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Original Investigation
November 23, 2016

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

Author Affiliations
  • 1University of Washington, Seattle
  • 2Hospital Nacional Guillermo Almenara, Lima, Peru
  • 3Universidad Peruana Cayetano Heredia, Lima, Peru
  • 4Hospital Maria Auxiliadora–Universidad Cientifica del Sur, Lima, Peru
JAMA Surg. Published online November 23, 2016. doi:10.1001/jamasurg.2016.4073
Key Points

Question  What is the impact of the globalization of medical education on surgical care in Peru?

Findings  In this qualitative study, interviews of 50 surgeons and emergency medicine physicians revealed their perceptions of the impact of the globalization of medical education to be both negative (such as an eroded sense of agency and the overwhelming nature of global medical information) and positive (such as access to research funds and improved clinical standardization and expectations for patient outcomes).

Meaning  While Peruvian trauma clinicians’ perceptions of the impact of the globalization of medical education on surgical care appear to be predominantly positive, thoughtful planning of training exchange is necessary to prevent exploitation of low- and middle-income countries such as Peru.


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.