North-South surgical training partnerships: a systematic review

Background: Fostering the success of surgical trainees from low- and middle-income countries (LMICs) plausibly addresses the existing workforce deficit in a sustainable manner, but it is unclear whether and how these trainees are targeted as strategic learners for educational exchanges. The purpose of this review was to assess the quality and outcomes of existing literature on exchanges of surgical trainees between high-income countries (HICs) and LMICs. Methods: We conducted a systematic review of reported instances of surgical training exchanges between HICs and LMICs. After database searching, 2 independent reviewers evaluated titles, abstracts and manuscripts. Selected studies were critically appraised with the use the Critical Assessment Skills Programme Qualitative Checklist and analyzed for trainee level, institutions, countries and subspecialties, as well as reported outcomes of the exchange. Results: Twenty-eight reports met the inclusion criteria and were analyzed. Most publications (18 [64%]) detailed North-to-South exchanges; 1 exchange was bidirectional. General surgery was the most common discipline identified, with 9 other subspecialties described involving learners at all phases of training. Reports were generally of good quality, although outcomes were reported variably, and most authors failed to acknowledge the ethical implications of their study. Conclusion: The articles identified described a variety of surgical exchanges across disciplines, learner types and host/home countries. Few of the exchanges prioritized the learning of surgical trainees from LMICs. There is an increasing need to formalize these exchanges via clear goals and objectives, as well as to prioritize the proper matching of educational goals with local clinical needs. Level of evidence: V - Evidence from systematic reviews of descriptive and qualitative studies. Contexte: Le soutien a la reussite des chirurgiens en formation des pays a revenu faible ou moyen (PRFM) pourrait concretement aider a remedier au manque d'effectifs actuel de facon durable. On ignore toutefois si ces apprenants sont cibles par les programmes d'echanges en tant que candidats strategiques et quelles sont les methodes de recrutement employees. La presente revue vise a evaluer la qualite et les resultats des publications sur les echanges entre pays a revenu eleve (PRE) et PRFM auxquels participent des chirurgiens en formation. Methodes: Nous avons procede a une revue systematique des cas rapportes d'echanges etudiants en chirurgie entre PRE et PRFM. Apres une recherche dans les bases de donnees, 2 evaluateurs independants ont passe en revue les titres, les resumes et les manuscrits retenus. Les etudes selectionnees ont fait l'objet d'une evaluation critique d'apres la liste de controle pour la recherche qualitative CASP (Critical Assessment Skills Programme Qualitative Checklist); les criteres d'analyse comprenaient le niveau de scolarite des apprenants, les etablisse-ments, les pays et les surspecialites, ainsi que les resultats rapportes pour l'echange. Resultats: Au total, 28 rapports repondaient aux criteres d'inclusion et ont donc ete analyses. La plupart d'entre eux (18 [64 %]) traitaient d'echanges du nord au sud; un echange etait bidirectionnel. La chirurgie generale etait la discipline la plus souvent recensee; on a aussi decrit la participation d'apprenants a differentes etapes de leur formation pour 9 autres surspecialites. Les rapports etaient en general de bonne qualite, mais la presentation des resultats variait, et la majorite des auteurs ont omis de rendre compte des considerations ethiques de leur etude. Conclusion: Les articles evalues decrivaient des echanges etudiants en chirurgie se rapportant a une multitude de disciplines, de types d'apprenants et de pays d'origine et d'accueil. Peu de programmes d'echanges priorisaient l'apprentissage des chirurgiens en formation issus des PRFM. Il est de plus en plus pressant de baliser les echanges etudiants en etablissant des buts et des objectifs clairs, et de faire une priorite de la juste correspondance des objectifs peda-gogiques et des besoins cliniques locaux. Niveau de preuve: V--Preuve issue de revues systematiques d'etudes descriptives et qualitatives.
The delivery of surgical care to underresourced areas has been increasingly prioritized by health care providers and governing bodies, as evidenced by the efforts of the Lancet Commission on Global [...]