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Soroski T, Hove K, Steblecki L, Yu JC. Evaluating the domains of generalism and equity, diversity and inclusion in preclinical simulated cases for targeted curricular improvements. MEDICAL EDUCATION ONLINE 2024; 29:2331852. [PMID: 38516698 PMCID: PMC10962297 DOI: 10.1080/10872981.2024.2331852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Simulated cases are widely used in medical education to develop clinical reasoning skills and discuss key topics around patient care. Such cases present an opportunity to demonstrate real world encounters with diverse patient and health provider identities, impacts of social and structural determinants of health, and demonstrate a generalist approach to problems. However, despite many calls-to-action for medical schools to better incorporate equity, diversity and inclusion (EDI) and generalism, it remains difficult to evaluate how well these goals are being met. METHODS A quality improvement project was completed at a single medical school to evaluate the domains of generalism and EDI within simulated cases used in the preclinical curriculum. Generalism was evaluated using the Toronto Generalism Assessment Tool (T-GAT). EDI was evaluated using a locally developed novel tool. Analysis included descriptive statistics and Pearson correlation coefficient. RESULTS A total of 49 simulated cases were reviewed. Twelve generalism and 5 EDI items were scored on a 5-point Likert scale, with higher scores indicating better demonstration of generalism or EDI within a case. Average generalism score across all cases was 45.6/60. Average EDI score across all cases was 11.7/25. Only 21/49 cases included representation of one or more diverse identity categories. The most common diverse identity represented was non-white races/ethnicities, and the identity represented the least was diversity in language fluency. Generalism and EDI scores demonstrated a weak positive correlation (R2 = 0.25). CONCLUSIONS Quantitative evaluation of simulated cases using specific generalism and EDI scoring tools was successful in generating insight into areas of improvement for teaching cases. This approach identified key content areas for case improvement and identities that are currently underrepresented in teaching cases. Similar approaches could be feasibly used by other medical schools to improve generalism and EDI in teaching cases or other curricular materials.
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Affiliation(s)
| | - Kuda Hove
- MD Program, University of Alberta, Edmonton, Canada
| | | | - Jaime C. Yu
- MD Program, University of Alberta, Edmonton, Canada
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Venturini G, Sarti C. Functional neurological disorder mimicking stroke: A case report. Clin Case Rep 2024; 12:e8992. [PMID: 38799525 PMCID: PMC11126745 DOI: 10.1002/ccr3.8992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
Even in the era of technology-guided medicine, the clinician must integrate into his daily practice a careful anamnesis and physical examination to be conducted within a close doctor-patient relationship. All these elements, together with tools such as teleconsultation and digitalized medical records, are able to significantly increase the effectiveness of health care action.
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Affiliation(s)
- G. Venturini
- Department of General MedicineAzienda USL Toscana CentroFlorenceTuscanyItaly
| | - C. Sarti
- NEUROFARBA DepartmentUniversity of FlorenceFlorence, TuscanyItaly
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Sinnott C, Alboksmaty A, Moxey JM, Morley KI, Parkinson S, Burt J, Dixon-Woods M. Operational failures in general practice: a consensus-building study on the priorities for improvement. Br J Gen Pract 2024; 74:e339-e346. [PMID: 38621805 PMCID: PMC11044020 DOI: 10.3399/bjgp.2023.0321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/19/2023] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND System problems, known as operational failures, can greatly affect the work of GPs, with negative consequences for patient and professional experience, efficiency, and effectiveness. Many operational failures are tractable to improvement, but which ones should be prioritised is less clear. AIM To build consensus among GPs and patients on the operational failures that should be prioritised to improve NHS general practice. DESIGN AND SETTING Two modified Delphi exercises were conducted online among NHS GPs and patients in several regions across England. METHOD Between February and October 2021, two modified Delphi exercises were conducted online: one with NHS GPs, and a subsequent exercise with patients. Over two rounds, GPs rated the importance of a list of operational failures (n = 45) that had been compiled using existing evidence. The resulting shortlist was presented to patients for rating over two rounds. Data were analysed using median scores and interquartile ranges. Consensus was defined as 80% of responses falling within one value below and above the median. RESULTS Sixty-two GPs responded to the first Delphi exercise, and 53.2% (n = 33) were retained through to round two. This exercise yielded consensus on 14 failures as a priority for improvement, which were presented to patients. Thirty-seven patients responded to the first patient Delphi exercise, and 89.2% (n = 33) were retained through to round two. Patients identified 13 failures as priorities. The highest scoring failures included inaccuracies in patients' medical notes, missing test results, and difficulties referring patients to other providers because of problems with referral forms. CONCLUSION This study identified the highest-priority operational failures in general practice according to GPs and patients, and indicates where improvement efforts relating to operational failures in general practice should be focused.
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Affiliation(s)
- Carol Sinnott
- The Healthcare Improvement Studies (THIS) Institute, Cambridge
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Shahaed H, Glazier RH, Anderson M, Barbazza E, Bos VLLC, Saunes IS, Auvinen J, Daneshvarfard M, Kiran T. Soins primaires pour tous: Le Canada peut s’inspirer de pays semblables ayant un niveau élevé de continuité relationnelle entre patientèle et centres de soins primaires. CMAJ 2024; 196:E359-E368. [PMID: 38499306 PMCID: PMC10948188 DOI: 10.1503/cmaj.221824-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Affiliation(s)
- Heba Shahaed
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Richard H Glazier
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Michael Anderson
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Erica Barbazza
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Véronique L L C Bos
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Ingrid S Saunes
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Juha Auvinen
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Maryam Daneshvarfard
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Tara Kiran
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande.
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Shahaed H, Glazier RH, Anderson M, Barbazza E, Bos VLLC, Saunes IS, Auvinen J, Daneshvarfard M, Kiran T. Primary care for all: lessons for Canada from peer countries with high primary care attachment. CMAJ 2023; 195:E1628-E1636. [PMID: 38049161 DOI: 10.1503/cmaj.221824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Affiliation(s)
- Heba Shahaed
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Richard H Glazier
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Michael Anderson
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Erica Barbazza
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Véronique L L C Bos
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Ingrid S Saunes
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha Auvinen
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Maryam Daneshvarfard
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tara Kiran
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland.
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Russo G, Perelman J, Zapata T, Šantrić-Milićević M. The layered crisis of the primary care medical workforce in the European region: what evidence do we need to identify causes and solutions? HUMAN RESOURCES FOR HEALTH 2023; 21:55. [PMID: 37443059 PMCID: PMC10347862 DOI: 10.1186/s12960-023-00842-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Primary care services are key to population health and for the efficient and equitable organisation of national health systems. This is why they are often financed through public funds. Primary care doctors are instrumental for the delivery of preventive services, continuity of care, and for the referral of patients through the system. These cadres are also the single largest health expenditure at the core of such services. Although recruitment and retention of primary care doctors have always been challenging, shortages are now exacerbated by higher demand for services from aging populations, increased burden of chronic diseases, backlogs from the COVID-19 pandemic, and patient expectations. At the same time, the supply of primary care physicians is constrained by rising retirement rates, internal and external migration, worsening working conditions, budget cuts, and increased burnout. Misalignment between national education sectors and labour markets is becoming apparent, compounding staff shortages and maldistribution. With their predominantly publicly funded health systems and in the aftermath of COVID-19, countries of the European region appear to be now on the cusp of a multi-layered, slow-burning primary care crisis, with almost every country reporting long waiting lists for doctor appointments, shortages of physicians, unfilled vacancies, and consequently, added pressures on hospitals' Accident and Emergency services. This articles collection aims at pulling together the evidence from countries of the European Region on root causes of such workforce crisis, impacts, and effectiveness of existing policies to mitigate it. Original research is needed, offering analysis and fresh insights into the primary care medical workforce crisis in wider Europe. Ultimately, the aim of this articles collection is to provide an evidence basis for the identification of policy solutions to present and future primary health care crises in high as well as lower-income countries.
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Affiliation(s)
- Giuliano Russo
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Julian Perelman
- Nova National School of Public Health and Comprehensive Health Research Center, Nova University of Lisbon, Lisbon, Portugal
| | - Tomas Zapata
- Division of Country Health Policies and Systems, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Milena Šantrić-Milićević
- Faculty of Medicine, School of Public Health and Health Management, Institute of Social Medicine, University of Belgrade, Belgrade, Serbia
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