University of Washington, Seattle.
Hospital Nacional Guillermo Almenara, Lima, Peru.
JAMA Surg. 2017 Mar 1;152(3):251-256. doi: 10.1001/jamasurg.2016.4073.
The globalization of medical education-the process by which trainees in any region gain access to international training (electronic or in-person)-is a growing trend. More data are needed to inform next steps in the responsible stewardship of this process, from the perspective of trainees and institutions at all income levels, and for use by national and international policymakers.
To describe the impact of the globalization of medical education on surgical care in Peru from the perspective of Peruvian surgeons who received international training.
DESIGN, SETTING, AND PARTICIPANTS: Observational study of qualitative interviews conducted from September 2015 to January 2016 using grounded theory qualitative research methods. The study was conducted at 10 large public institutions that provide most of the trauma care in Lima, Peru, and included urban resident and faculty surgery and trauma care physicians.
Access to international surgical rotations and medical information.
Outcome measures defining the impact of globalization on surgical care were developed as part of simultaneous data collection and analysis during qualitative research as part of a larger project on trauma quality improvement practices in Peru.
Fifty qualitative interviews of surgeons and emergency medicine physicians were conducted at 10 hospitals, including multiple from the public and social security systems. A median of 4 interviews were conducted at each hospital, and fewer than 3 interviews were conducted at only 1 hospital. From the broader theme of globalization emerged subthemes of an eroded sense of agency and a perception of inadequate training on the adaptation of international standards as negative effects of globalization on surgical care in Peru. Access to research funds, provision of incentives for acquisition of advanced clinical training, increased expectations for patient outcomes, and education in quality improvement skills are ways in which globalization positively affected surgeons and their patients in Peru.
Short-term overseas training of surgeons from low- and middle-income countries may improve care in the surgeons' country of origin through the acquisition of skills and altered expectations for excellence. Prioritization of evidence-based medical education is necessary given widespread internet access and thus clinician exposure to variable quality medical information. Finally, the establishment of centers of excellence in low- and middle-income countries may address the eroded sense of agency attributable to globalization and offer a local example of world-class surgical outcomes, diminishing surgeons' most frequently cited reason for emigration: access to better surgical training.
医学教育全球化——即任何地区的受训者获得国际培训（电子或面对面）的过程——是一个日益增长的趋势。需要更多的数据来为这一过程的负责任管理提供信息，从各个收入水平的受训者和机构的角度出发，并供国家和国际政策制定者使用。
从接受国际培训的秘鲁外科医生的角度描述医学教育全球化对秘鲁外科护理的影响。
设计、地点和参与者：2015 年 9 月至 2016 年 1 月期间，采用扎根理论定性研究方法，对秘鲁利马 10 家大型公立机构进行了定性访谈的观察性研究。这些机构提供了利马的大部分创伤护理，包括城市居民和教职员工的外科和创伤护理医生。
获得国际外科轮转和医学信息的机会。
作为秘鲁创伤质量改进实践的更大项目的一部分，同时进行数据收集和分析，在定性研究中制定了定义全球化对外科护理影响的结果衡量标准。
在 10 家医院进行了 50 次外科医生和急诊医师的定性访谈，其中包括公共和社会保障系统的多次访谈。每家医院中位数进行了 4 次访谈，只有 1 家医院进行了不到 3 次访谈。从全球化的更广泛主题中出现了以下子主题：代理感的侵蚀以及对国际标准适应的培训不足，这是全球化对秘鲁外科护理的负面影响。获得研究资金、提供激励措施以获得先进的临床培训、提高对患者结果的期望以及质量改进技能教育，这些都是全球化对秘鲁外科医生及其患者产生积极影响的方式。
来自中低收入国家的外科医生接受短期海外培训，可能通过获得技能和对卓越的期望改变来改善其原籍国的护理。鉴于广泛的互联网接入和因此临床医生接触到不同质量的医疗信息，必须优先考虑循证医学教育。最后，在中低收入国家建立卓越中心可能会解决全球化带来的代理感侵蚀问题，并提供世界级手术结果的本地范例，减少外科医生最常提到的移民原因：获得更好的外科培训。
