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Table 2 Key themes and subthemes emerging from participant interviews. Each theme and subtheme is illustrated by a relevant verbatim quotation from the interviews. N Nurse, JD Junior Doctor, SD Senior Doctor. Numbers refer to participant study number

From: Healthcare professionals’ experiences with education in short term medical missions: an inductive thematic analysis

Theme Subtheme Quote
Program Co-creation
 Developing relationships “I think that overall the relationship that we form with all the relevant organisations felt very positive. And I think it was very effective in engaging students and participation.” - 2, JD
 Creating programs in partnership “I think it is good to see and to see groups mingle together and trying to get that cohesive unit because that’s what healthcare is all about. Everyone doing their little bit trying to get the best outcome.” – 23, N “What we did after the first few years was to email the head of department that we were going through in Malawi or Zimbabwe and get them to talk to the students, to ask them what they would like to be taught on. So that they would give us topics that we would prepare.” – 6, SD “I think that there is something very vital about seeing where the gaps are in their knowledge, face to face and they are probably getting more out of it. But I don’t think it’s perfect and I think there are times when we do need to come together and explore and challenge the learning.” – 7, SD
 Knowledge transfer “We have the opportunity to give our skills as educators to local educators who can go on with the kind of work that we’re doing.” – 12, JD “We have a great deal of collegiality and learning that is shared in both directions.” – 1, SD
 Integrating local staff “Part of the program I saw was how little local input there was. I think I thought that the program would be delivered with locals side by side with the doctors from the program.” – 7, SD “It would be good to utilize, in some way, some of the local physicians and surgeons. That way they would feel proud of it...I think it would be tricky to do, but I think it would better. It would give you more buy-in to the locals.” - 13, SD
 Responding to participant’s needs “They’re not given Professional Development Days, and so they were sacrificing their income to come to our seminar… While we couldn’t necessarily pay their wages to attend, we had to find a way to offset their losses they were incurring.” – 5, N
 Sustainability “I think you have to look towards what your end goal is when you offer programmes like this... there are lots of things like getting local participation in the running of the program. And the delivery of the programme as well.” – 5, N “It’s a partnership. I hope that ultimately we become redundant. That we’re not needed and that the education can be provided by, you know, in country clinicians and specialists.” – 17, JD
Connecting with context
 Understanding local disease patterns and clinical setting “(What) we should be aiming (at) or thinking about? What are the diseases, pattern of disease in that country? What are the things they see? They probably see things different to here.” – 11, SD “Going onto the ward allowed me to see what I could change about what I talked about in burns for the next time that I did it, which I thought was really good.” – 21, N “They have Metformin in Malawi. But what does it cost them to get on it? ...What do they have to sacrifice to take it, is it free, is it not free? There are so many issues.” – 5, N
 Matching content to context “You’ve got to move with what works well and adapt it to your setting and also adapt it when new concepts come out.” – 5, N
 Responding to local preferences “I think we’ve adapted the program appropriately to what the you know, what the local medical students and surgical trainees want. So shorter lectures as kind of an introduction and small group teaching.” – 17, JD
 Applying skills in practice “We’ve had nurses report back to us that they did a neuro obs (observations) sessions with us, and then neuro obs (observations) with patients and then picked up on a patient who’s deteriorating on their next shift, who might otherwise have gone unnoticed.” – 5, N
 Enabling a global understanding “That experience and understanding has certainly been informative in terms of understanding what’s required not only in medicine but socially and politically in different parts of the world.” – 6, SD
Engaging through culture
 Encouraging communication through cultural barriers “One really, really important thing is the communication and breakdown of those barriers between doctors and nurses. I think that’s super, super well done… and that doesn’t require physical resources.” – 2, JD “We learnt early on that African communities are very shy by nature. You have to break down the barrier with sensitivity in order to really interact and relate. Which is why SCIMs (structured clinical instruction modules) worked so well in Africa as they were small groups which encouraged the participants to speak out and interact as part of the learning process.” – 6, SD “We’ve also evolved more into the area of communication as being
important, and it’s probably in the last two years, more specifically interdisciplinary communication between medical students, doctors and nurses, getting them communicating with each other...is probably one of the more important aspects of what we do.” – 1, SD
 Empowering clinicians to advocate for patients “It’s really about promoting their confidence, knowledge levels to be able to advocate for their patients.” – 24, N
 Embracing commonalities with students “It was very humbling, I guess watching those people and the things that, I guess, motivate them and drive them to learn. And it made me think about, I guess, my interaction with patients here and my own personal clinical practice and the things that I take for granted.” – 10, N “You know, everyone’s really the same in the end, aren’t they? You know, like the people showing me photos of their children, you know, that family stuff … humans are often all the same, the world over. And they were very nice to talk to.” – 20, N
Optimizing clinical Care
 Respecting teammates capabilities “Trying to build those multidisciplinary afternoons where the nurses and doctors are in together trying to build and the medical students are trying to build respect amongst the teams for each person’s skills.” – 24, N
 Understanding resource availability “We didn’t know what the facilities were before we went. And so we would be talking about doing procedures and things that they just didn’t have the equipment for, no possibility of doing them… The teaching anaesthetist was saying, the particular value of one type of drug for pain relief and how another type was really not suitable. And they listened very quietly and took it all in. But at the end, one of them said, ‘Well, we don’t have any capacity to choose what drugs we use. We just use whatever we can get. And quite often we don’t have anything at all’.” – 3, SD “I think more in depth collaboration from local contacts prior, kind of more information about what’s available…There’s no point in saying, ‘Oh, CT’s the gold standard’, if they don’t have it...their resources are very slim. And if they haven’t got resources, it’s very difficult for them to do some of the stuff.” – 12, JD
 Appreciating resourcefulness “The ingenuity of, do the best you can with what you’ve got… they obviously don’t have enteral nutrition rotation regimes available to them, so they’re talking about if the patient’s got an NG in, and they need a high protein diet, well, they’re mostly giving them milk, if they need a more carbohydrate rich diet, they’re giving them porridge and it’s the same stuff. It’s just not a fancy version of it.” – 5, N
 Empowering local workforce “I try and do teaching in a very particular way. I quite like the idea of being able to impart some knowledge and teach some skills that they can follow on rather than go and do surgery and then leave.” – 12, JD “There’s something to be said for not contributing to skills drain in developing countries… that’s something which is a fine balance with working with people who are in vulnerable circumstances, in developing settings where, you know, you want to make sure you strike a balance between empowering them to work in their own setting, but not giving them something that makes them want to leave their own setting.” – 5, N