'Did I pass the licensing exam?' aspects influencing migrant physicians' results: a mixed methods study

OBJECTIVES

Migrant physicians (MPs) who wish to practise their profession in a new country often must undergo a recertification process, including a licensing exam. In many cases, this is the same licensing exam used for peers educated within the country; however, the pass rate of MPs is usually lower. This study aimed to explore MPs exam results, focusing on MPs that had participated in a complementary programme (CPP) for physicians with a medical degree from outside the European Union/European Economic Area (EU/EEA), and aspects that may influence these.

METHODS

Mixed methods were applied. The data consisted of 2013 to 2019 licensing exam results of 564 physicians in Sweden that were educated outside of the EU. The data was analysed using linear and logistic regression analysis. Further, 14 interviews with MPs were conducted and thematically analysed.

RESULTS

An interaction between age and CPP participation was found for both the total score in per cent (p=0.01) and for the proportion failing their first attempt (p=0.04). Age was found to be a very strong predictor for failing on the first attempt, with those 45 and older failing on the first attempt in 72 and 82 per cent for CPP and non-CPP participants, respectively. Interview data was categorised into two themes: preparations and biographical aspects, and the exam and exam situation.

CONCLUSIONS

Age seems to be an important predictor for failing the first attempt. MPs have had less time to familiarise themselves with the exam type and the language used on the exam. To improve exam results, MPs used different strategies and tools, that is, studying with nationally trained physicians, and using old exams and a web-based study tool consisting of common exam subjects. At the same time, these strategies and tools have also become mediators in the socialisation of MPs into the exam context.

Impact of late and prolonged working life on subjective health: the Swedish experience

This paper explores the relationship between the prolongation of working life and subjective health. Drawing on a unique combination of longitudinal data and the results of a postal survey in Sweden, we investigate the health consequences of extending working life beyond the normal retirement age of 65. To do this, we compare the health status of two groups of retired people: one group who left the labour market completely at the age of 65, and a second group who remained in employment after the age of 65. Using a standard linear probability model and controlling for a range of socio-economic variables as well as previous labour market experiences, perceived life expectancy, pre-retirement income and health, our estimations show that those continuing to work after 65 on average display a 6.8% higher probability of reporting better health during retirement than those leaving at the age of 65. However, we find that this positive correlation between the extension of working life and health is only transitory. After 6 years of retirement, the health advantage of working after the normal retirement age disappears. Furthermore, we did not find any evidence that working after the age of 65 is positively correlated with physical fitness, self-reported depressive symptoms or well-being.

Alterations in bone turnover markers in patients with noncardio-embolic ischemic stroke

Background

The major cause of ischemic stroke is unstable or thrombogenic atherosclerotic plaques. Vascular calcification, a process that appears crucial for plaque stability, shares common features with bone formation. Many bone turnover proteins exhibit metabolic properties, but the evidence is conflicting regarding their possible involvement in vascular disease. Antibodies against sclerostin and dickkopf-1 are currently being evaluated as potential therapy for treating bone disorders. It is important to carefully assess the cardiovascular and metabolic effects of these proteins. The aim of the present study was to explore serum levels of bone turnover markers in patients with acute noncardio-embolic ischemic stroke in comparison with healthy controls.

Methods

In a cross-sectional study, we compared 48 patients aged ≥75 years with noncardio-embolic ischemic stroke and 46 healthy controls. Serum levels of dickkopf-1, sclerostin, osteoprotegerin, osteopontin and osteocalcin were determined by Luminex technique.

Results

We found clearly increased serum levels of osteoprotegerin, sclerostin, dickkopf-1 and osteopontin in patients with stroke compared with healthy controls. No difference was seen in serum levels of osteocalcin between the two groups.

Conclusion

Our findings strengthen the hypothesis of bone turnover markers being involved in vascular disease. Whether these proteins can be used as candidate markers for increased stroke risk or prognostic biomarkers remains to be further elucidated.