Training for impact: the socio-economic impact of a fit for purpose health workforce on communities

Supporting best practice in the management of chronic diseases in primary health care settings: a scoping review of training programs for Indigenous Health Workers and Practitioners

Background To improve diabetes management in primary health care for the Aboriginal and Torres Strait Islander peoples population, training programs that are culturally and contextually relevant to the local context are required. Using a scoping review methodology, the aim of this review was to describe the characteristics of chronic disease management training programs for Aboriginal Health Workers and Practitioners, their effectiveness on knowledge and skills, and client-related outcomes, and the enablers, barriers to delivery and participation. Methods Following protocol parameters, a systematic search was conducted in relevant databases and grey literature. Two independent reviewers screened the title and abstract of each paper to determine if the study met the inclusion criteria. Results Of the 23 included studies, most were developed with stakeholders, profession facilitated and delivered by cultural facilitators. All training programs included content knowledge, two included a professional support network, four provided on-the-job support and six had follow-up support post-training. Modes of delivery ranged from didactic, storytelling and hands-on learning. Two studies reported significant improvement in participants' knowledge and confidence; one reported improvement in knowledge (12.7% increase pre-post training), and an increase in confidence in both clinical and non-clinical skills. Enablers (relevance, modes of learning, power of networking, improved knowledge, confidence and clinical practice) and barriers (adult learning capabilities, competing work-family commitments) were reported. Few studies reported on knowledge transfer into clinical practice and client-related outcomes. Conclusions Multifaceted training programs for Aboriginal health workers are well received and may improve workforce capability.

A qualitative study of social accountability translation: from mission to living it

BACKGROUND

Medical schools are increasingly adopting socially accountable mission and curricula, the realisation of which are dependent on engaging individuals to embody the mission's principles in their everyday activities as doctors. However, little is known about how graduates perceive the efforts taken by their medical school to sensitise them to social accountability values, and how they translate this into their working lives. Our aim was to explore and understand graduate perceptions of how their medical school influenced them to embody a social accountability mission in their working lives.

METHODS

This was a qualitative interview study carried out with graduates/alumni [n = 51] of Christian Medical College, Vellore [CMCV], India, a school with a long-established and explicit social-accountability mission. Data coding and analysis were initially inductive and thematic using Braun and Clarke's six step framework. MacIntyre's virtue ethics theory framed secondary analysis, allowing us to consider the relationships between individual and contextual factors.

RESULTS

Our participants perceived that CMCV invested heavily in selecting personal qualities aligned with the CMCV mission. They saw that these qualities were reinforced through various practices: [e.g., placements in resource limited and/or remote and rural settings]; community engagement and expectations [e.g., student self-governance]; role modelling [staff and more senior students]. Much emphasis was placed on sustaining these traditions and practices over time, creating a strong sense of identity and belonging among participants, traditions which were fostered further by the alumni network and continued engagement with CMCV post-graduation.

CONCLUSIONS

Ensuring social accountable medical education depends on alignment and interactions over time between context and structures, systems and human agents. Further studies are needed to extend understanding of how students from diverse contexts experience socially accountable medical education and translate their educational experience into their thinking and practice after graduation.

What are the impacts of setting up new medical schools? A narrative review

BACKGROUND

The growth of the UK's population together with an aging society with increasingly complex health and social care needs has placed a greater demand on statutory care services. In view of this emerging landscape, the UK Government has sought to increase its medically trained workforce in order to better respond to the demands placed on the health service. Five universities were announced as homes to new medical schools offering undergraduate places to boost the numbers of doctors training in England. The aim of this narrative review was to explore how new medical schools could improve the health outcomes of the local population and evaluate the potential contribution it may make to the local economy, workforce and to research and innovation.

METHODS

A narrative review was undertaken using a systematic approach for the search literature strategy. The articles were evaluated by undertaking a critical assessment evaluating the fitness of a paper for review according to results, methods used to test the hypothesis, conclusions and impact and limitations. Thematic analysis was employed to organise and summarise the findings across a heterogeneous body of literature included in the review. The analysis was developed in an inductive manner and there were not any predefined themes to guide data extraction and analysis.

RESULTS

Thirty-six articles were selected for inclusion for this narrative review. The review identified six key themes: influence of prior rural exposure, medical school environment and rural enrichment programmes, workforce, health outcomes of local populations, social accountability, economic contribution of medical schools to communities and impact on rural research.

CONCLUSIONS

The studies included found a wealth of information on a wide-range of topics on the expansion of undergraduate education and its implications on the future medical workforce. It was shown that medical schools can have a positive effect on the health, social, economic and research activity of a region, but this literature tended to be heterogeneous in focus without consideration of the inter-connections between the wider societal and economic impacts arising from long-term sustainable change being brought to a region.

Influences and outcomes of less than full-time working in the medical profession: a systematic review protocol

INTRODUCTION

An impoverished medical workforce is a global phenomenon, which can impact patient care significantly. Greater flexibility in working patterns is one approach policy-makers adopt to address this issue, and the expansion of less than full-time (LTFT) working forms part of this. Studies suggest that LTFT working has the potential to improve recruitment and retention by aligning with how doctors increasingly want to balance their careers with other commitments and interests. What is less well understood are the influencing factors and outcomes related to LTFT working among doctors. This protocol outlines the methodology for a systematic review that will evaluate existing knowledge on LTFT working in the medical profession.

METHODS AND ANALYSIS

The Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines will be followed. Embase, MEDLINE, PsycINFO, Health Management Information Consortium, Web of Science, Cochrane Library, Healthcare Administration, and Applied Social Sciences Index and Abstracts will be searched for studies published up to March 2022. Unpublished literature from EThos and ProQuest Dissertations & Theses Global will also be searched. Bibliographic searching, citation searching and handsearching will be used to retrieve additional papers. Authors will be contacted for data or publications if necessary. Two independent reviewers will undertake study screening, data extraction and quality assessment, with disagreements resolved by consensus or by a third reviewer if necessary. Data synthesis will be by narrative synthesis and meta-analysis if possible.

ETHICS AND DISSEMINATION

The proposed study does not require ethical approval; however, it forms part of a larger body of research on the impact of LTFT working on the medical workforce for which ethics approval has been granted by the Research Ethics Committee at University College London. Findings will be published in a peer-reviewed journal and will be presented at national and international conferences.

PROSPERO REGISTRATION NUMBER

CRD42022307174.

[Interprofessional health education in the Region of the Americas from a nursing perspectiveEducação interprofissional em saúde na Região das Américas na perspectiva da enfermagem]

This study presents a reflective analysis of the implementation of interprofessional education in undergraduate nursing courses, considering as an example the curricula of undergraduate nursing careers in Brazil. Despite investments to advance interprofessional education, its practice is not institutionalized in the curricula of undergraduate courses. These findings represent a limitation for the implementation of interprofessional education in nursing courses, and the case of Brazil allows to learn lessons for the education of nursing professionals in other countries of the Region of the Americas. Recommendations are provided for training, management and intersectoral articulation of health and education services, with emphasis on primary health care and the Sustainable Development Goals, aimed at educational institutions wishing to implement interprofessional education.

Global accreditation practices for accelerated medically trained clinicians: a view of five countries

BACKGROUND

Shortages and maldistribution of healthcare workers persist despite efforts to increase the number of practitioners. Evidence to support policy planning and decisions is essential. The World Health Organization has proposed National Health Workforce Accounts (NHWA) to facilitate human resource information systems for effective health workforce planning and monitoring. In this study, we report on the accreditation practices for accelerated medically trained clinicians in five countries: Ethiopia, Ghana, Kenya, Malaysia, and Mongolia.

METHOD

Using open-ended survey responses and document review, information about accreditation practices was classified using NHWA indicators. We examined practices using this framework and further examined the extent to which the indicators were appropriate for this cadre of healthcare providers. We developed a data extraction tool and noted any indicators that were difficult to interpret in the local context.

RESULTS

Accreditation practices in the five countries are generally aligned with the WHO indicators with some exceptions. All countries had standards for pre-service and in-service training. It was difficult to determine the extent to which social accountability and social determinants of health were explicitly part of accreditation practices as this cadre of practitioners evolved out of community health needs. Other areas of discrepancy were interprofessional education and continuing professional development.

DISCUSSION

While it is possible to use NHWA module 3 indicators there are disadvantages as well, at least for accelerated medically trained clinicians. There are aspects of accreditation practices that are not readily coded in the standard definitions used for the indicators. While the indicators provide detailed definitions, some invite social desirability bias and others are not as easily understood by practitioners whose roles continue to evolve and adapt to their health systems.

CONCLUSION

Regular review and revision of indicators are essential to facilitate uptake of the NHWA for planning and monitoring healthcare providers.

Structured internship in health promotion: an approach used in a middle-income developing country-Jamaica

Internship programmes have the potential to provide learning and professional experiences, build students' competency and strengthen partnerships between community and training institutions. In this paper, we examine the extent to which a structured internship at The University of the West Indies contributed to experience and competency-building, provided focus and met learners' expectations and satisfaction among a cohort of unpaid health promotion interns. The contribution of placements to the strengthening of health education and promotion competencies and interns' feelings about their experiences are included. Twenty-four (24) internship reports were reviewed using a mix of quantitative and qualitative methods. The majority of interns were Jamaicans (70.8%), 12.5% were from Dominica and the remaining 16.7% represented other nationalities. Health professionals comprised the highest percentage of cohorts (79.2%) and governmental agencies comprised the largest proportion (63%) of internship sites. Activities undertaken were in the areas of planning, implementing and evaluating programmes (71%) and conducting needs assessments (63%). Communication-related activities were reported by 43% of interns. Twenty-one per cent were engaged in lobbying and collaboration with other partners, while 23% established committees to oversee the sustainability of initiatives. While some interns reported negative experiences with supervision at their placement agencies, all valued internship seminars, which they found as a supportive environment in which they were able to share their progress with peers and academics. The opportunity for applying theory to practice and acting as resource persons were reflected as positives. The structured internship approach seems to have merits for building competence and engendering individual satisfaction.

Facilitators of the health advocacy role practice of the nurse in Ghana: A qualitative study

BACKGROUND

Identifying facilitators of health advocacy role practice of nurses is important in reducing health disparities and inequities in Ghana. The struggle to reducing these disparities and inequities needs a combination of bravery, courage, and professionalism. In many instances, many barriers hinder nurses from practicing their health advocacy role in Ghana. Facilitators that motivate nurses who would perform this health advocacy role have not been identified and adequately described in Ghana.

AIM

To explore and describe the facilitators of the health advocacy role of nurses in Ghana.

METHODS

This qualitative study used Strauss and Corbin's grounded theory approach to collect and analyze data from 2018 to 2019 in three regions in Ghana. Semistructured interviews (n = 24) and field notes were used to collect data.

RESULTS

Professional influence emerged as a core category among other three facilitators that motivate nurses to perform the health advocacy role. The other three are clientele influence, intrinsic influence, and cultural influence.

CONCLUSIONS

Facilitators to the health advocacy role practice of nurses are multidimensional and hidden. In this respect, educating hospital managers on these facilitators should be done through workshops and seminars to enhance the managers' strategies of motivating nurses to advocate for the less privileged and the disadvantaged of the society.

A Framework to Guide the Implementation of Best Practice Clinical Learning Environments in Community General Practice: Australia

Clinical education/training is increasingly being expanded to community general practice settings (primary care clinics led by doctors). This plays an important role in developing a skilled “primary-care ready” workforce. However, there is limited information to guide the implementation of high-quality learning environments suitable for the range of general practices and clinical learners they oversee. We aimed to develop a consensus-based framework to address this. A co-design participatory action research method involved working with stakeholders to agree a project plan, collect and interpret data and endorse a final framework. As a starting point, an initial draft framework was adapted from an existing framework, the Best Practice Clinical Learning Environment (BPCLE) Framework. We gathered feedback about this from a national GP Supervisor Liaison Officer Network (SLON) (experienced GP clinical supervisors) during a 90-minute face-to-face focus group. They rated their agreement with the relevance of objectives and elements, advising on clear terminology and rationale for including/excluding various components. The resulting framework was refined and re-tested with the SLON and wider GP educational stakeholders until a final graphically designed version was endorsed. The resulting “GP Clinical Learning Environment” (GPCLE) Framework is applicable for planning and benchmarking best practice learning environments in general practice.

Attending a Blended In-Service Management Training in a Public Health System: Constraints and Opportunities for Pharmacists and Health Services

Management and public health are important domains of competency for pharmacists. In about 90% of Brazilian health departments, pharmacists manage the selection and purchase of medicines. The Pharmaceutical Services and Access to Medicines Management Course (PSAMM) was offered to pharmacists working in the public health system. The aim of this study is to analyze the impacts of the course as perceived by the students (pharmacists). Two thousand five hundred pharmacists completed the course. It is a mixed-methods study, including subscribing forms (n = 2500), evaluation questionnaire (n = 1500), focus groups (n = 10), and semi-structured interviews (n = 31). Participants reported a high level of satisfaction with the course; they considered to have developed competencies related to leadership and management, competencies needed to enhance and sustain their practices in health services. Data analyses showed important barriers to complete the course: high course workload, poor quality of Internet access, lack of support from the health services. Participants highlighted crucial features of the course that helped them develop key competencies: practical in-service activities, useful and realistic contents, tutoring. These features helped participants overcome some important constraints described by them. The educational model described in this study was perceived as having a long-term impact on their behaviors and management practices in health services.

Accountability in medical education from theory to practice Tabriz 2018 statement: A step towards the implementation of this social necessity

Background: To implement the education reform package on accountability in medical education, the Education Development Center (EDC) of Tabriz University of Medical Sciences has held the first national conference on accountability in medical education, and the present statement is the result of scientific interactions and exchanges in the conference.

Methods: For implementation of the accountability in medical education, there was a need to inform faculty members and other stakeholders about their responsibility in education and health care needs. The provision of such platform was provided by holding a specialized conference on accountability in medical education by Tabriz University of Medical Sciences. Steps of preparing the draft version of the Tabriz 2018 Statement were as follow: Formation the scientific committee; Division of the responsibility for drafting the statement between various workgroups; and Preparation and primary approval of the draft of Tabriz 2018 Statement.

Results: Steps of preparing the draft version of the Tabriz 2018 Statement were: Formation of the scientific committee, Division of the responsibility for drafting the statement between the various workgroups and Preparation and primary approval of the draft of Tabriz 2018 Statement.

Conclusion: Establishing an educational accreditation model and reviewing accreditation standards based on social accountability can be an effective step to strengthen accountability towards community needs.

How does GP training impact rural and remote underserved communities? Exploring community and professional perceptions

Background

Substantial government funding has been invested to support the training of General Practitioners (GPs) in Australia to serve rural communities. However, there is little data on the impact of this expanded training on smaller communities, particularly for smaller rural and more remote communities. Improved understanding of the impact of training on underserved communities will assist in addressing this gap and inform ongoing investment by governments and communities.

Method

A purposive sample of GP supervisors, GP registrars, practice managers and health services staff, and community members (n = 40) from previously identified areas of workforce need in rural and remote North-West Queensland were recruited for this qualitative study. Participants had lived in their communities for periods ranging from a few months to 63 years (Median = 12 years). Semi-structured interviews and a focus group were conducted to explore how establishing GP training placements impacts underserved communities from a health workforce, health outcomes, economic and social perspective. The data were then analysed using thematic analysis.

Results

Participants reported they perceived GP training to improve communities’ health services and health status (accessibility, continuity of care, GP workforce, health status, quality of health care and sustainable health care), some social factors (community connectedness and relationships), cultural factors (values and identity), financial factors (economy and employment) and education (rural pathway). Further, benefits to the registrars (breadth of training, community-specific knowledge, quality of training, and relationships with the community) were reported that also contributed to community development.

Conclusion

GP training and supervision is possible in smaller and more remote underserved communities and is perceived positively. Training GP registrars in smaller, more remote communities, matches their training more closely with the comprehensive primary care services needed by these communities.

Analysis of a Blended, In-Service, Continuing Education Course in a Public Health System: Lessons for Education Providers and Healthcare Managers

Introduction: To train pharmacists working in the public health system, the Brazilian Ministry of Health developed a specialization course called Pharmaceutical Service and Access to Medicine Management (PSAMM) between 2010 and 2016. The course was free of charge and used e-learning as its main approach. In the end, 2,500 pharmacists were trained. The purpose of this study was to identify and analyze the strengths, weaknesses, opportunities, and threats of an in-service and e-learning course for pharmacists working in a public health system.

Materials and Methods: Three workshops involving 67 participants were conducted at the conclusion of the course to analyze the perspective of the PSAMM course's faculty (tutors, regional coordinators, professors, and management committee) and students (pharmacists). Strengths, weaknesses, opportunities, and threats analysis and qualitative analysis methods were used.

Results and Discussion: The strength dimension had the greatest number of items. The qualitative analysis resulted in six categories: the category “E-learning in continuing education” had the most cited items. Internal elements such as in-service hands-on activities directly related to the professionals' roles, course contents, faculty, and the methods to offer the course (the mixed methods and materials) were positively assessed. Nonetheless, external elements were considered critical for the course's outcomes such as investments in the infrastructure of pharmaceutical services, access to the internet, local managers' support for continuing education and innovation implementation, practice of interprofessional collaboration, and political stability. The continuing education course in the public health system was affected by internal elements such as its project and structure as well as external elements such as the sociopolitical scenario. Continuing education investment must be accompanied by infrastructure investment and coordination of services.

Future medical student practice intentions: the South Africa experience

BACKGROUND

Primary care is a broad spectrum specialty that can serve both urban and rural populations. It is important to examine the specialties students are selecting to enter, future community size they intend to practice in as well as whether they intend to remain in the communities in which they trained.

AIM

The goals of this study were to characterize the background and career aspirations of medical students. Objectives were to (1) explore whether there are points in time during training that may affect career goals and (2) assess how students' background and stated motivations for choosing medicine as a career related to intended professional practice.

SETTING

The setting for this study was the Nelson R. Mandela School of Medicine, located in Durban, South Africa.

METHODS

We conducted a cross-sectional survey of 597 NRMSM medical students in their first, fourth, or sixth-year studies during the 2017 academic year.

RESULTS

Our findings show a noticeable lack of interest in primary care, and in particular, family medicine amongst graduating students. Altruism is not as motivating a factor for practicing medicine as it was among students beginning their education.

CONCLUSION

Selection of students into medical school should consider personal characteristics such as background and career motivation. Once students are selected, local context matters for training to sustain motivation. Selection of students most likely to practice primary care, then emphasizing family medicine and community immersion with underserved populations, can assist in building health workforce capacity. There are institutional, legislative, and market pressures influencing career choice either toward or away from primary care. In this paper, we will discuss only the institutional aspects.

"Get us partnerships!" - a qualitative study of Angolan and Mozambican health academics' experiences with North/South partnerships

BACKGROUND

Sustainable Development Goal (SDG) 17 focuses on North/South partnerships for sustainable development. Literature on research partnerships and capacity -building often neglects how these processes are carried out in practice, their social impacts and participants' subjective experiences. Recognizing the increasingly global dimensions of Higher Education Institutions, the University Development and Innovation - Africa project (UDI-A) was designed to train lecturers and administrative staff of Angolan and Mozambican Universities through collaborations with European institutions, aiming at strengthening African academic and social landscapes through knowledge translation and dissemination. This paper examines potential outcomes of UDI-A on participants' academic pathways, investigating the conflict between different imaginaries of capacity-building and partnerships, focusing on how Angolan and Mozambican health sciences researchers experience international collaborations.

METHODS

Semi-structured interviews were conducted with seven health academics, as well as a focus group discussion involving all participants. These were recorded, fully transcribed, anonymized and coded to identify common themes. A consent form was signed by all participants.

RESULTS AND DISCUSSION

UDI-A was considered innovative, fostering the improvement of pedagogical skills and increasing social entrepreneurship activities. Participants arrived with a specific institutional mandate and believed that the training received should be incorporated into institutional practices to "modernize" these specific Portuguese speaking African Universities and the health sector. The institutional mechanisms put in place to attain this goal, Centres for Academic Development and Innovation ("CADIs"), were considered potential research and development hubs and drivers of academic and societal transformation. Nevertheless, participants shared a sense of asymmetry (infrastructural, financial, in terms of access to information) between them and European trainers. Although this asymmetry was the underlying basis of this capacity-building project, they argued that UDI-A did not fully acknowledge their local contexts, compromising the prospective development of partnerships in the health field.

CONCLUSIONS

More attention should be devoted to understanding how participants experience capacity building processes, integrating the diversity of their aspirations and perceptions into subsequent phases of the project, requiring the development of methodological innovations to increase the impact of these programs.

Conceptualising social accountability as an attribute of medical education

Background

Health professionals need to be both person- and community oriented to improve population health. For educators to create socially accountable physicians, they must move learners from understanding social accountability as an expectation to embracing and incorporating it as an aspect of professional identity that informs medical practice.

Aim

The aim of this article was to assess the degree to which medical students, preceptors and community mentors understand the concept of social accountability.

Setting

The setting is the KwaZulu-Natal Province in Durban, South Africa.

Methods

Using an observational design, we surveyed 332 participants, including the first- and sixth-year medical students, physician preceptors and community mentors.

Results

Whilst most respondents understood social accountability as requiring an action or set of actions, it was defined by some as simply the awareness one must have about the needs of their patients, community or society at large. Some respondents defined social accountability as multi-dimensional, but these definitions were the exception, not the rule. Finally, most respondents did not identify to whom the accountable party should answer.

Conclusion

Whilst the development of professional identity is seen as a process of ‘becoming’, the ability to define and understand what it means to be socially accountable is not a linear process. Assessment of this progress may start with comprehending how social accountability is understood by students when they begin their education and when they are graduating, as well as in knowing how their educators, both clinical and community, define it.

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

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.

Health workforce planning in Namibia: assessing a pilot workforce survey of pharmacists

Background

Southern Africa lacks resources necessary to combat presenting health challenges. This crisis will likely be remedied through the in-country training of healthcare professionals, for example, in Namibia. Monitoring the workforce will be essential to inform planning in health services and training. A national pilot workforce survey in Namibia using a multi-modal sampling approach aimed to test methodology for describing the pharmacy workforce and quantifying preferences towards further training.

Methods

The survey tool included questions relating to socio-demographics, professional and practice aspects. A conjoint analysis approach was utilised to quantify preferences around study programme, modality of study and cost.

Key findings

Respondents (N = 135; ~20% response) represented a diverse range of individuals in various pharmacy sectors in Namibia. The majority of respondents reported female gender, private sector working, studying outside Namibia and societal group membership. Societal membership and pharmacy ownership – indicators of professional engagement – were associated with higher age; ownership was also associated with study outside Namibia and practice in community pharmacy. Regarding further study preferences, respondents placed more importance on study programme and modality over cost with the most preferred scenario being a 2-year full-time Masters programme in pharmaceutical industry/regulation by distance learning at the highest cost bracket.

Conclusions

This national survey sampled the population of pharmacists in Namibia exploring the composition of the profession and preferences towards training. Further work will validate the findings and provide ongoing monitoring of the pharmacy workforce that can be expanded to other professional groups over a larger geographical area.

The value of interprofessional education in identifying unaddressed primary health-care challenges in a community: a case study from South Africa

Many countries rely on community health workers (CHWs) at a primary health care (PHC) level to connect individuals with needs to health professionals at health-care facilities, especially in resource-limited environments. The majority of health professionals are centrally based in facilities with little to no interaction with communities or CHWs. Stellenbosch University (South Africa), included interprofessional home visits in collaboration with CHWs as part of students' contextual PHC exposure in a rural community to identify factors impacting on the health of patients and their families. The aim of this study was to determine the impact of this interprofessional student service-learning initiative on identifying and addressing health-care challenges of households known to CHWs. Active physical, social and attitudinal factors were identified and recorded using a standardized paper case report form. Data were anonymized, captured and categorized for analysis. The frequency and proportion of each type of active problem and referral were calculated. The collaborative team identified many unaddressed health and social issues during their visits. Their exposure to communities at a PHC level offered benefits of experiential learning and provided insight into community needs, as well as offering services to enhance the current health-care system.

Two decades of building capacity in rural health education, training and research in Australia: University Departments of Rural Health and Rural Clinical Schools

This review article reports on the contribution of university Departments of Rural Health and Rural Clinical Schools to the development of rural health and the rural health workforce and is set at the Australian Government's university Departments of Rural Health and Rural Clinical Training and Support Programs. The main outcome measures include educational infrastructure, clinical academic workforce, student numbers, community engagement, research outputs, rural health and workforce outcomes. As a result, university Departments of Rural Health and Rural Clinical Schools have established a substantial geographical footprint covering most of the rural and remote populations and regions across Australia. They have a large distributed rural clinical academic workforce that exceeds 1300. Medical student numbers on long-term placements have increased threefold from inception to 1200 annually. Allied health and nursing numbers doubled over 10 years to 4000 in 2013 and are projected to double again by 2018. In 2013, they published 363 peer-reviewed papers - half of which specifically addressed rural and/or remote health issues. High levels of intention to practise rurally and uptake of rural and remote practice following exposure to rural training have been reported, especially for medicine. Thus, university Departments of Rural Health and Rural Clinical Schools constitute a national network of academic units that deliver academically enriched clinical education and training for medical, nursing and allied health students and fulfil an essential academic role for the health system in rural and remote Australia. Community engagement and accountability to region are hallmarks of the program. Early evidence of the uptake of rural and remote practice following exposure to rural training has set expectations for the Rural Health Multidisciplinary Training Program.

Practice intentions at entry to and exit from medical schools aspiring to social accountability: findings from the Training for Health Equity Network Graduate Outcome Study

BACKGROUND

Understanding the impact of selection and medical education on practice intentions and eventual practice is an essential component of training a fit-for-purpose health workforce distributed according to population need. Existing evidence comes largely from high-income settings and neglects contextual factors. This paper describes the practice intentions of entry and exit cohorts of medical students across low and high income settings and the correlation of student characteristics with these intentions.

METHODS

The Training for Health Equity Network (THEnet) Graduate Outcome Study (GOS) is an international prospective cohort study tracking learners throughout training and ten years into practice as part of the longitudinal impact assessment described in THEnet's Evaluation Framework. THEnet is an international community of practice of twelve medical schools with a social accountability mandate. Data presented here include cross-sectional entry and exit data obtained from different cohorts of medical students involving eight medical schools in six countries and five continents. Binary logistic regression was used to create adjusted odds ratios for associations with practice intent.

RESULTS

Findings from 3346 learners from eight THEnet medical schools in 6 countries collected between 2012 and 2016 are presented. A high proportion of study respondents at these schools come from rural and disadvantaged backgrounds and these respondents are more likely than others to express an intention to work in underserved locations after graduation at both entry and exit from medical school. After adjusting for confounding factors, rural and low income background and regional location of medical school were the most important predictors of intent to practice in a rural location. For schools in the Philippines and Africa, intention to emigrate was more likely for respondents from high income and urban backgrounds.

CONCLUSIONS

These findings, from a diverse range of schools with social accountability mandates in different settings, provide preliminary evidence for the selection and training of a medical workforce motivated to meet the needs of underserved populations. These respondents are being followed longitudinally to determine the degree to which these intentions translate into actual practice.

Translating medical school social missions to student experiences

CONTEXT

There is a growing focus on the social missions of medical schools as a way of expressing an institutional commitment to service, responsibility and accountability. However, there has been little exploration of how a social mission translates to student experiences.

METHODS

This multicentre study explored how the social missions of eight medical schools (from Australia, Belgium, Canada, the Philippines, South Africa, Sudan and the USA) translated to their medical education programmes, and how their students perceived the mission. The study used a nested case study design involving interviews with final-year medical students. Constructivist grounded theory techniques were used to analyse the data. Cultural-historical activity theory concepts of externalisation and internalisation were used to structure the analyses.

RESULTS

The study identified substantial variation in the form, focus and depth of expression of each school's social mission, significant variation in how and to what extent the mission was externalised in the design of each school's undergraduate medical education programme, and significant variation in how students perceived the social mission and its translation to their training experiences. The translation of a social mission to educational outcomes depended on a cascade of externalisation and internalisation processes, each of which could alter or reinterpret the mission. Translation depended to a great extent on sensitising learners to the mission's values and issues and subsequently activating this knowledge in the context of direct clinical encounters that embodied the issues the mission was seeking to address.

CONCLUSION

Whether a medical school's social mission is focused on equity of access to the medical profession or on its graduates serving particular community needs, the mission principles need to be translated into practice. This translation process involves a series of externalisation and internalisation steps, each of which determines how much and what aspects of the mission are translated.

The long-term impact of undergraduate interprofessional education on graduate interprofessional practice: A scoping review

Several recent high-quality systematic reviews have identified the importance of measuring outcomes in evaluating the effectiveness of interprofessional education (IPE) in healthcare, but also the process- and context-dependent nature of these outcomes. This paper presents a scoping review, the objectives of which were to evaluate the evidence for the long-term impact of undergraduate IPE on graduate interprofessional practice (IPP) and to identify areas for further research in the specific context of practice-based IPE. An initial search identified 596 potentially relevant titles published between 2008 and 2016. Screening for inclusion of documented IPE with IPP evaluation reduced this to 130. Abstract reading excluded 99 studies that were not longitudinal. Full reading of the remaining 31 articles identified 23 original studies which were analysed descriptively and tabulated. The main findings were synthesised around three themes: undergraduate evidence for a long-term impact of IPE on IPP; graduate evidence for a long-term impact of IPE on IPP; and barriers to an impact of IPE on graduate IPP. Drawing on these findings, research areas likely to produce further evidence for the impact of practice-based IPE on graduate IPP are discussed, along with some suitable methodologies.

Examining the implementation of collaborative competencies in a critical care setting: Key challenges for enacting competency-based education

Interprofessional collaboration is recognised as an important factor in improving patient care in intensive care units (ICUs). Competency frameworks, and more specifically interprofessional competency frameworks, are a key strategy being used to support the development of attitudes, knowledge, skills, and behaviours needed for an interprofessional approach to care. However, evidence for the application of competencies is limited. This study aimed to extend our empirically based understanding of the significance of interprofessional competencies to actual clinical practice in an ICU. An ethnographic approach was employed to obtain an in-depth insight into healthcare providers' perspectives, behaviours, and interactions of interprofessional collaboration in a medical surgical ICU in a community teaching hospital in Canada. Approximately 160 hours of observations were undertaken and 24 semi-structured interviews with healthcare workers were conducted over a period of 6 months. Data were analysed using a directed content approach where two national competency frameworks were used to help generate an understanding of the practice of interprofessional collaboration. Healthcare professionals demonstrated numerous instances of interprofessional communication, role understandings, and teamwork in the ICU setting, which supported a number of key collaborative competencies. However, organisational factors such as pressures for discharge and patient flow, staffing, and lack of prioritisation for interprofessional learning undermined competencies designed to improve collaboration and teamwork. The findings demonstrate that interprofessional competencies can play an important role in promoting knowledge, attitudes, skills, and behaviours needed. However, competencies that promote interprofessional collaboration are dependent on a range of contextual factors that enable (or impede) individuals to actually enact these competencies.

Promoting Regulatory Reform: The African Health Profession Regulatory Collaborative (ARC) for Nursing and Midwifery Year 4 Evaluation

As countries across sub-Saharan Africa work towards universal health coverage and HIV epidemic control, investments seek to bolster the quality and relevance of the health workforce. The African Health Profession Regulatory Collaborative (ARC) partnered with 17 countries across East, Central, and Southern Africa to ensure nurses and midwives were authorized and equipped to provide essential HIV services to pregnant women and children with HIV. Through ARC, nursing leadership teams representing each country identify a priority regulatory function and develop a proposal to strengthen that regulation over a 1-year period. Each year culminates with a summative congress meeting, involving all ARC countries, where teams present their projects and share lessons learned with their colleagues. During a recent ARC Summative Congress, a group survey was administered to 11 country teams that received ARC Year 4 grants to measure advancements in regulatory function using the five-stage Regulatory Function Framework, and a group questionnaire was administered to 16 country teams to measure improvements in national nursing capacity (February 2011-2016). In ARC Year 4, eight countries implemented continuing professional development projects, Botswana revised their scope of practice, Mozambique piloted a licensing examination to assess HIV-related competencies, and South Africa developed accreditation standards for HIV/tuberculosis specialty nurses. Countries reported improvements in national nursing leaders' teamwork, collaborations with national organizations, regional networking with nursing leaders, and the ability to garner additional resources. ARC provides an effective, collaborative model to rapidly strengthen national regulatory frameworks, which other health professional cadres or regions may consider using to ensure a relevant health workforce, authorized and equipped to meet the emerging demand for health services.

Professional groups driving change toward patient-centred care: interprofessional working in stroke rehabilitation in Denmark

BACKGROUND

Patient-centred care based on needs has been gaining momentum in health policy and the workforce. This creates new demand for interprofessional teams and redefining roles and tasks of professionals, yet little is known on how to implement new health policies more effectively. Our aim was to analyse the role and capacity of health professions in driving organisational change in interprofessional working and patient-centred care.

METHODS

A case study of the introduction of interprofessional, early discharge teams in stroke rehabilitation in Denmark was conducted with focus on day-to-day coordination of care tasks and the professional groups' interests and strategies. The study included 5 stroke teams and 17 interviews with different health professionals conducted in 2015.

RESULTS

Professional groups expressed highly positive professional interest in reorganised stroke rehabilitation concerning patients, professional practice and intersectoral relations; individual professional and collective interprofessional interests strongly coincided. The corresponding strategies were driven by a shared goal of providing needs-based care for patients. Individual professionals worked independently and on behalf of the team. There was also a degree of skills transfer as individual team members screened patients on behalf of other professional groups.

CONCLUSIONS

The study identified supportive factors and contexts of patient-centred care. This highlights capacity to improve health workforce governance through professional participation, which should be explored more systematically in a wider range of healthcare services.