after applying for a SEA-HVO Traveling Fellowship will spend four weeks teaching anesthesia in a low resources country. The SEA-HVO Fellowship is co-sponsored by the Society for Education in Anesthesia and Health Volunteers Overseas. Traveling Fellows may choose to rotate at any pre-approved HVO site if the dates they choose to teach are dates that are available at the site. Traveling Fellows must be HVO members and travel arrangements will be administered by HVO. This is considered a clinical rotation outside the primary program and pre-approval must be obtained from the ABA Credentials Committee. Because this is an outside rotation it should normally be completed prior to the last three months of residency. Two days on either end of the rotation may be taken as travel days; otherwise residents are expected to be teaching on site all days that have been agreed upon by their program and HVO site.

Educational Objectives

  1. Medical Knowledge: Residents must learn and practice teaching skills. In order to teach well they will need to know their subject matter thoroughly. Residents will need to acquire knowledge of local surgical pathologies, medical illnesses, and anesthesia techniques. They will learn to be adaptable to the locally expressed training needs and creative while teaching in unique and often challenging environments. Residents must understand issues related to their own health and safety in a foreign country.
    • Cognitive Objectives
      1. Identify and learn about the topics in which the students at the HVO site are requesting instruction. Information is available from HVO to guide the selection of appropriate topics.
      2. Learn about anesthetic techniques, equipment and medical problems that are common at the HVO site but uncommon in the US: halothane, EMO inhalers, drawover vaporizers, malaria, etc.
      3. Identify several effective teaching techniques and strategies. SEA can serve as a reference source.
      4. Identify potential health and safety risks as they apply to visiting medical personnel
    • Psychomotor Objectives
      1. Formally prepare at least five lesson topics and plans prior to departure from the US. Recognize that these should be modified as students’ needs and background are assessed. Review these topics with an advisor in the US prior to departure.
      2. Pack the necessary resources to prepare additional lessons and modify those already prepared.
      3. Become familiar with the teaching resources available at the site: photocopier for handouts? Blackboard? Audiovisual aids?
      4. Teach students at the site by responding to their learning needs and ensure that you are achieving their educational goals.
      5. Use several different methods of teaching to learn which technique works well: e.g. lecture, discussion group, demonstration, assigned guided topic.
      6. Periodically assess the effectiveness of teaching by quizzes, questioning or other methodology.
      7. Review travel health resources and determine need for vaccinations, prophylaxis and precautions for destination country.
    • Affective Objectives
      1. Appreciate that effective teaching must be practical, culturally sensitive, and non-judgmental.
      2. Teach responsibly to meet the needs of the students and hospital.
      3. The recognition that you cannot help others without first caring for your own health and safety.
  2. Patient Care: Residents must be able to teach and demonstrate patient care that is compassionate, appropriate, and effective for the treatment of health problems, some of which may be uncommon in the US. The resources of the health care environment may be limited.
    • Cognitive Objectives
      1. Identify how local resources influence perioperative care.
      2. Identify familiar management questions (the approach to the patient with a difficult airway, or the management of postoperative pain, for example) and learn how care differs when available resources are limited.
      3. Learn standards of care for the host medical community.
      4. Identify the influences of spiritual attitudes and non-western medicine on issues of health and death.
    • Psychomotor Objectives
      1. Observe all aspects of anesthetic and perioperative patient care in a low resource country.
      2. Identify the local resources available for perioperative care. What drugs and equipment are available and commonly used? Is there a recovery room or intensive care unit? What are the personnel resources? For example, are there nurses on the surgical wards and who takes anesthesia call at night?
      3. Discuss the management of students’ routine and challenging cases.
      4. Demonstrate patient care techniques under supervision and using available resources.
      5. Teach at the bedside in a way that is sensitive to the needs of students, colleagues, and patients.
      6. Model behaviors that will assist students in providing good care: critical thinking, careful planning, altruism, vigilance.
      7. Teach patient care that is safe and will be sustainable. Teach only using available equipment and drugs unless specifically requested to do otherwise.
      8. Creatively apply US-acquired patient care practices in a new setting, adapting to the available resources.
      9. Learn how medical care is viewed and valued in the host country and determine the role of spirituality and alternate medicine techniques.
    • Affective Objectives
      1. Develop an appreciation for the asymmetry of global resource allocation.
      2. Appreciate the importance of optimizing the safety of anesthesia worldwide, using whatever resources are locally available.
      3. Appreciate cultural differences in the expectations surrounding medical care.
      4. Appreciate ways in which the fundamentals of anesthesia practice can be resource-independent (“airway, breathing, circulation”) and that scarce external resources make the anesthesiologist’s intellectual and clinical skills more essential.
  3. Interpersonal and Communication Skills: Residents must demonstrate interpersonal and communication skills that result in effective and culturally appropriate information exchange with their students, colleagues and patients. They must learn the importance of relationship building, collaboration and support of local “advocates” for the success of international programs.
    • Cognitive Objectives
      1. Become familiar with cultural differences between the US and the host country.
      2. Identify core values of the hosting community
    • Psychomotor Objectives
    1. Speak clearly and slowly when teaching so that you can be understood.
    2. Communicate politely, respectfully and patiently at all times.
    3. Identify ways in which cultural differences may impede effective communication for a visitor. Strive to overcome impediments and adapt to your cultural setting.
    4. Identify an appropriate “local advocate” who can carry on your teaching principles after you have left the country.
    5. Never criticize the government, hospital administration, patients, or people you work with: you are a guest.
    • Affective Objectives
      1. Demonstrate cultural sensitivity, respect and mutual learning in all interactions.
      2. Realize that change comes slowly and that trying to force change by criticizing, complaining or being impatient will be counterproductive.
      3. Learn to respect and appreciate the value of happiness, dignity, and contentment.
  4. Professionalism: Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and culturally appropriate behavior. Residents should strive to serve as good role models and act as medical “diplomats.”
    • Cognitive Objectives
      1. Understand that character and ethics are core aspects of professionalism.
      2. Understand that you are representing your hospital, the SEA-HVO Fellowship, your profession, and US physicians as a whole.
    • Psychomotor Objectives
    1. Trip plans must be executed in a timely fashion.
    2. Display a professional demeanor when interacting with students and hospital staff.
    3. Be enthusiastic and involved in your teaching.
    4. Do not knowingly embarrass your hosts or go against their wishes if they have requested that you don’t do something.
    5. Do not promise to do something that you are not certain to be able to.
    6. Recognize that local standards of professional and appropriate behavior may differ from those you are accustomed to. Respect these differences and comport yourself so that both your hosts and your US colleagues would agree that you are behaving appropriately.
    • Affective Objectives
      1. Be polite and respectful in all interactions.
      2. Demonstrate a commitment to teach as well as you can.
      3. Appreciate that the manner in which you conduct yourself reflects not only on you but your specialty and your country.
  5. Practice-based Learning and Improvement: Residents must be able to self-educate, evaluate and readjust their teaching as they practice and get feedback during their rotation overseas.
    • Cognitive Objectives
      1. Demonstrate knowledge of the several methods of medical teaching; assess and adapt as indicated.
      2. Teach the importance of self-education and continuous improvement of medical care.
    • Psychomotor Objectives
      1. Prior to departure, anticipate, prepare, and pack the resources you will need to support your own teaching and learning in another country. Will you have internet access? How about small and portable reference books? Will a laptop computer be of help to you? Do you have written handouts or CDs to give?
      2. Become familiar with the library, reference, and information technology resources available to students.
      3. Teach students how to find and apply evidence in peer-reviewed articles to improve clinical care.
      4. Instruct students in self-education via the internet. Be familiar with at least three web sites that students can use as reference sites if needed.
      5. Actively seek discussion and feedback from students about cases they find interesting or puzzling.
      6. Seek information from colleagues at the site about how they manage limited resources.
    • Affective Objectives
      1. Display a willingness to acknowledge that you don’t know an answer and look it up together with the student or students.
      2. Listen and respond to feedback.
      3. Be willing to try new ideas and approaches to teaching (be in a learning mode).
  6. Systems-Based Practice: Residents must demonstrate an awareness of and interest in the way optimal care of patients fits into the larger context of the health care system of the country in which they are visiting.
    • Cognitive Objectives
      1. Inform yourself on health care delivery structures in the host country.
      2. Educate yourself on what resources are available for anesthesia in the hospital where you are teaching and what some of the constraints are on obtaining additional resources.
      3. Collect practical suggestions on which teaching tools and information future volunteers might want to bring.
    • Psychomotor Objectives
      1. Learn how patient care is accessed.
      2. Learn how hospital supplies are accessed.
      3. Learn who provides anesthesia care and determine how anesthesia care providers are trained.
      4. Assist in maximizing the resources available to the anesthesia department you are visiting.
      5. Contribute teaching plans and materials (handouts or CD’s) which can be used for future volunteers and students.
    • Affective Objectives
      1. Be willing to learn from your students and hosts as well as to teach.
      2. Commit yourself to improving health care delivery at your site, in whatever way you are able.
      3. If asked, be willing to share what you have learned with your colleagues in the US when you return.