title: Malawian impressions of expatriate physicians: A qualitative study.
abstract: In many low-income countries, including Malawi, expatriate physicians serve diverse roles in clinical care, education, mentorship, and research. A significant proportion of physicians from high-income countries have global health experience. Despite the well-known benefits of global health experiences for expatriates, little is known about local physician and trainee impressions of their expatriate counterparts. The objective of this study was to explore University of Malawi College of Medicine (COM) physicians' and trainees' impressions of expatriate physicians.
  
  
  
  We conducted a cross-sectional qualitative study using semi-structured interviews with COM medical students, interns, registrars, and faculty. Through open coding, we developed a codebook that we applied to interview transcripts and used thematic analysis to identify major themes.
  
  
  
  We interviewed 46 participants from across the continuum of medical education at two teaching hospitals in Malawi. Participants discussed themes within the following domains: perceived benefits of expatriate physicians in Malawi, perceived challenges, past contributions, and perceived roles that expatriate physicians should play going forward. Malawian faculty and trainees appreciated the approachability, perspectives, and contribution to education that expatriates have provided, though at times some have been perceived as aggressive, unable to relate to patients and trainees, deficient at adapting to the setting, and self-serving. Potential roles that Malawian physicians and trainees feel expatriates should serve include education, training, capacity building, and facilitating exchange opportunities for local physicians and trainees.
  
  
  
  This study highlights the perceived benefits and challenges that physicians and trainees at the COM have experienced with their expatriate counterparts, and suggests roles that expatriates should play while abroad. These findings can be used to help inform existing global health guidelines, assist with the establishment of host institution expectations for global health programmes, and guide individual expatriate physicians who hope to optimise their roles abroad.
authors.affiliation: Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Natasha
authors.initials: N
authors.lastname: Parekh
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Sawatsky
authors.affiliation: TeamHealth, Oak Ridge Methodist Medical Center, Oak Ridge, Tennessee, USA.
authors.forename: Ihunanya
authors.initials: I
authors.lastname: Mbata
authors.affiliation: School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: Adamson S
authors.initials: AS
authors.lastname: Muula
authors.affiliation: Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Thuy
authors.initials: T
authors.lastname: Bui
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D054521:Cultural Competency; D005260:Female; D006801:Humans; D007391:International Cooperation; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research