American Society of Plastic Surgeons
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International research experiences: Reflections and Insights

It's 5 a.m., and roosters have begun to crow. You scramble awake, but then you quickly realize this strange noise isn't the incessant beeping of a pager – it's the sound of an inoffensive, colorful bird somewhere outside, announcing the day. You've traded time in a minuscule, city-center apartment within a large concrete-and-corporate environment for a shared house with only essential furniture, no running water and a small, comfortable bed covered by a much-needed mosquitero. At home, you feel eloquent and accustomed to engaging in discussions of a somewhat sophisticated nature. Here, you attempt to expand your basic vocabulary and ensure you're intelligible by using body language and simple drawings. But you're not home; you're conducting research abroad.

Plastic surgeons who perform research in such drastically contrasting surroundings are often inspired to work harder and be more open to novelty. This international experience can allow researchers to approach their work with a new vision.

International research initiatives have become increasingly available to surgical residents. These opportunities take place in a context of a growing need for surgical care worldwide as demonstrated by the Lancet Commission on Global Surgery. Approximately 30 percent of the global burden of disease was found to be attributed to surgically treatable conditions. It was also estimated that 5 billion individuals worldwide cannot access safe and affordable surgical care.1 Undertaking research projects in international settings presents intrinsic challenges and rewards. Below are a few reflections that could help facilitate and enrich research experiences for plastic surgery residents abroad.Building on pre-existing collaborations, hand-in-hand with the community Conducting research in a community far different than your own begs the questions: Why? And, how can one contribute in an integrative and participatory manner?2 The literature highlights the importance and value of participatory research and establishment of long-term partnerships. This participatory approach (whether with local experts or community members) should be initiated prior to the deployment of active research efforts. It also should help direct research topic and study design-selection to answer the needs of the community. Local mentors, research assistants and community leaders are allies in this process. Pre-existing institutional partnerships increase the feasibility of studies and creates space for even more meaningful research projects in the future.

Introductions and field visits

Once a protocol has been designed, reviewed and approved by all parties and team members, an on-site visit may provide better understanding of the research environment and setting. Unexpected challenges can arise from environmental amenities (e.g., internet connection) to cultural and linguistic differences. Meeting research collaborators ahead of time may help identify possible, unanticipated barriers – as well as facilitators – for your research.

Ethics approval across the board

Ethical review and approval from your own institution and the host institution is usually required. Such a process benefits from being started early. The research you're conducting may be a new and unfamiliar initiative that requires more preparation. Evidence previously published in similar settings (e.g., low-resource) can be essential to demonstrate need and feasibility.

Psychological, social and physical preparation

Psychological: Finding a grounding activity outside of research can be helpful in helping to engage with the community, make friends, learn the local language and explore the cultural diversity. Staying engaged with friends and family back home also facilitates adjusting in both the host and home environments.

Physical: A consultation to a travel clinic to discuss vaccinations and medications is recommended. Oral rehydration salts, hand sanitizer and eating thoroughly washed and cooked foods can help protect from new and unfamiliar pathogens.

Social: Informing the appropriate institution, embassy and licensing bodies of your travel plans is important. It's suggested that you become familiar with linguistic, cultural and social norms of the community prior to traveling to the research location. You may also want to invest in a local SIM card that may provide you with mobile and internet data.

The importance of pilot studies

A pilot study allows for preliminary testing of a research protocol and provides ideas and approaches that may not have been thought of before. It also leads to the recognition of potential barriers and facilitators especially in an international and less-familiar setting. Finally, it provides space to make amendments prior to the start of the study.

Teamwork makes the dream work

Overall, whether in home territory or in an international foreign environment, research remains teamwork and flourishes with collaborations. The wealth of international research experiences lies in the sharing of new perspectives and approaches, the exchange of ideas and the establishment of a partnership dialogue.

Data quality checks

Data may be collected in a different language and may require electronical entry, transcription or translation. It's necessary to check the data regularly for quality assurance to ensure uniformity and collection as per the established protocol.

Dr. Karen Chung is a plastic surgery resident who has been conducting a multi-center research study for the past five months in Addis Ababa, Ethiopia while completing her MSc. The later focuses on health-related quality of life methods, patient preferences, and their applications in economic analyses.

Dr. Mélissa Roy is a plastic surgery resident who has taken part in an international cooperation project in Langue, Honduras and a participatory research partnership in the community of Chilcapamba, Ecuador.