Obstacle Considerations
Administration Is there sufficient administrative support to coordinate agreements between the two institutions?  Who are the key contacts?
Supervision Will there be appropriate international rotation resident supervision to meet ACGME* qualification requirements for rotation directors?  If not, is there a U.S. faculty champion who will travel with resident rotators for supervision?
Safety Disease risks, vaccination and prophylaxis needs, security, government stability, views toward US citizens, etc. have been considered and the resident has been educated regarding safety?
Credit How will the department schedule the rotation: credited elective time, or non-credited leave time? If credited as an elective, is ACGME approval required? What are the requirements of your specialty board for graduation? If attempting elective credit without formal ACGME approval, are individual petitions for international rotators required for ACGME or specialty board?
Funding What are average travel and in-country living expenses, and how will they be covered? Who will fund the resident’s salary while on rotation? Who will provide travel insurance? Will the host institution cover resident malpractice insurance?
*ACGME: Accreditation Council for Graduate Medical Education
Table 2: Obstacles to be Mindful of during Rotation Planning.