TABLE I.

Study Information^*

Section 1.1. HIC Resident Motivations for Seeking LMIC Rotation
Author	Study Population	Country/World Health Organization (WHO) Income Level	Data Collection Instrument	Primary Findings
Barton et al. 200725	103 general surgery residents	Canada/HIC	Electronic survey	Operating, travel, learning, and teaching
Cheung et al. 201726	61 general surgery residents	US/HIC	Electronic survey	Clinical experience, research, and training the local population
Disston et al. 200927	31 orthopaedic surgery residents†	US/HIC	Electronic survey	Opportunity to serve a less privileged population, desire for cross-cultural experience, and limited-resource setting
Javidnia et al. 201128	53 ear nose throat residents	Canada/HIC	Electronic survey	Contribute to an important cause, personal growth, learn about medicine in developing countries, travel, and improve understanding of other cultures
Johnston et al. 201829	74 surgical residents	US/HIC	Paper survey	Giving back by participating on surgical, medical, or disaster relief missions, long-term career goals, and religious motivation
Matar et al. 201230	361 general and orthopaedic surgery residents	Canada/HIC	Electronic survey	Contribute to an important cause, enhance technical/clinical skills, tourism/cultural enhancement, determine interest in international volunteerism, exposure to uncommon pathologies, teaching, and establishing contacts abroad
Pope et al. 201631	278 obstetrics, gynecology residents	US/HIC	Electronic survey	Promote maternal survival, research social determinants of health, and health policy
Powell et al. 200732	52 general surgery residents	US/HIC	Electronic survey	Technical/clinical skills, cultural experience, personal goals, language skills, altruism, and international contacts
Powell et al. 20093‡	724 surgical residents	US/HIC	Electronic survey	Cultural experience, technical/clinical skills, fulfilling personal goals, altruism, language skills, and international contacts
Sawatsky et al. 201633	377 reflective reports from residents	US/HIC	Qualitative analysis	Making a difference, altruism Impact§: experience of gratitude and trust from patients, meaningful patient-doctor relationship, and noting patient resilience
Stagg et al. 201734	4,926 obstetrics and gynecology (OBGYN) residents	US/HIC	Electronic survey	Education, practicing medicine in other countries, full OBGYN experience, humanitarian opportunity, cultural competency, and “chance to see the world”
Zhang et al. 201635	122 orthopaedic surgery residents	US/HIC	Electronic survey	Contribute to care for the underserved, improve communication skills, physical exam and surgical techniques and resource allocation, and improve knowledge base with pathology not commonly seen in the United States

Section 1.2. Self-Described Impact of LMIC Rotation on HIC Residents
Author	Study Population	Country/WHO Income Level	Data Collection Instrument	Primary Findings
Graf et al. 201736	Surgical residents 9 blog reviews 6 survey responses	US and Israel/HIC	Qualitative analysis of resident reports and electronic survey	Positive learning experience, exposure to new pathology and disease, and development of close relationships. Difficulty functioning with limited language proficiency and emotional challenges of dealing with different standards of care
Henry et al. 201237	14 surgical residents#	US/HIC	Electronic survey/qualitative analysis of free text	Unique learning opportunity with more authority and leadership. Opportunity to form sustainable relationships and feel rejuvenated. Helps awareness of growing burden of operative disease worldwide
Jafari et al. 201738	44 residents, 8 fellows**	Multiple/HIC	Electronic survey	Residents believed that the experience was life-changing and confirmed their passion for surgery
Kelley et al. 201539	21 current/former surgical residents	Canada/HIC	Electronic survey	Helped residents grow as physicians and develop new appreciation for their home health care system and public health. Improved managerial skills, creativity, and resourcefulness.
Tarpley et al. 201340	9 4th year residents returning from 4-week surgical rotation in Kenya	US/HIC	Survey and discussion	Opportunity to work with LMIC residents and care for patients in a resource-challenged environment. Challenged by language differences, unfamiliar clinical issues, and adjusting to different medical environment.

Section 1.3. LMIC Host Perspective of HIC Collaboration
Author	Study Population	Country/WHO Income Level	Data Collection Instrument	Primary Findings
Cadotte et al. 201441	14 LMIC neurosurgeons (10 residents, 4 faculty) 7 HIC neurosurgeons	Ethiopia/LMIC and Canada, US, Norway††/HIC	In-person open-ended interviews	HIC mentorship of LMIC trainees is valuable if sustained. Do not undermine authority of local healthcare providers.
Elobu et al. 201442	33 “postgraduate trainees” in anesthesia and surgery at single institution	Uganda/LMIC	Paper survey	Value in internationally organized surgical skill workshops and specialist camps. International groups had a neutral or negative impact on patient care and questioned the ethics of clinical decisions made by visiting faculty. Research projects are often conducted without crediting LMIC authors and are not in locally identified priority areas.
Ibrahim et al. 201527	13 HIC surgeons, 18 LMIC surgeons	Multiple HICs and LMICs	In-person and online semi-structured interviews	Need to monitor and evaluate longitudinal success of international collaboration and impact on local community with broad regional and national indicators.
O’Donnell et al. 201458	3 department chairs, 6 residents, 15 attending physicians of EM medicine	Peru/LMIC	Semi-structured interviews	There is value in knowledge transfer with long-term relationships. Challenges include visitor’s lack of language proficiency and reciprocity and short rotation length and low level of training.

^*HIC = High Income Country; LMIC = Low-, Middle-Income Country.

^†Completed survey in June, immediately after graduation.

^‡Follow-up study to Powell et al. 2007 with expanded study population.

^§Included here with “motivations,” see also section 1.2.

^#Study included attending surgeons and medical students, but stratified the responses, enabling inclusion.

^**Responses from residents and fellows were not separated.

^††Could not exclude HIC neurosurgeons (even though faculty) as thematic analysis did not separate out responses.