Low- and Middle-Income Country Host Perceptions of Short-Term Experiences in Global Health: A Systematic Review

Acad Med. 2021 Mar 1;96(3):460-469. doi: 10.1097/ACM.0000000000003867.


Purpose: Stakeholders have expressed concerns regarding the impact of visiting trainees and physicians from high-income countries (HICs) providing education and/or short-term clinical care in low- and middle-income countries (LMICs). This systematic review aimed to summarize LMIC host perceptions of visiting trainees and physicians from HICs during short-term experiences in global health (STEGH).

Method: In September 2018 then again in August 2020, the authors searched 7 databases (PubMed, Embase, Scopus, Web of Science, ERIC, Cochrane Library, Global Index Medicus) for peer-reviewed studies that described LMIC host perceptions of STEGH. They extracted information pertaining to study design, participant demographics, participant perceptions, representation of LMICs and HICs, and HIC visitors' roles and used thematic synthesis to code the text, develop descriptive themes, and generate analytical themes.

Results: Of the 4,020 studies identified, 17 met the inclusion criteria. In total, the studies included 448 participants, of which 395 (88%) represented LMICs. The authors identified and organized 42 codes under 8 descriptive themes. They further organized these descriptive themes into 4 analytical themes related to STEGH: (1) sociocultural and contextual differences, (2) institutional and programmatic components, (3) impact on host institutions and individuals, and (4) visitor characteristics and conduct.

Conclusions: STEGH can have both beneficial and detrimental effects on LMIC host institutions and individuals. The authors translated these findings into a set of evidence-based best practices for STEGH that provide specific guidance for LMIC and HIC stakeholders. Moving forward, LMIC and HIC institutions must work together to focus on the quality of their relationships and create conditions in which all stakeholders feel empowered to openly communicate to ensure equity and mutual benefit for all parties.

Publication types

  • Systematic Review

MeSH terms

  • Cross-Cultural Comparison
  • Developing Countries / economics*
  • Evidence-Based Practice / standards*
  • Evidence-Based Practice / trends
  • Female
  • Global Health / education*
  • Global Health / statistics & numerical data
  • Humans
  • International Cooperation
  • International Educational Exchange / trends
  • Male
  • Peer Review
  • Perception / physiology*
  • Publication Bias
  • Quality Improvement
  • Stakeholder Participation / psychology
  • Thematic Apperception Test / standards