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Kirubakaran S, Kumar K, Worley P, Pimlott J, Greenhill J. Establishing new medical schools in diverse contexts: A novel conceptual framework for success. MEDICAL EDUCATION 2024. [PMID: 38803145 DOI: 10.1111/medu.15421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Establishing a new medical school is a significant venture involving many complex political, social, economic, educational, and organisational considerations. The published literature on the process of establishing a new medical school is, however, under-developed with minimal empirical research and no explicit reference to theory. This research sought to address these gaps and establish an empirical and theoretical evidence-base for the process of new medical school establishment in diverse contexts, particularly medically under-served areas. METHODS A Critical Realist Multiple Case Study was undertaken to examine the establishment of new medical schools across three continents. Data were collected between 2016 and 2018 through observational data gathered on site visits to three medical schools in medically under-served areas, relevant documents/audio-visual materials, and semi-structured interviews with key founding personnel. Data were analysed using the Critical Realist approach. Institutional Entrepreneurship theory was applied, adapted, and extended to explore and explain the phenomenon of new medical school establishment in diverse contexts. RESULTS This study identifies eight critical success factors underpinning new medical school establishment. Framed as the Eight C's Framework (8CF), these factors include Context (field conditions), Catalysts (institutional entrepreneurs), Conducing (helping to bring about a particular situation or outcome), Collecting (resources), Connecting (relationships), Convincing (rationales), Challenges, and Consequences (outcomes). 8CF highlights that new medical schools are successfully established when Catalysts act within their Contexts to undertake the tasks of Conducing, Convincing, Collecting, and Connecting in order to produce desired Consequences and overcome Challenges. CONCLUSIONS The Eight C's Framework is a theory-based, empirically supported framework that can be applied across different contexts to strategically guide the successful establishment of new medical schools. Founding leaders and stakeholders could use 8CF to ensure their establishment efforts are underpinned by theory and scholarship.
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Affiliation(s)
- Sneha Kirubakaran
- The University of Queensland Medicine Program, Herston, Queensland, Australia
- Flinders University Medicine Program, Adelaide, South Australia, Australia
| | - Koshila Kumar
- Flinders University Medicine Program, Adelaide, South Australia, Australia
- Charles Sturt University, Albury, New South Wales, Australia
| | - Paul Worley
- Flinders University Medicine Program, Adelaide, South Australia, Australia
| | - Joanne Pimlott
- Flinders University Medicine Program, Adelaide, South Australia, Australia
- University of South Australia Business Management and Human Resource Management Discipline, Adelaide, South Australia, Australia
| | - Jennene Greenhill
- Flinders University Medicine Program, Adelaide, South Australia, Australia
- Southern Cross University Discipline of Nursing, Lismore, New South Wales, Australia
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Noya F, Carr S, Thompson S. Social accountability in a medical school: is it sufficient? A regional medical school curriculum and approaches to equip graduates for rural and remote medical services. BMC MEDICAL EDUCATION 2024; 24:526. [PMID: 38734593 PMCID: PMC11088763 DOI: 10.1186/s12909-024-05522-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Social accountability is increasingly integral to medical education, aligning health systems with community needs. Universitas Pattimura's Faculty of Medicine (FMUP) enhances this through a curriculum that prepares graduates for rural and remote (RR) medical practice, exceeding national standards. The impact of this curriculum on graduate readiness in actual work settings remains unassessed. OBJECTIVE This study was conducted to capture the perspectives of FMUP medical graduates in a rural-centric curriculum, focusing on the teaching and learning opportunities afforded to them during their medical education. These insights are crucial for evaluating the accountability of regional medical schools in delivering quality service, particularly in underserved areas. METHODS Semistructured interviews were conducted with nine FMUP graduates employed in the RR areas of Maluku Province. A qualitative analysis was employed to examine graduates' views on the curriculum concerning medical school accountability. RESULTS The FMUP curriculum, informed by social accountability principles, partially prepares graduates to work under Maluku's RR conditions. However, it was reported by participants that their skills and preparedness often fall short in the face of substandard working environments. CONCLUSIONS The FMUP curriculum supports the government's aim to develop an RR medical workforce. However, the curriculum's social accountability and rural emphasis fall short of addressing community health needs amid inadequate practice conditions. Political investment in standardizing medical facilities and equipment is essential for enhancing graduates' effectiveness and health outcomes in RR communities.
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Affiliation(s)
- Farah Noya
- Department of Medical Education, Faculty of Medicine Universitas Pattimura, Jl. Ir. M. Putuhena Poka, Ambon, Maluku, 97233, Indonesia.
| | - Sandra Carr
- Division of Health Professions Education, School of Allied Health, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, WA, 6530, Australia
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Larkins SL, Cristobal F, Hogenbirk J, Tandinco F, Othman AB, Mbokazi J, Van Roy K, Upadhyay S, Johnston K, Neusy AJ. Mission and role modelling in producing a fit-for-purpose rural health workforce: perspectives from an international community of practice. Med J Aust 2023; 219 Suppl 3:S20-S26. [PMID: 37544007 DOI: 10.5694/mja2.52020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Sarah L Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, QLD
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD
| | - Fortunato Cristobal
- School of Medicine, Ateneo de Zamboanga University, Zamboanga City, the Philippines
| | - John Hogenbirk
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Canada
| | - Filedito Tandinco
- School of Health Sciences, University of the Philippines Manila, Leyte, the Philippines
| | - Abu-Bakr Othman
- Faculty of Medicine, University of Gezira, Wad Madani, Sudan
| | - Jabu Mbokazi
- Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Kaatje Van Roy
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Karen Johnston
- College of Medicine and Dentistry, James Cook University, Townsville, QLD
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Punzalan JK, Guingona M, Punzalan MG, Cristobal F, Frahsa A, Liwanag HJ. The Integration of Primary Care and Public Health in Medical Students' Training Based on Social Accountability and Community-Engaged Medical Education. Int J Public Health 2023; 68:1605359. [PMID: 36776739 PMCID: PMC9908606 DOI: 10.3389/ijph.2023.1605359] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
Objectives: Primary care and public health comprise the bedrock of health systems, but their divergence has produced two groups of practitioners either focused on individual health or population health. We explored how primary care and public health were integrated in medical students' training in Zamboanga Peninsula, Philippines. Methods: Our qualitative study reviewed community health plans in two municipalities and thematically analyzed the perspectives of medical students, faculty, alumni, and community stakeholders through focus group discussions and in-depth interviews. Results: Integration began by operationalizing a curriculum requiring medical students to serve rural communities during most of their training-a departure from the conventional, hospital-based medical education in the Philippines. The medical students' community immersion provided opportunities for integrating primary care and public health activities that influenced their personal orientations and the health situation in communities. Integration continued after training as alumni found themselves serving as primary care and public health practitioners in the region. Conclusion: Social accountability and community-engaged medical education provided the foundation for medical students to integrate primary care and public health in practice to respond to local needs.
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Affiliation(s)
| | - Monserrat Guingona
- Ateneo de Zamboanga University School of Medicine, Zamboanga City, Philippines
| | | | - Fortunato Cristobal
- Ateneo de Zamboanga University School of Medicine, Zamboanga City, Philippines
| | - Annika Frahsa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Harvy Joy Liwanag
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland,*Correspondence: Harvy Joy Liwanag,
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Marjadi B, Scobie J, Doyle K, Tobin S, Whitton G, Rollinson N, Haque S, Fava G, Smith M, Spannenberg J, Micheal S. Twelve tips for engaging students and community partners in medical education. MEDICAL TEACHER 2022; 44:1340-1346. [PMID: 34634989 DOI: 10.1080/0142159x.2021.1986625] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There is increasing evidence on the positive outcomes of engaging students and community partners in medical education, especially in achieving social accountability. However, less is known about the steps through which these engagements are established. This paper outlines twelve tips on establishing a robust and enduring partnership with students and community partners in medical education, using examples from the Western Sydney University School of Medicine. While context is paramount in any engagement program, these tips are formulated to be transferable to medical education settings in different countries, education systems, and the broader context of health professional education.
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Affiliation(s)
| | - Jeff Scobie
- Macarthur Disability Services, Campbelltown, Australia
| | - Kerrie Doyle
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Stephen Tobin
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Gilbert Whitton
- Drug Health Service, South Western Sydney Local Health District, Liverpool, Australia
| | - Nathan Rollinson
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Shafiul Haque
- Western Sydney Medical Society, Campbelltown, Australia
| | - Grace Fava
- Autism Advisory and Support Service, Liverpool, Australia
| | - Mitchell Smith
- New South Wales Refugee Health Service, South Western Sydney Local Health District, Liverpool, Australia
| | | | - Sowbhagya Micheal
- School of Medicine, Western Sydney University, Campbelltown, Australia
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Noya F, Carr S, Freeman K, Thompson S, Clifford R, Playford D. Strategies to Facilitate Improved Recruitment, Development, and Retention of the Rural and Remote Medical Workforce: A Scoping Review. Int J Health Policy Manag 2022; 11:2022-2037. [PMID: 34973053 PMCID: PMC9808272 DOI: 10.34172/ijhpm.2021.160] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 11/14/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Medical workforce shortages in rural and remote areas are a global issue. High-income countries (HICs) and low- and middle-income countries (LMICs) seek to implement strategies to address this problem, regardless of local challenges and contexts. This study distilled strategies with positive outcomes and success from international peer-reviewed literature regarding recruitment, retention, and rural and remote medical workforce development in HICs and LMICs. METHODS The Arksey and O'Malley scoping review framework was utilised. Articles were retrieved from electronic databases Medline, Embase, Global Health, CINAHL Plus, and PubMed from 2010-2020. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guideline was used to ensure rigour in reporting the methodology in the interim, and PRISMA extension for scoping review (PRISMA-ScR) was used as a guide to report the findings. The success of strategies was examined against the following outcomes: for recruitment - rural and remote practice location; for development - personal and professional development; and for retention - continuity in rural and remote practice and low turnover rates. RESULTS Sixty-one studies were included according to the restriction criteria. Most studies (n=53; 87%) were undertaken in HICs, with only eight studies from LMICs. This scoping review found implementation strategies classified as Educational, Financial, and Multidimensional were successful for recruitment, retention, and development of the rural and remote medical workforce. CONCLUSION This scoping review shows that effective strategies to recruit and retain rural and remote medical workforce are feasible worldwide despite differences in socio-economic factors. While adjustment and adaptation to match the strategies to the local context are required, the country's commitment to act to improve the rural medical workforce shortage is most critical.
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Affiliation(s)
- Farah Noya
- Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Sandra Carr
- Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Kirsty Freeman
- Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, WA, Australia
- Duke National University Singapore Medical School, Singapore, Singapore
| | - Sandra Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, WA, Australia
| | - Rhonda Clifford
- School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Denese Playford
- The Rural Clinical School of WA, School of Medicine, The University of Western Australia, Perth, WA, Australia
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Noya F, Carr S, Thompson S, Clifford R, Playford D. Factors associated with the rural and remote practice of medical workforce in Maluku Islands of Indonesia: a cross-sectional study. HUMAN RESOURCES FOR HEALTH 2021; 19:126. [PMID: 34627282 PMCID: PMC8502290 DOI: 10.1186/s12960-021-00667-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Many factors contribute to engagement in rural and remote (RR) medical practice, but little is known about the factors associated with rural and remote medical practice in such remote locations as the Maluku Province of Indonesia. This study describes factors associated with actual RR practice, preferred RR practice, and intention to remain practice in Maluku Province. METHODS An online survey of work-related experience and intentions for future rural work was administered to 410 doctors working in the Maluku province of Indonesia. Participant characteristics were described using descriptive statistics, associations between the independent variables with the location of the workforce, intention to remain practice in Maluku, preference for future RR practice in Maluku were analysed using Chi-square tests and logistic regression. RESULTS A total of 324 responses (79% response rate) were recorded, comprising 70% females and 30% Pattimura University graduates of doctors employed in Maluku. Doctors working in RR areas were more likely to be a GP (OR 3.49, CI 1.03-11.8), have a monthly salary of more than IDR 6 million (OR 11.5, CI 4.24-31.1), and have no additional practice (OR 2.78, CI 1.34-5.78). Doctors intended to stay practice in Maluku were more likely to be born in Maluku (OR 7.77, CI 3.42-17.7) and have graduated from Pattimura University (OR 3.06, CI 1.09-8.54), and less likely to be a temporary employee (OR 0.24, CI 0.10-0.57). Doctors who prefer future RR practice in Maluku were more likely to experience rural living (OR 2.05 CI 1.05-3.99), have a positive indication of the impact of community exposure during medical schools on their current practice (OR 2.08, CI 1.06-4.09), currently practising in RR Maluku (OR 8.23, CI 3.27-20.8); and less likely to have bigger take-home pay (OR 0.30, CI 0.13-0.70). CONCLUSION This study indicates that special attention should be given to recruiting doctors with a rural background and ongoing support through attractive opportunities to build a sustainable RR workforce. Since a regional medical school helps supply doctors to the RR areas in its region, a sustained collaboration between medical schools and local government implementing relevant strategies are needed to widen participation and improve the recruitment and retention of RR doctors.
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Affiliation(s)
- Farah Noya
- Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, Australia
- Medical Education Unit, Faculty of Medicine, Pattimura University, Ambon, Indonesia
- Health Professions Education Building, The University of Western Australia, Crawley Avenue (off Mounts Bay Road-next to CAR PARK 25), Nedlands, WA 6009 Australia
| | - Sandra Carr
- Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, Australia
| | - Rhonda Clifford
- School of Allied Health, University of Western Australia, Perth, Australia
| | - Denese Playford
- The Rural Clinical School of WA, School of Medicine, The University of Western Australia, Perth, Australia
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O'Sullivan BG, Couper I, Kumar P, McGrail MR. Editorial: Effective Strategies to Develop Rural Health Workforce in Low and Middle-Income Countries (LMICs). Front Public Health 2021; 9:702362. [PMID: 34150713 PMCID: PMC8212967 DOI: 10.3389/fpubh.2021.702362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/10/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Ian Couper
- Ukwanda Centre for Rural Health, Stellenbosch University, Cape Town, South Africa
| | - Pratyush Kumar
- Department of Family Medicine, Sir Ganga Ram Hospital, New Delhi, India
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Guignona M, Halili S, Cristobal F, Woolley T, Reeve C, Ross SJ, Neusy AJ. A Curriculum for Achieving Universal Health Care: A Case Study of Ateneo de Zamboanga University School of Medicine. Front Public Health 2021; 9:612035. [PMID: 34026703 PMCID: PMC8132581 DOI: 10.3389/fpubh.2021.612035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/30/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Universal Health Care requires equal distribution of a health workforce equipped with competencies appropriate for local population needs. While health inequities persist in the Philippines, the Ateneo de Zamboanga University School of Medicine (ADZU-SOM) in Zamboanga Peninsula – an impoverished and underserved region – has demonstrated significant success retaining graduates and improving local health statistics. This study describes the qualitative evidence of ADZU-SOM students and graduates having positive impacts on local health services and communities, and the contextual factors associated with the school's socially-accountable mission and curriculum that contribute to these impacts. Methods: This qualitative study involved 41 one-on-one or group interviews conducted across seven participant groups (faculty, graduates, final-year students, health professionals, health workers, community members, community leaders). Gale et al's method for analyzing qualitative data in multi-disciplinary health research, WHO's “6 Building Blocks for quality health systems” framework and THEnet's social-accountability framework were used to organize and interpret data. Results: Local community members, community leaders, and health staff consistently reported examples of ADZU-SOM students and graduate doctors developing health infrastructure and providing health education, health promotion, and disease prevention activities accessible to all population groups. Students and graduates suggested these impacts were due to a number of factors, including how ADZU-SOM's sandwich model of longitudinal community-engagement culminating in 10-months continuous community placement in the final year helped them develop a strong motivation for community service, the teachings and curriculum activities that focused on public health and the social determinants of health, and faculty's commitment and ability to operationalize ADZU-SOM's mission and values. Staff also reported impacts were driven by integration of regional and national health priorities as core curriculum, and involving local stakeholders in curriculum development. Conclusions: This study provides qualitative evidence that ADZU-SOM's curriculum content and immersive community placements are training a medical workforce that is strengthening local health systems and health infrastructure across all 6 WHO “Building Blocks for quality health systems.” These findings suggest ADZU-SOM has managed to evolve a consciousness toward community service among final year students and graduates, adding evidence to the assertion it is a fully socially-accountable health professions institution.
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Affiliation(s)
- Monserrat Guignona
- School of Medicine, Ateneo de Zamboanga University, Zamboanga, Philippines
| | - Servando Halili
- School of Medicine, Ateneo de Zamboanga University, Zamboanga, Philippines.,Research and Extension, Zamboanga State College of Marine Sciences and Technology, Zamboanga, Philippines
| | | | - Torres Woolley
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Carole Reeve
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.,School of Medicine, Flinders University, Alice Springs, NT, Australia
| | - Simone Jacquelyn Ross
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.,The Training for Health Equity Network, New York, NY, United States
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Woolley T, Ross S, Larkins S, Sen Gupta T, Whaleboat D. "We learnt it, then we lived it": Influencing medical students' intentions toward rural practice and generalist careers via a socially-accountable curriculum. MEDICAL TEACHER 2021; 43:93-100. [PMID: 33016806 DOI: 10.1080/0142159x.2020.1817879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The James Cook University (JCU) medical school has a mission to produce graduates committed to practising with underserved populations. This study explores the views of final-year students regarding the influence of the JCU medical curriculum on their self-reported commitment to socially-accountable practice, intentions for rural practice, and desired postgraduate training pathway. METHODS Cross-sectional survey of final year JCU medical students (n = 113; response rate = 65%) to determine whether their future career directions (intentions for future practice rurality and postgraduate specialty training pathway) are driven more by altruism (commitment to socially accountable practice/community service) or by financial reward and/or prestige. RESULTS Overall, 96% of responding students reported their JCU medical course experiences had cultivated a greater commitment towards 'socially-accountable' practice. A commitment to socially-accountable practice over financial reward and/or prestige was also significantly associated with preferring to practise Medicine in non-metropolitan areas (p = 0.036) and intending to choose a 'generalist' medical discipline (p = 0.003). CONCLUSIONS The findings suggest the JCU medical curriculum has positively influenced the commitment of its graduating students towards more socially accountable practice. This influence is a likely result of pre-clinical teachings around health inequalities and socially-accountable medical practice in combination with real-world, immersive experiences on rural and international placements.
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Affiliation(s)
- Torres Woolley
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Simone Ross
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Tarun Sen Gupta
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Donald Whaleboat
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
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Putri LP, O’Sullivan BG, Russell DJ, Kippen R. Factors associated with increasing rural doctor supply in Asia-Pacific LMICs: a scoping review. HUMAN RESOURCES FOR HEALTH 2020; 18:93. [PMID: 33261631 PMCID: PMC7706290 DOI: 10.1186/s12960-020-00533-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 11/03/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND More than 60% of the world's rural population live in the Asia-Pacific region. Of these, more than 90% reside in low- and middle-income countries (LMICs). Asia-Pacific LMICs rural populations are more impoverished and have poorer access to medical care, placing them at greater risk of poor health outcomes. Understanding factors associated with doctors working in rural areas is imperative in identifying effective strategies to improve rural medical workforce supply in Asia-Pacific LMICs. METHOD We performed a scoping review of peer-reviewed and grey literature from Asia-Pacific LMICs (1999 to 2019), searching major online databases and web-based resources. The literature was synthesized based on the World Health Organization Global Policy Recommendation categories for increasing access to rural health workers. RESULT Seventy-one articles from 12 LMICs were included. Most were about educational factors (82%), followed by personal and professional support (57%), financial incentives (45%), regulatory (20%), and health systems (13%). Rural background showed strong association with both rural preference and actual work in most studies. There was a paucity in literature on the effect of rural pathway in medical education such as rural-oriented curricula, rural clerkships and internship; however, when combined with other educational and regulatory interventions, they were effective. An additional area, atop of the WHO categories was identified, relating to health system factors, such as governance, health service organization and financing. Studies generally were of low quality-frequently overlooking potential confounding variables, such as respondents' demographic characteristics and career stage-and 39% did not clearly define 'rural'. CONCLUSION This review is consistent with, and extends, most of the existing evidence on effective strategies to recruit and retain rural doctors while specifically informing the range of evidence within the Asia-Pacific LMIC context. Evidence, though confined to 12 countries, is drawn from 20 years' research about a wide range of factors that can be targeted to strengthen strategies to increase rural medical workforce supply in Asia-Pacific LMICs. Multi-faceted approaches were evident, including selecting more students into medical school with a rural background, increasing public-funded universities, in combination with rural-focused education and rural scholarships, workplace and rural living support and ensuring an appropriately financed rural health system. The review identifies the need for more studies in a broader range of Asia-Pacific countries, which expand on all strategy areas, define rural clearly, use multivariate analyses, and test how various strategies relate to doctor's career stages.
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Affiliation(s)
- Likke Prawidya Putri
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, IKM Building 2nd Floor, Jl. Farmako, Sekip Utara, 55281 Yogyakarta, Indonesia
- School of Rural Health, Monash University, 26 Mercy Street, Bendigo, VIC 3550 Australia
| | | | | | - Rebecca Kippen
- School of Rural Health, Monash University, 26 Mercy Street, Bendigo, VIC 3550 Australia
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12
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O'Sullivan B, Chater B, Bingham A, Wynn-Jones J, Couper I, Hegazy NN, Kumar R, Lawson H, Martinez-Bianchi V, Randenikumara S, Rourke J, Strasser S, Worley P. A Checklist for Implementing Rural Pathways to Train, Develop and Support Health Workers in Low and Middle-Income Countries. Front Med (Lausanne) 2020; 7:594728. [PMID: 33330559 PMCID: PMC7729061 DOI: 10.3389/fmed.2020.594728] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/30/2020] [Indexed: 12/11/2022] Open
Abstract
Background: There is an urgent need to scale up global action on rural workforce development. This World Health Organization-sponsored research aimed to develop a Rural Pathways Checklist. Its purpose was to guide the practical implementation of rural workforce training, development, and support strategies in low and middle-income countries (LMICs). It was intended for any LMICs, stakeholder, health worker, context, or health problem. Method: Multi-methods involved: (1) focus group concept testing; (2) a policy analysis; (3) a scoping review of LMIC literature; (4) consultation with a global Expert Reference Group and; (5) field-testing over an 18-month period. Results: The Checklist included eight actions for implementing rural pathways in LMICs: establishing community needs; policies and partners; exploring existing workers and scope; selecting health workers; education and training; working conditions for recruitment and retention; accreditation and recognition of workers; professional support/up-skilling and; monitoring and evaluation. For each action, a summary of LMICs-specific evidence and prompts was developed to stimulate reflection and learning. To support implementation, rural pathways exemplars from different WHO regions were also compiled. Field-testing showed the Checklist is fit for purpose to guide holistic planning and benchmarking of rural pathways, irrespective of LMICs, stakeholder, or health worker type. Conclusion: The Rural Pathways Checklist provides an agreed global conceptual framework for the practical implementation of "grow your own" strategies in LMICs. It can be applied to scale-up activity for rural workforce training and development in LMICs, where health workers are most limited and health needs are greatest.
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Affiliation(s)
- Belinda O'Sullivan
- Faculty of Medicine, Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - Bruce Chater
- Faculty of Medicine, Rural Clinical School, University of Queensland, Theodore, QLD, Australia
| | - Amie Bingham
- Faculty of Medicine, Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - John Wynn-Jones
- Keele Medical School, Keele University, Keele, United Kingdom
| | - Ian Couper
- Ukwanda Center for Rural Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Nagwa Nashat Hegazy
- Medical Education and Human Resources Center, Faculty of Medicine, Menoufia University, Shibin el Kom, Egypt
| | - Raman Kumar
- Family Medicine Practitioner, DOC24 Family Practice Clinic, Ghaziabad, India
| | - Henry Lawson
- Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | | | - James Rourke
- Center for Rural Health Studies, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Sarah Strasser
- Faculty of Medicine, Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - Paul Worley
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Johnston K, Guingona M, Elsanousi S, Mbokazi J, Labarda C, Cristobal FL, Upadhyay S, Othman AB, Woolley T, Acharya B, Hogenbirk JC, Ketheesan S, Craig JC, Neusy AJ, Larkins S. Training a Fit-For-Purpose Rural Health Workforce for Low- and Middle-Income Countries (LMICs): How Do Drivers and Enablers of Rural Practice Intention Differ Between Learners From LMICs and High Income Countries? Front Public Health 2020; 8:582464. [PMID: 33194989 PMCID: PMC7604342 DOI: 10.3389/fpubh.2020.582464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/14/2020] [Indexed: 11/13/2022] Open
Abstract
Equity in health outcomes for rural and remote populations in low- and middle-income countries (LMICs) is limited by a range of socio-economic, cultural and environmental determinants of health. Health professional education that is sensitive to local population needs and that attends to all elements of the rural pathway is vital to increase the proportion of the health workforce that practices in underserved rural and remote areas. The Training for Health Equity Network (THEnet) is a community-of-practice of 13 health professional education institutions with a focus on delivering socially accountable education to produce a fit-for-purpose health workforce. The THEnet Graduate Outcome Study is an international prospective cohort study with more than 6,000 learners from nine health professional schools in seven countries (including four LMICs; the Philippines, Sudan, South Africa and Nepal). Surveys of learners are administered at entry to and exit from medical school, and at years 1, 4, 7, and 10 thereafter. The association of learners' intention to practice in rural and other underserved areas, and a range of individual and institutional level variables at two time points-entry to and exit from the medical program, are examined and compared between country income settings. These findings are then triangulated with a sociocultural exploration of the structural relationships between educational and health service delivery ministries in each setting, status of postgraduate training for primary care, and current policy settings. This analysis confirmed the association of rural background with intention to practice in rural areas at both entry and exit. Intention to work abroad was greater for learners at entry, with a significant shift to an intention to work in-country for learners with entry and exit data. Learners at exit were more likely to intend a career in generalist disciplines than those at entry however lack of health policy and unclear career pathways limits the effectiveness of educational strategies in LMICs. This multi-national study of learners from medical schools with a social accountability mandate confirms that it is possible to produce a health workforce with a strong intent to practice in rural areas through attention to all aspects of the rural pathway.
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Affiliation(s)
- Karen Johnston
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | - Monsie Guingona
- Ateneo de Zamboanga University School of Medicine, Zamboanga City, Philippines
| | | | - Jabu Mbokazi
- School of Medicine, Walter Sisulu University, Mthatha, South Africa
| | - Charlie Labarda
- School of Health Sciences, University of the Philippines, Manila, Philippines
| | | | | | | | - Torres Woolley
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | | | - John C Hogenbirk
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, ON, Canada
| | - Sarangan Ketheesan
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | | | - Sarah Larkins
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
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14
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Woolley T, Clithero-Eridon A, Elsanousi S, Othman AB. Does a socially-accountable curriculum transform health professional students into competent, work-ready graduates? A cross-sectional study of three medical schools across three countries. MEDICAL TEACHER 2019; 41:1427-1433. [PMID: 31407932 DOI: 10.1080/0142159x.2019.1646417] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Socially-accountable health professional education (SAHPE) is committed to achieving health equity through training health-workers to meet local health needs and serve disadvantaged populations. This research assesses the biomedical and socially-accountable competencies and work-readiness of first year graduates from socially-accountable medical schools in Australia, the United States and Sudan.Method: A self-administered survey to hospital and community health facility staff closely associated with the training and/or supervision of first year medical graduates from three SAHPE medical schools.Main outcome measure: Likert scale ratings of key competencies of SAHPE graduates (as a group) employed as first-year doctors, compared to first year doctors from other medical schools in that country (as a group).Findings: Supervisors rated medical graduates from the 3 SAHPE schools highly for socially-accountable competencies ('communication skills', 'teamwork', 'professionalism', 'work-readiness', 'commitment to practise in rural communities', 'commitment to practise with underserved ethnic and cultural populations'), as well as 'overall performance' and 'overall clinical skills'.Interpretation: These findings suggest SAHPE medical graduates are well regarded by their immediate hospital supervisors, and SAHPE can produce a medical workforce as competent as from more traditional medical schools, but with greater commitment to health equity, working with underserved populations, and addressing local health needs.
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Affiliation(s)
- Torres Woolley
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Amy Clithero-Eridon
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Salwa Elsanousi
- Department of Family and Community Medicine, University of Gezira, Gezira, Sudan
| | - Abu-Bakr Othman
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
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15
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Woolley T. Influencing intention for a family medicine career may need a whole-curriculum approach. MEDICAL EDUCATION 2019; 53:537-539. [PMID: 31106888 DOI: 10.1111/medu.13888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Torres Woolley
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
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16
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Woolley T, Sen Gupta T, Larkins S. Work settings of the first seven cohorts of James Cook University Bachelor of Medicine, Bachelor of Surgery graduates: Meeting a social accountability mandate through contribution to the public sector and Indigenous health services. Aust J Rural Health 2018; 26:258-264. [PMID: 29799145 DOI: 10.1111/ajr.12418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The James Cook University medical school's mission is to produce a workforce appropriate for the health needs of northern Australia. DESIGN, SETTING AND PARTICIPANTS James Cook University medical graduate data were obtained via cross-sectional survey of 180 early-career James Cook University medical graduates from 2005-2011 (response rate of 180/298 contactable graduates = 60%). Australian medical practitioner data for 2005-2009 graduates were obtained via the 2015 'Medicine in Australia: Balancing Employment and Life' wave 8 dataset. MAIN OUTCOME MEASURE Comparison of the range of work settings and hours worked by James Cook University medical graduates to Australian medical graduates. RESULTS Compared to a similar group of Australian medical graduates, James Cook University Bachelor of Medicine, Bachelor of Surgery graduates are significantly more likely to work in government-funded 'public' organisations (hospitals, community health centres, Aboriginal Community Controlled Health Services, government departments, agencies or defence forces). In particular, James Cook University medical graduates were more likely to work in Aboriginal Community Controlled Health Services and community health centres and other state-run primary health care organisations than other Australian medical graduates. CONCLUSION James Cook University medical graduates appear to work in a higher proportion of public settings; in particular, primary care settings, than Australian medical graduates. This is an appropriate mix for the predominantly rural and remote geography of Queensland and its associated medical workforce priorities. Reporting medical graduate outcomes by their nature of practice could be an important adjunct to other measures, such as geographic location and choice of specialty.
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Affiliation(s)
- Torres Woolley
- College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Tarun Sen Gupta
- College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Sarah Larkins
- College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia
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Woolley T, Halili SD, Siega-Sur JL, Cristobal FL, Reeve C, Ross SJ, Neusy AJ. Socially accountable medical education strengthens community health services. MEDICAL EDUCATION 2018; 52:391-403. [PMID: 29266421 DOI: 10.1111/medu.13489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/02/2017] [Accepted: 10/02/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT Socially accountable health professional education (SAHPE) is committed to achieving health equity through training health professionals to meet local health needs and serve disadvantaged populations. This Philippines study investigates the impact of SAHPE students and graduates on child and maternal health services and outcomes. METHODS This is a non-randomised, controlled study involving a researcher-administered survey to 827 recent mothers (≥1 child aged 0-5 years). Five communities were serviced by SAHPE medical graduates or final-year medical students (interns) in Eastern Visayas and the Zamboanga Peninsula, and five communities in the same regions were serviced by conventionally trained (non-SAHPE) graduates. FINDINGS Mothers in communities serviced by SAHPE-trained medical graduates and interns were more likely than their counterpart mothers in communities serviced by non-SAPHE trained graduates to: have lower gross family income (p < 0.001); have laboratory results of blood and urine samples taken during pregnancy discussed (p < 0.001, respectively); have first pre-natal check-up before 4th month of pregnancy (p = 0.003); receive their first postnatal check-up <7 days of birth (p < 0.001); and have a youngest child with normal (>2500 g) birthweight (p = 0.003). In addition, mothers from SAHPE-serviced communities were more likely to have a youngest child that: was still breastfed at 6 months of age (p = 0.045); received a vitamin K injection soon after birth (p = 0.026); and was fully immunised against polio (p < 0.001), hepatitis B (p < 0.001), measles (p = 0.008) and diphtheria/pertussis/tetanus (p < 0.001). In communities serviced by conventional medical graduates, mothers from lower socio-economic quartiles (<20 000 Php) were less likely (p < 0.05) than higher socio-economic mothers to: report that their youngest child's delivery was assisted by a doctor; have their weight measured during pregnancy; and receive iron syrups or tablets. CONCLUSIONS The presence of SAHPE medical graduates or interns in Philippine communities significantly strengthens many recommended core elements of child and maternal health services irrespective of existing income constraints, and is associated with positive child health outcomes.
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Affiliation(s)
- Torres Woolley
- College of Medicine & Dentistry, James Cook University, Townsville, Qld, Australia
| | - Servando D Halili
- School of Medicine, Ateneo de Zamboanga University, Zamboanga City, Mindanao, Philippines
- Zamboanga State College of Marine Sciences and Technology, Zamboanga City, Mindanao, Philippines
| | | | - Fortunato L Cristobal
- School of Medicine, Ateneo de Zamboanga University, Zamboanga City, Mindanao, Philippines
| | - Carole Reeve
- College of Medicine & Dentistry, James Cook University, Townsville, Qld, Australia
- School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Simone J Ross
- College of Medicine & Dentistry, James Cook University, Townsville, Qld, Australia
- The Training for Health Equity Network, New York City, New York, USA
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