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Bryce M, Hanks S, Burns L, Zahra D, Gale T. Mutual recognition of qualifications, health workforce migration, and graduate outcomes: a comparative mapping study of undergraduate dental education in Europe. HUMAN RESOURCES FOR HEALTH 2024; 22:37. [PMID: 38835022 DOI: 10.1186/s12960-024-00918-9] [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: 04/05/2023] [Accepted: 05/16/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND The resource needs of health services are served by the recognition of qualifications across borders which allows professionals to migrate between countries. The movement of dentists across the European Union (EU), especially into the United Kingdom (UK), has provided a valuable boost to workforce supply. Recent changes to policy recognising overseas qualifications have brought attention to the equivalence of qualifications awarded in EU countries. Professional regulators need to be confident that dentists who qualified elsewhere have the appropriate knowledge, skills and experience to practise safely and effectively. The aim of this study was to compare UK and EU dental curricula, identify any differences, and compare the extent of pre-qualification clinical experience. METHODS This was a mixed methods study comprising a questionnaire and website searches to identify information about curricula, competences, and quality assurance arrangements in each country. The questionnaire was sent to organisations responsible for regulating dental education or dental practice in EU member states. This was supplemented with information obtained from website searches of stakeholder organisations for each country including regulators, professional associations, ministries, and providers of dental education. A map of dental training across the EU was created. RESULTS National learning outcomes for dental education were identified for seven countries. No national outcomes were identified 13 countries; therefore, learning outcomes were mapped at institution level only. No information about learning outcomes was available for six countries. In one country, there is no basic dental training. Clinical skills and communication were generally well represented. Management and leadership were less represented. Only eight countries referenced a need for graduates to be aware of their own limitations. In most countries, quality assurance of dental education is not undertaken by dental organisations, but by national quality assurance agencies for higher education. In many cases, it was not possible to ascertain the extent of graduates' direct clinical experience with patients. CONCLUSIONS The findings demonstrate considerable variation in learning outcomes for dental education between countries and institutions in Europe. This presents a challenge to decision-makers responsible for national recognition and accreditation of diverse qualifications across Europe to maintain a safe, capable, international workforce; but one that this comparison of programmes helps to address.
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Affiliation(s)
- Marie Bryce
- Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom
- Peninsula Dental School, University of Plymouth, Plymouth, United Kingdom
| | - Sally Hanks
- Peninsula Dental School, University of Plymouth, Plymouth, United Kingdom
| | - Lorna Burns
- Peninsula Dental School, University of Plymouth, Plymouth, United Kingdom.
| | - Daniel Zahra
- Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom
| | - Thomas Gale
- Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom
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Rajpoot A, Merriman C, Rafferty AM, Henshall C. Transitioning experiences of internationally educated nurses in host countries: A narrative systematic review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 6:100195. [PMID: 38832236 PMCID: PMC11145537 DOI: 10.1016/j.ijnsa.2024.100195] [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: 12/05/2023] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 06/05/2024] Open
Abstract
Background The shortage of nurses worldwide is a well-known issue that has changed the health and social workforce picture. Increased recruitment and migration of internationally educated nurses in the health and social care workforce pose many risks to successful integration into the healthcare system. Understanding the barriers and enablers affecting their integration in their host countries is imperative. Objective To critically and systematically review the current literature to explore the transitioning experiences of internationally educated nurses to understand the enabling influences affecting their workforce integration into their host countries. Design A narrative systematic literature review was conducted. This study was registered in the International Prospective Register of Systematic Reviews (Registered Number: CRD42023401090). The study results were reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Methods A comprehensive literature search using the search engines CINAHL, MEDLINE, PsycINFO, Academic Search, and PubMed was conducted. Only peer-reviewed papers written in the English language were included. Primary research studies published between 2019 and 2023, which explored the lived experiences of internationally educated nurses, were considered for review. Results Seventeen studies (16 qualitative and one quantitative) were included in the review. Three main themes were developed: (1) push and pull factors that mediated internationally educated nurses' migration experiences, (2) one-way integration logic, and (3) expectations versus reality. Conclusions There is a need for a comprehensive and collaborative organisational approach to enhance the integration experiences of internationally educated nurses into their host countries. This can also ensure their contribution is recognised and will help them fulfil the responsibilities of their role and become influential team members within their organisations. This comprehensive and collaborative approach is also required to tackle discrimination, racism, communication and language barriers. Addressing these challenges can improve internationally educated nurses' job satisfaction and, thereby, improve retention. Tweetable abstract A new systematic review study explores barriers and enablers for optimising internationally educated nurses' experiences of working in their host country @cathy_Henshall @clairmerriman9 @annemarieraffer.
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Affiliation(s)
- Aasia Rajpoot
- Oxford Brookes University, Jack Straw's Ln, Marston, Oxford OX3 0FL, UK
| | - Clair Merriman
- Nursing, Midwifery, and AHP Clinical Research Oxford Institute of Applied Health Research (OxInAHR), Oxford Brookes University, UK
| | - Anne-Marie Rafferty
- Nursing, Midwifery, and AHP Clinical Research Oxford Institute of Applied Health Research (OxInAHR), Oxford Brookes University, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57, Waterloo Rd, London SE1 8WA, UK
| | - Catherine Henshall
- Nursing Oxford Institute of Applied Health Research (OxInAHR), Oxford Brookes University, UK
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Davda LS, Radford DR, Scambler S, Gallagher JE. A typology of internationally qualified dentists in the United Kingdom. J Migr Health 2024; 9:100232. [PMID: 38826513 PMCID: PMC11141152 DOI: 10.1016/j.jmh.2024.100232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 08/11/2023] [Accepted: 05/05/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction The Global Strategy for Human Resources for Health 2030, requires member states to half their dependency on an international workforce by 2030. In order to design policies towards that goal, country-specific research on migration motivations of the health workforce is required. The United Kingdom (UK) is a net importer of health professionals and whilst there is a body of research on doctors' and nurses' migration, there is no research on the migration motivations of migrant dentists in the UK. This research explored the migration motivations of internationally qualified dentists (IQDs) in the UK and presents a typology to understand the global migration of dentists in the context of oral health workforce. Methods The paper presents qualitative data from semi-structured interviews conducted between August 2014 and October 2017, of IQDs working in the United Kingdom. The topic guide for interviews was informed by the literature, with new themes added inductively. A phenomenological approach involving an epistemological stance of interpretivism, was used with framework analysis. Results A total of 38 internationally qualified dentists (M = 18, F = 20), migrating from the five World Health Organization regions, and working in general practice, NHS hospitals and in community dental services across the four nations of the UK were interviewed. Seven types of internationally qualified dentists were identified working in the UK. They were livelihood migrants, career-orientated migrants, dependant migrants, backpacker migrants, commuter migrants, undocumented migrants, and education-tourist migrant. The categories were based on their migration motivations, which were complex, multifactorial, and included personal, professional, national, and international drivers. The typology, based on their migration motivations, offered a structured, comprehensive understanding of the migrant dental workforce. This typology involving dentists provides additional dimensions to commuter and undocumented migrants described in the context of other health professionals. The education-tourist migrant is a new category proposed as an extension to existing typology in health professional migration. Conclusions The typology of internationally qualified dentists has congruency with other health professionals' typology in categories previously described and demonstrates that each of these categories are complex, fluid and change in response to policy changes. The new category of education-tourist migrant along with oral health dimensions of commuter and undocumented migrants adds to the existing typology in health professional migration.
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Affiliation(s)
- Latha S Davda
- Ministry of Defence, Bulford SP4 9AD, UK
- University of Portsmouth Dental Academy, Portsmouth, PO1 2QG, UK
| | - David R Radford
- University of Portsmouth Dental Academy, Portsmouth, PO1 2QG, UK
- King's College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, Denmark Hill Campus, London SE5 9RS, UK
| | - Sasha Scambler
- King's College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, Denmark Hill Campus, London SE5 9RS, UK
| | - Jennifer E Gallagher
- King's College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, Denmark Hill Campus, London SE5 9RS, UK
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Ung DSK, Goh YS, Poon RYS, Lin YP, Seah B, Lopez V, Mikkonen K, Yong KK, Liaw SY. Global migration and factors influencing retention of Asian internationally educated nurses: a systematic review. HUMAN RESOURCES FOR HEALTH 2024; 22:17. [PMID: 38429767 PMCID: PMC10905872 DOI: 10.1186/s12960-024-00900-5] [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: 06/23/2023] [Accepted: 02/14/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Given nurses' increasing international mobility, Asian internationally educated nurses (IENs) represent a critical human resource highly sought after within the global healthcare workforce. Developed countries have grown excessively reliant on them, leading to heightened competition among these countries. Hence, this review aims to uncover factors underlying the retention of Asian IENs in host countries to facilitate the development of more effective staff retention strategies. METHODS A mixed-methods systematic review was conducted using the Joanna Briggs Institute methodology for mixed-method systematic review. A search was undertaken across the following electronic databases for studies published in English during 2013-2022: CINAHL, Embase, PubMed, Scopus, Web of Science and PsycINFO. Two of the researchers critically appraised included articles independently using the Joanna Briggs Critical Appraisal Tools and Mixed Methods Appraisal Tool (version 2018). A data-based convergent integrated approach was adopted for data synthesis. RESULTS Of the 27 included articles (19 qualitative and eight quantitative), five each were conducted in Asia (Japan, Taiwan, Singapore and Malaysia), Australia and Europe (Italy, Norway and the United Kingdom); four each in the United States and the Middle East (Saudi Arabia and Kuwait); two in Canada; and one each in New Zealand and South Africa. Five themes emerged from the data synthesis: (1) desire for better career prospects, (2) occupational downward mobility, (3) inequality in career advancement, (4) acculturation and (5) support system. CONCLUSION This systematic review investigated the factors influencing AMN retention and identified several promising retention strategies: granting them permanent residency, ensuring transparency in credentialing assessment, providing equal opportunities for career advancement, instituting induction programmes for newly employed Asian IENs, enabling families to be with them and building workplace social support. Retention strategies that embrace the Asian IENs' perspectives and experiences are envisioned to ensure a sustainable nursing workforce.
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Affiliation(s)
- Danny Shin Kai Ung
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yong Shian Goh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | | | | | - Betsy Seah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Violeta Lopez
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Australia
| | - Kristina Mikkonen
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Keng Kwang Yong
- National Healthcare Group, Ministry of Health, Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Davis D, Sharma S, Taylor M. Language tests and tests of competence for registration purposes - a scoping review of the experiences of overseas nurses. Contemp Nurse 2024:1-13. [PMID: 38421736 DOI: 10.1080/10376178.2024.2318360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The overseas applicant's capability of practising safely and effectively is proven through the tests of competence which consist of computer-based tests and the Objective Structured Clinical Examination (OSCE). All prospective applicants to the Nursing and Midwiferey Council (NMC) register must be able to demonstrate that their skills, knowledge and behaviours are at the level required to meet the NMC preregistration nursing or midwifery standards for the United Kingdom (UK). AIM The aim of this review is to explore the challenges faced whilst undertaking these tests of competence, the OSCE, by overseas educated nurses who aspire for Nursing and Midwifery Council (NMC) registration in the UK. METHODS A scoping review using the Arksey and O'Malley (2005) framework was conducted to explore and produce a profile of the existing literature on the registration requirements of the NMC. A search of CINAHL, Medline and Scopus resulted in 150 records, which were then screened against the inclusion criteria - English Language, publication between 2015 onwards and discussed the language tests/competency tests required for gaining entry to the NMC register. A total of nine articles met the criteria and are included in this scoping review. The PRISMA-ScR framework is used to present the review. RESULTS There was a paucity of studies that addressed the experience of overseas nurses who faced the OSCE. An interpretative stance was adopted to formulate the themes which were: competence/practice disparity, arbitrary issues for failing, failure to capture the digital health agenda, financial implications, and consequences of failing the OSCE. The results raise concern whether the nurses from overseas are held to higher standards than those trained in the UK and whether the assessment process is realistic and not pedantic. CONCLUSIONS This scoping review demonstrates there is a lack of robust research evaluating the effectiveness of tests of competencies. The review indicates there is no due acknowledgement of the previous skills and knowledge of the overseas nurses. Future research should focus on exploring the feasibility of tests of competence and its role in the integration of the nursing workforce.
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Affiliation(s)
- Dilla Davis
- Department of Adult Nursing Faculty of Nursing, Midwifery & Palliative Care, Kings College, London, UK
| | - Shelly Sharma
- Health and Society, University of Salford, Manchester, UK
| | - Maria Taylor
- Health and Society, University of Salford, Manchester, UK
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Calderón-Larrañaga S, González-De-La-Fuente Á, Espinosa-González AB, Casado-Vicente V, Brito-Fernandes Ó, Klazinga N, Kringos D. What can we learn from general practitioners who left Spain? A mixed methods international study. HUMAN RESOURCES FOR HEALTH 2024; 22:9. [PMID: 38263243 PMCID: PMC10804741 DOI: 10.1186/s12960-023-00888-4] [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: 07/20/2023] [Accepted: 12/29/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND International mobility of health workforce affects the performance of health systems and has major relevance in human resources for health policy and planning. To date, there has been little research exploring the reasons why general practitioners (GPs) migrate. This mixed methods study aimed to investigate the reasons why Spain-trained GPs migrate and develop GP retention and recruitment health policy recommendations relevant to Spanish primary care. METHODS The study followed an explanatory sequential mixed methods study design combining surveys with semi-structured interviews and focus groups with GPs who qualified in Spain and were living overseas at the time of the study. The survey data examined the reasons why GPs left Spain and their intention to return and were analysed using quantitative methods. The transcripts from interviews and focus groups centred on GPs' insights to enhance retention and recruitment in Spain and were analysed thematically. RESULTS The survey had 158 respondents with an estimated 25.4% response rate. Insufficient salary (75.3%), job insecurity and temporality (67.7%), excessive workload (67.7%), poor primary care governance (55.7%), lack of flexibility in the workplace (43.7%) and personal circumstances (43.7%) were the main reasons for leaving Spain. Almost half of the respondents (48.7%) would consider returning to Spanish general practice if their working conditions improved. Interviews and focus groups with respondents (n = 24) pointed towards the need to improve the quality of employment contracts, working conditions, opportunities for professional development, and governance in primary care for effective retention and recruitment. CONCLUSION Efforts to improve GP retention and recruitment in Spain should focus on salary, job security, flexibility, protected workload, professional development, and governance. We draw ten GP retention and recruitment recommendations expected to inform urgent policy action to tackle existing and predicted GP shortages in Spanish primary care.
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Affiliation(s)
- Sara Calderón-Larrañaga
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
- XX Place Health Centre, Bromley By Bow Health Partnership, London, United Kingdom.
| | - Ángel González-De-La-Fuente
- Global Business School for Health, University College London, London, United Kingdom
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ana Belén Espinosa-González
- School of Public Health, Imperial College of London, London, United Kingdom
- Canberra Old Oak Surgery, London, United Kingdom
| | - Verónica Casado-Vicente
- Parquesol Health Centre, SACYL, Valladolid, Spain
- General Practice Teaching Unit, University of Valladolid, Valladolid, Spain
| | - Óscar Brito-Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Flood M, Strawbridge JD, Barlow JW. The experiences of migrant pharmacists: A phenomenographical study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100367. [PMID: 38045650 PMCID: PMC10692705 DOI: 10.1016/j.rcsop.2023.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/16/2023] [Accepted: 11/09/2023] [Indexed: 12/05/2023] Open
Abstract
Objectives To understand the experiences of migrant pharmacists in Ireland as they applied for recognition of their qualifications and registration with the national accrediting body. Methods Semi structured interviews were conducted with eight participants recruited using purposive sampling. Interview transcripts were subject to a phenomenographic study using a stepwise, inductive approach. Results Data analysis led to the development of a number of categories or descriptions of understanding that provided insight into the ways that participants experienced and conceptualised the phenomenon under study. Five categories of description were identified. These are (1) the migrator, (2) the navigator, (3) the student again, and (4) the registrant. For some, an additional category, (5) the mentee, was experienced. Within these categories, variation in participants' experiences was explored. Conclusions Participants reported a variety of reasons for migration, and upon embarking on the process, applicants were required to take on a variety of roles, with variation within each role dependent on a number of personal and external factors. Applicants faced personal, administrative, experiential and regulatory hurdles prior to registration, all of which should inform the development of future iterations of this and similar processes.
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Affiliation(s)
- Michelle Flood
- School of Pharmacy and Biomolecular Sciences, 1st Floor, Ardilaun House Block B, 111 St. Stephen's Green, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Judith D. Strawbridge
- School of Pharmacy and Biomolecular Sciences, 1st Floor, Ardilaun House Block B, 111 St. Stephen's Green, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - James W. Barlow
- Department of Chemistry, 123 St. Stephen's Green, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
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Brennan N, Langdon N, Gale T, Humphries N, Knapton A, Bryce M. Exploring recent patterns of migration of doctors to the United Kingdom: a mixed-methods study. BMC Health Serv Res 2023; 23:1204. [PMID: 37924092 PMCID: PMC10625180 DOI: 10.1186/s12913-023-10199-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
INTRODUCTION A shortage of doctors is currently one of the biggest challenges faced by the healthcare workforce in the United Kingdom (UK). While plans are in place to increase the number of medical school places, in the short-term this gap will need to continue to be filled by the international recruitment of doctors. The aim of this study is to identify key factors that explain the patterns of migration of doctors to the UK, in order to aid the development of policies to recruit and retain a sustainable workforce. METHODS We analysed General Medical Council (GMC) secondary data on the patterns of migration of internationally trained doctors (2009-2019). Qualitative interviews were conducted with 17 stakeholders by videoconferencing which were audio-recorded, transcribed and thematically analysed using NVivo. RESULTS In 2019, 34.5% of UK doctors were trained internationally mainly in India, Pakistan, Italy, Nigeria, Greece, Romania and Egypt. Most new registrations by internationally trained doctors from 2009-2019 did not have a specialty at the time of initial registration (96.2% in 2019). Only a relatively small number of these doctors go on to gain specialist or GP registration (11.6% within 5 years and 27.2% within 10 years of registration). The stakeholder interviews highlighted training opportunities and career progression as the main drivers of migration. The barriers internationally trained doctors face regarding specialty training included differences between UK and destination health systems, systematic bias, bureaucracy and selection processes not being accessible. CONCLUSION This study makes a contribution to the literature by identifying recent patterns in the migration of doctors to the UK. The UK's dependence on internationally trained doctors has important global implications as source countries are losing skilled health workers which is undermining their health systems. In keeping with the WHO Global Code on the International Recruitment of Healthcare Personnel, policymakers need to consider how to reduce the UK's reliance on internationally trained doctors, particularly from countries on the safeguard list whilst continuing the drive to increase medical school places. Additional support is required for internationally trained doctors, to ensure that they get on the training programmes they seek, enabling their career progression.
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Affiliation(s)
- N Brennan
- CAMERa, Peninsula Medical School, Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK.
| | - N Langdon
- CAMERa, Peninsula Medical School, Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - T Gale
- CAMERa, Peninsula Medical School, Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - N Humphries
- Graduate School of Healthcare Management, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Knapton
- Strategic Modelling Analysis and Planning Limited (SMAP), Winchester, UK
| | - M Bryce
- CAMERa, Peninsula Medical School, Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
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Toyin-Thomas P, Ikhurionan P, Omoyibo EE, Iwegim C, Ukueku AO, Okpere J, Nnawuihe UC, Atat J, Otakhoigbogie U, Orikpete EV, Erhiawarie F, Gbejewoh EO, Odogu U, Akhirevbulu ICG, Kwarshak YK, Wariri O. Drivers of health workers' migration, intention to migrate and non-migration from low/middle-income countries, 1970-2022: a systematic review. BMJ Glob Health 2023; 8:bmjgh-2023-012338. [PMID: 37156560 PMCID: PMC10174016 DOI: 10.1136/bmjgh-2023-012338] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The migration of healthcare workers (HWs) from low/middle-income countries (LMICs) is a pressing global health issue with implications for population-level health outcomes. We aimed to synthesise the drivers of HWs' out-migration, intention to migrate and non-migration from LMICs. METHODS We searched Ovid MEDLINE, EMBASE, CINAHL, Global Health and Web of Science, as well as the reference lists of retrieved articles. We included studies (quantitative, qualitative or mixed-methods) on HWs' migration or intention to migrate, published in either English or French between 1 January 1970 and 31 August 2022. The retrieved titles were deduplicated in EndNote before being exported to Rayyan for independent screening by three reviewers. RESULTS We screened 21 593 unique records and included 107 studies. Of the included studies, 82 were single-country studies focusing on 26 countries, while the remaining 25 included data from multiple LMICs. Most of the articles focused on either doctors 64.5% (69 of 107) and/or nurses 54.2% (58 of 107). The UK (44.9% (48 of 107)) and the USA (42% (45 of 107)) were the top destination countries. The LMICs with the highest number of studies were South Africa (15.9% (17 of 107)), India (12.1% (13 of 107)) and the Philippines (6.5% (7 of 107)). The major drivers of migration were macro-level and meso-level factors. Remuneration (83.2%) and security problems (58.9%) were the key macro-level factors driving HWs' migration/intention to migrate. In comparison, career prospects (81.3%), good working environment (63.6%) and job satisfaction (57.9%) were the major meso-level drivers. These key drivers have remained relatively constant over the last five decades and did not differ among HWs who have migrated and those with intention to migrate or across geographical regions. CONCLUSION Growing evidence suggests that the key drivers of HWs' migration or intention to migrate are similar across geographical regions in LMICs. Opportunities exist to build collaborations to develop and implement strategies to halt this pressing global health problem.
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Affiliation(s)
- Patience Toyin-Thomas
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Paul Ikhurionan
- Department of Child Health, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Efe E Omoyibo
- Department of Paediatrics, Federal Medical Centre, Asaba, Nigeria
| | - Chinelo Iwegim
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Avwebo O Ukueku
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Jermaine Okpere
- Department of Clinical Research, Alpha Research Clinic, Edmonton, Alberta, Canada
| | - Ukachi C Nnawuihe
- Department of Clinical Services, Intercountry Centre for Oral Health for Africa, Jos, Nigeria
| | - Josephine Atat
- Department of Restorative Dentistry, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Uwaila Otakhoigbogie
- Department of Oral Pathology and Oral Medicine, University of Nigeria, Enugu, Nigeria
| | | | - Franca Erhiawarie
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Uyoyo Odogu
- Department of Preventive Dentistry, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | | | - Oghenebrume Wariri
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Jack FJG, Kotronoulas G. The Perceptions of Healthcare Staff Regarding Moral Injury and the Impact on Staff Life and Work During COVID-19: A Scoping Review of International Evidence. JOURNAL OF RELIGION AND HEALTH 2023:1-25. [PMID: 37027110 PMCID: PMC10080521 DOI: 10.1007/s10943-023-01803-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 06/19/2023]
Abstract
The COVID-19 response introduced legal restrictions on social distancing globally, affecting healthcare staff personally and professionally. These restrictions suspended routine hospital visiting, which may have left staff feeling they had to compromise on the care they provided. Such conflict may be experienced as moral injury. This scoping review aimed to synthesise international evidence, to answer this question: "Have COVID-19 restrictions affected healthcare staff's experiences of moral injury? If so, how?" Nine studies met the search criteria. Although healthcare staff seemed to be aware of the risks and effects of moral injury, they were still reluctant to "name" it. Healthcare staff's own emotional and spiritual needs were mostly ignored. Although psychological support is often the recommended approach by organisations, a greater focus on spiritual and emotional support is recommended.
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Affiliation(s)
- Fiona J. G. Jack
- NHS Fife–Department of Spiritual Care, Queen Margaret Hospital, Whitefield Road, Dunfermline, Fife, KY12 OSU Scotland, UK
| | - Grigorios Kotronoulas
- School of Medicine Dentistry and Nursing, Nursing and Health Care School, College of Medical, Veterinary and Life Sciences, University of Glasgow, 57-61 Oakfield Avenue, Glasgow, G12 8LL Scotland, UK
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Bayuo J, Abboah-Offei M, Duodu PA, Salifu Y. A meta-synthesis of the transitioning experiences and career progression of migrant African nurses. BMC Nurs 2023; 22:104. [PMID: 37024886 PMCID: PMC10079157 DOI: 10.1186/s12912-023-01273-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/27/2023] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION With the rise in global migration, hospitals and health systems in developed countries are looking to supplement their workforces with migrant nurses who have been reported to feel devalued, underutilized with experience of deskilling and unmet expectations as they transitioned. Despite the plethora of literature reporting on the experiences of internationally trained nurses, only limited work has been done regarding understanding the experiences of Migrant African nurses. Thus, this study sought to synthesize existing qualitative studies to develop in-depth understanding of the transitioning experiences of migrant African nurses, their career progression and to highlight existing gaps to guide future studies as well as inform policies. METHOD A meta-synthesis was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Enhancing transparency in reporting the synthesis of qualitative research statement. A pre-planned search strategy was developed guided by the SPIDER tool for qualitative synthesis searching EMBASE via OVID, CINAHL via EBSCO, PubMed, Web of Science, and PsychINFO databases. We included published studies that 1) focused on migrant African nurses, 2) employed a qualitative design and 3) reported in English. RESULTS The search yielded 139 studies of which nine studies met the inclusion criteria and included in final synthesis. Three themes with corresponding subthemes emerged from data synthesis: 1) Navigating reality shock (a. Navigating a new culture, b. Survival strategies and support amidst the shock); 2) Discrimination and limited opportunities for promotion (a. Prejudices and preference for White over Black, b. Lack of recognition and limited opportunities for a workplace promotion); and 3) Finding one's feet (a. Standing up for oneself and looking beyond discrimination, b. Experiencing growth). CONCLUSION Transitioning to a new setting can be a challenging experience for migrant African nurses warranting the availability of a tailor-made adaptation or orientation programme. Though African nurses may experience discrimination and prejudices as part of their transition, they consider their situation to be better off compared to back home. Therefore, clear transitioning policies which focus on career pathways are required by hiring institutions, and migrant nurses should be proactive in taking active roles in pushing their career ahead, instead of maintaining a culture of silence.
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Affiliation(s)
- Jonathan Bayuo
- Department of Nursing and Midwifery, Presbyterian University, Kwahu East, Ghana.
| | - Mary Abboah-Offei
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Precious Adade Duodu
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, England, UK
| | - Yakubu Salifu
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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12
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Brennan N, Langdon N, Bryce M, Burns L, Humphries N, Knapton A, Gale T. Drivers and barriers of international migration of doctors to and from the United Kingdom: a scoping review. HUMAN RESOURCES FOR HEALTH 2023; 21:11. [PMID: 36788569 PMCID: PMC9927032 DOI: 10.1186/s12960-022-00789-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/21/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Many high-income countries are heavily dependent on internationally trained doctors to staff their healthcare workforce. Over one-third of doctors practising in the UK received their primary medical qualification abroad. Simultaneously, an average of around 2.1% of doctors leave the UK medical workforce annually to go overseas. The aim of this study was to identify the drivers and barriers of international migration of doctors to and from the UK. METHODS A scoping review was conducted. We searched EMBASE, MEDLINE, CINAHL, ERIC and BEI in January 2020 (updated October 2021). Grey literature and citation searching were also carried out. Empirical studies reporting on the drivers and barriers to the international migration of doctors to and from the UK published in the English language from 2009 to present were included. The drivers and barriers were coded in NVivo 12 building on an existing framework. RESULTS 40 studies were included. 62% were quantitative, 18% were qualitative, 15% were mixed-methods and 5% were literature reviews. Migration into and out of the UK is determined by a variety of macro- (global and national factors), meso- (profession led factors) and micro-level (personal factors). Interestingly, many of the key drivers of migration to the UK were also factors driving migration from the UK, including: poor working conditions, employment opportunities, better training and development opportunities, better quality of life, desire for a life change and financial reasons. The barriers included stricter immigration policies, the registration process and short-term job contracts. CONCLUSIONS Our research contributes to the literature by providing a comprehensive up-to-date review of the drivers and barriers of migration to and from the UK. The decision for a doctor to migrate is multi-layered and is a complex balance between push/pull at macro-/meso-/micro-levels. To sustain the UK's supply of overseas doctors, it is vital that migration policies take account of the drivers of migration particularly working conditions and active recruitment while addressing any potential barriers. Immigration policies to address the impact of Brexit and the COVID-19 pandemic on the migration of doctors to and from the UK will be particularly important in the immediate future. Trial registration PROSPERO CRD42020165748.
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Affiliation(s)
- N Brennan
- Collaboration for the Advancement of Medical Education Research, Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK.
| | - N Langdon
- Collaboration for the Advancement of Medical Education Research, Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - M Bryce
- Collaboration for the Advancement of Medical Education Research, Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - L Burns
- Collaboration for the Advancement of Medical Education Research, Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - N Humphries
- Graduate School of Healthcare Management, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Knapton
- Strategic Modelling Analysis and Planning Limited (SMAP), Winchester, UK
| | - T Gale
- Collaboration for the Advancement of Medical Education Research, Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
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13
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Bond S, Ricketts B, Walthall H, Merriman C. An online questionnaire exploring how recruiting organisations support international nurses and midwives undertake the OSCE and gain UK professional registration. Contemp Nurse 2023:1-13. [PMID: 36636911 DOI: 10.1080/10376178.2023.2166549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: There is an active strategy to recruit international nurses and midwives to help manage vacancy gaps in the United Kingdom's healthcare system. However, there is little evidence detailing how recruiting organisations prepare new recruits for the Objective Structured Clinical Exam (OSCE) they are required to pass.Aims and objectives: To gather and analyse feedback from recruiting organisations on the preparation offered to international nurses and midwives on arrival in the United Kingdom, prior to undertaking an OSCE in order to gain Nursing and Midwifery Council professional registration.Design and methods: An online cross-sectional questionnaire. The data was analysed using thematic analysis.Results: Four main themes were generated from thematic analysis of the qualitative data: SAME IDEAS DIFFERENT PRACTICE; PASSING THE OSCE; INDIVIDUALISED SUPPORT; SUPPORT NETWORKS.Conclusion: Differences in how organisations prepare and support international nurses and midwives to undertake the OSCE suggest standardised approaches could benefit new recruits.Impact statement: Addressing an evidence gap, this research suggests recruits may benefit from standardised support around working and living in the UK.
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Affiliation(s)
- Samuel Bond
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Oxford OX3 OFL, UK
| | - Barry Ricketts
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Oxford OX3 OFL, UK
| | - Helen Walthall
- Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, UK
| | - Clair Merriman
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Oxford OX3 OFL, UK
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14
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Migrant physicians' unlocking of gateways to practise their knowledge: A qualitative quasi-longitudinal study. PLoS One 2023; 18:e0282317. [PMID: 36920993 PMCID: PMC10016640 DOI: 10.1371/journal.pone.0282317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 02/13/2023] [Indexed: 03/16/2023] Open
Abstract
This study explores the establishment experiences of physicians in the Swedish medical context who have been trained outside the European Union. The study used a qualitative approach with a quasi-longitudinal research design. The data were gathered via 63 semi-structured interviews with migrant physicians at three different periods. The data were analysed using qualitative thematic content analysis, adopting the theory on the context dependence of knowledge, which includes different forms of knowledge as sensitising concepts in the discussion. The MPs perceived themselves as having the medical knowledge (encoded knowledge) needed to work in Sweden. However, they perceived that they needed to develop knowledge of how to use the encoded knowledge in the Swedish medical context. The needed knowledge was thus foremost encultured, embedded, embodied, or embrained. The results are presented in the following themes: medical knowledge; knowledge of the healthcare system and its variations; knowledge of administrative routines; understanding the role as a physician, interaction and hierarchies between physicians and other healthcare staff; understanding the interaction and hierarchies between physicians and patients; and knowledge of the Swedish language. Knowledge, as described in the themes, function as gateways that needs to be unlocked for practising medicine in a new context. Embedded, embrained, embodied, and encultured knowledge interact and are interdependent, and the different forms of knowledge work as gateways to other forms of knowledge, and thus, they open for each other. However, to pass the gateways, managing the common language is important. We conclude that language is an enabler and a key to unlocking gateways to practise.
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Ikhurionan P, Kwarshak YK, Agho ET, Akhirevbulu ICG, Atat J, Erhiawarie F, Gbejewoh EO, Iwegim C, Nnawuihe U, Odogu U, Okpere J, Omoyibo EE, Orikpete EV, Otakhoigbogie U, Ukueku A, Ugwi P, Wariri O. Understanding the trends, and drivers of emigration, migration intention and non-migration of health workers from low-income and middle-income countries: protocol for a systematic review. BMJ Open 2022; 12:e068522. [PMID: 36600347 PMCID: PMC9730369 DOI: 10.1136/bmjopen-2022-068522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The WHO estimates a shortage of 18 million health workers (HWs) by 2030, primarily in low-income and middle-income countries (LMICs). The perennial out-migration of HWs from LMICs, often to higher-income countries, further exacerbates the shortage. We propose a systematic review to understand the determinants of HWs out-migration, intention to migrate and non-migration from LMICs. METHODS AND ANALYSIS This protocol was designed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols guideline for the development and reporting of systematic review protocols. We will include English and French language primary studies (quantitative or qualitative) focused on any category of HWs; from any LMICs; assessed migration or intention to migrate; and reported any determinant of migration. A three-step search strategy that involves a search of one electronic database to refine the preliminary strategy, a full search of all included databases and reference list search of included full-text papers for additional articles will be employed. We will search Ovid MEDLINE, EMBASE, CINAHL, Global Health and Web of Science from inception to August 2022. The retrieved titles will be imported to EndNote and deduplicated. Two reviewers will independently screen all titles and abstract for eligibility using Rayyan. Risk of bias of the individual studies will be determined using the National Institute of Health study quality assessment tools for quantitative studies and the 10-item Critical Appraisal Skills Programme checklists for qualitative studies. The results will be presented in the form of narrative synthesis using a descriptive approach ETHICS AND DISSEMINATION: We will not seek ethical approval from an institutional review board, as this is a systematic review. At completion, we will submit the report of this review to a peer-reviewed journal for publication. Key findings will be presented at local and international conferences. PROSPERO REGISTRATION NUMBER CRD42022334283.
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Affiliation(s)
- Paul Ikhurionan
- Department of Paediatrics, University of Benin Teaching Hospital, Benin City, Nigeria
| | | | - Ekhosuehi T Agho
- Department of Oral Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Itua C G Akhirevbulu
- Orthopaedics and Trauma Division, Department of Surgery, Edo Specialist Hospital, Benin City, Nigeria
| | - Josephine Atat
- Department of Restorative Dentistry, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Franca Erhiawarie
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Chinelo Iwegim
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Ukachi Nnawuihe
- Intercountry Centre for Oral Health for Africa, Jos, Nigeria
| | - Uyoyo Odogu
- Department of Preventive Dentistry, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Jermaine Okpere
- Department of Clinical Research, Alpha Research Clinic Inc, Edmonton, Alberta, Canada
| | - Efe E Omoyibo
- Department of Paediatrics, Federal Medical Centre, Asaba, Nigeria
| | - Efetobo Victor Orikpete
- Department of Oral Pathology and Oral Biology, University of Port Harcourt, Port Harcourt, Nigeria
| | - Uwaila Otakhoigbogie
- Department of Oral Pathology and Oral Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Avwebo Ukueku
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Patience Ugwi
- Lawton Community Health Center, Lawton, Oklahoma, USA
| | - Oghenebrume Wariri
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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16
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Integration strategies and models to support transition and adaptation of culturally and linguistically diverse nursing staff into healthcare environments: An umbrella review. Int J Nurs Stud 2022; 136:104377. [DOI: 10.1016/j.ijnurstu.2022.104377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/18/2022] [Accepted: 10/04/2022] [Indexed: 12/12/2022]
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Pressley C, Newton D, Garside J, Simkhada P, Simkhada B. Global migration and factors that support acculturation and retention of international nurses: A systematic review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100083. [PMID: 38745611 PMCID: PMC11080352 DOI: 10.1016/j.ijnsa.2022.100083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/20/2022] [Accepted: 06/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background International nurses (migrant nurses who are recruited to work in different countries) make essential contributions to global health and care workforces that are experiencing domestic nurse shortages. Global recruitment and migration is increasing, and with growing dependency on international nurses, health and care employers must understand their lived experiences if they want to support acculturation and subsequent retention. Aim This paper reports a systematic review of qualitative literature on the experiences of international nurses working overseas. The aim is to explore the lived experiences of international nurses working and living in different countries globally. We argue their experiences shape socialisation and contribute to longer term retention of this fundamental nursing workforce. Method A systematic literature search was carried out in Medline, CINAHL, PsychInfo, PubMed and Web of Science for global research publications from 2010 to 2020. Research studies conducted in Australia, Canada, New Zealand, the United Kingdom and the United States were identified, quality appraised and subjected to data extraction/analysis. Findings The findings of twenty seven papers were synthesised into six themes: (1) individual and organisational preparedness, (2) communication and the art of language, (3) principles and practices of nursing, (4) social and cultural reality, (5) equality, diversity and inclusion, and (6) facilitators of integration and adaptation. Discussion Whilst experiences are multifaceted and complex, factors shaping acculturation of international nurses were transferable across various countries. Individual motivations for migration should be recognised, and short term, transitional and long term needs must be identified to support development needs and ongoing career progression. Cultural integration and language barriers should be sensitively managed to enable effective acculturation. Culturally sensitive leadership is also key to ensuring zero tolerance of inappropriate racist and discriminatory behaviours. Conclusion Health and care employers offer tangible benefits for international nurse workforces and in culturally compassionate and professional sociocultural environments, international nurses can thrive. However, to effectively retain this workforce in the longer term, significant improvement is required across a number of areas. Tweetable abstract This new systematic review paper explores the factors that can support acculturation and retention of internationally-recruited nurses globally.
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Affiliation(s)
- Charlene Pressley
- People Directorate, NHS England and Improvement, Quarry House, Quarry Hill, Leeds, UK
- Department of Nursing and Midwifery, University of Huddersfield, Huddersfield, UK
| | - Dillon Newton
- Department of Nursing and Midwifery, University of Huddersfield, Huddersfield, UK
| | - Joanne Garside
- Department of Nursing and Midwifery, University of Huddersfield, Huddersfield, UK
| | - Padam Simkhada
- Department of Nursing and Midwifery, University of Huddersfield, Huddersfield, UK
| | - Bibha Simkhada
- Department of Nursing and Midwifery, University of Huddersfield, Huddersfield, UK
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18
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Al-Yateem N, Timmins F, Alameddine M, Dias JM, Saifan A, AbuRuz M, Subu MA, Rahman SA, Hijazi H. Recruitment of internationally trained nurses: Time for a global model for shared responsibility. J Nurs Manag 2022; 30:2453-2456. [PMID: 36056572 DOI: 10.1111/jonm.13785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Nabeel Al-Yateem
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Health and Workforce Studies Research Group, Research Institute for Health and Medical Sciences, Sharjah, United Arab Emirates
| | - Fiona Timmins
- School of Nursing, Midwifery and Health Systems University College Dublin, Dublin, Ireland
| | - Mohamad Alameddine
- Health and Workforce Studies Research Group, Research Institute for Health and Medical Sciences, Sharjah, United Arab Emirates.,College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Jacquline Maria Dias
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Ahmad Saifan
- Faculty of Nursing, Applied Sciences Private University, Amman, Jordan
| | - Mohanad AbuRuz
- Faculty of Nursing, Applied Sciences Private University, Amman, Jordan
| | - Muhammad Arsyad Subu
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Syed Azizur Rahman
- Department of Health Service Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Heba Hijazi
- Department of Health Service Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Faculty of Medicine, Department of Health Management and Policy, Jordan University of Sciences and Technology, Irbid, Jordan
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Schumann M, Sepke M, Peters H. Doctors on the move 2: a qualitative study on the social integration of middle eastern physicians following their migration to Germany. Global Health 2022; 18:78. [PMID: 36028861 PMCID: PMC9412787 DOI: 10.1186/s12992-022-00871-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 08/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background The integration of immigrating physicians has become a challenge for many societies and health care systems worldwide. Facilitating the integration process may benefit both the uptaking country and the immigrating physicians. Previous studies have approached this problem from a system integration perspective. The present study explores the degree of social integration of an exemplary group of Middle Eastern physicians following their migration to Germany from an individual perspective. Methods Based on social constructivist epistemology, a series of fifteen interviews and two focus groups with immigrated Middle Eastern physicians (n = 23, purposively sampled) were conducted between 2017 and 2020 in Germany. The audio recordings were transcribed, translated into English and analysed deductively based on Esser’s model of social integration, consisting of four dimensions: acculturation, positioning, interaction and identification. Results The social integration of the participants showed a multifaceted picture. The early phase was characterized by disorientation and trial and error. Cultural differences were of major importance. Acculturation was facilitated by German language acquisition and increased over time, although some cultural difficulties remained. Professional positioning was facilitated by the need for physicians and a relatively low-hurdle relicensing procedure. Interaction and identification depended on the efforts of the individual physicians. Conclusions This study provides a comprehensive picture of the individual social integration of Middle Eastern physicians in Germany. Language and cultural adaptation are identified as being of primary importance. Social integration can be facilitated through orientation programmes or cross-cultural training that benefits the uptaking countries as well as the immigrating physicians.
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Affiliation(s)
- Marwa Schumann
- Dieter Scheffner Center for Medical Education and Educational Research, Dean's Office of Student Affairs, Charité - Universitätsmedizin Berlin, Free and Humboldt University Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.,Medical Education Department, Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Maria Sepke
- Dieter Scheffner Center for Medical Education and Educational Research, Dean's Office of Student Affairs, Charité - Universitätsmedizin Berlin, Free and Humboldt University Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Harm Peters
- Dieter Scheffner Center for Medical Education and Educational Research, Dean's Office of Student Affairs, Charité - Universitätsmedizin Berlin, Free and Humboldt University Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.
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Xie F. Human Resource Data Integration System Based on Artificial Intelligence Environment. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:1650583. [PMID: 36017240 PMCID: PMC9398809 DOI: 10.1155/2022/1650583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Abstract
In an AI environment, this article suggests an HR data integration system based on a hidden semantic model to address the low integration of HR raw data. It provides a decision-making framework for enterprise personnel recruitment and employee training by making predictions and analyses based on HR information. The basis for the HR data integration model base is established in this article, along with its construction principle, process, and model types. Based on this, a method for creating an HR data integration system that has a straightforward modeling process, an easy solution, high prediction accuracy, verifiability, and correction is chosen. An HR recommendation algorithm combining a hidden semantic model and a deep forest model is proposed. At the same time, preprocess HR data and create a data warehouse. According to experiments, this system's stability can reach a maximum of 95.84 percent and its efficiency in integrating HR data can reach 96.37 percent. The system operates with ease and consistently delivers superior performance. It can more effectively realize the fusion and mining of HR data and offer practical services for related work.
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Affiliation(s)
- Fei Xie
- Law School, Hunan University, Changsha 410082, China
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21
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Davda LS, Radford DR, Scambler S, Gallagher JE. Accreditation and professional integration experiences of internationally qualified dentists working in the United Kingdom. HUMAN RESOURCES FOR HEALTH 2022; 20:7. [PMID: 35012564 PMCID: PMC8744036 DOI: 10.1186/s12960-021-00703-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/14/2021] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Regulatory processes for Oral health care professionals are considered essential for patient safety and to ensure health workforce quality. The global variation in their registration and regulation is under-reported in the literature. Regulatory systems could become a barrier to their national and international movement, leading to loss of skilled human resources. The General Dental Council is the regulatory authority in the UK, one of the nine regulators of health care overseen by the Professional Standards Authority. AIM The aim of this paper is to present the professional integration experiences of internationally qualified dentists (IQDs) working in the UK, against the background of regulation and accreditation nationally. METHODS Registration data were obtained from the General Dental Council to inform the sampling and recruitment of research participants. Semi-structured interviews of 38 internationally qualified dentists working in the United Kingdom were conducted between August 2014 and October 2017. The topic guide which explored professional integration experiences of the dentists was informed by the literature, with new themes added inductively. A phenomenological approach involving an epistemological stance of interpretivism, was used with framework analysis to detect themes. RESULTS Internationally qualified dentist's professional integration was influenced by factors that could be broadly classified as structural (source country training; registration and employment; variation in practising dentistry) and relational (experiences of discrimination; value of networks and support; and personal attributes). The routes to register for work as a dentist were perceived to favour UK dental graduates and those qualifying from the European Economic Area. Dentists from the rest of the world reported experiencing major hurdles including succeeding in the licensing examinations, English tests, proving immigration status and succeeding in obtaining a National Health Service performer number, all prior to being able to practice within state funded dental care. CONCLUSION The pathways for dentists to register and work in state funded dental care in UK differ by geographic type of registrant, creating significant inconsistencies in their professional integration. Professional integration is perceived by an individual IQD as a continuum dictated by host countries health care systems, workforce recruitment policies, access to training, together with their professional and personal skills. The reliance of the UK on internationally qualified dentists has increased in the past two decades, however, it is not known how these trends will be affected by UK's exit from the European Union and the COVID-19 pandemic.
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Affiliation(s)
- Latha S Davda
- University of Portsmouth Dental Academy, Faculty of Science and Health, University of Portsmouth, PO1 2QG, Portsmouth, United Kingdom.
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, Denmark Hill Campus, SE5 9RS, London, United Kingdom.
| | - David R Radford
- University of Portsmouth Dental Academy, Faculty of Science and Health, University of Portsmouth, PO1 2QG, Portsmouth, United Kingdom
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, Denmark Hill Campus, SE5 9RS, London, United Kingdom
| | - Sasha Scambler
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, Denmark Hill Campus, SE5 9RS, London, United Kingdom
| | - Jennifer E Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, Denmark Hill Campus, SE5 9RS, London, United Kingdom
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22
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Arifa YN, El Baroudi S, Khapova SN. How do Individuals Form Their Motivations to Expatriate? A Review and Future Research Agenda. FRONTIERS IN SOCIOLOGY 2021; 6:631537. [PMID: 34490407 PMCID: PMC8416985 DOI: 10.3389/fsoc.2021.631537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
For two decades, individual motivations to expatriate have received substantial attention in the expatriation literature examining self-initiated and assigned expatriation. Recently, however, this literature has changed direction, demonstrating that prior to forming their actual motivations, individuals undergo a process wherein they actively form those motivations. No review has yet unraveled this motivation process, and this systematic literature review fills this gap. Using the Rubicon Action model that discusses the motivation process of expatriation, this article demonstrates that for self-initiated and assigned expatriation, individuals follow similar processes: expatriation expectations are formed; then, they are evaluated; and finally, preferences are built that result in motivations to expatriate. Findings for each stage are discussed in light of their contributions to the expatriation literature. For major gaps, new research suggestions are offered to advance our understanding of the individual motivation process that expats experience prior to forming their motivations to move abroad.
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Kuzemski D, Thirlwall A, Brunton M, Brownie S. I speak a little Arabic: Nursing communication in a cross-cultural context. J Clin Nurs 2021; 31:145-157. [PMID: 34263493 DOI: 10.1111/jocn.15891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES This study investigated the challenges of cross-cultural communication among internationally qualified nurses, and the impact on nurse-to-nurse and nurse-to-patient relationships. BACKGROUND Open and authentic communication between nurses and patients is required as a foundation of patient-centred practice; however, this may be a challenge in cross-cultural settings. DESIGN An exploratory qualitative study with an inductive approach. METHODS Semi-structured, face-to-face interviews explored the influences on communication and practice of 21 internationally qualified nurses practising in the United Arab Emirates. Manual and software-driven processes guided coding and analysis of data. Caring theory guided the analysis of themes; while COREQ criteria guided research conduct and reporting. RESULTS Four key themes emerged; (a) Challenges in communication, (b) The science versus art of nursing; (c) The impact of ineffective communication and (d) Strategies for coping. Eleven sub-themes are reported within these themes. Overall, nurses felt they had sufficient language and nursing skills to undertake the technical or scientific aspects of their work; however, they reported experiencing restricted ability to participate in complex cross-cultural conversations, such as providing explanations and reassurance about treatment options or discussing end of life and treatment decisions. This limitation diminished the nurses' ability to engage in the art of nursing and left them unable to employ themselves therapeutically to attain a sense of true presence with patients and their families. CONCLUSION This article highlights the need for language and communication support, and Arabic-speaking advocates as partners in care for expatriate nurses. RELEVANCE TO PRACTICE Internationally qualified nurses in this Middle Eastern setting lack cultural orientation and language skills to fully enact the art and true presence of nursing. Findings indicate that health service employers need to increase the employment of Arabic-speaking nurses and provide additional language for other expatriate nurses.
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Affiliation(s)
| | - Alison Thirlwall
- Faculty of Business, University of Wollongong, Dubai, United Arab Emirates
| | - Margaret Brunton
- School of Communication, Journalism and Marketing, Massey University, Auckland, New Zealand
| | - Sharon Brownie
- Centre for Health & Social Practice, Wintec, Hamilton, New Zealand.,School of Medicine, Griffith University, Southport, Queensland, Australia.,School of Nursing, Midwifery & Public Health, University of Canberra, Bruce, ACT, Australia
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Bourgeault IL, Runnels V, Atanackovic J, Spitzer D, Walton-Roberts M. Hiding in plain sight: the absence of consideration of the gendered dimensions in 'source' country perspectives on health worker migration. HUMAN RESOURCES FOR HEALTH 2021; 19:40. [PMID: 33761939 PMCID: PMC7992834 DOI: 10.1186/s12960-021-00571-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 02/18/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND Gender roles and relations affect both the drivers and experiences of health worker migration, yet policy responses rarely consider these gender dimensions. This lack of explicit attention from source country perspectives can lead to inadequate policy responses. METHODS A Canadian-led research team partnered with co-investigators in the Philippines, South Africa, and India to examine the causes, consequences and policy responses to the international migration of health workers from these 'source' countries. Multiple-methods combined an initial documentary analysis, interviews and surveys with health workers and country-based stakeholders. We undertook an explicit gender-based analysis highlighting the gender-related influences and implications that emerged from the published literature and policy documents from the decade 2005 to 2015; in-depth interviews with 117 stakeholders; and surveys conducted with 3580 health workers. RESULTS The documentary analysis of health worker emigration from South Africa, India and the Philippines reveal that gender can mediate access to and participation in health worker training, employment, and ultimately migration. Our analysis of survey data from nurses, physicians and other health workers in South Africa, India and the Philippines and interviews with policy stakeholders, however, reveals a curious absence of how gender might mediate health worker migration. Stereotypical views were evident amongst stakeholders; for example, in South Africa female health workers were described as "preferred" for "innate" personal characteristics and cultural reasons, and in India men are directed away from nursing roles particularly because they are considered only for women. The finding that inadequate remuneration was as a key migration driver amongst survey respondents in India and the Philippines, where nurses predominated in our sample, was not necessarily linked to underlying gender-based pay inequity. The documentary data suggest that migration may improve social status of female nurses, but it may also expose them to deskilling, as a result of the intersecting racism and sexism experienced in destination countries. Regardless of these underlying influences in migration decision-making, gender is rarely considered either as an important contextual influence or analytic category in the policy responses. CONCLUSION An explicit gender-based analysis of health worker emigration, which may help to emphasize important equity considerations, could offer useful insights for the health and social policy responses adopted by source countries.
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Affiliation(s)
- Ivy Lynn Bourgeault
- School of Sociology and Anthropology, University of Ottawa, Ottawa, ON K1N 6N5 Canada
| | - Vivien Runnels
- Gender, Work & Health Lab, University of Ottawa, Ottawa, ON K1N 6N5 Canada
| | - Jelena Atanackovic
- Gender, Work & Health Lab, University of Ottawa, Ottawa, ON K1N 6N5 Canada
| | - Denise Spitzer
- School of Public Health Sciences, University of Alberta, Edmonton, AB Canada
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Eden A, Fleet JA, Cominos N. The learning experiences of international students in nursing and midwifery programs: A literature review. Nurse Educ Pract 2021; 52:103027. [PMID: 33862347 DOI: 10.1016/j.nepr.2021.103027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/24/2022]
Abstract
Globally, education continues to diversify, with a growing body of literature that describes the experiences of international higher education students. While the research includes representation from the health sciences, nursing and midwifery programs are underrepresented; understanding the experiences of international students therein may assist in determining whether discipline-specific teaching, learning and support is required. This review aims to summarise international nursing and midwifery students' perceptions of challenge and enablement when undertaking an undergraduate or baccalaureate program. A total of 408 articles were identified and after duplicates were removed and inclusion/exclusion criteria applied, eight primary studies were included. No papers were identified that reported on the experiences of international midwifery students. For international nursing students, five themes emerged: language and culture, isolation and segregation, teaching and learning, services and support, and resilience and growth. This review concludes that the available data both affirms the existing body of knowledge around international students and illuminates unique challenges and opportunities for nursing students undertaking clinical placements. There is a need for increased language and peer support, socialisation and specially educated support staff. Research is required to identify best practice in teaching methodology for an increasingly diverse cohort and importantly, to provide a midwifery perspective.
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Affiliation(s)
- Amye Eden
- UniSA Clinical and Health Sciences, University of South Australia, City East Campus, Corner North Terrace and Frome Road, Adelaide, SA 5000, Australia.
| | - Julie-Anne Fleet
- UniSA Clinical and Health Sciences, University of South Australia, City East Campus, Corner North Terrace and Frome Road, Adelaide, SA 5000, Australia.
| | - Nayia Cominos
- Prideaux Health Professions Education, Flinders University, Flinders Medical Centre, Bedford Park SA 5042, Australia.
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Davda LS, Radford DR, Scambler S, Gallagher JE. Profiles of registrant dentists and policy directions from 2000 to 2020. BDJ Open 2020; 6:26. [PMID: 33298834 PMCID: PMC7695988 DOI: 10.1038/s41405-020-00054-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/04/2020] [Accepted: 10/16/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction The National Health Service’s reliance on overseas doctors and nurses, unlike dentists, has been widely reported. As the United Kingdom (UK) leaves the European Union, an understanding of the migration trends and possible influences are important to inform future planning. Aim To examine trends in the profile of UK registered dentists in the context of key events and policy changes from 2000 to 2020. Method Data were obtained from the General Dental Council via annual reports, and under ‘freedom of information’ communications; details of policy initiatives were obtained from the government and professional websites. Results Over a 20-year period (2000–2019), the number of registered dentists increased from 31,325 to 42,469, a net increase of 36% (11,144 dentists), the majority of whom were international graduates (58%; n = 6,416) such that by December 2019, 28% of all registered dentists had qualified outside of the UK. Similarly, regarding new registrants, there were increases of graduates from UK (18%), EEA countries (214%) and, via the Overseas Registration Examination route (621%); and a decrease from countries with bilateral agreements for recognition (43%), in line with changes in health and immigration policies. Conclusions International dental graduates increasingly contribute to the UK dental workforce and there is an urgent need for research into dentist migration and retention in the UK in support of patient access to dental care. Impact The United Kingdom (UK) dental workforce is increasingly reliant on international dental graduates representing 28% of current registrants compared with 18% in 2000. Health policies and immigration policies were the main drivers that influenced dental workforce migration to the UK along with wider events, such as EU expansions, global recession and Brexit. Pre-existing lack of research into dental workforce could add to the uncertainties of post COVID-19 oral health care access and delivery.
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Affiliation(s)
- Latha S Davda
- University of Portsmouth Dental Academy, Portsmouth, PO1 2QG, UK. .,Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London,, Denmark Hill Campus, London, SE5 9RS, UK.
| | - David R Radford
- University of Portsmouth Dental Academy, Portsmouth, PO1 2QG, UK.,Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London,, Denmark Hill Campus, London, SE5 9RS, UK
| | - Sasha Scambler
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London,, Denmark Hill Campus, London, SE5 9RS, UK
| | - Jennifer E Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London,, Denmark Hill Campus, London, SE5 9RS, UK
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Sturesson L, Öhlander M, Nilsson GH, Palmgren PJ, Stenfors T. Migrant physicians' entrance and advancement in the Swedish medical labour market: a cross-sectional study. HUMAN RESOURCES FOR HEALTH 2019; 17:71. [PMID: 31615515 PMCID: PMC6794744 DOI: 10.1186/s12960-019-0414-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/10/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Worldwide, physicians are migrating to new countries and want to practise their profession. However, they may experience difficulties doing so. To optimise and accelerate their entrance into and advancement within the Swedish healthcare system, there is an urgent need to explore how they are currently doing so, as their competences should be put to use without any unnecessary delay. The aim of the study was to explore how migrant physicians with a medical degree from outside EU/EEA enter and advance within the medical labour market in Sweden and to identify perceived barriers and facilitating aspects in the process. The empirical findings are discussed in light of Bourdieu's concept symbolic capital as adapted in the Swedish medical field. METHODS A cross-sectional study with a self-administrated questionnaire was disseminated. A sample of 498 migrant physicians were identified. Descriptive statistical analysis and qualitative thematic analysis were used to analyse the data. RESULTS The response rate was 57% (n = 283). Respondents mainly found their first positions via spontaneous job applications, during internships, while participating in an educational intervention or via personal contacts. Perceived barriers to entering and advancing within the medical field in Sweden were mainly related to having a medical degree from and/or originating from another country, which could in turn represent discrimination and/or having one's competence undervalued as a result. Facilitating aspects included having or developing contacts in Swedish healthcare and gaining proficiency or fluency in the Swedish language. CONCLUSIONS When MPs find their first positions, the contacts they have developed appear to play a role, and when advancing in their positions, the active development of a variety of contacts seems to be beneficial. MPs experience a variety of barriers to entering and advancing within the field that could be related to discrimination. Many MPs perceived having their competences undervalued due to their origin or to being educated abroad. Based on the respondents' experiences, our interpretation is that MPs as a group are hierarchically positioned lower in the Swedish medical field than physicians trained in the country. Facilitating aspects included educational interventions, having contacts and developing language skills. For optimal entry into the labour market, it is vitally important for MPs to learn the new language and obtain a job or internship in the field as soon as possible.
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Affiliation(s)
- Linda Sturesson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Magnus Öhlander
- Department of Ethnology, History of Religions and Gender Studies, Stockholm University, 106 91 Stockholm, Sweden
| | - Gunnar H. Nilsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Per J. Palmgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Terese Stenfors
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
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Wearne SM, Brown JB, Kirby C, Snadden D. International medical graduates and general practice training: How do educational leaders facilitate the transition from new migrant to local family doctor? MEDICAL TEACHER 2019; 41:1065-1072. [PMID: 31215285 DOI: 10.1080/0142159x.2019.1616681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objectives: To document medical educators' experience and initiatives in training international medical graduates (IMGs) to become general practitioners (GP). Design: Qualitative social-constructivist emergent design with descriptive and interpretive analyses. Setting: GP vocational training in Australia, Canada, Ireland, New Zealand, the Netherlands, and UK. Participants: Twenty-eight leaders of GP training. Intervention: Data collected from public documents, published literature and 27 semi-structured interviews. Main outcome measures: Tensions in training and innovations in response to these tensions. Results: Medical educators identified tension in teaching IMGs as it could be different to teaching domestic graduates in any or all aspects of a training program. They felt an ethical responsibility to support IMGs to provide quality health care in their adopted country but faced multiple challenges to achieve this. They described initiatives to address these throughout GP training. Conclusions: IMG's differing educational needs will benefit from flexible individualized adaptation of training programs.
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Affiliation(s)
- Susan M Wearne
- Academic Unit of General Practice, Australian National University , Canberra , Australia
| | - James B Brown
- Eastern Victoria General Practice Training , Churchill , Australia
| | - Catherine Kirby
- Eastern Victoria General Practice Training , Churchill , Australia
| | - David Snadden
- Northern Medical Program, University of British Columbia , British Columbia , Canada
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Eriksson E, Berg S, Engström M. Internationally educated nurses' and medical graduates' experiences of getting a license and practicing in Sweden - a qualitative interview study. BMC MEDICAL EDUCATION 2018; 18:296. [PMID: 30518350 PMCID: PMC6282362 DOI: 10.1186/s12909-018-1399-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/22/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND The Swedish healthcare system has an increased need for nurses and physicians, and the number of International Educated Nurses (IENs) and International Medical Graduates (IMGs) seeking job opportunities and a license to practice in Sweden is rising. This study explored how IENs and IMGs describe their experience of getting a license to practice, their perceptions of working in Sweden and of how their intercultural competence is utilized. METHOD A qualitative study based on semi-structured interviews with 11 IENs and 11 IMGs. The interviews were conducted between 2015 and 2017. The data were analyzed using qualitative content analysis. RESULTS Three main themes were identified: 'Getting a license - a different story,' 'The work is familiar, yet a lot is new,' 'Trying to master a new language.' The time to obtain a license to practice and finding a job was shorter for IENs and IMGs coming from European countries than for those from non-European countries. Some of the experiences of getting a license to practice and of entering a new workplace in another country were the same for nurses and physicians. In general, both IENs and IMGs felt welcomed and used their intercultural competence at work. Lack of language skills was regarded as the main problem for both professions, while workplace introduction was shorter for IMGs than for IENs. CONCLUSIONS Problems related to language and culture are often underestimated, therefore organizations and managers employing IENs and IMGs should provide longer workplace introduction to facilitate the acculturation process. More time-efficient language courses specifically adapted to IENs and IMGs could make the transition easier and shorten the time to obtain a license to practice for both professions.
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Affiliation(s)
- Elisabet Eriksson
- Department of Health and Caring Sciences, University of Gävle, Kungsbäcksvägen 47, 801 76 Gävle, Sweden
| | - Sören Berg
- Department of Medicine and Health Sciences, Department of Cardiothoracic Surgery, Linköping University, County Council of Östergötland, Linköping, Sweden
| | - Maria Engström
- Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Nursing Department, Medicine and Health College, Lishui University, Lishui, China
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