Explore This IssueJune 2008
International Head and Neck Surgeons Who Train in North America Find Benefits and Limitations When Returning Home
Over the years, articles in the scientific literature have documented the trials and rewards of foreign doctors who come to North America for their residencies and fellowships.1-3 The psychosocial and professional stresses of leaving one’s native country, and then returning after training, can run the range from negligible to substantial. ENT Today spoke to four graduates of North American fellowships in otolaryngology-head and neck surgery at their offices in Brazil, the Netherlands, Germany, and Puerto Rico. All said their training was superb, but they also thought some aspects of their experiences could be modified to better prepare them for practicing when they returned home.
André Lopes Carvalho, MD, PhD, is a head and neck surgeon practicing in Barretos, Brazil, a small city with a major cancer hospital. He has been there just six months. He went to the United States three different times for training, spending the bulk of his time here as a researcher. In 1999, Dr. Carvalho completed a four-month fellowship at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York, researching clinical outcomes; he received his PhD based on research partially carried out there. In a second training program on cancer epidemiology and prevention, he spent four months at McGill University in Montreal in 2000, and another two months at the National Cancer Institute in Washington, DC in 2002. In his third training program he stayed 18 months at Johns Hopkins Medical Center in Baltimore in 2004, where he completed a postdoctoral fellowship in basic research in head and neck oncology working in the laboratory with Joseph A. Califano III, MD.
Dr. Carvalho cited his greatest gain from these programs as the opportunity to think outside the box and to see many different people working in this field. I could bring back something new every time, not only to change my practice but to teach others, he said.
Dr. Carvalho and a colleague of his, who was also his supervisor and had done extensive clinical training himself in the United States, identified a formidable problem: patients with head and neck cancer arriving at their hospital in Brazil had much more advanced disease than the admitted patients at MSKCC. However, when they compared outcomes in patients from both centers who were at the same clinical stage, they observed that they could provide similar treatment and get similar outcomes. That was very satisfying for us, Dr. Carvalho said.