Malawian impressions of expatriate physicians: A qualitative study

Abstract

BackgroundIn many low-income countries, including Malawi, expatriate physicians serve diverse roles in clinical care, education, mentorship, and research. A significant proportion of physicians from high-income countries have global health experience. Despite the well-known benefits of global health experiences for expatriates, little is known about local physician and trainee impressions of their expatriate counterparts. The objective of this study was to explore University of Malawi College of Medicine (COM) physicians' and trainees' impressions of expatriate physicians. Methods We conducted a cross-sectional qualitative study using semi-structured interviews with COM medical students, interns, registrars, and faculty. Through open coding, we developed a codebook that we applied to interview transcripts and used thematic analysis to identify major themes. ResultsWe interviewed 46 participants from across the continuum of medical education at two teaching hospitals in Malawi. Participants discussed themes within the following domains: perceived benefits of expatriate physicians in Malawi, perceived challenges, past contributions, and perceived roles that expatriate physicians should play going forward. Malawian faculty and trainees appreciated the approachability, perspectives, and contribution to education that expatriates have provided, though at times some have been perceived as aggressive, unable to relate to patients and trainees, deficient at adapting to the setting, and self-serving. Potential roles that Malawian physicians and trainees feel expatriates should serve include education, training, capacity building, and facilitating exchange opportunities for local physicians and trainees. Conclusions This study highlights the perceived benefits and challenges that physicians and trainees at the COM have experienced with their expatriate counterparts, and suggests roles that expatriates should play while abroad. These findings can be used to help inform existing global health guidelines, assist with the establishment of host institution expectations for global health programmes, and guide individual expatriate physicians who hope to optimise their roles abroad.

Impact of Global Health Electives on US Medical Residents: A Systematic Review

“…Literature pertaining to undergraduate medical students has demonstrated multiple concerns of global health electives including practicing medicine or performing procedures above the students’ level of competence [678], risks for occupational exposure [9], navigating different sociocultural norms [67810], and power imbalances [610]. Furthermore, recent studies examining the perspective of LMIC host institutions have described multiple concerns of working with visiting trainees [11121314151617]. Specific concerns included lack of cultural sensitivity [1213141517], inexperience with practicing medicine in a low-resource setting [17], resource drain [1113], and preventable harms in patient care [11].…”

“…Furthermore, recent studies examining the perspective of LMIC host institutions have described multiple concerns of working with visiting trainees [11121314151617]. Specific concerns included lack of cultural sensitivity [1213141517], inexperience with practicing medicine in a low-resource setting [17], resource drain [1113], and preventable harms in patient care [11]. These concerns highlight the need for proactive effort by US medical institutions to ensure that their visiting trainees arrive adequately prepared prior to their global health elective and remain a net benefit to LMIC host institutions.…”

The do’s, don’ts and don’t knows of redressing differential attainment related to race/ethnicity in medical schools

“…Role models are influential in terms of career and specialty choice [ 110 ], developing clinical knowledge and skills, as well as understanding the culture of medicine [ 49 , 111 ]. Students identify more strongly with role models who are similar to them in some way [ 112 , 113 ] and there is value in having role models from the same ethnic background as students [ 114 , 115 ]. However, diversity of ethnic backgrounds is often under-represented in faculty, especially in senior positions, giving rise to a paucity of role models for medical students [ 98 , 116 – 120 ].…”

The contribution of Dutch doctors in Global Health and Tropical Medicine to research in global health in low- and middle-income countries: an exploration of the evidence

“…1,[4][5][6] Several expatriate physicians from HICs fill some of the gaps in human resources for health in LMICs. 7,8 In addition to their clinical, managerial and teaching responsibilities, many expatriate physicians also conduct medical scientific research, generally aiming to improve the local quality of care and, less so, to contribute to advances in medical knowledge, experience and practice. Because of the growing attention in regard to health research capacity in LMICs in recent years, 1,4,9 including the role of local coauthors, 6,10 we will elaborate on the added value of studies of expatriate physicians.…”