Commercialism in Medical Education in Low- and Middle-Income Countries through a Neo-colonial Lens: A Qualitative...

Commercialization of medical education in low- and middle-income countries (LMICs) has intensified over the past decade, intersecting with neo-colonial power structures that shape training priorities, credentialing practices, and professional mobility. This review synthesizes qualitative evidence on how commercialism operates through neo-colonial mechanisms within LMIC medical education and assesses confidence in review findings using the GRADE-CERQual approach. A qualitative evidence meta-synthesis was conducted of peer-reviewed qualitative studies published between January 1, 2015 and August 15, 2025. The search was conducted on August 15, 2025, and included studies published online ahead of print where available. Databases searched included PubMed/MEDLINE, Embase, Scopus, Web of Science, and ERIC. Eligible studies from Q1/Q2 journals were thematically synthesized in accordance with PRISMA guidance for qualitative reviews. A total of four studies met strict inclusion criteria; therefore, findings should be interpreted as analytically illustrative and theory-generating rather than generalizable across all LMICs, which represent highly heterogeneous contexts. Four analytical themes were identified: credentialing dependence linked to migration markets, market-driven cross-border student recruitment, commercial sponsorship in continuing medical education, and accreditation functioning as a market signal. These mechanisms reinforce global inequities and may undermine socially accountable medical education. Strengthening regional accreditation systems, regulating industry involvement, and prioritizing social accountability are essential to rebalance medical education systems in LMICs. Abbreviations: LMICs: Low- and middle-income countries. CME: Continuing medical education. CERQual: Confidence in the Evidence from Reviews of Qualitative Research. QES: Qualitative evidence synthesis. HICs: High-income countries.