Table 1 Interview guide based on the WEIGHT guidelines

For each of the following guidelines regarding international clinical internationals:

- What is your current approach (how do you do this)?

- In what ways does this work well?

- In what ways does this not work well?

- How do you think it ought to work in an ideal scenario?

- Who exactly is responsible for what aspects of this?

- Is there anything we have not discussed that you would like to add?

Guidelines topics:

1. Toward equitable benefits: Develop well-structured programs so that host and sender derive mutual, equitable benefits, including:

a. Written agreement: discuss expectations and responsibilities of both host and sending institutions and agree on terms before program implementation (may be outlined in MOU), and revisit expectations on a periodic basis

b. Local priorities: consider local needs and priorities regarding the structure of the ICI

c. Recognizing all costs: recognize the true cost to all institutions (e.g., costs of orientation, insurance, translation, supervision and mentoring, transportation, lodging, health care, administration) and ensure they are appropriately reimbursed and/or Monitoring costs: Monitor costs and benefits to host institutions, local trainees, patients, communities, and sponsoring institutions to assure equity

d. Nesting in long-term relationships: aspire to maintain long-term relationships so that short-term experiences may be nested within them

e. Transparent motives: promote transparency regarding the motivations for establishing and maintaining programmes (e.g., to meet an educational mission, to establish a relationship that might be used to support research, to meet student need) and identifying and addressing any conflicts of interest or conflicts of engagement (e.g., to local patients, communities, or local trainees compared with global health trainees) that may arise from such a programme

2. Explicit agreements: Clarify goals, expectations and responsibilities through explicit agreements and periodic review by:

a. Senders and hosts

b. Trainees and mentors

c. Sponsors and recipients

3. Training for all involved: Develop, implement, regularly update and improve formal training for trainees and mentors, both local and foreign, regarding materials that includes:

a. Norms of professionalism (local and sending)

b. Standards of practice (local and sending)

c. Cultural competencies e.g., behaviours (local and sending)

d. Dealing appropriately with conflicts (i.e. professionalism, culture, scientific and clinical differences of approach)

e. Language capability

f. Personal safety and Safety of Trainees: Promote safety of trainees to the extent possible (e.g., vaccinations, personal behaviours, medications, physical barriers, security awareness, road safety, sexual harassment, psychological support, insurance and knowledge of relevant local laws)

g. Implications of differential access to resources for foreign and local trainees

4. Conflict resolution: Encourage non-threatening communication to resolve ethical conflicts as they arise in real-time and identify a mechanism to involve the host and sending institutions when issues are not readily resolved

5. Clarifying trainee’s abilities: Clarify the trainees’ level of training and experience for the host institution so that appropriate activities are assigned and patient care and community well-being is not compromised

6. Selection of trainees: Select trainees who are adaptable, motivated to address global health issues, sensitive to local priorities, willing to listen and learn, whose abilities and experience matches the expectations of the position, and who will be good representatives of their home institution and country

7. Supervisory model: Establish effective supervision and mentorship of trainees by the host and sending institution, including the selection of appropriate mentors and supervisors and facilitating communication among them.

8. Feedback from trainees: Establish methods to solicit feedback from the trainees both during and on completion of the program, including exit interviews, and track the participants post-training to evaluate the impact of the experience.