‘Piggy-Back’ Short-Term Engagements in Global Health for Surgical Residents: A Rapid Qualitative Analysis

Purpose: Supportive policy changes from graduate medical education bodies have prompted growing development of short-term experiences in global health (STEGHs), particularly in resource-limited settings. Due to a lack of internal global surgery experts, our general surgery residency program “piggybacks” on two structurally distinct surgical STEGHs hosted by other US programs: 1-week mission trips to Central America with a non-profit organization and an 8-week Residency Review Committee-approved surgical rotation in Eastern Africa. We performed a rapid qualitative assessment exploring our residents’ changing perspectives on global surgery through participation in these diverse external STEGHs. Methods: Current and former trainees who participated in at least one STEGH during residency were purposively sampled for participation in semi-structured interviews or focus group discussions (FGD). Recordings were summarized independently by at least two research team members using an iteratively refined template of domains mirroring the facilitation guide. Reconciled summaries were aggregated into a matrix, and rapid qualitative analysis was used to triangulate salient themes. Results: Twenty-six trainees participated in surgical STEGHs from 2009-2024, of which 13 (50%) participated in seven IDIs and three FGDs about their experiences. Rapid analysis revealed significant maturation of trainee perspectives on global surgery practice models, cultural humility, and healthcare delivery following STEGHs. However, trainees also faced many challenges during this period of growth, including dilemmas involving fulfilment of the social contract with the local hosting community and adapting to different health systems. Structural differences between two STEGHs – including scope of practice, trainee role, and duration – influenced the type and extent of impact on trainee growth. Trainees expressed a desire for more sustainable engagement and noted the importance of their home institution’s engagement across all phases of the STEGH. Longitudinal investment in global surgery leaders was viewed as a responsible and powerful method of engagement in global surgery efforts, both domestically and internationally. Conclusions: General surgery residency programs that seek to “piggyback” off of existing global surgery partnerships can maximize trainee and host community benefits by shifting trainee mindset from service to education and emphasizing programmatic and individual sustainability to help support effective, ethical and sustainable collaborations.