Universidad Peruana Cayetano Heredia

Surgeons' and Trauma Care Physicians' Perception of the Impact of the Globalization of Medical Education on Quality of Care in Lima, Peru

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dc.contributor.author LaGrone, Lacey N.
dc.contributor.author Isquith-Dicker, Leah N.
dc.contributor.author Huaman Egoavil, Eduardo
dc.contributor.author Rodríguez Castro, Manuel Jorge Augusto
dc.contributor.author Allagual, Alfredo
dc.contributor.author Revoredo, Fernando
dc.contributor.author Mock, Charles N.
dc.date.accessioned 2019-01-25T16:03:21Z
dc.date.available 2019-01-25T16:03:21Z
dc.date.issued 2017
dc.identifier.uri https://hdl.handle.net/20.500.12866/4769
dc.description.abstract Importance: 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. Objective: 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. Exposures: Access to international surgical rotations and medical information. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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. en_US
dc.language.iso eng
dc.publisher American Medical Association
dc.relation.ispartofseries JAMA Surgery
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Attitude of Health Personnel en_US
dc.subject Developing Countries en_US
dc.subject Education, Medical en_US
dc.subject Quality of Health Care en_US
dc.subject Traumatology en_US
dc.subject Education, Distance en_US
dc.subject Faculty, Medical/psychology en_US
dc.subject General Surgery/education/standards en_US
dc.subject Humans en_US
dc.subject International Educational Exchange en_US
dc.subject Internationality en_US
dc.subject Internship and Residency en_US
dc.subject Interviews as Topic en_US
dc.subject Perception en_US
dc.subject Peru en_US
dc.subject Qualitative Research en_US
dc.subject Surgeons/psychology en_US
dc.title Surgeons' and Trauma Care Physicians' Perception of the Impact of the Globalization of Medical Education on Quality of Care in Lima, Peru en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1001/jamasurg.2016.4073
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.11
dc.relation.issn 2168-6262


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