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Introduction: Over the last two decades, GH programs have offered experiences at partner sites through established global health partnerships (GHPs). Historically, GHPs have been one-directional, favoring partners from resource-rich settings. These partnerships are now being reevaluated through the lens of equity and decolonization. We seek to understand how US pediatric GH faculty define the concept of “bidirectionality”, assess perspectives on their institution’s practice of bidirectional activities, and explore perceived benefits and challenges to prioritizing bidirectionality within their own GHPs. Methods: This is a cross-sectional qualitative survey study on bidirectionality of 206 AAMC-accredited US pediatric residency programs. 24 survey responses from global health faculty or staff at these programs were received. The REDCap-based online survey was developed by iterative repetition with a diverse author group. Data was collected from January 18, 2023 to February 20, 2023. Free-text responses were reviewed and coded through an inductive approach. Results: The majority of participants were “very familiar” with bidirectionality. Bidirectionality was described in terms of reciprocity, equity, and collaboration. Examples of programs’ own efforts to be bidirectional varied, and examples given varied to the degree of achieving bidirectionality. Perceived benefits of bidirectionality included friendship and mutual respect, educational opportunities, and opportunities to achieve equity. Perceived challenges of bidirectionality included technical barriers, cultural barriers and mismatched expectations, and financial barriers. Despite challenges, participants expressed persistence and the ability to be flexible in order to create and maintain bidirectional GHPs. Conclusions: A shared concept of bidirectionality exists, whereby partners collaborate at the personal and institutional level, forming a relationship based on mutual respect and understanding, resulting in a reciprocal and equitable exchange of benefits. Perceived benefits of bidirectionality can be difficult to quantify and justify in comparison to perceived challenges of bidirectionality. US pediatric GH programs should continue to reevaluate their own GHPs to assess if they are achieving true bidirectionality.




Presented at the 15th Annual CHOP Pediatric Global Health Conference; Philadelphia, Pennsylvania; September 29-30, 2023.

Exploring bidirectionality in US pediatric global health programs

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