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Turner A, Ryan M, Wolvaardt J. We know but we hope: A qualitative study of the opinions and experiences on the inclusion of management, health economics and research in the medical curriculum. PLoS One 2022; 17:e0276512. [PMID: 36269759 PMCID: PMC9586360 DOI: 10.1371/journal.pone.0276512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022] Open
Abstract
The achievement of global and national health goals requires a health workforce that is sufficient and trained. Despite considerable steps in medical education, the teaching of management, health economics and research skills for medical doctors are often neglected in medical curricula. This study explored the opinions and experiences of medical doctors and academic educationalists on the inclusion of management, health economics and research in the medical curriculum. A qualitative study was undertaken at four medical schools in Southern Africa (February to April 2021). The study population was medical doctors and academic educationalists. Semi-structured interviews with purposively sampled participants were conducted. All interviews were recorded and professionally transcribed. Constructivist grounded theory guided the analysis with the use of ATLAS.ti version 9.1.7.0 software. In total, 21 academic educationalists and 28 medical doctors were interviewed. In the first theme We know, participants acknowledged the constraints of medical schools but were adamant that management needed to be taught intentionally and explicitly. The teaching and assessment of management and health economics was generally reported to be ad hoc and unstructured. There was a desire that graduates are able to use, but not necessarily do research. In comparison to management and research, support for the inclusion of health economics in the curriculum was insignificant. Under We hope, educationalists hoped that the formal clinical teaching will somehow instil values and best practices of management and that medical doctors would become health advocates. Most participants wished that research training could be optimised, especially in relation to the duration of allocated time; the timing in the curriculum and the learning outcomes. Despite acknowledgement that management and research are topics that need to be taught, educationalists appeared to rely on chance to teach and assess management in particular. These qualitative study findings will be used to develop a discrete choice experiment to inform optimal curricula design.
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Affiliation(s)
- Astrid Turner
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- * E-mail:
| | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, King’s College, Aberdeen, Scotland
| | - Jacqueline Wolvaardt
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Medical Students’ Perception Regarding Health Policy Teaching and Their Participation in Health Policy Roles: A Survey at a Public University in Malaysia. Healthcare (Basel) 2022; 10:healthcare10060967. [PMID: 35742019 PMCID: PMC9223141 DOI: 10.3390/healthcare10060967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/14/2022] [Accepted: 05/21/2022] [Indexed: 01/09/2023] Open
Abstract
Background: Health policy is a set of comprehensive principles and legislations that guide how healthcare should be effectively delivered in the community. Medical schools should prepare students to undertake managerial responsibilities by incorporating health policy into the curriculum to deal with the intricacies of healthcare systems and their clinical roles in their future professional careers. Objective: To examine medical students’ perception at a Public University in Malaysia regarding teaching health policy and their participation in health policy roles. Material and Methods: A cross-sectional study using universal sampling was carried out among the medical students using a paper-based questionnaire to collect the data. Results: Most respondents opined their willingness to learn health policy (80.9%) and that teaching health policy (83.6%) should be compulsory for medical students. The respondents thought health policy should be introduced earlier in Year 1 or 2. The student scores on their knowledge regarding health policy and year of study were significantly associated with their involvement in the health policy roles in both the simple and multiple logistic regression. Both statistical tests reported higher participation in health policy roles with the higher year of study, though only Year 4 and 5 were significant in the simple logistic regression and only Year 5 in the multiple logistic regression compared to Year 1. On the other hand, age and type of admission show significant results only in the simple logistic regression, while the race was only significant at the multivariate level. Conclusions: This study demonstrated that most respondents showed their willingness to learn health policy, participate in the health policy programs, and recommend that health policy be considered an essential topic in the medical curriculum, which should be taught right from the first year of medical school. We recommend encouraging students’ participation in health policy activities.
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How to fairly allocate scarce medical resources? Controversial preferences of healthcare professionals with different personal characteristics. HEALTH ECONOMICS POLICY AND LAW 2021; 17:398-415. [PMID: 34108069 DOI: 10.1017/s1744133121000190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The scarcity of medical resources is widely recognized, and therefore priority setting is inevitable. This study examines whether Portuguese healthcare professionals (physicians vs nurses): (i) share the moral guidance proposed by ethicists and (ii) attitudes toward prioritization criteria vary among individual and professional characteristics. A sample of 254 healthcare professionals were confronted with hypothetical prioritization scenarios involving two patients distinguished by personal or health characteristics. Descriptive statistics and parametric analyses were performed to evaluate and compare the adherence of both groups of healthcare professionals regarding 10 rationing criteria: waiting time, treatment prognosis measured in life expectancy and quality of life, severity of health conditions measured in pain and immediate risk of dying, age discrimination measured in favoring the young over older and favoring the youngest over the young, merit evaluated positively or negatively, and parenthood. The findings show a slight adherence to the criteria. Waiting time and patient pain were the conditions considered fairer by respondents in contrast with the ethicists normative. Preferences for distributive justice vary by professional group and among participants with different political orientations, rationing experience, years of experience, and level of satisfaction with the NHS. Decision-makers should consider the opinion of ethicists, but also those of healthcare professionals to legitimize explicit guidelines.
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Zhao X, Goldman E, Banani T, Kline K, Brown K, Lee J, Jurjus RA. The process of curricular integration and its effects on anatomical knowledge retention. Clin Anat 2020; 33:960-968. [PMID: 32449191 DOI: 10.1002/ca.23632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Integration has been recognized as an important aspect of medical education. After transitioning from a discipline-specific to a systems-based preclinical curriculum, we examined faculty perceptions of the integrated approach and also whether it would lead to better anatomy knowledge retention. METHODS To understand faculty perspectives, we reviewed curricular materials, interviewed block directors, and observed educational sessions. We analyzed knowledge retention through a 27-question anatomy test, comparing scores from the last class of the discipline-based curriculum and the first two classes of the integrated curriculum. RESULTS Planning integrated content involves purposeful ordering, is challenging for faculty, and requires additional resources. Evaluation of the integrated approach for anatomy content demonstrated a significant increase in knowledge retention (p = .012; 56.28% vs. 63.98% for old vs. new curriculum). CONCLUSIONS This study helps the understanding of what is required for curricular integration. Our anatomy evaluation results corroborated the view that contextually embedded information is easier to learn and retain.
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Affiliation(s)
- Xian Zhao
- Division of Pediatric Emergency Medicine, Children's National Health System, Washington, District of Columbia, USA
| | - Ellen Goldman
- Department of Human and Organizational Learning, Graduate School of Education and Human Development, George Washington University, Washington, District of Columbia, USA
| | - Tara Banani
- Department of Anatomy and Cell Biology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Kathleen Kline
- Office of Medical Education, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Kirsten Brown
- Department of Anatomy and Cell Biology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Juliet Lee
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Rosalyn A Jurjus
- Department of Anatomy and Cell Biology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Da'ar OB, Al-Mutairi T. How do patient demographics, time-related variables, reasons for cancellation, and clinical procedures affect frequency of same-day operating room surgery cancelation? A maximum likelihood method. BMC Health Serv Res 2018; 18:454. [PMID: 29903002 PMCID: PMC6003070 DOI: 10.1186/s12913-018-3247-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 05/29/2018] [Indexed: 11/17/2022] Open
Abstract
Background Cancelation of same-day surgery is a common global problem, wasting valuable hospitals’ operating room (OR) times and imposing significant economic costs. There is limited evidence to support the association between frequency of same-day surgery cancelation and patient demographics, time-related variables, healthcare provider reasons for cancelation, and clinical procedures in Saudi Arabia. The aim of this study was to explore this relationship, providing an understanding of the local context. Methods A retrospective cross-sectional study that retrieved medical records to examine the association between the frequency of same-day surgery cancelation and covariates including patient demographics, time-related variables, healthcare provider reason for cancelation, and clinical procedures. The data covered from January 2014 to December 2014 at King Fahad National Guard Hospital in Riyadh. We considered 440 patients that met the inclusion criteria for final analysis. The cancelation was regarded less frequent if a patient canceled once in the12 months and more frequent if a patient canceled two times or more in the same period. We used descriptive statistics to summarize data and employed a probit regression to estimate the association of frequency of same-day surgery cancelation and covariates via maximum likelihood method. King Abdullah International Medical Research Center granted the institutional approval. Results Our study suggests that while reasons of unavailability of OR time were associated with less frequent same-day surgery cancelation, scheduling issues were linked to more frequent cancelations, compared with reasons for patients being unwell on the day of surgery. Waiting time of more than six hours and morning sessions were associated with less frequent cancelations compared to shorter waiting time and afternoon sessions. Compared to general procedures, specialized clinical procedures were associated with cancelations that are more frequent. Further, female patients were more likely to have more cancelations. Finally, being married was associated with the less frequent cancelation of same-day surgery. Conclusion Our findings provide evidence of determinants of the frequency of same-day surgery cancelations. This study draws several important implications for hospitals, especially on optimal utilization of resources and minimization of same-day surgery cancellations. The study also offers several recommendations that we believe will spur future research.
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Affiliation(s)
- Omar B Da'ar
- Department of Health Systems & Quality Management, College of Public Health & Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia. .,Graduate School of Professional Studies, St. Mary's University of Minnesota, Minneapolis, MN, USA.
| | - Talal Al-Mutairi
- King Fahad Hospital, King Abdulaziz Medical City, National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
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Da'ar OB, Alshaya A. Is it cost-beneficial to society? Measuring the economic worth of dental residency training. EVALUATION AND PROGRAM PLANNING 2018; 68:117-123. [PMID: 29549781 DOI: 10.1016/j.evalprogplan.2018.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 02/07/2018] [Accepted: 02/16/2018] [Indexed: 06/08/2023]
Abstract
This study estimated whether continued programming of a highly specialized four-year dentistry residency training in Saudi Arabia was cost-beneficial. We utilized a purposive sampling to administer a survey to trainees in major cities. Additionally, we used publically available market information about general practitioners. We employed Benefit-Cost Analysis accounting approach as a conceptual framework. Using general practitioners as the base category, we grouped overall social analytical perspectives into resident trainees and rest of society. The residency program was cost-beneficial to trainees, realizing an estimated return of SR 4.07 per SR 1 invested. The overall societal return was SR 0.98 per SR 1 invested, slightly shy of a bang for the buck, in part because the public sector largely runs the training. Benefits included increased earnings and enhanced restorative dentistry skills accruing to trainees; increased charitable contributions and programming-related payments accruing to programs and the public; and practice-related payments accruing to governmental, professional, and insurance agencies. Rest of society, notably government underwrote much of the cost of programming. A sensitivity analysis revealed the results were robust to uncertainties in the data and estimation. Our findings offer evidence to evaluate whether continued residency training is cost-beneficial to trainees and potentially to overall society.
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Affiliation(s)
- Omar B Da'ar
- Department of Health System & Quality Management, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia.
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Da'ar OB, El-Metwally A, Abu-Saris R, Jazieh AR. A finite and stable exponential growth-adjusted indirect cost of cancer associated with discounted years of life lost in Saudi Arabia. Heliyon 2018; 4:e00637. [PMID: 29872769 PMCID: PMC5986542 DOI: 10.1016/j.heliyon.2018.e00637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 05/17/2018] [Accepted: 05/23/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The risk of getting cancer before full life expectancy and mortalities per year are on the rise in Saudi Arabia. Yet, evidence of economic burden of cancer in the country remains largely unknown. In order to provide evidence, we attempted to estimate the economic burden in terms of indirect cost associated with premature cancer deaths among the active or potentially economically active population aged 15-60 years in Saudi Arabia. METHOD Within the framework of the World Health Organization guide of identifying the economic consequences of disease and injury, our method employs cost-of-illness approach. This approach is based on a macroeconomic model that estimates the indirect cost of cancer in terms of total non-health gross domestic product resource loss associated with a disease. We used epidemiological, health system, and macroeconomic data for our estimation. We discounted the net loss at 3% and computed an extension of the loss with a finite and stable upper limit proxied by non-health gross domestic product per capita. We carried out separate analyses for male and female. We conducted sensitivity analyses to account for uncertainties of epidemiological and economic factors on the robustness of the estimated economic burden. We varied the proportion of total cancer deaths, discount rate, and value of health expenditure per capita by ±20%. We further determined which of these factors or parameters had the greatest uncertainty or variation on the net present value total non-health gross domestic product resource loss per Capita. RESULTS Our results indicate the indirect cost associated with cancer deaths among Saudi population aged 15-60 years to be Int$ 2.57 billion of which Int$ 1.46 billion (57%) was accounted for by females. The total indirect loss of cancer deaths increased by 8% to Int$ 2.77 billion when the loss is allowed to grow with a finite and stable upper limit proxied by non-health gross domestic product per capita over the discounted years of life lost per a death among female and male respectively. Much of the uncertainty in the determination of the value of the loss was accounted for by the proportion of total cancer deaths and discount rate, while health expenditure per capita was responsible for the least variability. CONCLUSION Our findings reveal evidence of indirect cost associated with cancer premature deaths in Saudi Arabia. In order to develop cancer control actions, the results of this study can inform health system policymakers not only of the extent of the enormous economic burden but also drawing attention to epidemiological and economic factors that explain the variability of the burden.
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Affiliation(s)
- Omar B. Da'ar
- College of Public Health & Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
- Graduate School of Professional Studies, St. Mary's University of Minnesota, USA
| | - Ashraf El-Metwally
- College of Public Health & Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
- University of Tampere, Tampere, Finland
| | - Raghib Abu-Saris
- College of Public Health & Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Abdul Rahman Jazieh
- Oncology Department, King Abdulaziz Medical City, National Guard Health Affairs Hospital, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
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