International Rotations for Anesthesiology Residents FAQs

1.  Can I get academic credit for an overseas anesthesia rotation?

There are two ways anesthesia residents can obtain credit toward residency requirements for international rotations. The first is to do a rotation to a standing overseas site which is part of your home accredited residency program and has been pre-approved as such by the Accreditation Council on Graduate Medical Education (ACGME)/Anesthesia Residency Review Committee (RRC).  Ask your residency director if your program has a standing rotation at an overseas site. If so, this rotation is usually treated like any other elective in your program and you will get academic credit for this rotation without needing further outside approval

The second way is to get academic credit for an overseas rotation at a site that is not part of your home residency program. This outside rotation will need to be approved by your home program and by the American Board of Anesthesiology (ABA). You may choose to apply for a rotation which is part of another ACGME/RRC-approved anesthesia residency program or a program such as a Non-Governmental Organization (NGO) which is independent of residencies. More information can be found at the ABA website.

2.  Do I need to get any special approval to get credit for an overseas rotation if the rotation is a standing rotation which is part of my residency program?

If the ACGME/RRC has approved an elective rotation at an overseas institution as an integral part of your home accredited residency program you will not need to get individual approval from the ABA to get credit for the rotation.  The process for your institution to get ACGME/RRC approval for a rotation to be an integral part of your residency program is complicated and can be difficult.  Approval is typically for only one overseas site with which your department has a written agreement.  You would need to rotate to the approved site and would not have the flexibility to go to another site. In order to get ACGME/RRC approval for an integral rotation your institution usually also needs to send one of its faculty members with you as a supervisor.  For more information on how an anesthesia residency program can obtain ACGME/RRC approval to make an international rotation part of an accredited ACGME residency program see question 5 below.

3.  What is the process for obtaining academic credit for an overseas rotation which is not a standing rotation of my home program?

First, you will need to get the permission of your home accredited anesthesia department. Secondly, your home residency program director will need to write to the American Board of Anesthesiology (ABA) on your behalf to get approval for your time overseas.  All requests to the ABA for credit and related inquiries must come from the program director, not the resident. The ABA’s rules include the following:

  • Overseas rotations may not occur in the first year of anesthesia training or in the last 3 months.  The ABA may make exceptions to this rule in some situations.
  • Residents may not spend more than 6 months away from their home accredited program in 3 years; fellows may not spend more than 2 months away from their home program in 1 year.
  • Your home residency (or fellowship) program director should submit a request for approval of the overseas rotation at least 4 months before the rotation is to begin. This request must include:
    • A description of the proposed rotation.
    • The CV of the person who will be supervising the resident overseas. 
    • Assurance by the program director that you are in good standing, that you will remain enrolled in your home program and that your home program will report your training on the ABA’s semi-annual record of competence.

More information can be found on the ACGME information web site:

4.  Can I get residency credit if I volunteer with a non-governmental organization (NGO) such as Health Volunteers Overseas or Operation Smile?

You can get credit for such volunteer programs as long as your home program approves, the volunteer organization accepts residents as volunteers, and you are with an anesthesiologist who has agreed to act as your supervisor. This supervisor needs to agree to assure that the goals and objectives of the rotation are being followed and to complete the evaluation paperwork.  Your home program director must submit a request for approval with the ABA.  (See question 3) Some residents choose to volunteer for such organizations on their time off/vacation without obtaining residency credit.

5. How does my residency program apply for ACGME/RRC accreditation for a standing international rotation to be considered an integral part of our program?

Any application for a rotation to be a standing part of an ACGME/RRC approved residency program must be initiated by the program director/department chairman. As of September of 2010, the ACGME Residency Review Committee for Anesthesiology requires that the following information be included with a request for approval of an international rotation

1.  Description of the rotation that includes each of the following elements:

    • Educational rationale
    • Location for the rotation
    • Requirements for resident participation
    • Supervision and oversight, including a description of the faculty and the relationship to the faculty and program director of the core program
    • Number of residents during each rotation and duration of participation; responsibilities for expenses associated with the rotation, including travel and living expenses (including an estimated cost for participation and the expectations of the resident to cover any expenses)
    • Specification of terms for malpractice and general liability coverage

2.  Program letter of agreement, specifying the affiliation between the program and the primary institution and the international site

3.  Letter of approval from the sponsoring institution’s Designated Institutional Official (DIO)  

4.  Curricula vitae of the faculty member at the international site responsible for resident education, including details of this faculty member’s training and certification and relationship to the core program and program director 

5. Competency-based goals and objectives for the international rotation

6.  Competency-based evaluation (faculty, rotation and resident)

7. Plan for monitoring compliance with ACGME duty hour rules

Expedited Approval of International Rotations The RRC for Anesthesiology will grant expedited approval for international rotations when the elements listed above are provided and, in addition, a faculty member from the resident's primary program or another diplomate of the American Board of Anesthesiology approved by the RRC will be on-site at the non-US hospital during the entire course of each resident rotation.

6.  Will I get paid during my overseas rotation?

This will depend on your home residency institution’s policies and Medicare policies. Some institutions may not pay you while you are on an outside rotation. Check with your individual institution.

7.  What about travel and living expenses?

Often the overseas rotation provides you with a place to stay but not with travel expenses. However, this also varies depending on the location of your rotation. There are grants that you can apply for to help with your expenses.

8.  Will my home institution’s malpractice policy cover me while working overseas?

This varies depending on the institution. Some institutions will cover you if the rotation is approved for academic credit but not if you are volunteering and not approved for credit. Check with your individual institution.

9. What happens if I get a work-related illness while overseas? Will my home hospital cover my treatment costs?

This varies by institution and may also depend on whether you are doing the rotation for credit.


About ASA: The American Society of Anesthesiologists is an educational, research and scientific association of physicians organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient. Since its founding in 1905, the Society's achievements have made it an important voice in American Medicine and the foremost advocate for all patients who require anesthesia or relief from pain.