Resident Rotations in Low- and Middle-Income Countries: Motivations, Impact, and Host Perspectives

Area of Science:

• Global Health
• Medical Education
• Orthopaedic Surgery

Background:

• Increasing interest among high-income country (HIC) orthopaedic residents in clinical rotations within low- and middle-income countries (LMICs).
• Need to understand motivations, impacts, and host perceptions of these international collaborations.

Purpose of the Study:

• To investigate the primary motivations of HIC surgical residents for undertaking rotations in LMICs.
• To assess the impact of these rotations on the professional development of HIC residents.
• To understand LMIC partner perceptions regarding collaboration with HIC residents.

Main Methods:

• Systematic literature search across multiple databases yielding 3,740 unique articles.
• Meta-ethnography, a qualitative synthesis method, was employed for data extraction and analysis.
• Analysis focused on HIC resident motivations, impacts, and LMIC host perspectives.

Main Results:

• HIC residents are primarily motivated by altruistic intentions, with significant professional development impact.
• LMIC partners value sustained HIC investment and educational opportunities but highlight potential harm from mismatched expectations.
• Key disparities noted in priorities: HIC focus on operative time and mentorship, LMIC focus on avoiding competition, respecting local authority, addressing local needs, and co-authorship on research.

Conclusions:

• Successful international electives require HIC residents to receive site-specific preparation prior to departure.
• Extended duration of stay in LMICs is crucial for developing site-specific skills and fostering deeper collaboration.
• Cultivating flexibility and cultural humility among HIC residents is essential for mutually beneficial partnerships.