Perspectives of host faculty and trainees on international visiting faculty to paediatric academic departments in East Africa

Abstract

BackgroundInvestments in faculty exchanges to build physician workforce capacity are increasing. Little attention has been paid to the expectations of host institution faculty and trainees. This prospective qualitative research study explored faculty and resident perspectives about guest faculty in paediatric departments in East Africa, asking (1) What are the benefits and challenges of hosting guest faculty, (2) What factors influence the effectiveness of faculty visits and (3) How do host institutions prepare for faculty visits?MethodsWe recruited 36 faculty members and residents from among four paediatric departments in East Africa to participate in semistructured interviews which were audio recorded and transcribed. Data were qualitatively analysed using principles of open coding and thematic analysis. We achieved saturation of themes.ResultsBenefits of faculty visits varied based on the size and needs of host institutions. Emergent themes included the importance of guest faculty time commitment, and mutual preparation to ensure that visit goals and scheduling met host needs. We documented conflicts that developed around guest emotional responses and ethical approaches to clinical resource limitations, which some hosts tried to prepare for and mitigate. Imbalance in resources led to power differentials; some hosts sought partnerships to re-establish control over the process of having guests.ConclusionsWe identified that guest faculty can assist paediatric institutions in building capacity; however, effective visits require: (1) mutually agreed on goals with appropriate scheduling, visit length and commitment to ensure that the visits meet the host's needs, (2) careful selection and preparation of guest faculty to meet the host's goals, (3) emotional preparation by prospective guests along with host orientation to clinical work in the host's setting and (4) attention to funding sources for the visit and mitigation of resulting power differentials.

The Collaborative Role of North American Departments of Pediatrics in Global Child Health

“…We indicate in our literature review a growing consensus in the best practices for GCH education. These include the following: (1) adequate preparation and orientation of residents before departure on GCH electives 16, 19, 50 -56 ; (2) adequate supervision of residents on GCH electives 16, 19, 57 ; (3) provision of post-GCH elective debriefing 58 -60 ; (4) establishment of ethical partnerships with host institutions, communities, and organizations that support the GCH electives and other educational opportunities, characterized by shared planning, 50,61,62 bidirectionality, 34,35,50,51,57,[62][63][64] long-term relationships, 16,50,51,65 cultural and contextual awareness, 50,56,65 and equitable resource allocation 8,66,67 ; (5) contributing to local professional development 22,27 ; and (6) ongoing evaluation. 16,50,51 In addition, the Federation of Pediatric Organizations recommended in…”

“…In addition, they also typically receive hands-on clinical experiences during GCH electives, although barriers exist to offering reciprocal experiences to LMIC trainees participating in bidirectional exchanges. 62 The research from bidirectional opportunities reveals that LMIC trainees who participate in these exchanges Careful selection and preparation of trainees for participation 16 Effective mentorship of trainees by sending institution 16,19 Specific trainee prerequisites before approval for international rotation 19 Trainee preparation to enhance medical knowledge, skills, and cultural sensitivity and/or cultural humility 12,19,50,51,54 Positive attitudes and commitment of trainees 52,53 Significant investment (eg, engaging in robust predeparture preparation, self-financing travel) by trainee 55 Strengthening and standardizing program curricula to provide adequate medical and sociocultural preparation for visiting rotations at LMIC institutions 56 Adequate supervision of the resident while on the GCH elective Effective mentorship and supervision of trainees at sending and hosting institutions 16,19 Collaboration with LMIC partner sites that are teaching institutions with traditional faculty supervision 57,69 Provision of post-GCH elective debriefing…”

“…Initial discussion and site visits between NA and LMIC partners, with explicit and transparent discussion about mutual benefits, costs, and financing 16,50 Written agreements (such as a Memorandum of Agreement) with clear goals, objectives, and responsibilities 16,61 Scheduled, frequent, real-time communication between partners to ensure that LMIC partner institutions have significant and frequent input throughout the program planning process 16,50 Transparency between partnering institutions 16…”

“…Reciprocal opportunities for residents or other trainees from partner LMIC institutions to train at NA institutions 34, 57,62 Bilateral partnerships to foster longitudinal relationships, professional development, and capacity building 34, 51,68 Bidirectional opportunities, with faculty and trainees from NA and LMIC willing to both gain and share knowledge 52,53 Share collective knowledge and resources between partners 35,50 Opportunities for professional exchanges and mentoring 35, 64,66 Peer-to-peer collaborative relationships 35 Focus on long-term relationships Continuous rather than intermittent interactions between LMIC and NA partners 51 Strong mutual interest from both partners to cultivate a long-term partnership 16 Long-term commitments to partners 12,35,36,50,64…”

“…Understand local disease epidemiology, medical conditions, health care systems, and cultural and/or sociopolitical considerations 12,50,65 Train in ethical challenges and considerations 12,65 Equitable resource allocation Partnerships should have equity 66 Direct greatest share of resources to the less-resourced partner 67 Work to achieve equity in health for all 8 Contribute to local professional development Support bidirectional learning opportunities for visiting and host trainees and faculty members during GCH electives 22,27 Evaluation Evaluation for program monitoring and improvement 16,50,51 or obtain qualifications in North America often return to their home country and become change agents promoting diagnostic and treatment techniques and educational approaches learned within NA training programs modified to be practical and appropriate in resourceconstrained settings. 33,62,80,81 Hosting NA institutions' faculty and learners also benefit from LMIC trainees' knowledge and experience in important GCH topics as well as learning from their different cultural view of medicine.…”