# Preferences and Perceptions of Training Models in Global Surgery With a Focus on Orthopedics: A Scoping Review

## TL;DR

This study explores how orthopedic trainees in low-resource settings prefer and experience different training models, highlighting the need for equitable and sustainable global education partnerships.

## Contribution

The study provides insights into the preferences and challenges of low-resource orthopedic trainees in global education models, emphasizing the need for reciprocity and sustainability.

## Key findings

- Learners in low-resource settings value international exchanges with structured teaching and subspecialty exposure.
- Virtual and simulation-based education improves knowledge and skills despite technical barriers.
- In-person programs offer capacity-building benefits but require significant resources and institutional commitment.

## Abstract

This scoping review examines learner-reported preferences and experiences with remote learning, observership, and visiting-surgeon exchange models in low-resource settings. We outline potential benefits, limitations, equity considerations, and evidence gaps that can inform ethical and sustainable global orthopaedic education partnerships.

Recent literature on global orthopaedic education has largely focused on training exchanges involving high-income country (HIC) trainees in low- and middle-income countries (LMICs), with reported benefits including skills transfer and professional development alongside challenges related to continuity of care, resource burden, and limited reciprocity. However, despite growing consensus around equity and reciprocity, the perspectives of orthopaedic trainees and practicing surgeons in low-resource settings remain underrepresented in the current literature.

Learners in low-resource settings valued international exchanges that provided structured teaching, subspecialty exposure, and access to higher-volume clinical environments. Virtual and simulation-based education demonstrated consistent improvements in knowledge and surgical skills despite technical and cost-related barriers. In-person and hybrid programs were associated with meaningful capacity-building benefits but required substantial resources, infrastructure, and long-term institutional commitment. Across all models, challenges related to infrastructure, cost, equity, and reciprocity remained. Notably, none of the included studies examined LMIC learner perspectives on bidirectional exchange with higher-resource settings, despite growing emphasis on reciprocity in contemporary partnership frameworks. These findings underscore the need for locally driven, sustainable global orthopaedic education partnerships with stronger outcome evaluation and greater LMIC leadership.