J Thorac Cardiovasc Surg 1996;112:1679
© 1996 Mosby, Inc.
Strengthening international ties in cardiothoracic surgery
Cornelius Dyke, MD
43rd Evarts Graham Memorial Traveling Fellow
Assistant Professor of Surgery
University of Pittsburgh
Pittsburgh, PA 15261
To the Editor:
This past year I had the honor of being the recipient of the forty-third Evarts Graham Memorial Traveling Fellowship of The American Association for Thoracic Surgery, for which I am deeply grateful. A change in the Graham Fellowship regulations makes me the last American eligible for the Graham Fellowship, because it is now open only to applicants from outside North America. This change prompts me to write, for one of the many lessons of this past year for me has been the importance of exposure to the surgical world outside North America.
When the Graham Fellowship was established in 1951, the United States dominated the world of thoracic surgery. In a spirit of education and altruism, the AATS established the Graham Memorial Traveling Fellowship to allow surgeons from abroad to come to the United States, learn from the leading centers of the day, and return to their native country, taking with them the expertise they had accrued. The fellowship continues to be very successful, with many recipients returning to their native countries and taking up leadership positions within the field. The spread of cardiac surgery from the United States outward is not a story that needs to be retold, and the Graham Fellowship played a significant role.
Times have changed though, and the United States is no longer the center of the surgical universe. It took me a year abroad to learn this. Having spent my medical school and postgraduate training at Duke and the Medical College of Virginia, my feelings about medicine were rather insular, and I do not think these feelings were unique. When it comes to seeing the world outside our borders, young American surgeons are generally myopic. And yet, today more than ever, this is a mistake. The number of publications in The Journal of Thoracic and Cardiovascular Surgery from outside North America has increased dramatically over the past 10 years. Clinical excellence and advances in permanent cardiac assistance and replacement, cardiomyoplasty, minimally invasive surgery, and reconstructive surgery are developing around the world. Many of the changes in health care delivery occurring in the United States have already occurred abroad: hospitals operate within fixed budgets and bidding among providers occurs; cost reduction and fast-tracking is an old concept—if today's patient does not go to the ward within 23 hours, tomorrow's case will be cancelled for lack of intensive care unit beds or nursing staff.
Information is strength, and it is in the interest of young American surgeons and American surgery not only to be aware of the outside world but also to embrace it and develop close international ties. The Graham Fellowship was a potential means of doing this; however, with the decision to close the Graham Fellowship to North Americans, this is no longer so. Although the motives of the AATS in establishing the Graham Fellowship in 1951 remain valid, other considerations and needs have arisen. If the Graham Fellowship is not the mechanism by which North American surgeons can learn from abroad, some other mechanism is needed to foster and encourage young North American surgeons to lift their heads and look beyond our borders and to seek out that which might benefit us here at home.
