As a result of the WFSA arrangement to sponsor the project, we approached the national anesthesiology societies of interested countries and planned interviews with candidates eager to take part in the program. Involvement of local society officers participating in the selection committee was vital. The local leaders were expected to know the candidates and assist in the process of selecting individuals with the highest potential to benefit from the observation period at SMC.

The interview, usually scheduled during an annual convention of the national anesthesia society, was in English and good command of this language was the first criterion in the selection of candidates. Equally important, the young anesthesia specialist was expected to explain what he/she anticipated from the observation period in Israel. In most cases the number of candidates exceeded the number of positions allocated to that specific country. The final decision was made after review by the committee members, which always included at least one SMC staff member.

WFSA decided to cover the cost of the foreign physicians’ stay in Beer Sheva. BGU accepted the role of controlling the funds received from WFSA by opening a special account dedicated solely to this project. The BGU president at that time donated a substantial sum of money in order to ease the inauguration of the program. FOHS assisted the project by arranging accommodations for the foreign physicians in the immediate vicinity of SMC, in the premises of student dormitories. The walking distance between the apartments and the hospital eased the participants’ approach to the special activities during the nights and weekends. The staff on duty would call and inform them about a special case or treatment deserving interest. Also, an agreement was reached with FOHS stipulating the right of the project participants to freely access the faculty library as well as the sport facilities of BGU.

We decided to ask each participant to cover his or her own travel expenses. This decision was based on the principle that the young physician involved in the program was supposed to be as invested as the sponsor in obtaining a place in the project. In discussions with the officers of the national societies we reached the conclusion that paying for the airplane ticket would not be too heavy a burden for any of the participants. The reality proved that this supposition was correct. During the 14 years of the project in Beer Sheva there have been no cancelations due to travel costs.

The decision to bring to Beer Sheva specialists in groups belonging to the same visiting country was taken after an intense discussion with WFSA officers. The alternative was to mix participants from different countries and offer everybody a chance to get information about other kinds of organizations in different parts of Eastern Europe. This would have also facilitated better command of English, the only common language for all. But the accepted idea was not to separate members of the same national group, and thus to accelerate their acclimatization with the new atmosphere and better organize their free time (weekends and afternoons) activities.

The participants arrived in Beer Sheva in groups of three or four when the project included only 1 month of observation, and then in pairs in the second part of the project, when the participants were offered a longer period of observation, thus giving each visiting physician a chance to become more familiar with one of the specialty fields: critical care, obstetrical anesthesia, cardiothoracic anesthesia, pain management, etc.

Each participant was integrated in the daily activity of the Division of Anesthesiology at SMC. It started with participation in the 7:00 a.m. meeting, which included the previous night’s report, a quick glance into the morning schedule, and a 10-min presentation by one of the residents. A simultaneous translation from Hebrew to English through headphones was provided by one of the staff.

Then members of the group were assigned to the activities of the morning, either in the OR non-OR areas such as the pain clinic, pre-anesthesia assessment clinic, or ICU. They also took part in the consultations on the floor and in any teaching activity involving the anesthesiology residents. When possible, the foreign physicians were given a chance to take part in educational events outside Beer Sheva, such as a national convention or a refresher course in anesthesiology and related domains. Special attention was given to those areas that interested the foreign physicians. Their interest varied from One year to another and from one group to another. The main explanation for varying interest in new knowledge was that gradually, the average Eastern Europe anesthesiologist became accustomed to new achievements in the profession. Hospitals in various countries of the eastern part of the continent started purchasing modern equipment and drugs, and a process of reorganization of the daily activity was evident in many medical centers. Additionally, a new system of continuous education was gradually implemented in many Eastern countries, with the aim of offering young physicians a chance to improve theoretical knowledge and apply it to the daily work.

Table 26.2 shows the gradual changes in the list of some topics of interest among the participants in the project. It reflects the progress made by the profession in various participating countries during the first decade of the free market system and liberation from the communist system limits. The table reveals some interesting points. At no stage of the project did the average participant feel a need for clinical theoretical presentations. The access to electronic information became progressively easier in every country involved in the program and the young specialist was able to improve his/her theoretical knowledge base by a simple process of self-learning.

The specific interest started with items belonging to compulsory monitoring in the OR, a demand difficult to achieve in the absence of the necessary equipment. Once the visiting specialist became accustomed to this basic equipment in his/her own hospital, the general interest switched to more complicated practical items, most of them originating from the personal subspecialty interest. Also some of the foreign specialists had the opportunity to visit and work in other developed medical centers (abroad and even in their own countries and cities). There they encountered modern equipment and all necessary drugs for modern anesthesia. They also were offered the opportunity to participate in international scientific conventions and contact colleagues from more developed countries. Once back home, they could implement some of the things seen and learned.

This rather new reality created the basis for changing the direction of the educational process. We felt the obligation to search for other ideas that could better serve the purpose of closing the gap between the two parts of the old continent (vide infra).

During 1992–2005, 148 foreign specialists in anesthesia, from nine countries, all younger than 40 years old, took part in the WFSA–Beer Sheva project, spending between 1 and 6 months, at SMC (Table 26.3). Most of them were allowed only to observe, but those who spent longer time in the hospital got the opportunity to directly participate in the daily activity in the OR and outside it, under continuous supervision. Thus they got more exposure than an average specialist in anesthesia is able to offer his/her patients. The observer was not involved in patient care; he/she just observed the treatment offered to the patient. But when the guest spent at least 6 months at SMC (very few cases), an educational license was issued by the Israeli Ministry of Health, thus the foreign physician was allowed to take part in patient care under direct and permanent supervision of an Israeli physician.