Three decades of partnership: lessons from the Duke-open medical institute collaboration in global family medicine.

Sustained international partnerships in health professions education are critical to strengthening global health systems that follow PHC principles, yet few models demonstrate long-term durability across changing institutional and geopolitical contexts. Drawing on semi-structured interviews with founding participants and archival program materials, this Perspective explores a three-decade partnership between Duke University's Department of Family Medicine and Community Health (DFMCH) and the Open Medical Institute (OMI), examining how it emerged, how it has been sustained for 30 years, and what lessons it offers for global primary health care transformation through education. Established in the mid-1990s, the partnership evolved into a sustained educational exchange that introduced interactive learning models and fostered global networks among physicians from over 130 countries. The collaboration supports the development of global primary care capacity and pedagogical innovation in diverse settings while intentionally mitigating physician "brain drain" from developing countries. Key factors contributing to its longevity include shared mission, relational continuity, and an immersive residential learning environment. An iterative narrative analysis was used to identify key themes related to partnership formation, educational innovation, sustainability, and impact. This Perspective synthesizes these themes to offer insights into the design and durability of international collaborations in health professions education, as well as a transferable framework for developing sustainable global collaborations in health professions education.