VICTORY Protocol - VIrtual knowledge exchange in primary Care Through effective digital Online couRses for all Young people without borders and barriers

Technical Summary of the VICTORY Protocol

Problem Statement
The paper addresses the critical need to equip healthcare practitioners with the skills to manage complex, interconnected global health challenges, including pandemics, climate change, and migration. These issues transcend national borders, requiring a shift from insular medical education to a "global citizen" perspective. A significant disparity exists in Primary Health Care (PHC) capacity between High-Income Countries (HICs) and Low- and Middle-Income Countries (LMICs), particularly in Sub-Saharan Africa (SSA), which bears 25% of the global disease burden but possesses only 3% of the global health workforce. Furthermore, traditional educational models often fail to address the "brain drain" where trained professionals migrate for better opportunities, leaving local systems understaffed. The paper posits that virtual exchange (VE) offers a mechanism to foster equitable collaboration, enhance intercultural competencies, and build sustainable PHC capacity without requiring physical migration, thereby addressing gaps in standardized curricula and clinical training in family medicine.

Methodology
The study employs a mixed-methods approach structured across three distinct phases to design, implement, and evaluate a virtual exchange programme between institutions in Europe (Ireland and Hungary) and SSA (Malawi and Zimbabwe).

• Phase 1: Scoping Review: A systematic scoping review following JBI methodology and PRISMA-ScR guidelines will synthesize evidence on the implementation, outcomes, barriers, and facilitators of virtual exchanges in global health. This phase aims to identify best practices and gaps in the literature to inform curriculum design.
• Phase 2: Curriculum Co-Development: A needs assessment will be conducted using quantitative surveys (targeting ~250 undergraduate and postgraduate medical students at University College Dublin) and qualitative focus groups (involving students and educators). This phase utilizes a sequential explanatory design to determine learning objectives, preferred pedagogical approaches, and assessment methodologies. The curriculum will be co-developed by a multidisciplinary team of experts, students, and trainees, grounded in theoretical frameworks such as Connectivism, Rhizomatic learning, Constructivism, and the Intergroup Contact Hypothesis.
• Phase 3: Implementation and Evaluation: The 12-week virtual exchange programme will be delivered via online platforms. Evaluation will utilize a concurrent triangulation mixed-methods design:
  • Quantitative: Pre- and post-course surveys will measure changes in global health competencies, cultural sensitivity (using the Intercultural Sensitivity Scale), and attitudes toward collaboration. Data will be analyzed using descriptive statistics and ordered logistic regression in SPSS.
  • Qualitative: Semi-structured interviews and focus groups will explore participant experiences, challenges, and intercultural development. Thematic analysis (following Braun and Clarke) will be applied to transcripts, utilizing the Council of Europe's Competences for Democratic Culture framework.

Key Contributions
The paper outlines a protocol for a novel educational intervention that:

1. Establishes an Equitable Partnership Framework: It emphasizes the necessity of avoiding "semicolonial" dynamics in North-South collaborations by adhering to frameworks that ensure mutual benefit, shared leadership, and ethical sustainability.
2. Integrates Theoretical Pedagogies: The curriculum design explicitly integrates Connectivism (networked learning), Rhizomatic learning (fluid, non-hierarchical knowledge construction), and Constructivism (social interaction and co-creation of meaning) to optimize intercultural competency development.
3. Addresses the "Brain Drain": By providing high-quality, accessible virtual education, the project aims to retain talent in resource-poor settings and allow diaspora professionals to contribute remotely, thereby strengthening local health systems.
4. Provides a Rigorous Evaluation Model: The study proposes a comprehensive evaluation strategy combining Kirkpatrick's levels of training evaluation with specific global health competency domains and intercultural sensitivity metrics.

Results
As this document is a study protocol and preprint describing the design and methodology of the research, it does not contain empirical results, statistical findings, or final conclusions regarding the efficacy of the VICTORY programme. The text explicitly states that data collection is expected to be completed within 24 months of the study start date, with results to follow. Consequently, no quantitative outcomes or qualitative themes regarding the programme's impact are reported in this manuscript.

Significance and Claims
The paper claims that the VICTORY project will generate essential evidence on the design and impact of virtual exchanges for global health education. Its significance lies in:

• Curriculum Development: Contributing to the creation of sustainable and equitable Primary Health Care curricula that bridge the gap between European and African medical education contexts.
• Workforce Development: Supporting the development of a globally connected primary care workforce capable of addressing transnational health threats.
• Health Equity: Promoting health equity by fostering collaboration that respects local contexts while sharing knowledge, ultimately aiming to improve health outcomes in underserved populations.
• Policy and Practice: The findings are intended to inform academic, policy, and professional networks (including WONCA and African academic consortia) to advance global collaboration and integrate virtual exchange models into standard medical education.

The authors maintain a modest stance, noting that the study is a protocol for generating evidence and that the findings will be disseminated to guide future iterations and scalability, rather than claiming immediate, definitive solutions to global health disparities.