Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
BMJ Open. 2023 Mar 22;13(3):e070148. doi: 10.1136/bmjopen-2022-070148.
This qualitative study aimed to explore the perspectives of Canadian global surgeons with experience developing surgical education partnerships with low- and middle-income countries (LMICs) for the purpose of identifying factors for success.
A purposive sample of leaders from global surgery programmes at Canadian Faculties of Medicine participated in virtual semi-structured interviews. A six-phase thematic analysis was performed using a constructivist lens on verbatim transcripts by three independent researchers. Key factors for success were thematically collated with constant comparison and inter-investigator triangulation in NVivo software until theoretical saturation was reached.
Fifteen surgeons, representing 11 subspecialties at 6 Canadian academic institutions and a combined experience across 6 continents, were interviewed between January and June 2022.
Four facilitators for success of global surgery training programmes were identified, with a strong undertone of relationship-building permeating all subthemes: (1) facilitative skill sets and infrastructure, (2) longitudinal engagement, (3) local ownership and (4) interpersonal humility. Participants defined facilitative skill sets to include demonstrated surgical competence and facilitative infrastructure to include pre-existing local networks, language congruency, sustainable funding and support from external organisations. They perceived longitudinal engagement as spanning multiple trips, enabled by strong personal motivation and arrangements at their home institutions. Ownership of projects by local champions, including in research output, was noted as key to preventing brain drain and catalysing a ripple effect of surgical trainees. Finally, interviewees emphasised interpersonal humility as being crucial to decolonising the institution of global surgery with cultural competence, reflexivity and sustainability.
The interviewed surgeons perceived strong cross-cultural relationships as fundamental to all other dimensions of success when working in low-resource capacity-building. While this study presents a comprehensive Canadian perspective informed by high-profile leadership in global surgery, a parallel study highlighting LMIC-partners' perspectives will be critical to a more complete understanding of programme success.
本定性研究旨在探讨具有与中低收入国家（LMICs）建立外科教育伙伴关系经验的加拿大全球外科医生的观点，目的是确定成功的因素。
参与虚拟半结构式访谈的是来自加拿大医学院全球外科学计划的领导人的有目的的样本。使用建构主义视角，由三名独立研究人员对逐字记录进行了六阶段主题分析。在 NVivo 软件中，使用恒比比较和内部调查员三角测量，对成功的关键因素进行主题汇编，直到达到理论饱和。
2022 年 1 月至 6 月期间，来自加拿大 6 所学术机构的 11 个专业的 15 名外科医生接受了采访，他们在 6 个大洲拥有丰富的经验。
确定了全球外科学培训计划成功的四个促进因素，所有子主题都贯穿着建立关系的强烈基调：（1）促进技能和基础设施，（2）纵向参与，（3）本地所有权和（4）人际谦逊。参与者将促进技能定义为展示手术能力，将促进基础设施定义为具有现有本地网络、语言一致性、可持续资金和外部组织支持。他们认为纵向参与跨越多次旅行，这得益于强烈的个人动机和其所在机构的安排。包括研究成果在内的本地冠军对项目的所有权被认为是防止人才流失和催化外科培训生的连锁反应的关键。最后，受访者强调人际谦逊对于通过文化能力、反思和可持续性实现全球外科学机构的去殖民化至关重要。
接受采访的外科医生认为，在资源匮乏的能力建设中，强大的跨文化关系是所有其他成功维度的基础。虽然这项研究提出了一个由全球外科领域的知名领导提供的全面的加拿大视角，但一项突出 LMIC 合作伙伴观点的平行研究对于更全面地理解项目成功至关重要。
