Host site experiences with resident and fellow global health electives: a qualitative study

Global health electives (GHEs) are increasingly integrated into residency and fellow training programs within the United States, offering benefits for trainees and institutions. However, limited data exists on the investment host institutions make to provide these experiences. This study aimed to explore the costs, benefits, and contextual factors that influence whether hosting visiting physician trainees is viewed as a worthwhile investment by GHE host sites.

We conducted a qualitative study using reflexive thematic analysis of semi-structured interviews with 11 physician educators from nine designated Mayo International Health Program (MIHP) global partner sites across Africa, Asia, and Central and South America. Participants included both national and expatriate physicians with longstanding institutional partnerships with Mayo Clinic. Interviews were transcribed, coded, and analyzed to identify key themes related to host experiences.

All participants acknowledged both the costs and benefits of hosting physician trainees on GHEs. Costs included time spent coordinating logistics, orienting and supervising trainees, and providing housing and resources, often within resource-constrained settings. Benefits included clinical workload support, educational contributions, staff morale enhancement, and institutional capacity strengthening. Perceptions of reciprocity varied where some felt their institution and the visiting trainee benefited equally, while others believed the visiting trainee gained more. Hosts identified strategies to improve reciprocity, such as stronger institutional partnerships, provision of relevant supplies, and bi-directional exchange programs. Three contextual factors strongly influenced whether hosts viewed their investment as worthwhile: trainees' language proficiency, level of training and engagement, and rotation duration. Despite costs noted, many hosts described GHE experiences as a meaningful investment when trainees were well-prepared, engaged, and stayed for at least one month.

Host institutions recognize value in hosting GHEs, yet this value is contingent upon thoughtful elective design. Trainee characteristics and rotation logistics significantly impact perceived reciprocity and institutional benefit. To ensure GHEs are ethical and sustainable, sending institutions should prioritize longer rotations, match trainees' experience to host capacity, direct pre-departure planning, and foster ongoing, reciprocal partnerships. Continuing to explore host perspectives is critical to developing more equitable and impactful global health training programs for all parties.