The participants from HIC will experience the host country’s models for teaching and training. They look to focus on and learn what they perceive as most important: acquisition of traditional cognitive knowledge and psychomotor skills. They may recognize that these differ from those in their home country, but are most apt to concentrate on what they feel will transfer to their resource rich context. This acquisition of traditional knowledge and skill may occur in clinical conferences and meetings, on the wards, in the operating theatre or in a multitude of clinical settings. However, not least important is the learning which reflects the local culture and ethical values. These insights into systems-based issues and differences in practice are perhaps the most important lessons learned during such experiences.

Depending on the environment, the emphasis may be more on ensuring patient survival than on improving the quality of life. This reality in certain resource restricted environments needs to be highlighted. The local trainers who serve as mentors to the trainees will provide insight based on the same body of knowledge available to colleagues in HIC, but tempered by personal experiences and preferences in the management of surgical conditions in their resource restricted environment. The trainee will also have peer learning opportunities while interacting with the local residents at various clinical/academic forums.

Complementary formal teaching sessions could further improve the overall capacity of the visiting trainee to understand the processes from a new perspective of limited manpower and limited resources. Many stakeholders from HIC recognize that well established bedside teaching methods that are utilized in LMIC are becoming extinct in resource rich environments. Formal efforts are being made to re-establish traditional bedside teaching rounds in many resource rich environments, largely based on experience from time spent in a LMIC. Another change in behavior by the trainee from HIC may be a shift in attitude towards greater resource efficiency. This is often the result of experiencing the constraints imposed by limited resources in LMIC, and may impact their practice upon return to their home country.

There is a growing awareness that while formal learning objectives may focus on the previously mentioned traditional criteria based on knowledge and skill, some of the most valuable lessons are learned in realms of communication, collaboration, professionalism, health advocacy and systems-based practice. Recognition of this concept as a whole, and the focus on tailored preparation will assist in appropriately sensitizing and preparing the trainee for the new context in which they will find themselves, and will help focus and maximize the learning experience.

The expectation is that the trainee from a HIC will integrate fully into the training structure of the host institution and therefore will readily provide information about perspectives in their own country. The presumption here is that the visiting trainees from HIC will be sufficiently advanced in training to participate more effectively in clinical care at the host site. The acceptable level of training is a matter to be carefully considered during the planning stages. In some situations, visiting trainees will encounter host LMIC peers with superior knowledge and skills. It is not unusual to find trainees from LMIC who have unique insights into local diseases, honed through reliance on clinical skills and adaptation to the scarcity of modern technology. For instance, trainees from HIC, accustomed to minimally invasive procedures, could have much to learn from their LMIC counterparts who may have more advanced open surgical skills. In many situations, both the visiting and host trainees and faculty can scrub together and learn from each other. These opportunities to exchange knowledge and skills with local trainees may also bring to the fore previously undeveloped leadership skills of the visitor, and help foster a spirit of collaboration and understanding. A sense of both humility and camaraderie on both sides can foster a positive learning environment for all. The exchange of knowledge can take place in the operating theatre as above, or through planned presentations made during formal clinical meetings and rounds, or even during informal bedside teaching. Careful planning, adequate supervision and close monitoring from a dedicated local stakeholder and a thoughtful HIC organizer are therefore imperative.