Building OHNS Capacity in Low- and Middle-Income Countries: Insights From Global Training Programs

Describe the design, goals, and perceived impacts of global otolaryngology-head and neck surgery (OHNS) training programs, with emphasis on institutional factors shaping workforce development and surgeon retention in low- and middle-income countries (LMICs).

We conducted a cross-sectional qualitative study from October 2024 to October 2025 using focused, semi-structured interviews on Zoom. Participants included program directors and faculty involved in training otolaryngologists from LMICs. Interview transcripts were analyzed using an inductive analysis approach to develop a codebook and identify emergent themes.

Sixteen otolaryngologists representing 15 fellowship-level programs in seven countries were interviewed. Collectively, programs had trained 49 fellowship graduates and nine current fellows from 23 countries. Thematic analysis identified four themes: program design and operational barriers, trainee recruitment and selection, trainee support and post-training mobility, and program impact. Directors emphasized shared goals of sustainable workforce development while describing substantial regulatory, financial, and structural constraints to recruitment and post-training mobility. Among LMIC trainees, 75% returned to their home country, though health system limitations, economic pressures, and credentialing barriers hindered reintegration. For faculty, the inclusion of foreign trainees fostered reciprocal learning environments that influenced perspectives on training adaptability and resource-conscious care.

Understanding the shared motivations and barriers shaping international OHNS training programs may inform future program design strategies that support sustainable workforce development and successful trainee reintegration within LMIC health systems.

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