Education during Surgical Outreach Trips in Vietnam: A Qualitative Study of Surgeon Learners

Abstract

Background: Visiting educator trips teach surgical care in low-resource settings to develop sustainable global surgery. Surgery has been integral in these volunteer activities, but it is unknown whether surgeon learners receive suitable education during these trips. We sought to describe the educational experiences of surgeon learners during a visiting educator trip to better understand the perceptions of surgical outreach education. Methods: We conducted semistructured interviews of 18 surgeon learners participating in a visiting educator trip to 2 hospitals in Thai Nguyen, Vietnam. Each interview was conducted in Vietnamese, translated into English, and transcribed. Narratives were content coded using thematic analyses. Results: We identified 3 main themes. First, participants noted the value in surgical outreach and believed that these trips provided a thorough understanding of surgical care from patient evaluation to complications management. Second, participants described key barriers to education. Participants desired to focus on “learning one topic in depth” rather than learning in breadth. Furthermore, they described the paucity of translated resources, a lack of English proficiency, and rudimentary translator services. Finally, participants provided substantive guidance in improving surgical outreach education, specifically regarding the limited nature of current international partnerships to foster long-term, sustainable relationships. Conclusions: Although Vietnamese surgeon learners felt that visiting educator trips were beneficial, they recognized important areas for improvement. The language barrier was a major impediment to effective learning with materials and lectures commonly provided in English, highlighting the need for improved language concordance. Additionally, participants desired continued relationships with the visiting surgeons to build long-term collaboration.

Systematic review of low-income and middle-income country perceptions of visiting surgical teams from high-income countries

“…Twenty-five studies (83%) described advantages with visiting surgical teams,17 19–42 further subgrouped into skills improvement, immediate clinical patient care, system-level strengthening, academic and career benefits and broader collaboration opportunities.…”

“…One of the most reported benefits of visiting surgical teams related to skill transfers (n=16, 53%)19–22 24–27 30 32–38 including both surgical techniques of advanced procedures, non-technical skills including ‘personal professionalism’, decision-making and a positive ‘cultural change’,19 22 25 26 31 which was emphasised by an attending surgeon in Ethiopia:…”

“…Potential areas of contention associated with visiting surgical teams were highlighted in 22 (73%) studies 17 18 21 22 25–27 29 31 33 35–46. These were further subgrouped as ethical dilemmas and inequity, insufficient knowledge transfers, poor quality of care, administrative and financial issues, competition and language barriers.…”

“…In seven studies (23%), language and communication barriers were described as a challenge preventing maximal training benefits and hindering visiting surgeons from working independently 17 25 29 31 33 36 39. Limited language skills were also associated with missing chart documentation,36 potentially negatively impacting follow-up and outcomes.…”

An Assessment Tool for Hand Surgical Education Needs and Capacity in Resource-Limited Settings

“…Furthermore, identification of hand educational needs and surgical capacity are essential steps to decreasing the risk of dependency on visiting educators or high-volume mission trips, building local infrastructure, and transitioning surgical care to a system that is completely directed by locals. 2,18 A recent study 49e demonstrated that the quality and quantity of educational materials in low-and middle-income countries are lacking 19 ; information garnered from this assessment tool can help curate selfdirected learning, didactic webinars, virtual case reviews, discussion boards, instructional operative videos, and relevant research articles. 3,12,20 In addition, future research should further assess how to effectively deliver surgical and trauma-related education in-person and over a virtual platform to ensure that contextualized learning occurs yearround in an uninterrupted manner.…”