Surgical Training Profiling in Low- and Middle-Income Countries: Peru, Ecuador, and Brazil.

Context Many people worldwide lack access to surgical care. Surgical access is inequitably distributed worldwide, with the burden falling most heavily on low- and middle-income countries (LMICs) due to geographical, financial, and educational barriers. Due to various challenges, surgical access and training in LMICs differ significantly from high-income countries (HICs). In LMICs, limited resources, infrastructure, and healthcare workforce shortages often lead to inadequate surgical care, with essential surgeries frequently inaccessible to a substantial portion of the population. Objectives The goal of this research study is to profile the surgical residents in cities of Peru, Ecuador, and Brazil and highlight the strengths, weaknesses, and limitations of various surgical training programs. Methods The research team established a point of contact in each city in its respective country. The researchers, VA, MM, and EB, distributed the emails to Peru, Ecuador, and Brazil's surgical residents. The email contained a link to the survey that asked for non-identifiable information. This research study was designated as "Exempt" by the Nova Southeastern University Institutional Review Board. Results Out of the 31 participants emailed, 10 responded and were included in this study. Most respondents are currently in general surgery training programs, and all residents, despite surgical specialty, would like to specialize further. Although they perform classic open surgeries, such as appendectomies and cholecystectomies, these residents express their desire to be trained in laparoscopic procedures. Trainees recognized that their facilities must transfer patients to other, more well-equipped facilities to perform a subset of surgeries. The participants expressed several areas for improvement regarding the outdated procedures and the lack of laparoscopic surgeries. Yet, their programs offer some strengths regarding the faculty and the number of surgeries performed. Conclusions Residents from LMICs strongly desire to further subspecialize in their training and continue to create or find opportunities with other LMICs and HICs. Technology, staff, and supply are the main limitations to surgical training in these areas of the world. However, surgical residents from Caruaru, Brazil; Loja, Ecuador; and Lambayeque, Peru, recognize the mentorship and willingness of their faculty as the main strength of their training.