This article about a UK trainee who went to Brazil to increase his clinical experience in plastic surgery is worth a read. Several things caught my eye:
[He] gained more surgical experience during a two month elective in Brazil than during his two year foundation training
The Instituto Ivo Pitanguy runs a three year residency programme—separate from the national plastic surgery programme—with a focus on technical surgical training. [emphasis added]
Successful applicants need to have completed two years of general surgery before passing the entry examination. These residents pay a fee of 4000 reals (£700) a month for the duration of the residency and are not paid. This might not seem like an enticing prospect, but trainees usually support themselves through locum work, and in return they receive three years of outstanding training and operating experience.
The clinic is always busy, so the 60 residents have plenty of opportunity to perform operations as they progress through the programme. First year residents assist the surgeons and are responsible for closing wounds. Second year residents have a greater role during operations in preparation for the final year, when residents perform around 80 operations as lead surgeons, with an unscrubbed supervisor.