International neurosurgery rotation in low- and middle-income countries: a report and roadmap for equitable...

Neurosurgery trainees from high-income countries (HICs) can learn valuable clinical, technical, and public health skills via international observerships at partner institutions in low- and middle-income countries (LMICs). Implementing a program that is mutually beneficial to both HIC and LMIC collaborators requires thoughtful planning and consideration of best practices in global partnerships. This report shares one such experience, including perspectives of both the HIC rotator and host LMIC institution, providing guidance for similar initiatives elsewhere.

A senior neurosurgery resident from the United States (US) completed a 6-week pediatric neurosurgery observership at the Philippine General Hospital (PGH) in Manila, Philippines from September to October 2023. To evaluate the experience, the resident gave a formal presentation and submitted an exit essay, while PGH trainees completed a survey, and the consultant faculty participated in a focus group discussion.

Pre-observership preparation involved forming partnerships, securing funding, setting mutual objectives, creating schedules, designing research projects, arranging travel and lodging, and pursuing cultural humility training. During the observership, the rotator was fully immersed in the PGH resident schedule, including team rounds, surgeries, clinics, and on-call shifts. Academic activities included a quality improvement project on external ventricular drain management and a pilot study on telementorship in the cadaver lab. PGH neurosurgery faculty supervised the rotator, supported by weekly virtual conferences and visits from U.S.- and Philippines-based pediatric neurosurgery faculty. Post-observership benefits included clinical, surgical, and public health insights, with positive feedback from PGH trainees and faculty.

This international observership was perceived as highly educational and mutually beneficial, due to shared goals, structured mentorship, and emphasis on bidirectional learning. Clear communication, well-defined clinical and research duties, cultural humility, and equitable engagement are key to overcoming challenges previously described in HIC-LMIC collaborations.