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Jessup B, Tran N, Stevens T, Allen P, Barnett T. Towards a home-grown rural health workforce: Evidence from Tasmania, Australia. Aust J Rural Health 2024; 32:976-986. [PMID: 39044449 DOI: 10.1111/ajr.13169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 06/14/2024] [Accepted: 07/04/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVE To examine the association between place of origin and principal place of practice (PPP) of domestic Tasmanian health graduates who received end-to-end training with the University of Tasmania (UTAS). METHODS The 2022 PPP for all UTAS domestic Tasmanian graduates from medicine, nursing, pharmacy, psychology, medical radiation science and paramedicine between 2011 and 2020 was identified using the online Australian Health Practitioner Regulation Agency (Ahpra) registration database. The graduate's place of origin (home address at the time of course application), together with their 2022 PPP, was described using the Modified Monash Model (MM) classification system of remoteness. Data were analysed using STATA. RESULTS Over the 10-year period, 4079 domestic Tasmanians graduated from health courses at UTAS, of which 3850 (94.4%) were matched to an Australian PPP. In all, 78.3% of graduates were working in Tasmania, while the remainder (21.7%) were employed interstate. Of those with a Tasmanian PPP, 81.4% were working in a regional setting (MM2), while 77.6% of interstate employed graduates recorded a metropolitan (MM1) PPP. Rural place of origin (MM3-7) was associated with rural employment (MM3-7) in both Tasmania (OR, 37.08; 95% CI 29.01-47.39, p < 0.001), and on the Australian mainland (OR, 21.4; 95% CI 17.4-26.3, p < 0.001). CONCLUSIONS Most domestic Tasmanian origin UTAS health graduates contribute to the state's health workforce after qualifying. Further research is needed to explore PPP over time and to understand why some graduates are motivated to seek employment on the Australian mainland and in particular, metropolitan cities.
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Affiliation(s)
- B Jessup
- Centre for Rural Health, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - N Tran
- Centre for Rural Health, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - T Stevens
- Centre for Rural Health, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - P Allen
- Centre for Rural Health, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - T Barnett
- Centre for Rural Health, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
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Tran M, Ralston A, Holliday E, Tapley A, Fielding A, Moad D, Ledger J, Wearne S, Davey A, van Driel M, Ball J, Moran V, Dizon J, Magin P. General practice registrars' practice in outer metropolitan Australia: a cross-sectional comparison with rural and inner metropolitan areas. Aust J Prim Health 2024; 30:PY23100. [PMID: 39270058 DOI: 10.1071/py23100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/27/2024] [Indexed: 09/15/2024]
Abstract
Background General practice training in outer metropolitan (OM) areas contributes to patients' access to care. Differences in clinical practice and training in rural versus urban areas have been established, but less is known about OM versus inner metropolitan (IM) differences - whether they offer a trainee learning experience of populations with distinct demographics and healthcare characteristics. This study sought to identify the characteristics and associations of general practice training in New South Wales and Australian Capital Territory OM areas, compared to IM and rural areas. Methods Cross-sectional analyses of data (2016-2020) from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing cohort study of Australian GP registrars' in-consultation clinical and educational experience and behaviours, were performed. Multinomial logistic regression assessed associations of rural/OM/IM practice location with registrar and practice factors, patient factors, consultation content factors and consultation action factors. Results Overall, 1308 registrars provided data from 177,026 consultations. For several variables, there was a pattern in the differences of associations across rural/OM/IM areas. Experience of care of older patients and Aboriginal and/or Torres Strait Islander health were more likely in OM than IM areas. Care of patients from non-English speaking background was more likely in OM than in rural areas. Possible markers of healthcare access (specialist referrals, and pathology and imaging requests) were less likely in OM than in both IM and rural areas. Conclusions OM areas are distinct (and educationally rich) clinical learning environments, with distinct demographic characteristics and seeming healthcare access limitations. This finding has implications for workforce support and health resource allocation.
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Affiliation(s)
- Michael Tran
- Discipline of General Practice, University of New South Wales, Wallace Wurth Building (C27), Corner High Street and Botany Street, Kensington, NSW 2052, Australia
| | - Anna Ralston
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; and NSW and ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia
| | - Amanda Tapley
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; and NSW and ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Alison Fielding
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; and NSW and ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Dominica Moad
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; and NSW and ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Jocelyn Ledger
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; and NSW and ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Susan Wearne
- Academic Unit of General Practice, Australian National University, The Canberra Hospital, Yamba Drive Garran, ACT 2605, Australia; and Health Workforce Division, Australian Government Department of Health, Sirius Building, Furzer Street, Woden Town Centre, ACT 2606, Australia
| | - Andrew Davey
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; and NSW and ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Mieke van Driel
- General Practice Clinical Unit, Faculty of Medicine, University of Queensland, Level 8, Health Sciences Building, Royal Brisbane & Women's Hospital, Brisbane, Qld 4029, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Vanessa Moran
- NSW and ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Jason Dizon
- Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Parker Magin
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; and NSW and ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
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Cheung BK, Anderson JG, Giles AJ, Martin P. Experiences of pursuing an intensivist career in regional and rural Australia: An interview study. Anaesth Intensive Care 2024; 52:223-231. [PMID: 38879796 DOI: 10.1177/0310057x241242813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
The regional and rural intensivist workforce is vital to delivering high standards of healthcare to all Australians. Currently, there is an impending workforce disaster, with higher senior medical officer vacancy rates among regional and rural intensive care units, with these units being staffed by junior doctors who are in earlier stages of their training, which in turn increases supervisory burden. There is a lack of comprehensive literature on the barriers and enablers of training, recruiting and retaining regional and rural intensivists. To address this gap, a qualitative study was conducted, involving 13 in-depth, structured interviews with full-time and part-time intensivists from eight Australian regional and rural hospitals. Content analysis of the interview data resulted in the identification of four major categories: unique practice context, need for a broad generalist skill set, perks and challenges of working in a regional/rural area and workforce implications. The study findings revealed that regional and rural intensive care practice offers positive aspects, including work satisfaction, supportive local teams and an appealing lifestyle. However, these benefits are counterbalanced by challenges such as a heavier burden of on-call work, a higher proportion of junior staff which increase supervisory burden and limited access to subspecialist services. The implications of these findings are noteworthy and can be utilised to inform government policies, hospitals, the College of Intensive Care Medicine and the Australian and New Zealand College of Anaesthetists in developing strategies to enhance the provision of intensive care services and improve workforce planning in regional and rural areas.
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Affiliation(s)
- Benjamin K Cheung
- Intensive Care Unit, St Vincent's Hospital Toowoomba, Toowoomba, Australia
- Rural Clinical School, The University of Queensland, Toowoomba, Australia
| | - James G Anderson
- Rural Clinical School, The University of Queensland, Toowoomba, Australia
| | | | - Priya Martin
- Rural Clinical School, The University of Queensland, Toowoomba, Australia
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Somerville JG, Strang NC, Jonuscheit S. Task-shifting and the recruitment and retention of eye care workers in under-served areas: a qualitative study of optometrists' motivation in Ghana and Scotland. Prim Health Care Res Dev 2024; 25:e30. [PMID: 38818764 PMCID: PMC11362676 DOI: 10.1017/s1463423624000185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/22/2023] [Accepted: 02/22/2024] [Indexed: 06/01/2024] Open
Abstract
AIM To assist policy-makers in improving access to eye care in under-served areas by analysing the relationship between motivational factors affecting the uptake of task-shifting in eye care and the recruitment and retention of optometrists in remote and rural areas. BACKGROUND The World Health Organization recommends two key strategies in tackling preventable blindness in under-served areas: improving human resources for health and task-shifting. The relationship between task-shifting and recruitment and retention of eye care workers in under-served areas is unknown. Ghana and Scotland are two countries from different levels of economic development that have notably expanded the roles of optometrists and struggle with rural recruitment and retention. METHODS Motivation was explored through semi-structured interviews with 19 optometrists in Ghana and Scotland with experience in remote and rural practice. Framework analysis was used to analyse interviews, explore the relationship between task-shifting and recruitment and retention and create recommendations for policy. FINDINGS The main motivational considerations included altruism, quality of life, learning and career opportunities, fulfilling potential, remuneration, stress of decision-making and collaboration. Motivational and demotivational factors for task-shifting and recruitment/retention shared many similar aspects. DISCUSSION Recruitment and retention in remote and rural areas require staff be incentivised to take up those positions, motivated to remain and given the adequate resources for personal and professional fulfilment. Task-shifting also requires incentivisation, motivation to continue and the resources to be productive. Many motivational factors influencing recruitment/retention and task-shifting are similar suggesting these two strategies can be compatible and complementary in improving access to eye care, although some factors are culture and context specific. Understanding optometrists' motivation can help policy-makers improve rural recruitment and retention and plan services.
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Affiliation(s)
- Joel G. Somerville
- Glasgow Caledonian University, Glasgow, UK
- University of the Highlands and Islands, Inverness, UK
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Chekar CK, Brewster L, Lambert M, Patel T. Gender, flexibility and workforce in the NHS: A qualitative study. Int J Health Plann Manage 2024; 39:740-756. [PMID: 38321952 DOI: 10.1002/hpm.3784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/11/2024] [Accepted: 02/01/2024] [Indexed: 02/08/2024] Open
Abstract
Data from the General Medical Council show that the number of female doctors registered to practise in the UK continues to grow at a faster rate than the number of male doctors. Our research critically discusses the impact of this gender-based shift, considering how models of medical training are still ill-suited to supporting equity and inclusivity within the workforce, with particular impacts for women despite this gender shift. Drawing on data from our research project Mapping underdoctored areas: the impact of medical training pathways on NHS workforce distribution and health inequalities, this paper explores the experiences of doctors working in the NHS, considering how policies around workforce and beyond have impacted people's willingness and ability to continue in their chosen career path. There is clear evidence that women are underrepresented in some specialties such as surgery, and at different career stages including in senior leadership roles, and our research focuses on the structural factors that contribute to reinforcing these under-representations. Medical education and training are known to be formative points in doctors' lives, with long-lasting impacts for NHS service provision. By understanding in detail how these pathways inadvertently shape where doctors live and work, we will be able to consider how best to change existing systems to provide patients with timely and appropriate access to healthcare. We take a cross-disciplinary theoretical approach, bringing historical, spatiotemporal and sociological insights to healthcare problems. Here, we draw on our first 50 interviews with practising doctors employed in the NHS in areas that struggle to recruit and retain doctors, and explore the gendered nature of career biographies. We also pay attention to the ways in which doctors carve their own career pathways out of, or despite of, personal and professional disruptions.
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Affiliation(s)
| | - Liz Brewster
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Michael Lambert
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Tasneem Patel
- Lancaster Medical School, Lancaster University, Lancaster, UK
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Lukaschek K, Sporkert A, Blank WA. [How to Motivate Medical Students to Practice in Rural Areas]. DAS GESUNDHEITSWESEN 2024; 86:274-280. [PMID: 38224695 PMCID: PMC11003249 DOI: 10.1055/a-2206-1684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
BACKGROUND The excellent project "LandArztMacher" is an attempt to work against the predicted shortage of rural doctors in Germany with diverse approaches. METHOD "LandArztMacher" is a clinical traineeship with four weeks of practical training in general practices and clinics in the Bavarian countryside, accompanied by joint professional teaching. Participants were asked before and after the internship about the topics "importance of an internship in rural areas"; "attractiveness of rural areas" (scale: 0/no agreement to 10/full agreement). Ideas about the tasks of a general practitioner were assessed (scale: 0/no idea at all to 100/exact idea). The present study is a repeated cross-sectional study. The median is reported as the location measure and the interquartile range as the dispersion measure. RESULTS Participants (n=363, 74% female, n=267, age: range 19-46 years, mean: 23.2 years, SD: 2.41 years) from the clinical section of the medical studies considered an internship in the rural area before and after the internship very important (median: 8 and 9, respectively) and could well imagine working in the countryside (median: 7 and 8, respectively). Their attitude towards the cultural offerings or the infrastructure did not change (median: 6 in each case). After the internship, the students had a more precise idea of what a general practitioner tasks are (median: 65 and 90, respectively). SUMMARY A well-structured four-week rural internship can enhance the appeal of future rural employment through individual supervision and collaborative training.
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Affiliation(s)
| | - Anna Sporkert
- Allgemeinmedizin, Gemeinschaftspraxis im Bayerwald, Kirchberg im Wald,
Germany
| | - Wolfgang A Blank
- Allgemeinmedizin, Gemeinschaftspraxis im Bayerwald, Kirchberg im Wald,
Germany
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Endalamaw A, Khatri RB, Erku D, Zewdie A, Wolka E, Nigatu F, Assefa Y. Barriers and strategies for primary health care workforce development: synthesis of evidence. BMC PRIMARY CARE 2024; 25:99. [PMID: 38539068 PMCID: PMC10967164 DOI: 10.1186/s12875-024-02336-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/11/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Having a sufficient and well-functioning health workforce is crucial for reducing the burden of disease and premature death. Health workforce development, focusing on availability, recruitment, retention, and education, is inseparable from acceptability, motivation, burnout, role and responsibility, and performance. Each aspect of workforce development may face several challenges, requiring specific strategies. However, there was little evidence on barriers and strategies towards comprehensive health workforce development. Therefore, this review explored barriers and strategies for health workforce development at the primary health care level around the world. METHODS A scoping review of reviews was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews. The article search was performed in Google Scholar, PubMed, Web of Science, and EMBASE. We used EndNote x9 for managing the collected articles, screening processes, and citation purpose. The scoping review included any kind of review articles on the application of health workforce development concepts, such as availability, recruitment, retention, role and responsibility, education and training, motivation, and burnout, with primary health care and published in English anywhere in the world. Based on the concepts above, barriers and strategies for health workforce development were identified. The findings were synthesized qualitatively based on the building blocks of the health system framework. The analysis involved specific activities such as familiarization, construction of the thematic framework, indexing, charting, and interpretation. The results were presented in texts, tables, and figures. RESULTS The search strategies yielded 7,276 papers were found. Of which, 69 were included in the scoping review. The most frequently cited barriers were financial challenges and issues related to health care delivery, such as workloads. Barriers affecting healthcare providers directly, including lack of training and ineffective teamwork, were also prominent. Other health system and governance barriers include lack of support, unclear responsibility, and inequity. Another notable barrier was the shortage of health care technology, which pertains to both health care supplies and information technology. The most common cited effective strategies were ongoing support and supervision, engaging with communities, establishing appropriate primary care settings, financial incentives, fostering teamwork, and promoting autonomous health care practice. CONCLUSIONS Effective leadership/governance, a robust health financing system, integration of health information and technology, such as mobile health and ensuring a consistent supply of adequate resources are also vital components of primary health care workforce development. The findings highlight the importance of continuous professional development, which includes training new cadres, implementing effective recruitment and retention mechanisms, optimising the skill mix, and promoting workplace wellness. These elements are essential in fostering a well-trained and resilient primary health care workforce.
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Affiliation(s)
- Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, Australia.
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Resham B Khatri
- School of Public Health, The University of Queensland, Brisbane, Australia
- Health Social Science and Development Research Institute, Kathmandu, Nepal
| | - Daniel Erku
- School of Public Health, The University of Queensland, Brisbane, Australia
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Australia
| | - Anteneh Zewdie
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Frehiwot Nigatu
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
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McEwen S, Vanderhoek J, Larsen T. Evaluation of a pre-professional pathway program: perspectives of former students in the rural pre-medicine program at Selkirk College. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:88-94. [PMID: 38045084 PMCID: PMC10690005 DOI: 10.36834/cmej.76951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background Having a rural background is one of the most predictive factors in eventually having a rural practice, but people from rural areas face several barriers to post-secondary education. Pre-professional rural pathway initiatives are a potential solution. The Rural Pre-Medicine Program (RPM) at Selkirk College, British Columbia was developed to provide students with the credits necessary to apply to medicine and other health professional programs, an introduction to rural healthcare issues, and a unique and comprehensive support program to enable success. Methods We administered a cross-sectional survey to former students who left the program from its inception in September 2014 to May 2020 to explore the extent to which program aims are being met. Results The response rate was 49.4% (40/81). Respondents agreed the program increased their skills, their understanding of rural healthcare issues, and enhanced their competitiveness for applying to health professional programs. Most agreed the program increased their future rural work intentions. Respondents suggested that academic programming be more flexible to allow for more varied post-program pathways. Conclusion This survey provides preliminary evidence the RPM Program is on track to increase the number of people with a rural affinity who prepare to become health professionals.
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Affiliation(s)
- Sara McEwen
- Rural Pre-Medicine Program, Selkirk College, British Columbia, Canada
| | | | - Takaia Larsen
- Rural Pre-Medicine Program, Selkirk College, British Columbia, Canada
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Jessup B, Tran N, Stevens T, Barnett T. Rural origin student representation in health courses at the University of Tasmania: 2011-2020. Aust J Rural Health 2023; 31:944-956. [PMID: 37545396 DOI: 10.1111/ajr.13027] [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: 03/28/2023] [Revised: 06/08/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE To describe longitudinal trends in the admission and completion of domestic Tasmanian rural origin students in health courses at the University of Tasmania (UTAS). METHODS A retrospective audit of records for all domestic Tasmanian students admitted to, or who completed a health course offered by UTAS between 2011 and 2020 was conducted. Data extracted from student records included gender, age, Indigenous background, rural origin (based on residential address outside of Launceston or Hobart at the time of application), health discipline, year of admission and/or completion. Data were analysed in STATA. RESULTS Between 2011 and 2020, 7516 domestic Tasmanian students were admitted to health courses at UTAS, of which 22.6% were rural origin (vs. a rural population of 36.7%). Students admitted were mostly female (77.0%) and studying nursing (51.1%). Rural origin students were more likely to study at the regional campus in Launceston than in Hobart, the capital city (OR, 3.79 [3.4-4.3, p < 0.00]). Over this same period, 5086 students completed a health course. There was little difference in completion rates among regional vs. rural origin students (OR, 1.04 [1.0-1.1, p < 0.00]); however, completion rates decreased with increasing remoteness. Indigenous and male students were less likely to complete than non-Indigenous (OR, 0.73 [0.7-0.8, p < 0.05]) and female students (OR, 0.97 [1.0-1.0, p < 0.05]) respectively. CONCLUSIONS Tasmanian rural origin students are admitted to a range of health courses at UTAS and many complete. However, additional measures are needed to attract a greater number of local rural origin students to study health courses and to support them through to course completion.
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Affiliation(s)
- Belinda Jessup
- Centre for Rural Health, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Nga Tran
- Centre for Rural Health, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Terri Stevens
- Centre for Rural Health, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Tony Barnett
- Centre for Rural Health, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
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Devillers L, Friesse S, Caranta M, Tarazona V, Bourrion B, Saint-Lary O. General practice undergraduate and vocational training: ambulatory teaching and trainers' curriculum and remuneration - a cross-sectional study among 30 member countries of WONCA Europe. BMC MEDICAL EDUCATION 2023; 23:439. [PMID: 37316837 DOI: 10.1186/s12909-023-04419-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/31/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND After a long phase without any propositions for real ambulatory training inside general practitioners' offices, general practice (GP) vocational training has begun to appear progressively and has been integrated into undergraduate medical programmes. The aim of this study was to provide an overview of GP vocational training and GP trainers in member countries of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) Europe. METHOD We carried out this cross-sectional study between September 2018 and March 2020. The participants responded to a questionnaire in real-life conversations, video conferences or e-mail exchanges. The respondents included GP trainers, teachers and general practitioners involved in the GP curriculum recruited during European GP congresses. RESULTS Representatives from 30 out of 45 WONCA Europe member countries responded to the questionnaire. Based on their responses, there is a well-established period for GP internships in undergraduate medical programmes, but with varying lengths. The programmes for some countries offer an internship after students graduate from medical school but before GP specialisation to ensure the career choice of the trainees. After specialisation, private practice GP internships are offered; however, in-hospital GP internships are more common. GP trainees no longer have a passive role during their internships. GP trainers are selected based on specific criteria and in countries, they have to follow some teacher training programmes. In addition to income from medical appointments carried out by GP trainees, GP trainers from some countries receive additional remuneration from various organisations. CONCLUSION This study collected information on how undergraduate and postgraduate medical students are exposed to GP, how GP training is organised and the actual status of GP trainers among WONCA Europe member countries. Our exploration of GP training provides an update of the data collected by Isabel Santos and Vitor Ramos in the 1990s and describes some specificities that can inspire other organisations to prepare young, highly qualified general practitioners.
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Affiliation(s)
- Louise Devillers
- Department of General Medicine, Simone Veil University of Versailles Saint-Quentin-en- Yvelines and Paris-Saclay, Versailles, France.
- Primary Care and Prevention Team, CESP, University Paris-Saclay, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France.
| | - Sébastien Friesse
- Department of General Medicine, Simone Veil University of Versailles Saint-Quentin-en- Yvelines and Paris-Saclay, Versailles, France
| | - Mette Caranta
- Department of General Medicine, Simone Veil University of Versailles Saint-Quentin-en- Yvelines and Paris-Saclay, Versailles, France
| | - Vincent Tarazona
- Department of General Medicine, Simone Veil University of Versailles Saint-Quentin-en- Yvelines and Paris-Saclay, Versailles, France
- Primary Care and Prevention Team, CESP, University Paris-Saclay, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France
| | - Bastien Bourrion
- Department of General Medicine, Simone Veil University of Versailles Saint-Quentin-en- Yvelines and Paris-Saclay, Versailles, France
- Primary Care and Prevention Team, CESP, University Paris-Saclay, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France
| | - Olivier Saint-Lary
- Department of General Medicine, Simone Veil University of Versailles Saint-Quentin-en- Yvelines and Paris-Saclay, Versailles, France
- Primary Care and Prevention Team, CESP, University Paris-Saclay, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France
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Davison R, Hobbs M, Quirk F, Guppy M. General practitioners' perspectives on the management of refugee health: a qualitative study. BMJ Open 2023; 13:e068986. [PMID: 36963788 PMCID: PMC10039989 DOI: 10.1136/bmjopen-2022-068986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVE To explore general practitioners' (GPs) perceptions of the challenges and facilitators to managing refugee healthcare needs in regional Australia. SETTING A regional community in Australia involved in the resettlement of refugees. PARTICIPANTS Nine GPs from five practices in the region. DESIGN A qualitative study based on semistructured interviews conducted between September and November 2020. RESULTS The main challenges identified surrounded language and communication difficulties, cultural differences and health literacy and regional workforce shortages. The main facilitators were clinical and community supports, including refugee health nurses and trauma counselling services. Personal benefits experienced by GPs such as positive relationships, satisfaction and broadening scope of practice further facilitated ongoing healthcare provision. CONCLUSIONS Overall, GPs were generally positive about providing care to refugees. However, significant challenges were expressed, particularly surrounding language, culture and resources. These barriers were compounded by the regional location. This highlights the need for preplanning and consultation with healthcare providers in the community both prior to and during the settlement of refugees as well as ongoing support proportional to the increase in settlement numbers.
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Affiliation(s)
- Rachel Davison
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - Megan Hobbs
- New England Institute of Healthcare and Research, University of New England, Armidale, New South Wales, Australia
| | - Frances Quirk
- New England Institute of Healthcare and Research, University of New England, Armidale, New South Wales, Australia
- Fife, University of St Andrews School of Medicine, St Andrews, Fife, UK
| | - Michelle Guppy
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
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Kolié D, Van De Pas R, Codjia L, Zurn P. Increasing the availability of health workers in rural sub-Saharan Africa: a scoping review of rural pipeline programmes. HUMAN RESOURCES FOR HEALTH 2023; 21:20. [PMID: 36918864 PMCID: PMC10013286 DOI: 10.1186/s12960-023-00801-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/07/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Rural pipeline approach has recently gain prominent recognition in improving the availability of health workers in hard-to-reach areas such as rural and poor regions. Understanding implications for its successful implementation is important to guide health policy and decision-makers in Sub-Saharan Africa. This review aims to synthesize the evidence on rural pipeline implementation and impacts in sub-Saharan Africa. METHODS We conducted a scoping review using Joanna Briggs Institute guidebook. We searched in PubMed and Google scholar databases and the grey literature. We conducted a thematic analysis to assess the studies. Data were reported following the PRISMA extension for Scoping reviews guidelines. RESULTS Of the 443 references identified through database searching, 22 met the inclusion criteria. Rural pipeline pillars that generated impacts included ensuring that more rural students are selected into programmes; developing a curriculum oriented towards rural health and rural exposure during training; curriculum oriented to rural health delivery; and ensuring retention of health workers in rural areas through educational and professional support. These impacts varied from one pillar to another and included: increased in number of rural health practitioners; reduction in communication barriers between healthcare providers and community members; changes in household economic and social circumstances especially for students from poor family; improvement of health services quality; improved health education and promotion within rural communities; and motivation of community members to enrol their children in school. However, implementation of rural pipeline resulted in some unintended impacts such as perceived workload increased by trainee's supervisors; increased job absenteeism among senior health providers; patients' discomfort of being attended by students; perceived poor quality care provided by students which influenced health facilities attendance. Facilitating factors of rural pipeline implementation included: availability of learning infrastructures in rural areas; ensuring students' accommodation and safety; setting no age restriction for students applying for rural medical schools; and appropriate academic capacity-building programmes for medical students. Implementation challenges included poor preparation of rural health training schools' candidates; tuition fees payment; limited access to rural health facilities for students training; inadequate living and working conditions; and perceived discrimination of rural health workers. CONCLUSION This review advocates for combined implementation of rural pipeline pillars, taking into account the specificity of country context. Policy and decision-makers in sub-Saharan Africa should extend rural training programmes to involve nurses, midwives and other allied health professionals. Decision-makers in sub-Saharan Africa should also commit more for improving rural living and working environments to facilitate the implementation of rural health workforce development programmes.
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Affiliation(s)
- Delphin Kolié
- Maferinyah National Training and Research Centre in Rural Health, Ministry of Health, Forecariah, Guinea.
| | - Remco Van De Pas
- Department of Public Health, Institute of Tropical Medicine of Antwerp, Antwerp, Belgium
| | - Laurence Codjia
- Department of Health Workforce, World Health Organisation, Geneva, Switzerland
| | - Pascal Zurn
- Department of Health Workforce, World Health Organisation, Geneva, Switzerland
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Hu D, Zhang B, Huang M, Liu M, Xia X, Zuo Y, Liu X. Evaluation of a medical education policy with compulsory rural service in China. Front Public Health 2023; 11:1042898. [PMID: 36817880 PMCID: PMC9933701 DOI: 10.3389/fpubh.2023.1042898] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023] Open
Abstract
Background Since 2010, China has implemented a national programme to train general practitioners for rural areas. The programme enrolled medical students with a rural background who signed a contract for 6 years' compulsory rural service after graduation. China is transitioning its national COVID-19 strategies in view of the features of coronavirus Omicron variant, the vaccination coverage, and the need for socioeconomic development. Strengthening primary health care, especially the health workforce in rural areas, should be an important consideration during the policy transition. This study aims to evaluate the implementation process of enrolling medical students in the programme, their willingness to work in the rural settings and their actual job choice after graduation. Methods The study chose four medical universities in central and western China. A total of 2,041 medical graduates who have signed a contract for compulsory rural service and 1,576 medical graduates enrolled "as usual" (no compulsory rural service) were recruited in five campaigns-every June from 2015 to 2019. A survey was conducted 1 week before their graduation ceremony. Results The top three reasons for choosing this programme were: a recommendation of a family member or teacher, a guaranteed job after graduation and the waiver of the tuition fee. 23.0-29.7% of the study participants were not familiar with the policy details. 39.1% of the medical students signed a contract with a county other than that of their hometown. Medical graduates on the compulsory rural service programme had very low willingness (1.9%) to work in rural areas but 86.1% of them actually worked at township health centers. In contrast, the willingness to work at township health centers was 0.2% for the comparison group (medical graduates without the contract), and their actual job choice at township health centers was 0%. Conclusions Although the well-trained medical graduates on the compulsory rural service programme have low willingness to work in the township health centers, 86.1% of them choose to do so following their contract. This programme will strengthen the primary health workforce to deal with the increasing disease burden as China is transitioning its national COVID-19 strategies.
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Affiliation(s)
- Dan Hu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Baisong Zhang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Mingyu Huang
- Qinghai Center for Health Development Studies, Medical College of Qinghai University, Xining, Qinghai, China
| | - Min Liu
- Center for Rural Medical Education Research, Gannan Medical College, Ganzhou, Jiangxi, China
| | - Xiulong Xia
- International Research Center for Rural Medical Education, Jiujiang University, Jiujiang, Jiangxi, China
| | - Yanli Zuo
- Department of General Medicine, Guangxi Medical University, Nanning, China
| | - Xiaoyun Liu
- China Center for Health Development Studies, Peking University, Beijing, China
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Ramanathan SA, Ling R, Tattersall A, Ingold N, De Silva MS, Close S, Searles A. Impact assessment of the medical practice assisting (MPA) program in general practice in the hunter New England and central coast regions of Australia. HUMAN RESOURCES FOR HEALTH 2022; 20:81. [PMID: 36471366 PMCID: PMC9721062 DOI: 10.1186/s12960-022-00781-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/10/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND A regional Australian Primary Health Network (PHN) has been subsidising administrative staff from local general practices to undertake the Medical Practice Assisting (MPA) course as part of its MPA Program. The MPA Program aimed to upskill administrative staff to undertake clinical tasks and fill in for busy or absent Practice Nurses (PNs), freeing up PNs to increase revenue-generating activity, avoiding casual replacement staff wages, and increasing patient throughput. An impact assessment was undertaken to evaluate the impact and estimate the economic costs of the MPA program to the PHN, general practices, and students to inform future uptake of the intervention. METHODS The Framework to Assess the Impact of Translational Health Research (FAIT) was utilised. Originally designed to assess the impact of health research, this was its first application to a health services project. FAIT combines three validated methods of impact assessment-Payback, economic analysis and narratives underpinned by a program logic model. Quantified metrics describe the impacts of the program within various "domains of benefit", the economic model costs the intervention and monetises potential consequences, and the narrative tells the story of the MPA Program and the difference it has made. Data were collected via online surveys from general practitioners (GPs), PNs, practice managers; MPA graduates and PHN staff were interviewed by phone and on Zoom. RESULTS FAIT was effective in evidencing the impacts and economic viability of the MPA Program. GPs and PNs reported greater work satisfaction, PNs reported less stress and reduced workloads and MPA graduates reported higher job satisfaction and greater confidence performing a range of clinical skills. MPA Program economic costs for general practices during candidature, and 12 month post-graduation was estimated at $69,756. With effective re-integration planning, this investment was recoverable within 12 months through increased revenue for practices. Graduates paid appropriately for their new skills also recouped their investment within 24 months. CONCLUSION Utilisation of MPA graduates varied substantially between practices and COVID-19 impacted on their utilisation. More strategic reintegration of the MPA graduate back into the practice to most effectively utilise their new skillset could optimise potential benefits realised by participating practices.
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Affiliation(s)
- Shanthi Ann Ramanathan
- Hunter Medical Research Institute, Newcastle, Australia.
- University of Newcastle College of Health, Medicine and Wellbeing, Newcastle, Australia.
| | - Rod Ling
- Hunter Medical Research Institute, Newcastle, Australia
- University of Newcastle College of Health, Medicine and Wellbeing, Newcastle, Australia
| | - Alison Tattersall
- Hunter New England Central Coast Primary Health Network, Newcastle, Australia
| | - Nicola Ingold
- Hunter New England Central Coast Primary Health Network, Newcastle, Australia
| | - Mary Sheffi De Silva
- Hunter Medical Research Institute, Newcastle, Australia
- University of Newcastle College of Health, Medicine and Wellbeing, Newcastle, Australia
| | - Shara Close
- Hunter Medical Research Institute, Newcastle, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, Newcastle, Australia
- University of Newcastle College of Health, Medicine and Wellbeing, Newcastle, Australia
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15
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Hashem F, Marchand C, Peckham S, Peckham A. What are the impacts of setting up new medical schools? A narrative review. BMC MEDICAL EDUCATION 2022; 22:759. [PMID: 36345021 PMCID: PMC9639304 DOI: 10.1186/s12909-022-03835-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The growth of the UK's population together with an aging society with increasingly complex health and social care needs has placed a greater demand on statutory care services. In view of this emerging landscape, the UK Government has sought to increase its medically trained workforce in order to better respond to the demands placed on the health service. Five universities were announced as homes to new medical schools offering undergraduate places to boost the numbers of doctors training in England. The aim of this narrative review was to explore how new medical schools could improve the health outcomes of the local population and evaluate the potential contribution it may make to the local economy, workforce and to research and innovation. METHODS A narrative review was undertaken using a systematic approach for the search literature strategy. The articles were evaluated by undertaking a critical assessment evaluating the fitness of a paper for review according to results, methods used to test the hypothesis, conclusions and impact and limitations. Thematic analysis was employed to organise and summarise the findings across a heterogeneous body of literature included in the review. The analysis was developed in an inductive manner and there were not any predefined themes to guide data extraction and analysis. RESULTS Thirty-six articles were selected for inclusion for this narrative review. The review identified six key themes: influence of prior rural exposure, medical school environment and rural enrichment programmes, workforce, health outcomes of local populations, social accountability, economic contribution of medical schools to communities and impact on rural research. CONCLUSIONS The studies included found a wealth of information on a wide-range of topics on the expansion of undergraduate education and its implications on the future medical workforce. It was shown that medical schools can have a positive effect on the health, social, economic and research activity of a region, but this literature tended to be heterogeneous in focus without consideration of the inter-connections between the wider societal and economic impacts arising from long-term sustainable change being brought to a region.
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Affiliation(s)
- Ferhana Hashem
- Centre for Health Services Studies, University of Kent, George Allen Wing, Cornwallis Building, Kent, Canterbury CT2 7NF UK
| | - Catherine Marchand
- Centre for Health Services Studies, University of Kent, George Allen Wing, Cornwallis Building, Kent, Canterbury CT2 7NF UK
| | - Stephen Peckham
- Centre for Health Services Studies, University of Kent, George Allen Wing, Cornwallis Building, Kent, Canterbury CT2 7NF UK
| | - Anna Peckham
- Centre for Health Services Studies, University of Kent, George Allen Wing, Cornwallis Building, Kent, Canterbury CT2 7NF UK
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16
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Hogenbirk JC, Strasser RP, French MG. Ten years of graduates: A cross-sectional study of the practice location of doctors trained at a socially accountable medical school. PLoS One 2022; 17:e0274499. [PMID: 36107944 PMCID: PMC9477294 DOI: 10.1371/journal.pone.0274499] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction The study predicted practice location of doctors trained at a socially accountable medical school with education programs in over 90 communities. Methods A cross-sectional study examined practice location 10 years after the first class graduated from the Northern Ontario School of Medicine (NOSM), Canada. Exact tests and logistic regression models were used to assess practice location in northern Ontario; northern Canada; or other region; and rural (population <10,000) or urban community. Results There were 435 doctors with 334 (77%) practising as family doctors (FPs), 62 (14%) as generalist specialists and 39 (9%) as other medical or surgical specialists. Approximately 92% (128/139) of FPs who completed both UG and PG at NOSM practised in northern Ontario in 2019, compared with 63% (43/68) who completed only their PG at NOSM, and 24% (30/127) who completed only their UG at NOSM. Overall, 37% (23/62) of generalist specialists and 23% (9/39) of other specialists practised in northern Ontario. Approximately 28% (93/334) of FPs practised in rural Canada compared with 4% (4/101) of all other specialists. FP northern Ontario practice was predicted by completing UG and PG at NOSM (adjusted odds ratio = 46, 95% confidence interval = 20–103) or completing only PG at NOSM (15, 6.0–38) relative to completing only UG at NOSM, and having a northern Ontario hometown (5.3, 2.3–12). Rural Canada practice was predicted by rural hometown (2.3, 1.3–3.8), completing only a NOSM PG (2.0, 1.0–3.9), and age (1.4, 1.1–1.8). Conclusion This study uniquely demonstrated the interaction of two mechanisms by which medical schools can increase the proportion of doctors’ practices located in economically deprived regions: first, admit medical students who grow up in the region; and second, provide immersive UG and PG medical education in the region. Both mechanisms have enabled the majority of NOSM-trained doctors to practise in the underserved region of northern Ontario.
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Affiliation(s)
- John C. Hogenbirk
- Centre for Rural and Northern Health Research, Laurentian University, Greater Sudbury, Ontario, Canada
- * E-mail:
| | - Roger P. Strasser
- NOSM University (Formerly the Northern Ontario School of Medicine), Greater Sudbury, Ontario, Canada
| | - Margaret G. French
- Centre for Rural and Northern Health Research, Laurentian University, Greater Sudbury, Ontario, Canada
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17
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Malau-Aduli BS, Jones K, Smith AM, Sen Gupta T, Hays RB. Understanding medical students' transformative experiences of early preclinical international rural placement over a 20-year period. BMC MEDICAL EDUCATION 2022; 22:652. [PMID: 36042497 PMCID: PMC9427436 DOI: 10.1186/s12909-022-03707-x] [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: 05/12/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Rural placements are an important component of rural medical education programs seeking to develop rural practice pathways for medical students. These placements are usually domestic, but James Cook University in Australia developed an international rural placement program in the first half of the medical course that was funded through bursaries. This study explores how the international rural placement helped to shape the lives (personal development and learning) of the participants, using Transformational Learning Theory as a framework for identifying and describing the transformational elements, process and impact of the program. METHODS Sixty-five students received a bursary for an international rural placement between 2001-2019. All were contacted by email and invited to participate in a short survey and a follow-up interview. Fifteen participants agreed and twelve were able to participate in individual semi-structured interviews which were recorded, transcribed and analysed using inductive thematic analysis. RESULTS Participants reported that the bursary provided a "once in a lifetime opportunity" to "experience eye-opening and culturally rich difference". Nonetheless, some elements of the placement experience presented disorientating dilemmas that triggered deep reflections and shifts in perceptions. The bursary recipients realised that "being open-minded" allowed them "enjoy good company". They were also able to assume "outsider view which allowed reassessment of their own country" and the "isolation experiences gingered desire to right health wrongs". The triggers and mental shifts had significant impact on the bursary recipients and fostered the development of "inspirational new horizons" based on an appreciation of the "value of rural practice" and "role-modelling for life-long learning." These findings are consistent with Transformational Learning Theory. CONCLUSION Participants in this study reported meaningful and strongly positive impacts from the experiences gained during an international rural clinical placement early in their course. They described transformative experiences which appear to contribute strongly to personal development. This finding supports maintaining opportunities for international experiences during rurally-oriented medical programs as these may impact longer term career choice.
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Affiliation(s)
- Bunmi S Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, Australia.
| | - Karina Jones
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Amy M Smith
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Tarun Sen Gupta
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Richard B Hays
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
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Dymmott A, George S, Campbell N, Brebner C. Experiences of working as early career allied health professionals and doctors in rural and remote environments: a qualitative systematic review. BMC Health Serv Res 2022; 22:951. [PMID: 35883068 PMCID: PMC9327222 DOI: 10.1186/s12913-022-08261-2] [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: 02/15/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background Maintaining a health professional workforce in rural and remote areas poses a significant challenge internationally. A range of recruitment and retention strategies have had varying success and these are generally developed from the collective experience of all health professions, rather than targeted to professional groups with differing educational and support contexts. This review explores, compares and synthesises the evidence examining the experience of early career rural and remote allied health professionals and doctors to better understand both the profession specific, and common factors that influence their experience. Methods Qualitative studies that include early career allied health professionals’ or doctors’ experiences of working in rural or remote areas and the personal and professional factors that impact on this experience were considered. A systematic search was completed across five databases and three grey literature repositories to identify published and unpublished studies. Studies published since 2000 in English were considered. Studies were screened for inclusion and critically appraised by two independent reviewers. Data was extracted and assigned a level of credibility. Data synthesis adhered to the JBI meta-aggregative approach. Results Of the 1408 identified articles, 30 papers were eligible for inclusion, with one rated as low in quality and all others moderate or high quality. A total of 23 categories, 334 findings and illustrations were aggregated into three synthesised findings for both professional groups including: making a difference through professional and organisational factors, working in rural areas can offer unique and rewarding opportunities for early career allied health professionals and doctors, and personal and community influences make a difference. A rich dataset was obtained and findings illustrate similarities including the need to consider personal factors, and differences, including discipline specific supervision for allied health professionals and local supervision for doctors. Conclusions Strategies to enhance the experience of both allied health professionals and doctors in rural and remote areas include enabling career paths through structured training programs, hands on learning opportunities, quality supervision and community immersion. Systematic review registration number PROSPERO CRD42021223187. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08261-2.
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Affiliation(s)
- Alison Dymmott
- Flinders University Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
| | - Stacey George
- Flinders University Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Narelle Campbell
- Flinders University Northern Territory, College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia
| | - Chris Brebner
- Flinders University Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Bhatia MB, Darkwa L, Simon C, Li HW, Allison H, Joplin TS, Meade ZS, Keung C, McDow AD. Uncovering the Overlap of Global and Domestic Rural Surgery for Medical Trainees. J Surg Res 2022; 279:442-452. [PMID: 35841813 PMCID: PMC9404475 DOI: 10.1016/j.jss.2022.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/01/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022]
Abstract
Introduction Medical trainees who participate in global rotations demonstrate improved cultural sensitivity, increased involvement in humanitarian efforts, and ability to adapt to limited resources. The global coronavirus pandemic halted global rotations for medical trainees. Domestic rural surgery (DRS) may offer a unique alternative. We aimed to understand medical students’ perceptions of the similarities and differences between global surgery and DRS and how students’ priorities impact career choices. Methods An electronic survey was administered at eleven medical training institutions in Indiana, Illinois, and Michigan in spring 2021. Mixed methods analysis was performed for students who reported an interest in global surgery. Quantitative analysis was completed using Stata 16.1. Results Of the 697 medical student respondents, 202 were interested in global surgery. Of those, only 18.3% were also interested in DRS. Students interested in DRS had more rural exposures. Rural exposures associated with DRS interest were pre-clinical courses (P = 0.002), clinical rotations (P = 0.045), and rural health interest groups (P < 0.001). Students interested in DRS and those unsure were less likely to prioritize careers involving teaching or research, program prestige, perceived career advancement, and well-equipped facilities. The students who were unsure were willing to utilize DRS exposures. Conclusions Students interested in global surgery express a desire to practice in low-resource settings. Increased DRS exposures may help students to understand the overlap between global surgery and DRS when it comes to working with limited resources, achieving work-life balance and practice location.
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Affiliation(s)
- Manisha B Bhatia
- Indiana University, Department of Surgery, Indianapolis, Indiana.
| | - Louis Darkwa
- University of Illinois Chicago, School of Medicine, Chicago, Illinois
| | - Chad Simon
- University of Illinois Chicago, School of Medicine, Chicago, Illinois
| | - Helen W Li
- Washington University School of Medicine in St. Louis, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Hannah Allison
- Indiana University, Department of Surgery, Indianapolis, Indiana
| | | | | | - Connie Keung
- Indiana University, Department of Surgery, Indianapolis, Indiana
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Seal AN, Playford D, McGrail MR, Fuller L, Allen PL, Burrows JM, Wright JR, Bain-Donohue S, Garne D, Major LG, Luscombe GM. Influence of rural clinical school experience and rural origin on practising in rural communities five and eight years after graduation. Med J Aust 2022; 216:572-577. [PMID: 35365852 PMCID: PMC9322683 DOI: 10.5694/mja2.51476] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/04/2022] [Indexed: 12/04/2022]
Abstract
Objective To examine associations between extended medical graduates’ rural clinical school (RCS) experience and geographic origins with practising in rural communities five and eight years after graduation. Design, participants Cohort study of 2011 domestic medical graduates from ten Australian medical schools with rural clinical or regional medical schools. Main outcome measures Practice location types eight years after graduation (2019/2020) as recorded by the Australian Health Practitioner Regulation Agency, classified as rural or metropolitan according to the 2015 Modified Monash Model; changes in practice location type between postgraduate years 5 (2016/2017) and 8 (2019/2020). Results Data were available for 1321 graduates from ten universities; 696 were women (52.7%), 259 had rural backgrounds (19.6%), and 413 had extended RCS experience (31.3%). Eight years after graduation, rural origin graduates with extended RCS experience were more likely than metropolitan origin graduates without this experience to practise in regional (relative risk [RR], 3.6; 95% CI, 1.8–7.1) or rural communities (RR, 4.8; 95% CI, 3.1–7.5). Concordance of location type five and eight years after graduation was 92.6% for metropolitan practice (84 of 1136 graduates had moved to regional/rural practice, 7.4%), 26% for regional practice (56 of 95 had moved to metropolitan practice, 59%), and 73% for rural practice (20 of 100 had moved to metropolitan practice, 20%). Metropolitan origin graduates with extended RCS experience were more likely than those without it to remain in rural practice (RR, 2.0; 95% CI, 1.3–2.9) or to move to rural practice (RR, 1.9; 95% CI, 1.2–3.1). Conclusion The distribution of graduates by practice location type was similar five and eight years after graduation. Recruitment to and retention in rural practice were higher among graduates with extended RCS experience. Our findings reinforce the importance of longitudinal rural and regional training pathways, and the role of RCSs, regional training hubs, and the rural generalist training program in coordinating these initiatives.
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Affiliation(s)
- Alexa N Seal
- Rural Clinical School, School of Medicine Sydney, the University of Notre Dame Australia, Wagga Wagga, NSW
| | - Denese Playford
- Rural Clinical School of Western Australia, University of Western Australia, Perth, WA
| | | | - Lara Fuller
- Rural Community Clinical School, Deakin University, Colac, VIC
| | - Penny L Allen
- Rural Clinical School, University of Tasmania, Burnie, TAS
| | - Julie M Burrows
- Rural Clinical School, University of Newcastle, Tamworth, NSW
| | - Julian R Wright
- Rural Clinical School, University of Melbourne, Melbourne, VIC
| | | | - David Garne
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW
| | - Laura G Major
- School of Rural Health, Monash University, Melbourne, VIC
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Williams M. Rural health careers for rural students: The entry-level degree stepping-stone challenge. Aust J Rural Health 2022; 30:426-427. [PMID: 35754177 DOI: 10.1111/ajr.12892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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22
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Fielding A, Moad D, Tapley A, Davey A, Holliday E, Ball J, Bentley M, FitzGerald K, Kirby C, Turnock A, Spike N, van Driel ML, Magin P. Prevalence and associations of rural practice location in early-career general practitioners in Australia: a cross-sectional analysis. BMJ Open 2022; 12:e058892. [PMID: 35473723 PMCID: PMC9045092 DOI: 10.1136/bmjopen-2021-058892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To: (1) establish the prevalence of urban, regional, rural and remote practice location of early-career general practitioners (GPs); and (2) examine demographic and training-related characteristics associated with working in regional, rural or remote areas post attainment of vocational general practice qualifications. DESIGN Cross-sectional, questionnaire-based study, combined with contemporaneously collected data from participants' prior vocational training. SETTING Australian general practice. PARTICIPANTS Newly vocationally qualified GPs (ie, within 6 months-2 years post fellowship) who had completed vocational training with regional training organisations in New South Wales, Australian Capital Territory, eastern Victoria, and Tasmania between January 2016 and July 2018. PRIMARY OUTCOME MEASURE Rurality of post-fellowship practice location, as defined by Modified Monash Model (MMM) geographical classifications, based on current practice postcode. Prevalence of regional/rural/remote ('rural') practice was described using frequencies, and associations of rural practice were established using multivariable logistic regression, considering a range of demographic factors and training characteristics as independent variables. RESULTS A total of 354 participants completed the questionnaire (response rate 28%) with 319 providing information for their current practice location. Of these, 100 (31.4%) reported currently practising in a rural area (MMM2-7). Factors most strongly associated with practising in a rural area included having undertaken vocational GP training in a rural location OR 16.0 (95% CI 6.79 to 37.9); p<0.001; and undertaking schooling in rural area prior to university OR 4.21 (1.98, 8.94); p<0.001. CONCLUSIONS The findings suggest that vocational training experience may have a role in rural general practice location post fellowship, attenuating the previously demonstrated 'leakage' from the rural practice pipeline.
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Affiliation(s)
- Alison Fielding
- NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Dominica Moad
- NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Amanda Tapley
- NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Andrew Davey
- NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Michael Bentley
- Australian General Practice Training, General Practice Training Tasmania (GPPT), Regional Training Organisation, Hobart, Tasmania, Australia
| | - Kristen FitzGerald
- Australian General Practice Training, General Practice Training Tasmania (GPPT), Regional Training Organisation, Hobart, Tasmania, Australia
- Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Catherine Kirby
- Australian General Practice Training, Eastern Victoria General Practice Training (EVGPT), Regional Training Organisation, Hawthorn, Victoria, Australia
| | - Allison Turnock
- Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Department of Health, Australian Government, Hobart, Tasmania, Australia
| | - Neil Spike
- Australian General Practice Training, Eastern Victoria General Practice Training (EVGPT), Regional Training Organisation, Hawthorn, Victoria, Australia
- Department of General Practice and Primary Health Care, University of Melbourne, Carlton, Victoria, Australia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Parker Magin
- NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
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Elma A, Nasser M, Yang L, Chang I, Bakker D, Grierson L. Medical education interventions influencing physician distribution into underserved communities: a scoping review. HUMAN RESOURCES FOR HEALTH 2022; 20:31. [PMID: 35392954 PMCID: PMC8991572 DOI: 10.1186/s12960-022-00726-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/24/2022] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Physician maldistribution is a global problem that hinders patients' abilities to access healthcare services. Medical education presents an opportunity to influence physicians towards meeting the healthcare needs of underserved communities when establishing their practice. Understanding the impact of educational interventions designed to offset physician maldistribution is crucial to informing health human resource strategies aimed at ensuring that the disposition of the physician workforce best serves the diverse needs of all patients and communities. METHODS A scoping review was conducted using a six-stage framework to help map current evidence on educational interventions designed to influence physicians' decisions or intention to establish practice in underserved areas. A search strategy was developed and used to conduct database searches. Data were synthesized according to the types of interventions and the location in the medical education professional development trajectory, that influence physician intention or decision for rural and underserved practice locations. RESULTS There were 130 articles included in the review, categorized according to four categories: preferential admissions criteria, undergraduate training in underserved areas, postgraduate training in underserved areas, and financial incentives. A fifth category was constructed to reflect initiatives comprised of various combinations of these four interventions. Most studies demonstrated a positive impact on practice location, suggesting that selecting students from underserved or rural areas, requiring them to attend rural campuses, and/or participate in rural clerkships or rotations are influential in distributing physicians in underserved or rural locations. However, these studies may be confounded by various factors including rural origin, pre-existing interest in rural practice, and lifestyle. Articles also had various limitations including self-selection bias, and a lack of standard definition for underservedness. CONCLUSIONS Various educational interventions can influence physician practice location: preferential admissions criteria, rural experiences during undergraduate and postgraduate medical training, and financial incentives. Educators and policymakers should consider the social identity, preferences, and motivations of aspiring physicians as they have considerable impact on the effectiveness of education initiatives designed to influence physician distribution in underserved locations.
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Affiliation(s)
- Asiana Elma
- Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Center, McMaster University, 100 Main St. W., Hamilton, ON, L8P 1H6, Canada
| | - Muhammadhasan Nasser
- Bachelor of Health Sciences Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Laurie Yang
- Bachelor of Health Sciences Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Irene Chang
- Bachelor of Health Sciences Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Dorothy Bakker
- Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Center, McMaster University, 100 Main St. W., Hamilton, ON, L8P 1H6, Canada
- McMaster Community and Rural Education Program, McMaster University, Hamilton, Canada
| | - Lawrence Grierson
- Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Center, McMaster University, 100 Main St. W., Hamilton, ON, L8P 1H6, Canada.
- McMaster Community and Rural Education Program, McMaster University, Hamilton, Canada.
- McMaster Education Research, Innovation and Theory, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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24
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Ramsden R, Lincoln M. Guest editorial: Digital solutions to bridging the gap between health services and workforce in rural areas. HEALTH EDUCATION 2022. [DOI: 10.1108/he-02-2022-137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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25
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Beks H, Walsh S, Alston L, Jones M, Smith T, Maybery D, Sutton K, Versace VL. Approaches Used to Describe, Measure, and Analyze Place of Practice in Dentistry, Medical, Nursing, and Allied Health Rural Graduate Workforce Research in Australia: A Systematic Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1438. [PMID: 35162455 PMCID: PMC8834932 DOI: 10.3390/ijerph19031438] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 01/06/2023]
Abstract
Redressing the maldistribution of the health workforce in regional, rural, and remote geographical areas is a global issue and crucial to improving the accessibility of primary health care and specialist services. Geographical classification systems are important as they provide an objective and quantifiable measure of access and can have direct policy relevance, yet they are not always consistently applied in rural health research. It is unclear how research focusing on the graduate health workforce in Australia has described, measured, and analyzed place of practice. To examine approaches used, this review systematically scopes Australian rural studies focusing on dentistry, medicine, nursing, and allied health graduates that have included place of practice as an outcome measure. The Joanna Brigg's Institute Scoping Review Methodology was used to guide the review. Database searches retrieved 1130 unique citations, which were screened, resulting in 62 studies for inclusion. Included studies were observational, with most focusing on the practice locations of medical graduates and predicators of rural practice. Variations in the use of geographical classification approaches to define rurality were identified and included the use of systems that no longer have policy relevance, as well as adaptations of existing systems that make future comparisons between studies challenging. It is recommended that research examining the geographical distribution of the rural health workforce use uniform definitions of rurality that are aligned with current government policy.
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Affiliation(s)
- Hannah Beks
- School of Medicine, Deakin University, Geelong 3220, Australia; (H.B.); (L.A.)
| | - Sandra Walsh
- Department of Rural Health, University of South Australia, Whyalla 5608, Australia; (S.W.); (M.J.)
| | - Laura Alston
- School of Medicine, Deakin University, Geelong 3220, Australia; (H.B.); (L.A.)
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla 5608, Australia; (S.W.); (M.J.)
| | - Tony Smith
- Department of Rural Health, University of Newcastle, Taree 2430, Australia;
| | - Darryl Maybery
- Department of Rural Health & Indigenous Health, Monash University, Warragul 3820, Australia; (D.M.); (K.S.)
| | - Keith Sutton
- Department of Rural Health & Indigenous Health, Monash University, Warragul 3820, Australia; (D.M.); (K.S.)
| | - Vincent L Versace
- School of Medicine, Deakin University, Geelong 3220, Australia; (H.B.); (L.A.)
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26
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Stigler FL, Zipp CR, Jeitler K, Semlitsch T, Siebenhofer A. Comprehensive catalogue of international measures aimed at preventing general practitioner shortages. Fam Pract 2021; 38:793-801. [PMID: 34160614 DOI: 10.1093/fampra/cmab045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many countries are facing a shortage and misallocation of general practitioners (GPs). The development of a policy response may benefit from the knowledge of worldwide policies that have been adopted and recommended to counteract such a development. AIM To identify measures proposed or taken internationally to prevent GP shortages. DESIGN AND SETTING A literature review followed by an expert assessment focussed on sources from OECD countries. METHOD The literature search identified international policy documents and literature reviews in bibliographical databases, and examined institutional websites and references of included publications. The internet search engine Google was also used. The resulting measures were then assessed for completeness by three experts. RESULTS Ten policy documents and 32 literature reviews provided information on 102 distinct measures aimed at preventing GP shortages. The measures attempt to influence GPs at all stages of their careers. CONCLUSIONS This catalogue of measures to prevent GP shortages is significantly more comprehensive than any of the policy documents it is based on. It may serve as a blueprint for effective reforms aimed at preventing GP shortages internationally.
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Affiliation(s)
- Florian L Stigler
- Austrian health insurance fund, Health Center (ÖGK) - Styria, Graz, Austria
| | - Carolin R Zipp
- Medical University of Graz, Institute of General Practice and Evidence-Based Health Services Research, Graz, Austria
| | - Klaus Jeitler
- Medical University of Graz, Institute of General Practice and Evidence-Based Health Services Research, Graz, Austria.,Medical University of Graz, Institute for Medical Informatics, Statistics and Documentation, Graz, Austria
| | - Thomas Semlitsch
- Medical University of Graz, Institute of General Practice and Evidence-Based Health Services Research, Graz, Austria
| | - Andrea Siebenhofer
- Medical University of Graz, Institute of General Practice and Evidence-Based Health Services Research, Graz, Austria.,Goethe University Frankfurt, Institute of General Practice, Frankfurt am Main, Hessen, Germany
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27
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Shah A, Gasner A, Bracken K, Scott I, Kelly MA, Palombo A. Early generalist placements are associated with family medicine career choice: A systematic review and meta-analysis. MEDICAL EDUCATION 2021; 55:1242-1252. [PMID: 34075608 DOI: 10.1111/medu.14578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/14/2021] [Accepted: 05/27/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Many developed countries have reported shortages of Primary Care (PC) physicians. The lack of a regular primary physician is associated with inferior health outcomes. One strategy to address this shortage is to increase the proportion of medical students selecting a Family Medicine (FM) or PC career. The purpose of this systematic review is to identify whether pre-clerkship general practice placements increase students' interest in, and selection of FM or PC residencies. METHODS Three databases (PubMed, Embase, Web of Science) searched for interventional studies of pre-clerkship generalist placements in medical school. Pooled statistical analysis and meta-analysis were performed, along with narrative summaries when possible. Intervention participants (IP) were compared to controls matched (MC) for baseline interest in FM and an unmatched sample (UC) of contemporary students. FINDINGS A 11 studies were identified including a total of 5430 students (2428 intervention participants and 3002 controls). IPs were more likely to match to FM than both MC (Risk Ratio: 1.62 [95% CI: 1.03-2.55]) and UC (RR: 2.04 [1.46-2.86]). Participation in long interventions (4-11 weeks) matched to FM at higher rates than short (25-40 hours) interventions (RR: 3.15 [2.28-4.35]). The percentage of students with FM/PC as their top specialty of interest increased after the placements (mean difference: +12.8%, n = 586). CONCLUSIONS Medical students who participated in pre-clerkship general practice placements were more likely to match to a FM residency. Longer pre-clerkship placements had a stronger association with FM specialty choice. The implementation of longitudinal block generalist placements in the pre-clerkship years is one strategy for increasing interest in generalist careers. LEVEL OF EVIDENCE IV, systematic review of level III and IV studies.
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Affiliation(s)
- Ajay Shah
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Adi Gasner
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Keyna Bracken
- Division of Family Medicine, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Ian Scott
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Martina A Kelly
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alessandra Palombo
- Division of Family Medicine, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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28
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Stewart R, McMillan Am F. Australia's Rural Health Multidisciplinary Training program: Preparing for the rural health workforce that Australia needs. Aust J Rural Health 2021; 29:617-619. [PMID: 34672054 DOI: 10.1111/ajr.12808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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29
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Terry D, Phan H, Peck B, Hills D, Kirschbaum M, Bishop J, Obamiro K, Hoang H, Nguyen H, Baker E, Schmitz D. Factors contributing to the recruitment and retention of rural pharmacist workforce: a systematic review. BMC Health Serv Res 2021; 21:1052. [PMID: 34610827 PMCID: PMC8493699 DOI: 10.1186/s12913-021-07072-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/16/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Recruiting and retaining medical, nursing, and allied health professionals in rural and remote areas is a worldwide challenge, compromising continuity of care and population health outcomes in these locations. Specifically, pharmacists play an essential and accessible frontline healthcare role, and are often the first point of contact for health concerns. Despite several incentives, there remains a maldistribution and undersupply of pharmacists in rural and remote areas across many parts of the world. Although current systematic reviews have focussed on factors affecting pharmacists' retention generally, literature specifically focused on rural pharmacist workforce in a global context remains limited. The aim of this systematic review is to identify factors associated with recruitment and retention of the pharmacist workforce in rural and remote settings. Better understanding of these contributors will inform more effective interventional strategies to resolve pharmacist workforce shortages. METHODS A systematic search of primary studies was conducted in online databases, including Medline, Embase, CINAHL, Scopus, Web of Science and PsycINFO, and by hand-searching of reference lists. Eligible studies were identified based on predefined inclusion/exclusion criteria and methodological quality criteria, utilising the Critical Appraisal Skills Programme (CASP) and Good Reporting of A Mixed Methods Study (GRAMMS) checklists. RESULTS The final review included 13 studies, with quantitative, qualitative, or mixed methods research design. Study-specific factors associated with recruitment and retention of pharmacists in rural practice were identified and grouped into five main themes: geographic and family-related, economic and resources, scope of practice or skills development, the practice environment, and community and practice support factors. CONCLUSIONS The results provide critical insights into the complexities of rural recruitment and retention of pharmacists and confirms the need for flexible yet multifaceted responses to overcoming rural pharmacist workforce challenges. Overall, the results provide an opportunity for rural communities and health services to better identify key strengths and challenges unique to the rural and remote pharmacist workforce that may be augmented to guide more focussed recruitment and retention endeavours.
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Affiliation(s)
- Daniel Terry
- School Health, Federation University, PO Box 663, Mt Helen, Victoria Australia
| | - Hoang Phan
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Blake Peck
- School of Health, Federation University Australia, Victoria Ballarat, Australia
| | - Danny Hills
- School of Health, Federation University, Victoria Ballarat, Australia
| | - Mark Kirschbaum
- School of Social Sciences, University of Tasmania, Tasmania, Australia
- Pharmacy Board of Australia, Perth, Australia
| | - Jaclyn Bishop
- Western Alliance, Warrnambool, Victoria Australia
- Centre for Rural Health, University of Tasmania, Tasmania, Australia
| | - Kehinde Obamiro
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | - Ha Hoang
- Center for Health Policy, Boise State University, Boise, Idaho USA
| | - Hoang Nguyen
- Department of Family and Community Medicine, University of North Dakota, Grand Forks, USA
| | - Ed Baker
- School of Health, Federation University Australia, Victoria Ballarat, Australia
| | - David Schmitz
- School of Health, Federation University Australia, Victoria Ballarat, Australia
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30
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Wilson E, Hanson LC, Tori KE, Perrin BM. Nurse practitioner led model of after-hours emergency care in an Australian rural urgent care Centre: health service stakeholder perceptions. BMC Health Serv Res 2021; 21:819. [PMID: 34391412 PMCID: PMC8364439 DOI: 10.1186/s12913-021-06864-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/05/2021] [Indexed: 02/05/2023] Open
Abstract
Background The challenges of providing and accessing quality health care in rural regions have long been identified. Innovative solutions are not only required but are also vital if effective, timely and equitable access to sustainable health care in rural communities is to be realised. Despite trial implementation of some alternative models of health care delivery, not all have been evaluated and their impacts are not well understood. The aim of this study was to explore the views of staff and stakeholders of a rural health service in relation to the implementation of an after-hours nurse practitioner model of health care delivery in its Urgent Care Centre. Methods This qualitative study included semi-structured individual and group interviews with professional stakeholders of a rural health service in Victoria, Australia and included hospital managers and hospital staff who worked directly or indirectly with the after-hours NPs in addition to local GPs, GP practice nurses, and paramedics. Thematic analysis was used to generate key themes from the data. Results Four themes emerged from the data analysis: transition to change; acceptance of the after-hours nurse practitioner role; workforce sustainability; and rural context. Conclusions This study suggests that the nurse practitioner-led model is valued by rural health practitioners and could reduce the burden of excessive after-hour on-call duties for rural GPs while improving access to quality health care for community members. As pressure on rural urgent care centres further intensifies with the presence of the COVID-19 pandemic, serious consideration of the nurse practitioner-led model is recommended as a desirable and effective alternative.
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Affiliation(s)
- Elena Wilson
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia.
| | - Lisa C Hanson
- La Trobe Rural Health School, Violet Vines Marshman Centre for Rural Health Research, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia
| | - Kathleen E Tori
- School of Nursing, College of Health and Medicine, University of Tasmania, Locked Bag 1351, Launceston, Tasmania, 7250, Australia
| | - Byron M Perrin
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia
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31
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Boettcher J, Boettcher M, Wiegand-Grefe S, Zapf H. Being the Pillar for Children with Rare Diseases-A Systematic Review on Parental Quality of Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4993. [PMID: 34066738 PMCID: PMC8125857 DOI: 10.3390/ijerph18094993] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022]
Abstract
Parents caring for children with rare diseases fear the long-term progression of the child's disease. The current study aims to systematically investigate the quality of life (QoL) in parents of children with different rare diseases. We performed a systematic literature search including quantitative studies on QoL of parents caring for children and adolescents with rare diseases in five databases (APA PsycArticles, APA PsycInfo, MEDLINE, PSYNDEXplus, and PubMed) published between 2000-2020. Of the 3985 titles identified, 31 studies met the inclusion criteria and were selected for narrative review. Studies were included if they investigated predictors of parental QoL or reported QoL compared to normative samples, parents of healthy children, or children with other chronic diseases. We used the Newcastle-Ottawa Scale to assess methodological quality. The systematic review revealed that parents of children with rare diseases experience reduced QoL compared to parents with healthy children and norm values. Psychosocial factors, beyond disease-specific predictors, were shown to influence parental QoL substantially and may thus present an essential aspect within interventions for this highly burdened group. Health care professionals should consider and address the impairment of parental QoL due to the child's rare disease. We discuss insights into existing research gaps and improvements for subsequent work.
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Affiliation(s)
- Johannes Boettcher
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (S.W.-G.); (H.Z.)
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Silke Wiegand-Grefe
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (S.W.-G.); (H.Z.)
| | - Holger Zapf
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (S.W.-G.); (H.Z.)
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Griffin B, Horton GL, Lampe L, Shulruf B, Hu W. The change from UMAT to UCAT for undergraduate medical school applicants: impact on selection outcomes. Med J Aust 2020; 214:84-89. [PMID: 33258184 DOI: 10.5694/mja2.50877] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/11/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess whether the change from the Undergraduate Medical and Health Sciences Admissions Test (UMAT; 1991-2019) to the University Clinical Aptitude Test (UCAT) for the 2020 New South Wales undergraduate medical degree intake was associated with changes in the impact of sex, socio-economic status and remoteness of residence, and professional coaching upon selection for interview. DESIGN, SETTING, PARTICIPANTS Cross-sectional study of applicants for the three NSW undergraduate medical programs for entry in 2019 (4114 applicants) or 2020 (4270); 703 people applied for both intakes. Applicants selected for interview were surveyed about whether they had received professional coaching for the selection test. MAIN OUTCOME MEASURES Scores on the three sections of the UMAT (2019 entry cohort) and the five subtests of the UCAT (2020 entry); total UMAT and UCAT scores. RESULTS Mean scores for UMAT 1 and 3 and for all four UCAT cognitive subtests were higher for men than women; the differences were statistically significant after adjusting for age, socio-economic status, and remoteness. The effect size for sex was 0.24 (95% CI, 0.18-0.30) for UMAT total score, 0.38 (95% CI, 0.32-0.44) for UCAT total score. For the 2020 intake, 2303 of 4270 applicants (53.9%) and 476 of 1074 interviewees (44.3%) were women. The effect size for socio-economic status was 0.47 (95% CI, 0.39-0.54) for UMAT, 0.43 (95% CI, 0.35-0.50) for UCAT total score; the effect size for remoteness was 0.54 (95% CI, 0.45-0.63) for UMAT, 0.48 (95% CI, 0.39-0.58) for UCAT total score. The impact of professional coaching on UCAT performance was not statistically significant among those accepted for interview. CONCLUSIONS Women and people from areas outside major cities or of lower socio-economic status perform less well on the UCAT than other applicants. Reviewing the test and applicant quotas may be needed to achieve selection equity.
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Affiliation(s)
| | | | - Lisa Lampe
- The University of Newcastle, Newcastle, NSW
| | - Boaz Shulruf
- University of New South Wales, Sydney, NSW.,Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Wendy Hu
- Western Sydney University, Sydney, NSW
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