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March 16, 2009

International Surgical Electives: Intellectual Capital, Authorship, and Capacity Building

Arch Surg. 2009;144(3):289-292. doi:10.1001/archsurg.2008.565

There is increasing interest among general surgery resident physicians to pursue international electives.1-4 However, there are 2 causes for concern that are worthy of mention and suggest that due caution be exercised to ensure the favorable establishment of relationships with institutions outside of the United States. These relationships should bear the commitment to equity that reflects the altruism with which the endeavor was originally intended, so as not to inadvertently exacerbate any preexisting disparities. First, in collaborative exchanges and capacity building, efforts should be made to advance the academic careers and opportunities of surgical trainees from institutions in low- and middle-income countries that are the recipients of the exchange. These exchanges should not, for example, serve to solely benefit the members of the visiting team. This should also be reflected in authorship of work that stems from collaborative research endeavors. Sub-Saharan Africa, for instance, provides the substratum for a plethora of biomedical publications, particularly those on the global infectious disease burden. Indeed, indigenously led institutions like Kenya Medical Research Institute, for example, are at the forefront of continental vaccine research in malaria and human immunodeficiency virus therapy.5 Authorship of some publications, derived from research based in Africa, often fails, however, to reflect the collaborative input of the indigenous contributors.

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