Background: Surgery residents who wish to travel during their residency will often seek an elective experience in a low-or middle-income country. Objectives for international health electives (IHEs) are often vague and poorly defined. Further, feedback to, and evaluation of, the resident after the IHE are often not specific because international preceptors are not familiar with the desired educational outcomes of Canadian residency programs. Residents who choose an elective in a low-income country usually anticipate that they will contribute some medical service to an existing impoverished health care system, and in this setting, they hope to gain exposure to a high operative volume with potentially fewer institutional and administrative obstacles.

Methods: In this paper, we describe one resident's elective experience in Mbarara, Uganda. In addition to her clinical experience, the resident performed a retrospective audit of surgical admissions. After her elective, we asked the resident to reflect on her experience and to use the Canadian Medical Education Directives for Specialists (CanMEDS) framework to describe the challenges she encountered and to define the learning outcomes gained with respect to each CanMEDS role.

Results: We discovered that the resident had a rich and insightful educational experience when discussed in this context. As a result, we have created a guide for structuring postgraduate IHEs around the CanMEDS roles, using them to ask pre-and postelective questions to develop relevant and practical IHE objectives.

Conclusion: We propose that this guide has the potential to improve both resident preparation before international experience and also subsequent evaluation of resident performance in this ill-defined area. More important, we found that IHEs are a useful vehicle to evaluate resident achievement of the CanMEDS competencies in a way that is reflective, realistic and representative of the multiple challenges involved when working in international health.