Attracting and retaining physicians in less attractive specialties: the role of continuing medical education

The influence of internship training experience on Kenyan and Ugandan doctors' career intentions and decisions: a qualitative study

BACKGROUND

Medical internship is a key period for doctors' individual career planning and also a transition period for the broader labour market.

OBJECTIVES

We aimed to understand the complex set of factors influencing the career intentions and decisions of junior doctors, post-internship in Kenya and Uganda.

METHODS

We conducted semi-structured interviews with 54 junior medical officers and 14 consultants to understand doctors' internship experiences and subsequent employment experiences. We analysed the data using a mix of a direct content approach, informed by an internship experience and career intentions framework developed primarily from high-income country literature, alongside a more inductive thematic analysis.

RESULTS

Echoing the internship experience and career intentions framework, we found that clinical exposure during internship, work-life balance, aspects of workplace culture such as relationships with consultants and other team members, and concerns over future job security and professional development all influenced Kenyan and Ugandan doctors' career preferences. Additionally, we added a new category to the framework to reflect our finding that interns might want to 'fill a health system gap' when they choose their future careers, based on what they witness as interns. However, often career intentions did not match career and employment decisions due to specific contextual factors, most importantly a shortage of job opportunities.

CONCLUSION

We have shown how internship experiences shape medical doctors' career intentions in Kenya and Uganda and highlighted the importance of job availability and context in influencing doctors' career choices.

Job preference of preventive medicine students during the COVID-19 pandemic: a discrete choice experiment survey in Shandong Province, China

BACKGROUND

Public health workers are a crucial part of the health workforce, particularly during the coronavirus disease (COVID-19) pandemic. They play an important role in achieving universal health coverage and sustainable development goals. Human resources in public health in China are in short supply, their distribution is unequal, and their turnover rate is high. A discrete choice experiment (DCE) was applied to investigate preventive medicine students' preferred job choice criteria and trends in trade-offs by calculating the marginal rate of substitution between these criteria. This study identified the properties of jobs primarily selected by preventive medicine students and estimated the monetary value of each attribute.

METHODS

Based on discussions and in-depth interviews with preventive medicine students and a literature review, we developed a DCE that assessed how students' stated preferences for a certain choice were influenced by several job attributes, including location, salary, bianzhi, career development opportunities, working environment, and workload. We applied this DCE to preventive medicine students in Shandong Province, China, using a brief, structured questionnaire. Conditional logit models were used to estimate the utility of each job's attributes. Willingness to pay (WTP) was estimated as the ratio of the value of the coefficient of interest to the negative value of the cost attribute.

RESULTS

A total of 307 respondents completed the questionnaire, and 261 passed the internal consistency test. All the attributes were statistically significant. Career development opportunities and work locations were the most important factors for the respondents. Preference heterogeneity existed among respondents, e.g., 3-year medical education college students placed a higher value on jobs with bianzhi compared to 5-year medical education college students. Furthermore, rural students' WTP for a job located in the county or city is much lower than that of urban students.

CONCLUSIONS

The heterogeneity of attributes indicates the complexity of job preferences. Monetary and nonmonetary job characteristics significantly influenced the job preferences of preventive medicine students in China. A more effective policy intervention to attract graduates to work in rural areas should consider both job incentives and the backgrounds of preventive medicine graduates.

"We don't need no education" - a qualitative study of barriers to continuous medical education among Danish general practitioners

BACKGROUND

Continuous medical education is essential for the individual patient care, the society, and the wellbeing of the general practitioner. There has been research into the reasons for participation in continuous medical education, but little is known about the barriers to participation. To tailor continuous medical education targeting general practitioners who are currently deselecting education, systematic knowledge of the barriers is needed. Continuous medical education can in addition to professional growth stimulate job satisfaction, diminish burnout, and reinforce feelings of competence. Continuous medical education may have positive implications for patients and for healthcare expenditures. Despite renumeration and a comprehensive continuous education model some Danish general practitioners do not participate in continuous medical education.

METHODS

From a total of 3440 Danish general practitioners 243 did not apply for reimbursement for accredited continuous medical education in a two-year period. Ten general practitioners were selected for an interview regarding maximum variation in practice form, number of listed patients, seniority as a general practitioner, geography, gender, and age. All ten selected general practitioners accepted to be interviewed. The interviews were analysed using Systematic Text Condensation.

RESULTS

Each of the ten interviewed general practitioners mentioned several barriers for participating in continuous education. The barriers fell into three main categories: barriers related to the individual general practitioner barriers related to the clinic barriers related to the accredited continuous medical education offered CONCLUSIONS: Approximately 7% of the Danish general practitioners did not participate in accredited remunerated continuous medical education. A knowledge of the barriers for participating in accredited continuous medical education can be used to better target continuous medical education to the general practitioners.

Evolution of teaching in short-term courses: A systematic review

Short-term courses are a useful tool for continuous training to update and deepen knowledge in various fields. In this article, we analyse the evolution of the teaching methods used in short-term courses through a systematic review conducted using the PRISMA methodology. The inclusion criteria for selecting articles were those that described the methodological structure of the teaching methods used in designing short-term courses. The exclusion criteria were courses longer than 90 days and unfinished documents. The search was conducted on April 9, 2022, using the SCOPUS database. The list of papers was reviewed and analysed three times by different researchers to ensure that they met the criteria. Articles approved by at least two researchers were selected. The results were systematically analysed based on criteria that allowed us to understand the learning methods used, such as the educational modality, content presentation, teaching methodology for teamwork and individual work, technological resources, and assessment methods. We selected 42 articles, and the results are presented in four parts: the learning experience, teaching methodology, technological resources, and assessment methods. One of the main findings is that short-term courses are primarily designed for experiential learning, and memory-related activities commonly used in traditional training are not typically included in short-term courses.

"I'm 'just' a community pediatrician" views and challenges of pediatricians working in the community in Israel

BACKGROUND

There are ongoing changes around the world in the training and practice of pediatricians who work in the community. These changes are driven by the understanding that pediatricians are required to provide not only acute primary care but also to address more comprehensive concerns, particularly the 'new morbidities'. The present study examines the professional identity of Israeli pediatricians in the community in light of these changes, the barriers and challenges to their work and professional adaptations in the field.

METHODS

We used a mixed-methods approach, collecting the perspectives of 137 pediatricians who work in the community through an anonymous online survey, followed by in-depth semi-structured interviews with 11 community pediatricians.

RESULTS

The survey results show that community pediatricians in Israel have limited knowledge on a variety of developmental, behavioral and emotional issues; that they lack working relationships with medical or other professionals; and are rarely engaged with other community services. Three main themes arose from the interviews that support and deepen the survey results: perceptions of the profession (pediatrics in the community vs. community pediatrics), the stature of pediatricians in the community (during residency, the choice to work in the community, their daily work) and barriers and change in community pediatrics (isolation, limited resources and challenges arising from the nature of community work).

CONCLUSIONS

The present study sheds light on the professional identity and the day-to-day challenges and successes of pediatricians working in the community. Continuing medical education, providing a supportive framework and professional community, better resources, more time with patients, and tools and opportunities for professional development would help pediatricians who work in the community to overcome some of these challenges. The research findings reinforce the need for policy change in the field of community pediatrics with a specific community training curriculum, provision of more resources and ongoing support for pediatricians. This requires partnership between the HMOs, the Ministry of Health, the Scientific Council (Israel Medical Association, professional organizations) and NGOs in order to turn individual-level solutions into system-level and policy-changing solutions.

Mapping the current state of the medical specialties in laboratory medicine in Italy

Laboratory medicine is the single highest volume medical activity and it plays an increasingly essential role in the modern healthcare systems. In vitro diagnostic tests are now used in virtually every aspect of the patient care, including disease prevention, diagnosis, disease monitoring as well as personalised medicine. Nevertheless, the profession of laboratory medicine differs between countries in many respects, such as specialist training (medical or scientific), fields of interest, responsibilities and professional organisation. Many attempts have been made to quantify the role of laboratory medicine in patient outcomes, but the precise figures are still not clear. Moreover, the relative contribution of medical specialists in laboratory medicine is not well known and somehow controversial. To start exploring these aspects, we studied the current state of the two medical specialties that make up the majority of laboratory medicine in Italy: clinical pathology and medical microbiology. Our analysis revealed that both specialties suffer from a low attractivity among postgraduate physicians, and suggest that a restructuring of the training programme and professional reorganisation should be considered.

Exploring employment preferences of nurses to improve retention in rural China

BACKGROUND

The scarcity of nurses in rural China deserves serious consideration in light of the widening gap in health outcomes between rural and urban populations. The outflow of primary care nurses suggests the value of examining their employment preferences to identify possible effective incentives for their retention.

METHODS

Our research used discrete choice experiment methodology designed to quantitatively measure the relative importance of various job attributes valued by primary care nurses using conditional logit and mixed logit models. Willingness to pay and uptake rates were also calculated.

RESULTS

A total of 1744 registered nurses in township health centres were surveyed. Participants considered all the job attributes included in the study to be significant, with pay increases demonstrating the greatest potential to improve the retention of nurses. Among the non-monetary aspects of work, nurse-patient relationships, bianzhi (positions allocated to each unit by the Chinese government with special benefits) and educational opportunities ranked highest in importance for respondents. Responses to hypothetical policy proposals suggest that incentive packages are also likely to be effective.

CONCLUSIONS

Policy making regarding rural nurses' retention is an important undertaking that requires an evidence-based approach. Our findings provide a range of policy options that shed light on effective retention strategies. Tailoring policy incentives to primary care nurses is also necessary.

Continuing medical education for general practitioners in Indonesia: Moving toward accountability

OBJECTIVE

The purpose of this study is to determine the effect of an online continuing medical education model on the learning outcomes of general practitioners (GPs) in Indonesia.

METHODS

The method used in this research is a pre-experimental pre-test, post-test group design. 1449 GPs originating from the major islands of Indonesia participated in this study. One hundred fifty questions from 10 disease systems were prepared for the pre-test and post-test with a total score of 100. The results of the pre-test and post-test were tested with paired sample t-test and Independent t-test.

RESULTS

The paired sample t-test revealed significant differences in the learning outcomes of GPs before and following the online module's continuing medical education approach. What is remarkable is the disparity in average post-test results between GPs in West and East Indonesia. The independent t-test revealed that the average post-test score of general practitioners in western Indonesia was higher than that of general practitioners in eastern Indonesia.

CONCLUSION

The findings of this study suggest that continuing medical education in the form of online learning can help general practitioners enhance their knowledge and abilities in disease management. This paradigm of online continuing medical education could be adapted for other professions.

Peer coaching increases emergency medicine faculty ability to perform and teach awake fiberoptic intubation

OBJECTIVES

This study sought to evaluate the impact of peer coaching as a continuing medical education (CME) modality to improve faculty performance and teaching of a low-frequency, high-complexity procedure, awake fiberoptic intubation (AFOI).

METHODS

Academic emergency medicine faculty at a single tertiary care, Level I trauma center participated in a prospective pre-/postinterventional assessment of a peer coaching educational intervention. Participants completed a preintervention online survey to identify comfort and previous experience with performing and teaching AFOI. The participants reviewed presession materials and then completed a 25-min didactic session with a peer coach. Participants were then broken into dyads where they initially each practiced the procedure and then attempted to teach the procedure to their colleague. An institutional standardized checklist for AFOI was utilized to assess participants procedural competency. Postintervention online surveys were compared to the preintervention surveys.

RESULTS

A total of 15 faculty members were recruited for the study and completed pre- and postintervention surveys. All participants showed ability to perform AFOI as proven by successful completion of the procedural checklist. There was a statistically significant increase for self-perceived efficacy in performing (p < 0.001, 95% confidence interval [CI] = 1.34 to 3.06) and teaching AFOI (p < 0.001, 95% CI = 1.56 to 3.05). All participants felt more likely to attempt AFOI after a single peer coaching session and most (14/15, 93.3%) were more likely to teach AFOI. Participants identified peer coaching as more effective at instilling confidence to perform and teach the skill than other CME activities that they have experienced.

CONCLUSION

This study demonstrates that peer coaching increases practicing faculty's ability to perform and teach a low-frequency, high-complexity procedure, AFOI. Peer coaching may offer an opportunity to improve the utility of learning compared to more traditional didactic-based CME initiatives.