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Dunleavy S, Edelman DS, Wimer G, Karelas G, Hassan A, Clarke CD, Canfield SM, Lebwohl B, Lypson ML, Moise N. Implementing Public Health Modules as an Approach to Improve Knowledge and Attitudes of Medical Students: A Student-Led, Multiyear Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:635-643. [PMID: 38266203 DOI: 10.1097/acm.0000000000005646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
PURPOSE Public health is a necessary focus of modern medical education. However, while numerous studies demonstrate benefits of public health education during medical school among self-selected students (i.e., those interested in public health), there are few educational models shown to be effective across the general medical student population. This study examined the effect of a multiyear, case-based, longitudinal online public health curriculum required for all medical students at an urban, research-focused U.S. medical school. METHOD The authors created 11 short public health modules to supplement a year-long, organ-based preclerkship course at Columbia University Vagelos College of Physicians and Surgeons. Beginning in 2020, all students were required to complete these modules, with repeated surveys to assess changes in attitudes and knowledge of public health over time. The authors compared responses for these domains before and after each module, across multiple time points throughout the year, and cross-sectionally to a 2019 cohort of students who were not provided the modules. RESULTS Across 3 cohorts, 405 of 420 (96.4%) students provided responses and were included in subsequent analyses. After completing the modules, students reported perceiving a greater importance of public health to nearly every medical specialty ( P < .001), more positive attitudes toward public health broadly ( P < .001), and increased knowledge of public health content ( P < .001). These findings were consistent across longitudinal analysis of students throughout the year-long course and when compared to the cohort who did not complete the modules. CONCLUSIONS Case-based, interactive, and longitudinal public health content can be effectively integrated into the required undergraduate medical education curriculum to improve all medical students' knowledge and perceptions of public health. Incorporating evidence-based public health education into medical training may help future physicians to better address the needs of the communities and populations in which they practice.
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Gjessing S, Guldberg TL, Risør T, Skals RG, Kristensen JK. Would you like to be a general practitioner? Baseline findings of a longitudinal survey among Danish medical trainees. BMC MEDICAL EDUCATION 2024; 24:111. [PMID: 38317110 PMCID: PMC10845756 DOI: 10.1186/s12909-024-05074-1] [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: 08/29/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Recruiting and securing primary care physician workforce has been the center of international attention for decades. In Denmark, the number of general practitioners has decreased by 8.5% since 2013. However, a rising population age and increasing prevalence of chronic diseases and multimorbidity place an even greater future need for general practitioners in Denmark. The choice of general practice as specialty has been associated with a range of both intrinsic and extrinsic factors, however, few studies have examined the recruitment potential that lies within medical trainees' who are undecided about general practice specialization. The aim of this study was, therefore, to explore how medical trainees who are undecided about general practice specialization (GP-positive/undecided) differ from medical trainees who are either committed (GP-committed) or not committed to a general practice career (GP-non-committed) regarding factors related to future work life. METHODS The present study concerns baseline findings from a longitudinal survey study. An online questionnaire was e-mailed to a national cohort of medical trainees during their transition from under- to postgraduate education. The associations between orientations towards general practice specialization and work-related factors and potential influencing factors, respectively, were analyzed using uni- and multivariable modified Poisson regression models. RESULTS Of 1,188 invited participants, 461 filled out key study variables concerning specialty preferences and rejections, corresponding to a response rate of 38.8%. We found significant positive associations between GP-positive/undecided orientation and valuing a good work/life balance and the opportunity to organize own working hours when compared to GP-non-committed respondents. Compared to the GP-committed orientations, the GP-positive/undecided orientation was associated with a positive attitude towards technology, working shift hours, and an openness towards several career paths. Across all orientations, undergraduate exposure to the specialties was found to be highly influential on the specialty preferences. CONCLUSION GP-positive/undecided medical trainees value autonomy over their working hours more than the GP-non-committed, but less than the GP-committed. However, the GP-positive/undecided respondents present more openness to different career opportunities and the use of technology in daily work. We suggest using this knowledge in the planning of recruitment strategies aiming to increase interest in general practice specialization.
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Affiliation(s)
- Sofie Gjessing
- Center for General Practice, Aalborg University, Aalborg, Denmark.
| | - Trine Lignell Guldberg
- Department of Postgraduate Medical Education, Aalborg University Hospital, Aalborg, Denmark
| | - Torsten Risør
- Section for General Practice & Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Section for General Practice, Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
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Nandiwada DR, Farkas AH, Nikiforova T, Leung PB, Donovan AK, Killian K, Thomas ML, Singh MK, Gallagher B, Callender DM. Exploring Models of Exposure to Primary Care Careers in Training: a Narrative Review. J Gen Intern Med 2024; 39:277-282. [PMID: 37989819 PMCID: PMC10853099 DOI: 10.1007/s11606-023-08532-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
Multiple models of clinical exposure to primary care exist within undergraduate medical education (UME) and graduate medical education (GME). In this narrative review, we explore the evidence behind these different models of exposure, their alignment with positive promoters of primary care careers, and the pros and cons of each. Without positive exposure to primary care during training, sustaining the future primary care work force becomes increasingly challenging. Here, we explore multiple models of clinical exposure in UME, including longitudinal integrated clerkships, primary care tracks, and primary care clerkships. Within GME, we will review the impact of primary care tracks, Area Health Education Centers, block scheduling models, and continuity clinic scheduling models. The goal of this narrative review is to allow educators to think broadly and intentionally about the array of models to develop positive primary care experiences and perceptions in training, ultimately sustaining the primary care workforce.
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Affiliation(s)
- D Rani Nandiwada
- Perelman School of Medicine, University of Pennsylvania, 51 North 39Th Street, MAB 102, Philadelphia, PA, 19104, USA
| | - Amy H Farkas
- Milwaukee VA Medical Center, 5000 W National Ave, Milwaukee, WI, 53211, USA
| | - Tanya Nikiforova
- Division of General Internal Medicine, UPMC Montefiore Hospital, 9 West 921, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Peggy B Leung
- Weill Cornell Internal Medicine Associates, 505 East 70Th St, HT-4, New York, NY, 10021, USA
| | - Anna K Donovan
- Division of General Internal Medicine, UPMC Montefiore Hospital, 9 West 930, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Katherine Killian
- Weill Cornell Internal Medicine, 178 East 85Th Street, Floor 2, New York, NY, 10028, USA
| | - Mary L Thomas
- University of Tennessee, 920 Madison Ave, Suite 531, Memphis, TN, 38163, USA
| | - Mamta K Singh
- Case Western Reserve University, VA Northeast Ohio Healthcare System, 1620 Magnolia Drive, Administrative Building, RM 5M678, Cleveland, OH, 44106, USA
| | | | - David M Callender
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA.
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Pereira LKM, da Silva JA, Valentim RADM, Lima TGFMS, Gusmão CMG, da Rocha MA, dos Santos MM, Caitano AR, de Barros RMB, Rosendo TS. Interventions of Brazil's more doctors program through continuing education for Primary Health Care. Front Public Health 2024; 11:1289280. [PMID: 38328538 PMCID: PMC10847326 DOI: 10.3389/fpubh.2023.1289280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/29/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction Brazil's More Doctors Program, in its training axis, aims to improve medical training for Primary Health Care through interventions related to the reality of the territory. The research presented here analyzed the interventions implemented by Brazil's More Doctors Program physicians, members of the Family Health Continuing Education Program, and the relationship with Primary Health Care programmatic actions. Methodology The research conducted made use of Text and Data Mining and content analysis. In total, 2,159 reports of interventions from 942 final papers were analyzed. The analysis process was composed of the formation of the corpus; exploration of the materials through text mining; and analysis of the results by inference and interpretation. Results It was observed that 57% of the physicians worked in the Northeast Region, which was also the region with the most interventions (66.8%). From the analysis of the bigrams, trigrams, and quadrigrams, four constructs were formed: "women's health," "child health," "chronic non-communicable diseases," and "mental health." Terms related to improving access, quality of care, teamwork, and reception were also present among the N-grams. Discussion The interventions carried out are under the programmatic actions recommended by the Brazilian Ministry of Health for Primary Health Care, also addressing cross-cutting aspects such as Reception, Teamwork, Access Improvement, and Quality of Care, which suggests that the training experience in the Family Health Continuing Education Program reflects on the way these professionals act.
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Affiliation(s)
- Laianny Krizia Maia Pereira
- Postgraduate in Family Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - José Adailton da Silva
- Postgraduate in Family Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Ricardo A. de M. Valentim
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
- Department of Biomedical Engineering, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Thaísa G. F. M. S. Lima
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
- Brazilian Ministry of Health, Brasília, Brazil
| | - Cristine M. G. Gusmão
- Department of Biomedical Engineering, Federal University of Pernambuco (UFPE), Recife, Brazil
| | - Marcela A. da Rocha
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Marquiony M. dos Santos
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Alexandre R. Caitano
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Rosires M. B. de Barros
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Tatyana Souza Rosendo
- Postgraduate in Family Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
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Pfarrwaller E, Maisonneuve H, Laurent C, Abbiati M, Sommer J, Baroffio A, Haller DM. Dynamics of Students' Career Choice: a Conceptual Framework-Based Qualitative Analysis Focusing on Primary Care. J Gen Intern Med 2023:10.1007/s11606-023-08567-9. [PMID: 38102409 DOI: 10.1007/s11606-023-08567-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Increasing primary care's attractiveness as a career choice is an important task of socially accountable medical schools. Research has broadly studied influences on medical students' career choice. However, a deeper understanding of the processes behind career decision-making could support medical schools in their efforts to promote primary care careers. OBJECTIVE To explore the dynamics of career choice during medical school with a focus on primary care, based on a previously developed conceptual framework. APPROACH Qualitative study using a phenomenological, inductive-deductive approach DESIGN AND PARTICIPANTS: Individual interviews were conducted from May 2019 to January 2020 with 14 first-year postgraduate trainee physicians, graduates of the Faculty of Medicine in Geneva, Switzerland, purposively sampled based on their interest in primary care during undergraduate studies. The interview guide was developed to elicit narratives about career-related decision-making. Two authors coded the transcripts. Thematic analysis alternated with data collection until thematic saturation was reached. Emerging themes were discussed and refined within the research team. KEY RESULTS Two main themes emerged: (1) developing professional identity, expressed as a changing professional image from unprecise and idealistic to concrete and realistic; priorities changed from content-based to lifestyle-based preferences; (2) individual trajectories of career-related decision-making, determined by different stages of refining professional interests; students navigated this process by employing various strategies, ranging from active exploration to passive behaviors. CONCLUSIONS This study's narrative approach illustrates the dynamic nature of career choice and refines elements of a conceptual framework previously developed by the authors. Its findings underline the importance of exploration, for which personal experiences and observations of physicians' work are crucial. To advance efforts to make primary care a more attractive career, students must be sufficiently exposed to primary care in a safe and individualized environment and should be supported in all stages of their career choice process.
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Affiliation(s)
- Eva Pfarrwaller
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Hubert Maisonneuve
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- University College of General Medicine, Faculty of Medicine, University Claude Bernard Lyon 1, Lyon, France
| | - Camille Laurent
- University College of General Medicine, Faculty of Medicine, University Claude Bernard Lyon 1, Lyon, France
| | - Milena Abbiati
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Johanna Sommer
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anne Baroffio
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Dagmar M Haller
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Scholz A, Gehres V, Schrimpf A, Bleckwenn M, Deutsch T, Geier AK. Long-term mentoring relationships in undergraduate longitudinal general practice tracks - a qualitative study on the perspective of students and general practitioners. MEDICAL EDUCATION ONLINE 2023; 28:2149252. [PMID: 36463500 PMCID: PMC9728122 DOI: 10.1080/10872981.2022.2149252] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Longitudinal general practice tracks have been established in medical faculties in Europe and worldwide to attract more graduates to general practice careers. In many programs, long-term mentoring relationships play an important role in providing students with positive role models, regular practical experiences, and acquisition of clinical skills in a community context. However, little is known about students' and general practitioner mentors' expectations, experiences, challenges, and ideas for improvement within these long-term mentoring relationships in general practice in our medical education system. METHODS Qualitative study based on semi-structured interviews with 15 students and 13 mentors. Interviews were audio-recorded and transcribed verbatim. MAXQDA was used for data analysis, following a mixed deductive/inductive approach. RESULTS Both groups had few and rather unstated expectations, particularly regarding their relationships. Consequently, expectations were often not clearly communicated. Nevertheless, a high level of satisfaction and good opportunities for teaching were achieved for both sides. The evolving familiarity facilitated a positive learning environment. Students valued independent medical tasks continuously adjusted to their current abilities. However, some felt a reluctance to demand their mentor's time and consideration. Conversely, the mentors criticized a lack of initiative from some of the students and wished that they would get more actively involved. Students, in contrast, wished for more guidance at the start of the project and joint events to deepen the relationship. CONCLUSIONS With this study, we gained detailed insights into and understanding of the nature of long-term relationships between students and mentors. Points for improvement revealed included: 1) education of both participating groups on the goals and benefits of mentoring, including binding expectations for the participants; 2) intensified support and training of teaching physicians; 3) structured and accompanied establishment of initial contact between mentor and mentee; and 4) encouraged additional shared (teaching) time, individualized timing, and intensification, if desired.
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Affiliation(s)
- Anna Scholz
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Vera Gehres
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Anne Schrimpf
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Markus Bleckwenn
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Tobias Deutsch
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Anne-Kathrin Geier
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
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Koike S, Okazaki K, Tokinobu A, Matsumoto M, Kotani K, Kataoka H. Factors associated with regional retention of physicians: a cross-sectional online survey of medical students and graduates in Japan. HUMAN RESOURCES FOR HEALTH 2023; 21:85. [PMID: 37885012 PMCID: PMC10604803 DOI: 10.1186/s12960-023-00871-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Physician shortage and maldistribution is an urgent health policy issue requiring resolution. Determination of factors associated with regional retention and development of effective policy interventions will help to solve this issue. The purpose of the present study was to identify factors associated with regional retention and discuss their policy implications. METHODS We conducted a cross-sectional online survey from February to March of 2022 for graduates from regional quotas (special quotas for medical schools to select students engaged in community medicine) and Jichi Medical University (JMU) and students at 10 medical schools including JMU. Completed surveys were obtained from 375 graduates and 1153 students. Questions included intention to continue to work in their home prefecture in the future, as well as background information and potential factors associated with regional retention. In the analyses, regional quotas and JMU were referred to as community medicine-oriented programs and schools (CMPS). We performed logistic regression analyses to identify factors associated with regional retention. RESULTS Among the students, scholarship-bonded obligatory service, satisfaction with current life, intention to belong to ikyoku (a traditional physician allocation/training system in Japanese medical schools), and interest in general practice/family medicine were significantly positively associated with regional retention. Among the graduates, satisfaction with training environment, intention to belong to ikyoku, and recommending their program to high school students were significantly positively associated with regional retention. For students of CMPS, satisfaction with the career development program was positively associated with future regional retention. For graduates, this association was observed only in the crude analysis. CONCLUSIONS In addition to known factors such as interest in general practice/family medicine, intention to belong to ikyoku had a substantial impact on regional retention. The present results suggest that the career support system represented by ikyoku as well as a career development program are of potential importance for increasing regional retention through the mechanisms of a sense of belonging and a life-long education system. These findings provide useful information for the development of further policy interventions that interweave traditional and new systems to maximize their effectiveness.
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Affiliation(s)
- Soichi Koike
- Division of Health Policy and Management, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Kentaro Okazaki
- Department of Education for Community-Oriented Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
- Faculty of Medical Sciences Community Medicine Education Unit, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Akiko Tokinobu
- Center for Diversity and Inclusion, Okayama University Hospital, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Masatoshi Matsumoto
- Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hitomi Kataoka
- Center for Diversity and Inclusion, Okayama University Hospital, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
- Center for Medical Education and Internationalization, Kyoto University, Yoshida-Konoe-Cho, Sakyo-Ku, Kyoto, 606-0007, Japan
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Heller O, Ismailova Z, Mambetalieva D, Brimkulov N, Beran D, Nendaz M, Vu NV, Loutan L, Baroffio A. Exploring medical students' perceptions of family medicine in Kyrgyzstan: a mixed method study. BMC MEDICAL EDUCATION 2023; 23:239. [PMID: 37046257 PMCID: PMC10099892 DOI: 10.1186/s12909-023-04126-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 02/24/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Despite knowing that health systems with strong primary care improve overall health outcomes within a population, many countries are facing a global trend of declining interest and shortage of family doctors. This is the case of the Kyrgyz Republic, in which rural areas are struggling to attract and retain family medicine (FM) doctors. This study aims to explore how Kyrgyz medical students perceive FM and the factors that influence their specialty choice. METHODS This study used a cross-sectional explanatory sequential design, including quantitative survey and focus group discussions that were carried out at the Kyrgyz State Medical Academy (KSMA) in Bishkek in 2017. Overall, 66% (953 out of 1449) of medical undergraduate students registered in year 1, 4 and 6 completed the survey, and 42 participated in the focus groups. The results were organized around 7 factors influencing perceptions and attitudes towards FM identified through a qualitative systematic review. RESULTS The interest of Kyrgyz students for FM was the lowest of all specialties. Access to high medical technologies, career opportunities, salary, patient interaction and possibility to work abroad were the five most important factors influencing specialty choice. FM was perceived as a difficult profession, yet with poor prestige, insufficient remuneration, limited career possibilities and poor working conditions, especially in rural areas. The academic discourse, which disregards FM specialty had a negative influence on student's perceptions and prevented students' ability to identify with the practice of family medicine. However, students' awareness of their social accountability arose as a positive leverage to increase the choice of FM, provided other problems were solved. CONCLUSION This study highlighted key factors responsible for the low number of students choosing to become FM in Kyrgyzstan. The first major factor, presumably specific to many low- and lower-middle- income countries was the poor working conditions in remote areas. The second factor, common to many countries, was the distorted image of FM and its specialty transmitted through the medical schools' institutional culture which does not value FM through positive role models. This study served as a basis to establish a strategy to promote FM within the KSMA and potentially at National level.
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Affiliation(s)
- Olivia Heller
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, Geneva, 1211 Switzerland
- Medical Education Reform (MERproject), Bishkek, Kyrgyzstan
| | - Zhyldyz Ismailova
- Medical Education Reform (MERproject), Bishkek, Kyrgyzstan
- Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | | | | | - David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, Geneva, 1211 Switzerland
- Medical Education Reform (MERproject), Bishkek, Kyrgyzstan
| | - Mathieu Nendaz
- Medical Education Reform (MERproject), Bishkek, Kyrgyzstan
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Rue Michel Servet 1, Geneva, 1211 Switzerland
| | - Nu V. Vu
- Medical Education Reform (MERproject), Bishkek, Kyrgyzstan
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Rue Michel Servet 1, Geneva, 1211 Switzerland
| | - Louis Loutan
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, Geneva, 1211 Switzerland
- Medical Education Reform (MERproject), Bishkek, Kyrgyzstan
| | - Anne Baroffio
- Medical Education Reform (MERproject), Bishkek, Kyrgyzstan
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Rue Michel Servet 1, Geneva, 1211 Switzerland
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Simmenroth A, Harding A, Vallersnes OM, Dowek A, Carelli F, Kiknadze N, Karppinen H. Early clinical exposure in undergraduate medical education: A questionnaire survey of 30 European countries. MEDICAL TEACHER 2023; 45:426-432. [PMID: 36315584 DOI: 10.1080/0142159x.2022.2137014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Fifteen years ago, a European survey demonstrated widespread adoption of early clinical exposure (ECE) programmes but little emphasis in the curricula of medical schools. We now repeat the survey in light of the ample emerging data suggesting multiple positive outcomes of ECE. METHODS Online cross-sectional survey in European medical schools conducted by the EURACT Basic Medical Education Committee in 2021. Descriptive quantitative analyses and a thematic analysis approach were used. RESULTS Eighy-nine (48%) medical schools in 30 European countries responded. ECE was used in 65 (73%) of the medical schools, and 88% of ECE programmes took place in primary care. The median total time spent on the ECE programme was 5 days. Teaching methods covered unstructured learning opportunities such as observation or shadowing doctors, as well as work-based learning whilst seeing real patients or reflecting on own encounters. Learning goals included knowledge, skills, and attitudes. More than half of the respondents expressed barriers to implementing or expanding ECE. CONCLUSIONS Compared to the previous survey, there was no significant change in the adoption or curricular emphasis of ECE programmes. Institutional attitudes towards certain disciplines and a lack of willingness to experiment with new teaching methods may be partially responsible.
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Affiliation(s)
- Anne Simmenroth
- Faculty of Medicine, Department of Family Medicine, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Alex Harding
- Department of Primary Care, University of Exeter College of Medicine and Health, Exeter, UK
| | | | - Aimee Dowek
- Royal Hampshire County Hospital, Winchester, UK
| | - Francesco Carelli
- Faculty of Medicine, Department of Clinical Medicine, Polo Policlinico, Milan, Italy
| | - Nino Kiknadze
- Faculty of Medicine, Department of Family Medicine, Tbilisi State Medical University, Tbilisi, Georgia
| | - Helena Karppinen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
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Pfarrwaller E, Voirol L, Karemera M, Guerrier S, Baroffio A. Dynamics of career intentions in a medical student cohort: a four-year longitudinal study. BMC MEDICAL EDUCATION 2023; 23:131. [PMID: 36849901 PMCID: PMC9972700 DOI: 10.1186/s12909-023-04102-w] [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: 07/04/2022] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Medical students' career intentions often change between matriculation and graduation, yet little is known about the precise timing and dynamics of individual students' career decisions. This study expands on previous research by exploring the stability of individual students' career intentions over four years and by analyzing associations between unstable career intentions and students' characteristics. METHODS Medical students from two classes were recruited into a cohort during their first academic year and completed a yearly survey over a four-year period (end of pre-clinical curriculum to graduation). Measures included career intention (specialty and practice type), personality, coping strategies, empathy, and motives for becoming a physician. The authors developed a score ranging from 0 to 10 quantifying instability of career intentions (0 = stable; 10 = unstable). The distribution of the score was analyzed descriptively, and the association between the score and other variables was quantified using a stepwise beta regression model. RESULTS The sample included 262 students (61% females). The mean score was 3.07 with a median of 3. 18% of students (N = 46) did not change their specialty intention over the four years, whereas 10% (N = 26) changed every year. No further subgroups were identified between these extremes. An intention to work in private practice in year 3 and the motive care for patients were significantly associated with more stable career intentions. CONCLUSION Most students are situated on a continuum between the two extremes of being firmly committed and undecided. Extrinsic factors may be more important drivers of these fluctuations than personal characteristics and should be explored in future research. This study's findings also provide avenues for supporting students in their career decision-making.
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Affiliation(s)
- Eva Pfarrwaller
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211 Genève 4, Geneva, Switzerland.
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Lionel Voirol
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
| | - Mucyo Karemera
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
| | - Stéphane Guerrier
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
- Faculty of Science, University of Geneva, Geneva, Switzerland
| | - Anne Baroffio
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Eddings SK, Brown LL, Godin S. Qualitative Findings of a Nominal Group Process to Identify Critical Factors in New LIC Implementation. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231217894. [PMID: 38106517 PMCID: PMC10725107 DOI: 10.1177/23821205231217894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/19/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Medical schools considering longitudinal integrated clerkships (LICs) have access to literature that provides recommendations for planning, implementation, and sustainability. However, LIC development and implementation remain notoriously challenging. University of Utah's LIC development process was informed by the documented experiences of long-established LIC programs. A literature gap was identified pertaining to more recently implemented LICs. The aim of this study was to explore the experiences of faculty in the early stages of LIC development. METHODS Thirteen representatives from eight LICs implemented after 2015 participated in 2 Zoom focus groups (5 participated in the first and the other 8 participated in the second). Participants were asked questions to assess key supports, barriers, and recommendations. Following the focus groups, participants were asked to rank the responses based on their level of importance. RESULTS Highest ranked supports included stakeholder and partner involvement; a dedicated coordinator or team; and strong, committed leadership. Highest ranked barriers included difficulty recruiting preceptors and clinical sites; underestimation of the amount of work required to coordinate the LIC; and challenges in providing the needed faculty development. Top recommendations for new LICs included investing in the needs of clinical partners; staffing or assigning a dedicated coordinator early in the development and implementation process; and frequent communication with all stakeholders. CONCLUSION Despite variation among the types of new LICs represented, there was consensus among participants on the importance of key supports, barriers, and recommendations. Knowledge of these factors can help new schools plan and allocate resources during their LIC development process. Participants found the focus group process and follow-up discussions useful and have formed an ongoing workgroup which meets quarterly.
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Affiliation(s)
- Stacy K. Eddings
- Dean's Office, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, United States
| | - Laura L. Brown
- Department of Pediatrics, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, United States
| | - Steven Godin
- Division of Public Health, Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, United States
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12
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Zhao M, Mathews CJ, Mulvey KL, Hartstone-Rose A, McGuire L, Hoffman AJ, Winterbottom M, Joy A, Law F, Balkwill F, Burns KP, Butler L, Drews M, Fields G, Smith H, Rutland A. Promoting Diverse Youth's Career Development through Informal Science Learning: The Role of Inclusivity and Belonging. J Youth Adolesc 2023; 52:331-343. [PMID: 36344878 PMCID: PMC9842558 DOI: 10.1007/s10964-022-01694-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
Little research has examined the associations between perceived inclusivity within informal science learning sites, youth program belonging and perceptions of program career preparation. This study explored relations between these factors at three timepoints (T1 = start of program, T2 = 3 months and T3 = 12 months after start). Participants were a diverse sample of 209 adolescents participating in STEM youth programs within informal science learning sites situated in the United States and United Kingdom (70% females: M age = 15.27, SD age = 1.60), with 53.1% British and 64.1% non-White. Path analysis revealed that only perceptions of inclusivity for own social identity group (i.e., gender, ethnicity) at T1 were associated with T2 STEM youth program belonging. There was a significant indirect effect of T1 perceptions of inclusivity for one's own social identity groups on T3 perceptions of program career preparation via T2 program belonging. This study highlights that, over time, perceptions of inclusivity around youth's own social identity groups (i.e., gender and ethnicity/culture) are related to a sense of youth program belonging, which in turn is later associated with perceptions of program career preparation.
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Affiliation(s)
- Mengya Zhao
- grid.8391.30000 0004 1936 8024University of Exeter, Exeter, UK
| | - Channing J. Mathews
- grid.40803.3f0000 0001 2173 6074North Carolina State University, Raleigh, NC USA
| | - Kelly Lynn Mulvey
- grid.40803.3f0000 0001 2173 6074North Carolina State University, Raleigh, NC USA
| | - Adam Hartstone-Rose
- grid.40803.3f0000 0001 2173 6074North Carolina State University, Raleigh, NC USA
| | - Luke McGuire
- grid.8391.30000 0004 1936 8024University of Exeter, Exeter, UK
| | - Adam J. Hoffman
- grid.5386.8000000041936877XCornell University, Ithaca, NY USA
| | | | - Angelina Joy
- grid.40803.3f0000 0001 2173 6074North Carolina State University, Raleigh, NC USA
| | - Fidelia Law
- grid.8391.30000 0004 1936 8024University of Exeter, Exeter, UK
| | - Frances Balkwill
- grid.4868.20000 0001 2171 1133Centre of the Cell, Queen Mary University of London, London, UK
| | - Karen P. Burns
- grid.448542.bVirginia Aquarium & Marine Science Center, Virginia Beach, VA, USA
| | | | - Marc Drews
- grid.486876.3EdVenture, Columbia, SC, USA
| | - Grace Fields
- grid.481203.c0000 0004 0428 1057Riverbanks Zoo & Garden, Columbia, SC USA
| | - Hannah Smith
- grid.421462.7The Florence Nightingale Museum, London, UK
| | - Adam Rutland
- grid.8391.30000 0004 1936 8024University of Exeter, Exeter, UK
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Nafziger M, Geier AK, Bauch FJ, Deutsch T, Frese T. When and why do medical students drop out of extracurricular longitudinal general practice tracks? A cross-sectional study from two German medical faculties. BMJ Open 2022; 12:e064481. [PMID: 36521907 PMCID: PMC9756222 DOI: 10.1136/bmjopen-2022-064481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To explore when and why undergraduate medical students drop out of longitudinal extracurricular general practice (GP) tracks and to describe their future career plans. DESIGN Cross-sectional online survey and descriptive analysis of routine data. SETTING GP tracks at two German medical faculties, data collection took place between September 2020 and April 2021. PARTICIPANTS Of 111 students who had taken part in one of the two GP tracks and dropped out prematurely, 101 were contactable via email. Overall, the response rate was 72.3% with 73 completed questionnaires and 75.3% of the participants were female. PRIMARY AND SECONDARY OUTCOME MEASURES Reasons for leaving the GP track (closed and free-text answers), attitudes towards a career in GP and future career plans. RESULTS Students left the tracks predominantly during the first 2 years of study. Students most frequently stated that structural reasons such as the distance to the GP teaching practice (74.2%), interest in another medical discipline (66.1%), private reasons (58.1%) and the GP mentor (53.1%) influenced their decision to drop out. However, 87.1% of the students indicated that their exit could not have been prevented by the project administration. CONCLUSIONS Reasons for dropping out differ between GP tracks and not all reasons are within reach of programme design and staff. Addressable issues include student selection with regard to career plans, support and strengthening of student-mentor relationships, the location of GP practices, and/or travel and accommodation support.
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Affiliation(s)
- Melanie Nafziger
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Anne-Kathrin Geier
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Felix Johannes Bauch
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Tobias Deutsch
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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14
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Thomson KB, Mirpuri P, Chen M. The impact of volunteering with a student-run free clinic on medical student specialty selection. BMC MEDICAL EDUCATION 2022; 22:714. [PMID: 36221082 PMCID: PMC9552362 DOI: 10.1186/s12909-022-03788-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The shortage of primary care physicians in the United States is expected to grow to 17,800-48,000 physicians by 2034. Student Run Free Clinics are an increasingly popular component of medical schools and may provide an avenue for increasing medical student interest in primary care specialties. However, there is limited research on the impact of Student Run Free Clinics on medical student specialty choice. This investigation sought to determine whether volunteering with the Interprofessional Community Clinic (ICC), the Student Run Free Clinic associated with Chicago Medical School, was associated with an increased likelihood of matching into primary care specialties. Secondarily, the authors investigated associations between volunteering and matching into family practice. Finally, the authors explored associations between volunteering and the competitiveness of specialty choice. METHODS This retrospective review utilized data on medical school graduates from 2015 - 2021 including their matched specialties, the number of ICC shifts they volunteered for, and whether they held an ICC leadership position (executive officers). Primary care specialties were defined as internal medicine, family practice, pediatrics, or combined internal medicine/pediatrics. Residency fill rate was used as a proxy for competitiveness. RESULTS This analysis included 506 medical students (254 ICC volunteers and 252 non-volunteers). Among ICC volunteers, 47.2% matched into a primary care specialty compared to 36.5% of non-volunteers (RR 1.29, 95% CI 1.05-1.59). Each additional shift worked at the ICC was correlated with increased odds of matching into family practice by a factor of 1.042 (95% CI 1.005-1.079). CONCLUSIONS Medical students who volunteered with the ICC were more likely to match into primary care residencies. Students who volunteered more frequently were more likely to match into family practice. Further investigation is warranted to determine whether these associations are causative and could thus be leveraged to encourage medical students to pursue primary care careers.
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Affiliation(s)
- Kyle B. Thomson
- Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | - Pranav Mirpuri
- Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | - Melissa Chen
- Rosalind Franklin University of Medicine and Science, North Chicago, USA
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Sarikhani Y, Ghahramani S, Bayati M, Lotfi F, Bastani P. Determining Factors Influencing Specialty Preferences of Iranian Medical Doctors: A Qualitative Study. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:350-359. [PMID: 35919085 PMCID: PMC9339108 DOI: 10.30476/ijms.2021.89938.2071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/21/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022]
Abstract
Background The medical specialty choice of physicians directly affects the healthcare system, community wellbeing, and their own professional life. It is therefore important to identify its underlying factors to predict such medical career choices and to draw up a comprehensive evidence-based public health policy and health human resources planning. The present qualitative study aimed to identify these determinants of career choices through semi-structured interviews with medical doctors in the context of country-specific social and cultural characteristics. Methods The present qualitative study was carried out in 2019-2020 at Shiraz University of Medical Sciences (Shiraz, Iran). The target population was medical students, junior doctors, and medical residents. The purposive sampling method was used to recruit the participants and sampling continued until data saturation, i.e., no new information could be extracted. Data were collected through individual, face-to-face, semi-structured interviews and analyzed using the conventional content analysis method. Inductive thematic analysis was used to interpret the data based on which a thematic map was developed illustrating the factors influencing medical specialty preferences in Iran. Data trustworthiness was assessed according to the criteria proposed by Guba and Lincoln. Results Analysis of the interview data resulted in three main themes and fourteen sub-themes. The main themes were "Personal determinants", "Career-related factors", and "Interpersonal influences". The most important sub-themes were personal interests, income, and prestige. Conclusion The determinants influencing the specialty preferences of Iranian medical doctors are identified. Our findings will facilitate the development of a comprehensive evidence-based public health policy, health human resources planning, and appropriate medical education policy.
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Affiliation(s)
- Yaser Sarikhani
- Department of Health Care Management and Health Economics, School of Health Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sulmaz Ghahramani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Bayati
- Health Human Resources Research Center, School of Health Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farhad Lotfi
- Health Human Resources Research Center, School of Health Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peivand Bastani
- Health Human Resources Research Center, School of Health Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
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16
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An evaluation of a student led career profiling project to support the exploration of a career in general practice and other specialties. BJGP Open 2022; 6:BJGPO.2022.0002. [PMID: 35504725 DOI: 10.3399/bjgpo.2022.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/08/2022] [Accepted: 04/26/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Choosing medical careers is complex but the undergraduate period is formative. St. George's University of London (SGUL) students called for greater careers information. AIM To develop & evaluate students' careers resources. DESIGN & SETTING A quality improvement student staff project at SGUL. METHOD A "Plan, Do, Study, Act" (PDSA) cycle was completed. For the "Plan" element we surveyed students' career intentions and information preferences. For the "Do" element, video interviews with clinicians and infographic posters were produced and published on SGUL's virtual learning environment. For the "Study" element, feedback questionnaires were thematically analysed using Kirkpatrick's framework. For the "Act" element the model was rolled out across SGUL programmes. RESULTS (Plan) 79 students ranked interest in specialties, with GP second most popular. Students were unconfident how to pursue careers and wanted more information. (Do) 13 careers videos & infographics were created for 10 specialties. The (Study) questionnaire showed changes across 3 of Kirkpatrick's levels. Level 1 (Response) students found resources helpful & accessible. Level 2 (Learning) students reported increased understanding of careers. Level 3 (Transfer) students planned using checklists and made career comparisons by specialty. Level 4 (Results) students' career choices were not demonstrated but there were tentative proxy measures such as copying and modelling career routes and choices. (Act) involved rolling out and regularly updating resources. CONCLUSION This PDSA model enabled development of resources by students mapped to students' needs. We demonstrated changes in relation to students' response, learning and transfer, with tentative suggestions of impact on career choice.
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17
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Fang Y, Soljak M, Tan SLL, Smith HE. Medical students' attitudes towards and views of general practice careers in Singapore: a cross-sectional survey and qualitative analysis. BMC MEDICAL EDUCATION 2022; 22:266. [PMID: 35410191 PMCID: PMC8995911 DOI: 10.1186/s12909-022-03298-7] [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: 10/01/2021] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Like many other countries, Singapore needs to support its ageing population by attracting more doctors into general practice (GP) and family medicine (FM). To achieve this requires a better understanding of what attracts or deters medical students. We conducted a cross-sectional survey among medical students in Singapore. METHODS An online survey was distributed to students from all three medical schools to understand their likelihood of choosing primary care careers, what they valued in their careers, their attitude towards different aspects of general practice and family medicine relative to other medical fields, and the positive and negative perceptions of primary care held by themselves, their lecturers, and clinical mentors. They were able to elaborate the negativity encountered in the open-ended questions. Quantitative data was analyzed with descriptive statistics, principal component analysis, and linear regression; qualitative data was analyzed thematically. RESULTS The survey was completed by 391 students. Slightly over half indicated a likelihood of choosing a career in primary care. For their own careers, the students valued job satisfaction and career development opportunities the most. They perceived careers in primary care as being most likely to offer reasonable hours and close patient relationships, but least likely to offer career advancement potential relative to other medical fields. Their likelihood of choosing primary care careers was significantly predicted by what they value in their own career and their attitudes toward GP/FM relative to other medical fields, but not by the perceptions of GP/FM by others. Free-text responses illustrated how students encounter derogatory comments about GP/FM: the work being "mundane and repetitive", the careers non-competitive, and the doctors poor in clinical competence. CONCLUSION While the shortage of primary care doctors is a global issue, our findings highlight the value of situating inquiries in localized contexts. Medical curriculum should emphasize the critical role of primary care in the healthcare system and primary care doctors should be given due recognition to build a strong and motivated primary care workforce to serve the future healthcare needs of the population.
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Affiliation(s)
- Yang Fang
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Michael Soljak
- Faculty of Medicine, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Shawn Lien Ler Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Singapore, 308232, Singapore
- Ministry of Health Holdings, 1 Maritime Square, Singapore, 099253, Singapore
| | - Helen E Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Singapore, 308232, Singapore.
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Markun S, Tandjung R, Rosemann T, Scherz N, Senn O. Attractiveness of medical disciplines amongst Swiss first-year medical students allocated to different medical education tracks: cross-sectional study. BMC MEDICAL EDUCATION 2022; 22:252. [PMID: 35392880 PMCID: PMC8986963 DOI: 10.1186/s12909-022-03313-x] [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: 01/27/2021] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND As most countries, Switzerland is experiencing a shortage of physicians especially in general practice and new medical education tracks with respective focusses have been started in response. This study investigated Swiss medical students' career openness and attractiveness of different medical disciplines as well as the concordance of students' career intentions with assigned medical education tracks. METHODS Cross-sectional study surveying first year medical students assigned to four different Swiss medical education tracks with distinctive additional education focuses (ETH Zurich: medical technology and engineering, University of St. Gallen and University of Lucerne: primary healthcare and University of Zurich: no distinctive focus). RESULTS We surveyed 354 medical students (response rate across all included medical education tracks 71.1%), 64.8% female, mean age 20 years. Regarding career openness, we found that 52.8% of medical students had neither a strong commitment nor a strong reservation for any of the proposed career options and 17.0% had a strong commitment. Among medical disciplines, medical subspecialties were attractive to the largest part of students (inpatient subspecialties attractive for 71%, outpatient for 58%), attractiveness of general practice was moderate (30%), academic (22%) and industrial sector (17%) careers were least attractive. Proportions of medical students attracted to general practice were similar at medical education tracks with focus on primary healthcare compared to other medical education tracks (32.2% vs. 25.8%, p = 0.391). Conversely, proportions of medical students attracted to academic or industry careers were significantly higher at the ETH Zurich compared to other medical education tracks (37.2%, vs. 13.1%, p < 0.001 and 31.9%, vs. 8.8%, p < 0.001 respectively). CONCLUSION While most first-year medical students were open to careers in many medical disciplines, attractiveness of disciplines varied strongly. Students attracted to academic or industrial careers accumulated at the medical education track with concordant teaching focus but students attracted to general practice did not accumulate at medical education tracks focused on primary healthcare. For medical education tracks with primary care teaching focus this is both a challenge and an opportunity to specifically counteract the shortage of general practitioners in Switzerland.
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Affiliation(s)
- Stefan Markun
- Institute of Primary Care, University and University Hospital Zurich, Zurich, Switzerland.
| | | | - Thomas Rosemann
- Institute of Primary Care, University and University Hospital Zurich, Zurich, Switzerland
| | - Nathalie Scherz
- Institute of Primary Care, University and University Hospital Zurich, Zurich, Switzerland
- Division of Internal Medicine, Centre Hospitalier de Bienne, Bienne, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University and University Hospital Zurich, Zurich, Switzerland
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Wild D, Linden K, Welchowski T, Dehnen D, Weltermann B. Attitudes of German GP trainees regarding add-on training programs differ if in office or hospital training phase. BMC MEDICAL EDUCATION 2022; 22:205. [PMID: 35346168 PMCID: PMC8959794 DOI: 10.1186/s12909-022-03273-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Many residents are exposed to negative attitudes towards primary care during hospital training. Attractive add-on training programs exist, but it is unclear whether these need to be tailored to the location of training (hospital vs. office). We report differences in learner attitudes from a large German add-on training program. METHODS Between 2017 and 2020, a regional network offered 31 quarterly seminars to primary care residents. The seminars addressed medical content, practice management and mentoring. We elicited participants' satisfaction, perceived topic relevance, preferences for future seminars, work situation and employer support for participation. A proportionate odds model was used to assess predictors of ratings; results were stratified by training location (hospital vs. office). RESULTS Most respondents were female (380/575 = 70.0%), aged between 26 and 40 (80.8%), and had on average 3.54 ± 1.64 years of residency training. The majority (83.8%) was working in an office and full-time (63.0%). Overall evaluations were positive (very satisfactory 72.1%). Comparing residents in the hospital phase vs. the office phase, overall seminar ratings of the perceived impact on the motivation for primary care did not differ (p = 0.73 vs. 0.18, respectively). Hospital-based residents were less likely to rate the topics as relevant (39.4% vs. 55.7%, p = 0.02) and had different preferences for future seminar topics (top 3: palliative care, emergencies and chronic care vs. billing, disease management and practice finances for hospital and office phase, respectively). CONCLUSIONS Keeping primary care residents motivated may require education tailored to training location. Our findings may be of interest to teachers, administrators and policymakers.
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Affiliation(s)
- Dmg Wild
- Institute of Family Medicine and General Practice, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, D-53127, Bonn, Germany.
| | - K Linden
- Institute of Family Medicine and General Practice, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, D-53127, Bonn, Germany
| | - T Welchowski
- Institute of Family Medicine and General Practice, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, D-53127, Bonn, Germany
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - D Dehnen
- Institute of Family Practice, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - B Weltermann
- Institute of Family Medicine and General Practice, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, D-53127, Bonn, Germany
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20
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Ladha FA, Pettinato AM, Perrin AE. Medical student residency preferences and motivational factors: a longitudinal, single-institution perspective. BMC MEDICAL EDUCATION 2022; 22:187. [PMID: 35300656 PMCID: PMC8929265 DOI: 10.1186/s12909-022-03244-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 03/07/2022] [Indexed: 05/02/2023]
Abstract
BACKGROUND A high proportion of medical school graduates pursue specialties different from those declared at matriculation. While these choices influence the career paths, satisfaction, and potential regret students will experience, they also impact the supply and demand ratio of the shorthanded physician workforce across many specialties. In this study, we investigate how the choice of medical specialty and the factors motivating those choices change between the beginning and end of medical school training. METHODS A questionnaire was administered annually from 2017 to 2020 to a cohort of medical students at the University of Connecticut to determine longitudinal preferences regarding residency choice, motivational factors influencing residency choice, future career path, and demographic information. RESULTS The questionnaire respondent totals were as follows: n = 76 (Year 1), n = 54 (Year 2), n = 31 (Year 3), and n = 65 (Year 4). Amongst newly matriculated students, 25.0% were interested in primary care, which increased ~ 1.4-fold to 35.4% in the final year of medical school. In contrast, 38.2% of matriculated students expressed interest in surgical specialties, which decreased ~ 2.5-fold to 15.4% in the final year. Specialty choices in the final year that exhibited the largest absolute change from matriculation were orthopedic surgery (- 9.9%), family medicine (+ 8.1%), radiology (+ 7.9%), general surgery (- 7.2%), and anesthesiology (+ 6.2%). Newly matriculated students interested in primary care demonstrated no differences in their ranking of motivational factors compared to students interested in surgery, but many of these factors significantly deviated between the two career paths in the final year. Specifically, students interested in surgical specialties were more motivated by the rewards of salary and prestige compared to primary care students, who more highly ranked match confidence and family/location factors. CONCLUSIONS We identified how residency choices change from the beginning to the end of medical school, how certain motivational factors change with time, how these results diverge between primary care and surgery specialty choice, and propose a new theory based on risk-reward balance regarding residency choice. Our study promotes awareness of student preferences and may help guide school curricula in developing more student-tailored training approaches. This could foster positive long-term changes regarding career satisfaction and the physician workforce.
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Affiliation(s)
- Feria A Ladha
- University of Connecticut School of Medicine, Farmington, CT, USA.
| | | | - Adam E Perrin
- Department of Family Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
- Family Medicine Center at Asylum Hill, Hartford, CT, USA
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Le Floc'h B, Bastiaens H, Le Reste JY, Nabbe P, Montier T, Peremans L. Examining positive views from students, trainees and GPs about general practice: a generational problem? A set of qualitative studies in France. BMJ Open 2022; 12:e048857. [PMID: 35105565 PMCID: PMC8808418 DOI: 10.1136/bmjopen-2021-048857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This study aimed to explore the positive factors related to working in general practice in France, from a student studying medicine, trainee general practitioner (GP) and GP point of view. SETTING Primary care, France. DESIGN Nine different qualitative studies involving medical students, trainees and GPs. PARTICIPANTS Sixty-seven medical students, 22 trainees in general practice and 71 GPs. RESULTS The final codebook contained 66 interpretative codes and 8 positive themes. The themes were general practice as a commitment, doctor-patient care and relationships, skills and competencies in general practice, practice organisation and work-life balance, relationship with the professional community, GPs and university, GPs in the social community and private life, relatives and family. Positive feelings about being a GP are similar throughout the different age groups, from young students to older professionals. DISCUSSION AND CONCLUSION This study provided a comprehensive picture of the satisfied GP across different ages. This picture describes GPs as patient-centred professionals who need to have the freedom to choose an efficient working environment, organise their practice, have opportunities for professional development and acquire specific competencies. Both younger and older GPs believe in the future of general practice.
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Affiliation(s)
- Bernard Le Floc'h
- Department of General Practice, Université de Bretagne Occidentale, Brest, France
- EA 7479 SPURBO, Université de Bretagne Occidentale, Brest, France
| | - Hilde Bastiaens
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | | | - Patrice Nabbe
- Médecine Générale EA Spurbo, Université de Bretagne Occidentale, Brest, France
| | - Tristan Montier
- Unité INSERM 1078, SFR 148 ScInBioS, Université Européenne de Bretagne, Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France
| | - Lieve Peremans
- Primary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Pfarrwaller E, Voirol L, Piumatti G, Karemera M, Sommer J, Gerbase MW, Guerrier S, Baroffio A. Students' intentions to practice primary care are associated with their motives to become doctors: a longitudinal study. BMC MEDICAL EDUCATION 2022; 22:30. [PMID: 35016672 PMCID: PMC8750802 DOI: 10.1186/s12909-021-03091-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medical schools can contribute to the insufficient primary care physician workforce by influencing students' career preferences. Primary care career choice evolves between matriculation and graduation and is influenced by several individual and contextual factors. This study explored the longitudinal dynamics of primary care career intentions and the association of students' motives for becoming doctors with these intentions in a cohort of undergraduate medical students followed over a four-year period. METHODS The sample consisted of medical students from two classes recruited into a cohort study during their first academic year, and who completed a yearly survey over a four-year period from their third (end of pre-clinical curriculum) to their sixth (before graduation) academic year. Main outcome measures were students' motives for becoming doctors (ten motives rated on a 6-point scale) and career intentions (categorized into primary care, non-primary care, and undecided). Population-level flows of career intentions were investigated descriptively. Changes in the rating of motives over time were analyzed using Wilcoxon tests. Two generalized linear mixed models were used to estimate which motives were associated with primary care career intentions. RESULTS The sample included 217 students (60% females). Career intentions mainly evolved during clinical training, with smaller changes at the end of pre-clinical training. The proportion of students intending to practice primary care increased over time from 12.8% (year 3) to 24% (year 6). Caring for patients was the most highly rated motive for becoming a doctor. The importance of the motives cure diseases, saving lives, and vocation decreased over time. Primary care career intentions were positively associated with the motives altruism and private practice, and negatively associated with the motives prestige, academic interest and cure diseases. CONCLUSION Our study indicates that career intentions are not fixed and change mainly during clinical training, supporting the influence of clinical experiences on career-related choices. The impact of students' motives on primary care career choice suggests strategies to increase the attractivity of this career, such as reinforcing students' altruistic values and increasing the academic recognition of primary care.
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Affiliation(s)
- Eva Pfarrwaller
- University Institute for Primary Care (IuMFE), Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Genève 4, Switzerland.
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Lionel Voirol
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
| | - Giovanni Piumatti
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute of Public Health, Faculty of BioMedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Mucyo Karemera
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
| | - Johanna Sommer
- University Institute for Primary Care (IuMFE), Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Genève 4, Switzerland
| | - Margaret W Gerbase
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Guerrier
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
- Faculty of Science, University of Geneva, Geneva, Switzerland
| | - Anne Baroffio
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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McDonald C, Henderson A, Barlow P, Keith J. Assessing factors for choosing a primary care specialty in medical students; A longitudinal study. MEDICAL EDUCATION ONLINE 2021; 26:1890901. [PMID: 33829968 PMCID: PMC8043606 DOI: 10.1080/10872981.2021.1890901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/07/2020] [Accepted: 02/01/2021] [Indexed: 05/18/2023]
Abstract
A shortage of primary care physicians exists in the US, and medical schools are investigating factors that influence specialty choice. To better understand the factors associated with medical students choosing primary care specialties, a longitudinal annual survey from 2013 to 2019 was administered to students at the University of Iowa Carver College of Medicine, starting pre-matriculation. A logistic regression model examined factors of interest. Matching into a primary care specialty (family medicine, internal medicine, pediatrics) for residency was the primary outcome. Our study compared factors students reported in annual surveys: demographics, mentorship, debt, and lifestyle. Factors significantly associated with primary care specialty included pre-medical and medical school research, a family member in primary care, student age and gender. 28% of men chose primary care, and 47% of women. Although there was no gender difference in rates of medical education debt (N = 286,χ2(1) = 0.28, p = 0.60), men were more likely to report being influenced by debt (N = 278, χ2(1) = 10.88, p = 0.001), and students who reported debt-influenced specialty choice were one-third as likely to enter primary care (N = 189, 95% CI [0.11-1.06], p = 0.06). For men, potential salary was negatively associated with entering primary care (p = 0.03). Women were more likely to have a mentor in primary care (N = 374, χ2(1) = 13.87, p < 0.001), but this was not associated with an increased likelihood of entering primary care for men or women. Having a family member who practices primary care was associated with a 2.87 times likelihood of entering primary care (N = 303, 95% CI [1.14-7.19], p = 0.03). The decision to enter primary care is influenced by many factors; a key gender differentiator is that men's specialty choice is more negatively influenced by financial concerns.
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Affiliation(s)
- Corry McDonald
- Department of Emergency Medicine, Lincoln Medical & Mental Health Center, Bronx, NY, USA
| | - Austin Henderson
- Washington State University Elson S. Floyd College of Medicine and Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| | - Patrick Barlow
- Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Jerrod Keith
- Department of Surgery, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
- CONTACT Jerrod Keith Department of Surgery, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 1500 John Colloton Pavilion, 200 Hawkins Dr, Iowa City, IA52242, USA
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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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25
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Yeoh A, Sathiakumar AK, Leung CNY, Hoffman R, Gosbell A, Tan KN. Impact of clinical placement sites on general practice as a career preference for Australian medical students. Aust J Rural Health 2021; 30:95-102. [PMID: 34787946 DOI: 10.1111/ajr.12819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/10/2021] [Accepted: 09/22/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE This study investigates whether General Practice placement experience or locations (urban/metropolitan vs non-metropolitan) promote student interest in pursuing general practice. DESIGN SurveyMonkey was used in the design of the survey. SETTING The study was conducted online. PARTICIPANTS A total of 520 and 705 clinical-year students were surveyed in 2009 and 2019, respectively. The study was conducted online, using SurveyMonkey, and the participants were mostly non-indigenous Australian medical students, between the ages of 18 and 30. INTERVENTIONS Students were recruited from the General Practice Students' Network membership database to complete the survey online. Chi-squared testing, Pearson's correlation and a multivariate logistic regression analysis were used to investigate the correlation between general practice placements and intention to become a general practice. MAIN OUTCOME MEASURES The association and causation between general practice placement location, student experience and students' intended career outcomes. RESULTS In 2009, majority of students rated their general practice experience 'mostly positive' while most metropolitan participants and majority of non-metropolitan placement participants in the 2019 survey responded with 'mostly positive' in 2019. Based on 2009 and 2019 data, general practice placement location had no association with the likelihood of pursuing general practice as a career, while student experience had a stronger positive correlation with the likelihood of pursuing general practice as a career. CONCLUSION Our study shows that students' overall experience with their general practice placements significantly encourages medical students to pursue the general practice pathway. As such, increasing both metropolitan and non-metropolitan placement experiences can potentially overcome general practice shortage.
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Affiliation(s)
- Alexandra Yeoh
- Bond University, Robina, QLD, Australia.,GPSN, Melbourne, Vic., Australia
| | | | | | | | | | - Kang Ning Tan
- GPSN, Melbourne, Vic., Australia.,James Cook University, Douglas, QLD, Australia
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26
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Pfarrwaller E, Abbiati M, Baroffio A, Haller DM. Geneva medical students increasingly identify primary care physicians as role models after introduction of a compulsory clerkship. Eur J Gen Pract 2021; 27:326-330. [PMID: 34755578 PMCID: PMC8583844 DOI: 10.1080/13814788.2021.1999925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Role modelling is recognised as an important element in career choice. In strongly hospital-based medical education settings, students identify few primary care physicians as positive role models, which might impact their career plans and potentially contribute to primary care workforce shortage. At Geneva Faculty of Medicine (Switzerland), a compulsory final-year clerkship in primary care practices was introduced to strengthen primary care teaching in the curriculum. Objectives To assess the proportion of graduating students identifying a primary care physician as positive role model, before and after the introduction of the clerkship. Methods Cross-sectional survey in four consecutive classes of graduating medical students one year before and three years after the introduction of the clerkship. The main outcome measure was the proportion of students in each class citing a primary care physician role model. Comparisons were analysed using Pearson’s Chi-square test and one-way ANOVA. Results The total sample included 505 students. The proportion of students recalling a primary care physician role model increased steadily from 8% (before introduction of the clerkship) to 13, 16, and 21%, respectively, at 1, 2 and 3 years after the introduction of the clerkship (p = 0.03). Conclusion Our exploratory study suggests that introducing a compulsory primary care clerkship may have contributed to increasing the visibility of primary care physicians as role models. Future research should explore primary care physicians’ awareness of role modelling and its contribution to career choices.
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Affiliation(s)
- Eva Pfarrwaller
- Faculty of Medicine, University Institute for Primary Care, University of Geneva, Geneva, Switzerland
| | - Milena Abbiati
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anne Baroffio
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Dagmar M Haller
- Faculty of Medicine, University Institute for Primary Care, University of Geneva, Geneva, Switzerland
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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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Geller G, Grbic D, Andolsek KM, Caulfield M, Roskovensky L. Tolerance for Ambiguity Among Medical Students: Patterns of Change During Medical School and Their Implications for Professional Development. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1036-1042. [PMID: 33149092 DOI: 10.1097/acm.0000000000003820] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Tolerance for ambiguity (TFA) is important for physicians, with implications for ethical behavior and patient care. This study explores how medical students' TFA changes from matriculation to graduation and how change in empathy and openness to diversity are associated with this change. METHOD Data for students who took the Matriculating Student Questionnaire (MSQ) in 2013 or 2014 and the Medical School Graduation Questionnaire (GQ) in 2017 or 2018 were drawn from the Association of American Medical Colleges (n = 17,221). Both the MSQ and GQ included a validated TFA scale and a shortened version of the Interpersonal Reactivity Index; the MSQ also included an openness to diversity scale. Tercile groups were used to assess how TFA changed from the MSQ to GQ, and regression analyses were used to assess associations between change in TFA and openness to diversity and between change in TFA and change in empathy. RESULTS Mean TFA scores decreased (d = -.67) among students with the highest TFA at matriculation but increased (d = .60) among students with the lowest TFA at matriculation. Regression results showed that change in TFA was significantly and positively associated with change in empathy (beta = .05, P < .001) and that openness to diversity (as reported at matriculation) was significantly and positively associated with TFA at graduation (beta = .05, P < .001). CONCLUSIONS This is the first nationally representative study to suggest that medical students' TFA changes over time, but in different directions depending on TFA at matriculation. TFA over time was also associated with change in empathy and openness to diversity. Medical schools should consider strategies to assess TFA in their admissions processes and for cultivating TFA throughout the learning process.
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Affiliation(s)
- Gail Geller
- G. Geller is professor, Johns Hopkins University Berman Institute of Bioethics, School of Medicine, Bloomberg School of Public Health, and Department of Sociology, Johns Hopkins University, Baltimore, Maryland; ORCID: https://orcid.org/0000-0003-4856-1942
| | - Douglas Grbic
- D. Grbic is lead research analyst, Medical Education, Association of American Medical Colleges, Washington, DC
| | - Kathyrn M Andolsek
- K.M. Andolsek is professor of family medicine and community health, Duke University School of Medicine, Durham, North Carolina
| | - Marie Caulfield
- M. Caulfield is manager of applicant, student, and resident data, Data Operations and Services, Association of American Medical Colleges, Washington, DC
| | - Lindsay Roskovensky
- L. Roskovensky is lead research and data analyst, Data Operations and Services, Association of American Medical Colleges, Washington, DC
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La Forgia A, Williams M, Williams S, Walters L, McArthur L, Gonzalez-Chica D. Are Australian rural clinical school students' career choices influenced by perceived opinions of primary care? Evidence from the national Federation of Rural Australian Medical Educators survey. Aust J Rural Health 2021; 29:373-381. [PMID: 34081368 DOI: 10.1111/ajr.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/12/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate whether perceived opinions of primary care are associated with student career preferences after graduation among a rural clinical school cohort and whether the preferred location of practice moderates these relationships. DESIGN Cross-sectional study using data from the national Federation of Rural Australian Medical Educators survey. PARTICIPANTS/SETTING Medical students across 18 Australian universities who completed a clinical year in a rural setting in 2019. MAIN OUTCOME MEASURE(S) Career preference in primary care after graduation. RESULTS The survey was completed by 624 students (response rate = 69.9%). A preference for primary care was reported by 35.5% (95% CI: 29.4-42.0) of students and was more likely among those age 30+ years, with a rural background, or preferring to practise rurally after graduation. Students reported that primary care was more commonly respected by medical academics (66.8%) than peers (24.0%) or junior/hospital doctors (24.0%). In adjusted analysis, none of the perceived opinions were associated with student career preferences. However, among students aiming to work in small rural locations, a career in primary care was associated with more frequent reports that peers had poor opinions of primary care (P = .004). CONCLUSION Rural clinical school students perceive negative opinions of primary care, particularly among peers and junior/hospital doctors. Students aiming to work in small towns after graduation are more likely to report negative opinions among their peers, suggesting they may be more attuned to negative attitudes. This points to the need for a community of practice of like-minded peers and clinicians to preserve the career interest of these students.
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Affiliation(s)
- Adina La Forgia
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, Australia
| | - Millie Williams
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, Australia
| | - Susan Williams
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, Australia
| | - Lucie Walters
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, Australia
| | - Lawrie McArthur
- General Practice Training, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - David Gonzalez-Chica
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, Australia.,Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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30
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Schwartz R, Frayne SM, Friedman S, Romodan Y, Berg E, Haskell SG, Shaw JG. Retaining VA Women's Health Primary Care Providers: Work Setting Matters. J Gen Intern Med 2021; 36:614-621. [PMID: 33063204 PMCID: PMC7947068 DOI: 10.1007/s11606-020-06285-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND When an experienced provider opts to leave a healthcare workforce (attrition), there are significant costs, both direct and indirect. Turnover of healthcare providers is underreported and understudied, despite evidence that it negatively impacts care delivery and negatively impacts working conditions for remaining providers. In the Veterans Affairs (VA) healthcare system, attrition of women's health primary care providers (WH-PCPs) threatens a specially trained workforce; it is unknown what factors contribute to, or protect against, their attrition. OBJECTIVE Based on evidence that clinic environment, adequate support resources, and workload affect provider burnout and intent to leave, we explored if such clinic characteristics predict attrition of WH-PCPs in the VA, to identify protective factors. DESIGN This analysis drew on two waves of existing national VA survey data to examine predictors of WH-PCP attrition, via logistic regression. PARTICIPANTS All 2,259 providers from 140 facilities VA-wide who were WH-PCPs on September 30, 2016. MAIN MEASURES The dependent variable was WH-PCP attrition in the following year. Candidate predictors were clinic environment (working in: a comprehensive women's health center, a limited women's health clinic, a general primary care clinic, or multiple clinic environments), availability of co-located specialty support resources (mental health, social work, clinical pharmacy), provider characteristics (gender, professional degree), and clinic workload (clinic sessions per week). KEY RESULTS Working exclusively in a comprehensive women's health center uniquely predicted significantly lower risk of WH-PCP attrition (adjusted odds ratio 0.40; CI 0.19-0.86). CONCLUSIONS A comprehensive women's health center clinical context may promote retention of this specially trained primary care workforce. Exploring potential mechanisms-e.g., shared mission, appropriate support to meet patients' needs, or a cohesive team environment-may inform broader efforts to retain front-line providers.
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Affiliation(s)
- Rachel Schwartz
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA. .,WellMD Center, Stanford University School of Medicine, Stanford, CA, USA.
| | - Susan M Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah Friedman
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.,School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | - Yasmin Romodan
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Eric Berg
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Sally G Haskell
- Women's Health Services, VA Central Office, Washington, DC, USA.,VA Connecticut Health Care System, West Haven, CT, USA.,Yale University School of Medicine, New Haven, CT, USA
| | - Jonathan G Shaw
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Strasser R, Berry S. Integrated clinical learning: team teaching and team learning in primary care. EDUCATION FOR PRIMARY CARE 2021; 32:130-134. [PMID: 33590813 DOI: 10.1080/14739879.2021.1882886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Developed in Northern Ontario, Canada, Integrated Clinical Learning (ICL) involves a team of clinical teachers from a range of health professions teaching a team of students and trainees together in common community and clinical settings. It is the balanced integration of educational strategies to develop healthcare providers and team-based competencies focused on improving the quality of care. Learning outcomes are developed with and in consideration of the goals of patients or the community through relational learning that mirrors patient-centred care. Implementing ICL requires a systematic approach that addresses the practical issues and enhances the quality of experience for all involved. These practicalities include academic institutions valuing ICL through the appointment and support of primary care clinicians as academic staff with protected time; the provision of physical space, as well as clinical and teaching equipment; and the appointment of local administrative coordinators. The team approach shares the teaching load with the multiple students actually teaching each other so that the load on individual clinicians is less than for one student at a time. Through ICL, students are learning from patients and developing a service-oriented professional identity. The patient and family centred nature of ICL helps bridge the primary care-secondary care divide as students follow their patients into and out of hospital services. This is positive for patients and specialists and provides authentic learning for students. ICL enhances the quality of care; the quality of learning; and the quality of professional satisfaction for primary care clinical teachers.
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Affiliation(s)
- Roger Strasser
- Northern Ontario School of Medicine, Founding Dean Emeritus, Laurentian University and Lakehead University, Sudbury, Thunder Bay, Canada.,Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand
| | - Sue Berry
- Northern Ontario School of Medicine, Clinical Sciences, Laurentian University and Lakehead University, Sudbury, Thunder Bay, Canada
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Abstract
OBJECTIVES This study investigated what kinds of experiences influence regional quota (chiikiwaku) medical students' motivation to practice community healthcare (CH), and the mechanism of this influence, by focusing on their experiences in a community-based medical education (CBME) programme. DESIGN A qualitative thematic analysis based on interviews. SETTING Participants were recruited from the chiikiwaku students of Kobe University, Japan, using purposive sampling. PARTICIPANTS Fourteen students participated. The median (IQR) age of participants was 23 (23-24); half were sixth-year and half fifth-year students. ANALYSIS From September to December 2018, the interviews were audiorecorded and transcribed verbatim. Data were analysed according to the 'Steps for Coding and Theorisation' method. Our theoretical framework comprised three internal motives (ie, needs, cognitions and emotions) and their subordinate motivation theories self-determination theory, expectancy-value theories, and positive and negative emotions, respectively. RESULTS Three mechanisms and corresponding experiences emerged. The first mechanism, envisioning and preparing for practising CH, included corresponding experiences-empathy for the community, grasping the demands for CH, understanding the practices of CH, finding a role model and diminishing the conflicts between personal life and career. The second mechanism, belonging to a supportive community, included the robust construction of students' CH community and harmonisation with community residents. The third mechanism, psychological effects included the affect heuristic and framing effect. Student experiences brought about the changes and influences described in the presented mechanisms, and had both positive and negative impacts on their motivation towards CH. These results can be interpreted through the multifaceted lenses of motivation theories. CONCLUSIONS The authors revealed that motivation mechanisms of medical students towards CH derived from positive interaction with community residents, healthcare professionals and other students, and from exposure to attractive community environments and cultures. These experiences should be incorporated into CBME programmes to further encourage positive attitudes towards CH.
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Affiliation(s)
- Shinsuke Yahata
- Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Taro Takeshima
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Fukushima, Japan
- Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Tsuneaki Kenzaka
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanobu Okayama
- Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe, Japan
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Yahata S, Takeshima T, Kenzaka T, Okayama M. Long-term impact of undergraduate community-based clinical training on community healthcare practice in Japan: a cross-sectional study. BMC MEDICAL EDUCATION 2020; 20:337. [PMID: 33004049 PMCID: PMC7528470 DOI: 10.1186/s12909-020-02258-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Community-based medical education (CBME) has been evolving globally. However, the long-term impacts of CBME programs on career intention are ambiguous. Therefore, this study aimed to reveal the long-term impact of community-based clinical training (CBCT) such as CBME programs in Japan on current community healthcare (CH) practice. METHODS This cross-sectional study targeted physicians who had graduated from Kobe University School of Medicine between 1998 and 2004 and had over 15 years' experience after graduation. Self-administered questionnaires were mailed to participants between September and November 2019. Of the 793 potential subjects, 325 questionnaires were undeliverable. A total of 468 questionnaires substantially sent to the subjects. The exposure was the undergraduate CBCT defined as clinical training about CH in a community. The primary outcome was the provision of current CH practice. The secondary outcome was rural retention. The odds ratios (ORs) and confidence intervals (CIs) were calculated, and the confounders (age, gender, and attitude toward CH at admission; primary outcome, and age, gender, attitude toward rural healthcare at admission, own and spouse's hometown, and emphasis on child education; secondary outcomes) were adjusted using multivariate logistic regression analysis. RESULTS A total of 195 (41.7%) questionnaires were analyzed. The mean (standard deviation [SD]) age of study participants was 43.8 (3.5) years and 76.4% were men. A total of 48 physicians (24.6%) experienced CBCT, of which the mean (SD) training period was 26.3 (27.3) days. As many as 148 (76.3%) physicians provided CH at the time of the study, and 12 (6.5%) worked in rural areas. There was no notable impact of undergraduate CBCT on current CH practice (OR, 1.24; 95% CI, 0.53-3.08; adjusted OR [aOR], 1.00; 95% CI, 0.43-2.30) and rural retention (OR, 0.59; 95% CI, 0.06-2.94; aOR, 0.59; 95% CI, 0.11-3.04). CONCLUSIONS It may be insufficient to use conventional CBCT in Japan to develop CH professionals effectively. Japanese CBME programs should be standardized through a review of their content and quality. They should continue to be evaluated for their medium- to long-term effects.
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Affiliation(s)
- Shinsuke Yahata
- Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe, Hyogo, 652-0032, Japan
| | - Taro Takeshima
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1, Toyochikamiyajiro, Shirakawa, Fukushima, 961-0005, Japan
- Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Tsuneaki Kenzaka
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe, Hyogo, 652-0032, Japan
| | - Masanobu Okayama
- Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe, Hyogo, 652-0032, Japan.
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Paulus R, Byler D, Casapulla S. Student and Preceptor Experiences in a Mini Longitudinal Integrated Clerkship: A Participatory Self-Study. PRIMER (LEAWOOD, KAN.) 2020; 4:24. [PMID: 33111051 PMCID: PMC7581209 DOI: 10.22454/primer.2020.439679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Students participating in longitudinal integrated clerkships (LIC) experience longitudinal, comprehensive care of patients, report improved satisfaction with their training, and express increased interest in pursuing a career in primary care. To gain these benefits without requiring major curricular change, Ohio University Heritage College of Osteopathic Medicine created a year-long mini LIC (mLIC). As participants in the mLIC, we sought to measure our own experiences, gathering data in a systematic way to share our perceptions. METHODS We developed an online survey that included scale and open-ended questions. Eight students and three cooperating preceptors completed the survey. We analyzed short answer responses thematically; we analyzed multiple choice responses using descriptive statistics. RESULTS Participants reported increased interest in underserved rural primary care. Students described the continuity with patients as the most beneficial aspect. Students felt the increased autonomy, self-learning, and hands-on nature of the mLIC increased clinical confidence and preparedness for intern year. Students stated the mLIC provided learning opportunities they would not have experienced in traditional block-based clerkships, including longitudinal relationships and prolonged exposure to primary care. Preceptors stated they were able to learn new ideas from the students and were surprised by how much they benefited from the experience. CONCLUSION Students did experience many of the benefits of a traditional LIC in our mLIC format focused on a longitudinal experience in family medicine. Students and preceptors were positively impacted and felt the mLIC led to increased student learning, professional development, and increased preceptor satisfaction. Our conclusions are limited by the small sample size included in our study.
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Affiliation(s)
- Ryan Paulus
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | - Dorvan Byler
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | - Sharon Casapulla
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH
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How nursing students' placement preferences and perceptions of community care develop in a more 'community-oriented' curriculum: a longitudinal cohort study. BMC Nurs 2020; 19:80. [PMID: 32863761 PMCID: PMC7448334 DOI: 10.1186/s12912-020-00473-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/18/2020] [Indexed: 11/12/2022] Open
Abstract
Background Extramuralisation in healthcare has influenced medical and nursing curricula internationally with the incorporation of themes related to primary/ community care. Despite this, students do not easily change their career preferences. The hospital is still favourite, leading to labour market shortages in extramural care. This study investigates how baccalaureate nursing students’ perceptions of community care and placement preferences develop over time in a more ‘community-care-oriented’ curriculum, to gain insights on which curriculum elements potentially influence career choices. Methods A nursing student cohort of a University of Applied Sciences in the Netherlands (n = 273) underwent a new four-year curriculum containing extended elements of community care. The primary outcome was assessed with the Scale on Community Care Perceptions (SCOPE). Data were collected each year of study. Descriptive statistics were used to investigate students’ placement preferences and perceptions, and linear mixed model techniques (LMMs) for measuring how students’ perceptions develop over time. Patterns of placement preferences at individual level were visualised. Results Students’ perceptions of community care, as measured with SCOPE, show a slight decrease between year 1 and 4, while items mutually differ substantially. In contrast, the preference of community care for a placement increases from 2.6% in year 1 tot 8.2% in year 4. The hospital is favourite in year 1 (79.8%), and remains most popular. At individual level, students often change placement preferences, although a preference for the hospital is more consistent. The LMMs indicates that, at the four time-points, the estimated marginal means of students’ perceptions fluctuate between 6 and 7 (range 1–10). A placement in community care did not positively influence students’ perceptions, and an intensive 1 week theoretical programme was only temporarily influential. Conclusions Although interest for placement in community care increased substantially, it was not clear which curriculum elements stimulated this, nor did the curriculum positively influence students’ perceptions. As most students do not look forward to the high responsibility of the field, other curricula with educational tracks for more mature students/ nurses with a vocational training may be an alternative contribution to solving the labour market problems in community care.
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Cope S, Alberti H. Exploring educational integrated training posts in general practice: a phenomenological study of trainees' perspectives. EDUCATION FOR PRIMARY CARE 2020; 31:297-304. [PMID: 32619382 DOI: 10.1080/14739879.2020.1787230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study explores the experience of undertaking an educational integrated training post (ITP) in general practice. There are problems with General Practice (GP) recruitment and retention in the UK and worldwide. It is thought that integrated training programmes (ITPs) within GP training may offer a new and appealing way of training, which may address this problem. Health Education England North East (HEENE) has been running educational integrated training posts for over 5 years. Integrated training schemes such as this have been rarely studied and in particular the trainees' perspectives. In order to improve understanding of these posts and their potential for aiding GP recruitment, we undertook a qualitative study to explore trainees' perceptions of the experience of undertaking an educational ITP. The study takes an interpretive phenomenological approach using focus groups and one-to-one interviews which were audio-recorded, transcribed and thematically analysed. Emerging themes from the data captured participants' views of their experience of undertaking the posts, as well as the factors influencing their decisions to undertake the posts. The overarching theme found centred on identity formation. The study draws upon social learning theories to help understand and explain the themes identified and the influence on the individuals. For the interested stakeholder, this provides an insight into the individuals' experience and highlights important areas that could be targeted and utilised in the development of future general practice training models.
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Affiliation(s)
- Sarah Cope
- Newcastle Medical School, University of Newcastle , Newcastle, UK
| | - Hugh Alberti
- School of Medical Education, Newcastle University
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Lakoff J, Howse K, Cofie N, Heeneman S, Dalgarno N. Analysis of factors affecting Canadian medical students' success in the residency match. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e43-e55. [PMID: 32802226 PMCID: PMC7378149 DOI: 10.36834/cmej.68981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND In North America, there is limited data to support deliberate application strategies for post-graduate residency training. There is significant interest in determining what factors play a role in Canadian medical graduate (CMG) matching to their first choice discipline and heightened concern about the number of students going unmatched altogether. METHODS We analyzed matching outcomes of CMGs based on seven years (2013-2019) of residency application data (n= 13,499) from the Canadian Residency Matching Service (CaRMS) database using descriptive and binary logistic regression modeling techniques. RESULTS The sample was 54% female, with 60% between the ages of 26 and 29, and 60% attended medical schools in Ontario. Applicants who received more rankings from residency programs were more likely (OR = 1.185, p < 0.001) to match. Higher research activities (OR = 0.985, p < 0.001) and number of applications submitted (OR = 0.920, p < 0.001) were associated with a reduced likelihood of matching. Number of volunteer activities and self-report publications did not significantly affect matching. Being male (OR = 0.799, p < 0.05) aged <25 (OR = 0.756, p < 0.05), and from Eastern (OR = 0.497, p < 0.01), or Western (OR = 0.450, p < 0.001) Canadian medical schools were predictors of remaining unmatched. CONCLUSIONS This study identified several significant associations of demographic and application factors that affected matching outcomes. The results will help to better inform medical student application strategies and highlight possible biases in the selection process.
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Bansal A, Singh D, Thompson J, Kumra A, Jackson B. Developing Medical Students' Broad Clinical Diagnostic Reasoning Through GP-Facilitated Teaching in Hospital Placements. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:379-388. [PMID: 32547289 PMCID: PMC7259453 DOI: 10.2147/amep.s243538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 02/29/2020] [Indexed: 05/25/2023]
Abstract
PURPOSE Graduating medical students need broad clinical diagnostic reasoning skills that integrate learning across clinical specialties to deal with undifferentiated patient problems. The opportunity to acquire these skills may be limited during clinical placements on increasingly specialized hospital wards. We developed an intervention of regular general practitioner (GP) facilitated teaching in hospital placements to enable students to develop broad clinical diagnostic reasoning. The intervention was piloted, refined and delivered to a whole cohort of medical students at the start of their third year. This paper examines whether students perceived opportunities to improve their broad diagnostic clinical reasoning through our intervention. METHODS GP-facilitated teaching sessions were delivered weekly in hospital placements to small groups of 6-8 students for 90 mins over 6 weeks. Students practiced clinical reasoning with real patient cases that they encountered on their placements. Evaluation of learning outcomes was conducted through a student questionnaire using Likert scales with free-text boxes for additional explanation. Focus groups were conducted to gain a more in-depth understanding of student perspectives. RESULTS As high as 87% of students agreed that their broad clinical diagnostic reasoning ability had improved. Thematic analysis of the qualitative data revealed four factors supporting this improvement: practicing the hypothetico-deductive method, using real patient cases, composing student groups from different speciality placements and the breadth of the facilitators' knowledge. Students additionally reported enhanced person-centredness in terms of understanding the patient's perspective and journey. Students perceived that the added value of general practitioner facilitators lay in their broad knowledge base and knowledge of patient needs in the community. CONCLUSION Our results suggest that medical students can develop broad clinical diagnostic reasoning skills in hospital settings through regular GP-facilitated teaching. Our approach has the advantage of working within the established curricular format of hospital placements and being deliverable at scale to whole student cohorts.
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Affiliation(s)
- Aarti Bansal
- Academic Unit of Primary Care, The University of Sheffield, Sheffield, UK
| | - Davinder Singh
- Academic Unit of Primary Care, The University of Sheffield, Sheffield, UK
| | - Joanne Thompson
- Academic Unit of Primary Care, The University of Sheffield, Sheffield, UK
| | - Alexander Kumra
- Academic Unit of Primary Care, The University of Sheffield, Sheffield, UK
| | - Benjamin Jackson
- Academic Unit of Primary Care, The University of Sheffield, Sheffield, UK
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Brown M, Laughey W, Finn GM. Physician Associate students and primary care paradigmatic trajectories: perceptions, positioning and the process of pursuit. EDUCATION FOR PRIMARY CARE 2020; 31:231-239. [PMID: 32436437 DOI: 10.1080/14739879.2020.1763210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
As the role of the Physician Associate (PA) establishes within the UK, there is increasing interest in the recruitment of PAs to primary care. Yet, currently 72% of all UK PAs work in secondary care. Recruitment to primary care is wanting, for reasons that remain unclear. This work sought to investigate student PA experiences in primary care and their attitudes to primary care as a career choice. A multi-site, qualitative study involving one-to-one semi-structured interviews with 19 student PAs was conducted. Data were thematically analysed, in line with an interpretivist approach and informed by communities of practice and paradigmatic trajectory theory - 'visible career paths provided by a community'. Factors were identified enabling student PA engagement with primary care paradigmatic trajectories including engaging students with a degree of responsibility in service provision. Barriers to engagement included ignorance regarding the PA role, and reverence of medical students as a 'gold standard'. A conceptual model is proposed detailing the student process of engagement with primary care trajectories, encapsulating how this process influences emerging career identity. This model could be used to optimise student PA engagement in learning about, and coming to identify with, primary care careers.
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Affiliation(s)
- Megan Brown
- Health Professions Education Unit, Hull York Medical School, University of York , York, UK
| | - William Laughey
- Health Professions Education Unit, Hull York Medical School, University of York , York, UK
| | - Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical School, University of York , York, UK
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Becker N, Barthen L, Pauscher L, Gerlach FM, Sader R, Ravens-Taeuber G. The "practice track" - How can teaching content related to outpatient healthcare be integrated into medical studies? Learning objectives, conception and implementation of a specialized voluntary program. GMS JOURNAL FOR MEDICAL EDUCATION 2020; 37:Doc30. [PMID: 32566732 PMCID: PMC7291382 DOI: 10.3205/zma001323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/09/2020] [Accepted: 02/11/2020] [Indexed: 05/28/2023]
Abstract
The "practice track" (PAT) at Goethe University Frankfurt provides students with the opportunity to focus on outpatient care during their medical studies. The aim of this article is to describe the objectives, conception and implementation of the program. At the Institute of General Practice, a new teaching concept has been developed in cooperation with the Dean's Office of the Faculty of Medicine at Goethe University and further partners. Medical students generally receive their training in highly specialized hospitals. However, the new concept will allow them to gain a practical insight into the outpatient care provided by physicians in private practice during their medical studies. Every year, 15 interested students will be able to participate in the longitudinal program, which includes internships, seminars and mentoring sessions. In the three current PAT cohorts, all 45 places have been taken up, and the first cohort has now completed the program. In addition to practical skills in the disciplines of family medicine, internal medicine, surgery, gynecology and pediatrics, it has been possible to show students the full scope of ambulatory health care. However, legal limitations to the implementation of the program in registered medical practices have meant that some parts of it could only be carried out voluntarily. Against the background of the current and future situation in health care, it makes sense that registered physicians in private practice should teach medical students about outpatient care during their medical studies. In order to establish such programs and permit their complete integration into the medical curriculum, it is essential that the necessary changes are made to medical licensing regulations.
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Affiliation(s)
- Nadja Becker
- Goethe University Frankfurt am Main, Institute of General Practice, Frankfurt/Main, Germany
| | - Linda Barthen
- Goethe University Frankfurt am Main, Institute of General Practice, Frankfurt/Main, Germany
| | - Lia Pauscher
- Goethe University Frankfurt am Main, Institute of General Practice, Frankfurt/Main, Germany
| | - Ferdinand M. Gerlach
- Goethe University Frankfurt am Main, Institute of General Practice, Frankfurt/Main, Germany
| | - Robert Sader
- Goethe University Frankfurt am Main, Dean's Office of the Faculty of Medicine, Frankfurt/Main, Germany
| | - Gisela Ravens-Taeuber
- Goethe University Frankfurt am Main, Institute of General Practice, Frankfurt/Main, Germany
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Querido S, De Rond M, Wigersma L, van den Broek S, ten Cate O. The Significance of Experiencing Clinical Responsibilities for Specialty Career Choice. MEDICAL SCIENCE EDUCATOR 2020; 30:163-171. [PMID: 34457655 PMCID: PMC8368942 DOI: 10.1007/s40670-019-00832-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIM Medical trainees make career choices in the final year of medical school or after graduation, if they do not continue with residency directly. Most Dutch medical students are trained in vertically integrated (VI) curricula, with early clinical experience and a gradual increase in clinical responsibilities. Students in such curricula have been reported to make career choices at an earlier stage than graduates from more traditionally designed curricula. Many Dutch graduates build further clinical experience after graduation as physicians-not-in-training (PNITs) before beginning residency. We explored how students make career choices and whether pre-residency clinical responsibilities influence this choice. METHOD A qualitative study with a phenomenology approach was used. The authors conducted a longitudinal interview study of medical students with two intervals over a 2-year period. The interview questions covered how trainees establish career preferences and which factors affect preference and choice over time. RESULTS Experiencing clinical responsibility was a key factor for career preference during all interview rounds. Being a PNIT who makes diagnostic and therapeutic decisions, have their own patients and have significant patient care responsibilities creates opportunities to build an image of a future context of employment. Some participants mentioned that their experience of having full responsibility as a PNIT was pivotal in a career preference change. CONCLUSION Clinical responsibility as a student or a PNIT appears to be important for career preference and choice. The experience of responsibility as a medical doctor forces trainees to reflect on personal needs and to consider which career preference fits best.
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Affiliation(s)
- Sophie Querido
- Central Board for Specialty training in Elderly Care Medicine in the Netherlands (SOON), P.O. Box 19025, 3501 DA Utrecht, The Netherlands
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marlies De Rond
- Royal Dutch Medical Association (KNMG), Utrecht, The Netherlands
| | - Lode Wigersma
- Dutch Association of Public Health Physicians (VAV), Utrecht, The Netherlands
| | - Sjoukje van den Broek
- Center of Education and Training, Unit of Medical Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olle ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
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What happened and why? A programme theory-based qualitative evaluation of a healthcare-academia partnership reform in primary care. BMC Health Serv Res 2019; 19:785. [PMID: 31675956 PMCID: PMC6825344 DOI: 10.1186/s12913-019-4665-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 10/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing interest in and demands for partnerships between academia and healthcare practices. Few empirical studies have described the influence of such partnerships from a practice perspective. The purpose of this study was to evaluate the impact of a reform launched to increase integration between primary care and academia and to identify potential reasons for why the observed impact occurred in three areas targeted by the reform: research, student education, and continued professional development. METHODS The study was conducted in Stockholm County, the largest healthcare region in Sweden, at the introduction of a partnership between primary care and academia, including eight coordinating centres and approximately 500 surrounding primary care units. A programme theory-based qualitative approach to evaluation was used, building on document analysis, and in-depth interviews with the centre managers (n = 6) and coordinators (n = 8) conducted 42-66 months after the initiation of the reform. RESULTS The analysis showed that the reform had some impact on all three areas targeted by the reform: research, student education, and continued professional development. The input that contributed most extensively to the impact was the establishment of facilitating roles. Most changes occurred at the coordinating centres and primarily in the area of student education. The effect on student education was primarily due to having prior experience in this area and perceptions of timely benefits of students to care practice. CONCLUSIONS Partnerships between primary care and academia hold the potential of practice impact. To increase integration between primary care and academia, the components of the integration must be understandable and relevant for primary care practitioners, and importantly, compliant with delivery of primary care.
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Geier AK, Saur C, Lippmann S, Nafziger M, Frese T, Deutsch T. LeiKA: an optional German general practice teaching project for first-semester medical students: who is taking part and why? A cross-sectional study. BMJ Open 2019; 9:e032136. [PMID: 31676656 PMCID: PMC6830716 DOI: 10.1136/bmjopen-2019-032136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES This study investigates students' adoption of LeiKA, a new extracurricular longitudinal general practice (GP) teaching project. LeiKA aims to attract a broad range of students, not only those who are already planning to become GPs. This study compares participants' and non-participants' characteristics, career preferences and job-related value orientations to assess the programme's initial potential to increase the number of students subsequently entering GP careers. Additionally, students' motives for taking part in the programme were explored. DESIGN We analysed administrative data and data from a cross-sectional questionnaire survey for the first three cohorts. LeiKA participants were compared with non-participants regarding baseline characteristics, career intentions and attitudes associated with GP careers. There was also a qualitative analysis of the reasons for taking part. SETTING Faculty of Medicine, University of Leipzig, Germany. PARTICIPANTS First-semester medical students in the years 2016-2018. RESULTS In the first 3 years, 86 of 90 LeiKA slots were taken, 9.0% (n=86/960) of those eligible to apply. LeiKA participants were a mean of 0.6 years older (LeiKA: 21.5 vs whole cohort: 20.9 years, p<0.001) and slightly more interested in long-term doctor-patient relationships (3.6 vs 3.3, scale from 1 'unimportant' to 5 'very important', p=0.018), but did not differ regarding other characteristics and attitudes. Although more participants definitely favoured a GP career (13.1% vs 4.9%, p=0.001), it was a possible option for most students in both groups (78.6% vs 74.0%). Early acquisition of skills and patient contact were the main motives for taking part, stated by 60.7% and 41.7% of the participants, respectively. CONCLUSIONS The extracurricular programme was taken up by a broad range of students, indicating its potential to attract more students to become GPs. The reasons for taking part that we identified may guide the planning of other similar projects.
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Affiliation(s)
- Anne-Kathrin Geier
- Department of General Practice, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Christiane Saur
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - Stefan Lippmann
- Department of General Practice, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Melanie Nafziger
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - T Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Tobias Deutsch
- Department of General Practice, University of Leipzig, Faculty of Medicine, Leipzig, Germany
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Diallo B, Rozsnyai Z, Bachofner M, Maisonneuve H, Moser-Bucher C, Mueller YK, Scherz N, Martin S, Streit S. [Not Available]. PRAXIS 2019; 108:779-786. [PMID: 31530123 DOI: 10.1024/1661-8157/a003300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
How Many Advanced Medical Students Aim for a Career as a GP? Survey among Swiss Students Abstract. According to an earlier prognosis for 2025, Switzerland will lack 5000 general practitioners (GP), since only 10-20 % of medical students wanted to choose this profession at the time of the survey. The aim of our investigation among advanced medical students was to record their career intentions anew. Beside the probability of becoming a GP, we looked at the time point of this decision and at factors around family medicine (doctor-patient relation, career possibilities, etc.) influencing this decision. The results showed that measures to promote family medicine have been successful: 60 % of interrogated students are possible GPs (20 % decided, 40 % interested), 15 % are undecided, 25 % have decided not to become a GP. The favorable factors to become a GP were: autonomy, doctor-patient relationship, possibility of part-time work, work content. Less favorable were: income, reputation, political situation. These are the points where action is required to promote careers in family medicine with attractive training and practice conditions.
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Affiliation(s)
- Beatrice Diallo
- Berner Institut für Hausarztmedizin (BIHAM), Universität Bern
| | - Zsofia Rozsnyai
- Berner Institut für Hausarztmedizin (BIHAM), Universität Bern
| | | | | | - Cora Moser-Bucher
- Universitäres Zentrum für Hausarztmedizin beider Basel (uniham-bb) Basel
| | - Yolanda Kathrin Mueller
- Abteilung Hausarztmedizin, Universitätszentrum für Allgemeinmedizin und Gesundheitswesen, Unisanté, Lausanne
| | | | - Sebastien Martin
- Cursus romand de médecine de famille (CRMF), Abteilung Hausarztmedizin, Universitätszentrum für Allgemeinmedizin und Gesundheitswesen, Unisanté, Lausanne
| | - Sven Streit
- Berner Institut für Hausarztmedizin (BIHAM), Universität Bern
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Motala M, Van Wyk J. Where are they working? A case study of twenty Cuban-trained South African doctors. Afr J Prim Health Care Fam Med 2019; 11:e1-e9. [PMID: 31478745 PMCID: PMC6739522 DOI: 10.4102/phcfm.v11i1.1977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 04/09/2019] [Accepted: 04/17/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The year 2017 marked the 21st anniversary of the South African Cuban Medical Collaboration (SACMC) programme that offers disadvantaged South African (SA) students an opportunity for medical training in Cuba. Graduates are expected to return to practice at a primary care level in rural communities; however, little is known about the professional trajectories and career choices of graduates from the programme. AIM This study explored the reasons why students enrolled in the programme, their professional and career choices as graduates and their career intentions. SETTING The study setting was the whole of SA although participants were primarily drawn from KwaZulu-Natal. METHODS An exploratory, qualitative case study used a purposive sampling strategy to gather data through semi-structured interviews from participants. RESULTS Graduates (N = 20) of the SACMC programme were all practicing in local SA settings. Participants preferred the SACMC programme as it offered them a full scholarship for medical training. Nineteen doctors had fulfilled their obligation to work in rural areas. Thirteen doctors are engaged in primary healthcare practice, either as private practice generalists or as public service medical officers. Three doctors had completed specialty training: one doctor was training towards specialisation, one doctor was employed at national government and two doctors were employed as medical managers. At the time of the study, 11 doctors were practicing in rural locations and 19 had indicated a long-term intention to work and live within South Africa. CONCLUSION The participants of this study who graduated from the SACMC programme are fulfilling their obligations in rural communities. They all intend to contribute to the SA medical workforce in the long-term.
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Affiliation(s)
- Munirah Motala
- School of Medicine, University of KwaZulu-Natal, Durban.
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van Iersel M, de Vos R, van Rijn M, Latour CHM, Kirschner PA, Scholte op Reimer WJM. Influencing nursing students' perceptions of community care with curriculum-redesign; a quasi-experimental cohort study. BMC MEDICAL EDUCATION 2019; 19:299. [PMID: 31382949 PMCID: PMC6683447 DOI: 10.1186/s12909-019-1733-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The shift in healthcare to extramural leads to more patients with complex health problems receiving nursing care at home. However, the interest of baccalaureate nursing students for community nursing is moderate, which contributes to widespread labour-market shortages. This study investigates the effect of a more 'community-care-oriented' curriculum on nursing students' perceptions of community care. METHODS A quasi-experimental quantitative survey study with a historic control group (n = 477; study cohorts graduating in 2015, 2016, and 2017; response rate 90%) and an intervention group (n = 170; graduating in 2018; response rate 93%) was performed in nursing students of a University of Applied Sciences in a large city in the Netherlands. The intervention group underwent a new curriculum containing extended elements of community care. The primary outcome was assessed with the Scale on Community Care Perceptions (SCOPE). The control and intervention group were compared on demographics, placement preferences and perceptions with a chi-square or T-test. Multiple regression was used to investigate the effect of the curriculum-redesign on nursing students' perceptions of community care. RESULTS The comparison between the control and intervention group on students' perceptions of community care shows no significant differences (mean 6.18 vs 6.21 [range 1-10], respectively), nor does the curriculum-redesign have a positive effect on students' perceptions F (1,635) = .021, p = .884, R2 = < .001. The comparison on placement preferences also shows no significant differences and confirms the hospital's popularity (72.7% vs 76.5%, respectively) while community care is less often preferred (9.2% vs 8.2%, respectively). The demographics 'working in community care' and 'belonging to a church/religious group' appear to be significant predictors of more positive perceptions of community care. CONCLUSIONS Graduating students who experienced a more 'community-care-oriented' curriculum did not more often prefer community care placement, nor did their perceptions of community care change. Apparently, four years of education and placement experiences have only little impact and students' perceptions are relatively static. It would be worth a try to conduct a large-scale approach in combination with a carefully thought out strategy, based on and tying in with the language and culture of younger people.
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Affiliation(s)
- Margriet van Iersel
- ACHIEVE - Centre of Applied Research Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, The Netherlands
| | - Rien de Vos
- Centre of Evidence Based Education, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Marjon van Rijn
- ACHIEVE - Centre of Applied Research Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, The Netherlands
- Department of Internal Medicine Section of Geriatric Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Corine H. M. Latour
- ACHIEVE - Centre of Applied Research Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, The Netherlands
| | - Paul A. Kirschner
- Open University of the Netherlands, Valkenburgerweg 177, 6419 AT Heerlen, The Netherlands
| | - Wilma J. M. Scholte op Reimer
- ACHIEVE - Centre of Applied Research Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Sales B, Masding M, Scallan S. General practice tasters for foundation doctors. CLINICAL TEACHER 2019; 16:125-130. [DOI: 10.1111/tct.12783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Bryony Sales
- Wessex School of General PracticeHealth Education England (Wessex) Hampshire UK
| | - Mike Masding
- Foundation SchoolHealth Education England (Wessex) Hampshire UK
| | - Samantha Scallan
- Wessex School of General PracticeHealth Education England (Wessex) Hampshire UK
- Faculty of Education, Health and Social CareUniversity of Winchester Hampshire UK
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Factors That Influence Job Choice at the Time of Graduation for Physician Assistant Students. J Physician Assist Educ 2019; 30:34-40. [PMID: 30801556 DOI: 10.1097/jpa.0000000000000235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research and data analysis show that there is a shortage of primary care providers throughout the United States. Physician assistants (PAs) play an important role in health care delivery; however, the percentage of PAs practicing in primary care has dramatically decreased in the past 15 years. The purpose of this study was to identify potential factors that influence PA students' first job choice following graduation from a PA program to determine whether they have a relationship to the choosing of primary care. The 2016 End of Program Survey data were analyzed using a multinominal logistic regression to determine what factors influenced PA students' selections of primary care as their first job choice: individual factors, program factors, and external factors. Of the 3038 subjects, 269 (8.9%) accepted a job in primary care, 847 (27.9%) accepted a specialty job, and 1922 (63.3%) did not accept a job. When comparing no job accepted versus primary care job choice, marital status and racial/ethnic differences influenced first job choice. Financial factors were also found to be significant predictors. In the second model, comparing specialty versus primary care job choice, marital status influenced first job choice along with financial factors. In addition, one program variable (moderate clinical rotation experience) was found to be statistically significant in the model of specialty versus primary care job choice. Financial factors were found to be the greatest predictor in first job choice. Focusing on policy to help reduce student debt and increase reimbursement rates could help increase the number of students choosing primary care.
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Williams MP, Agana DF, Rooks BJ, Harrell G, Klassen RA, Hatch R, Malouin RA, Carek PJ. Primary Care Tracks in Medical Schools. PRIMER (LEAWOOD, KAN.) 2019; 3:3. [PMID: 32537574 PMCID: PMC7205094 DOI: 10.22454/primer.2019.799272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION With the estimated future shortage of primary care physicians there is a need to recruit more medical students into family medicine. Longitudinal programs or primary care tracks in medical schools have been shown to successfully recruit students into primary care. The aim of this study was to examine the characteristics of primary care tracks in departments of family medicine. METHODS Data were collected as part of the 2016 CERA Family Medicine Clerkship Director Survey. The survey included questions regarding the presence and description of available primary care tracks as well as the clerkship director's perception of impact. The survey was distributed via email to 125 US and 16 Canadian family medicine clerkship directors. RESULTS The response rate was 86%. Thirty-five respondents (29%) reported offering a longitudinal primary care track. The majority of tracks select students on a competitive basis, are directed by family medicine educators, and include a wide variety of activities. Longitudinal experience in primary care ambulatory settings and primary care faculty mentorship were the most common activities. Almost 70% of clerkship directors believe there is a positive impact on students entering primary care. CONCLUSIONS The current tracks are diverse in what they offer and could be tailored to the missions of individual medical schools. The majority of clerkship directors reported that they do have a positive impact on students entering primary care.
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Affiliation(s)
| | - Denny Fe Agana
- Department of Community Health and Family Medicine, University of Florida, Gainesville
| | - Benjamin J Rooks
- Department of Community Health and Family Medicine, University of Florida
| | - Grant Harrell
- Department of Community Health and Family Medicine, University of Florida
| | | | - Robert Hatch
- Department of Community Health and Family Medicine, University of Florida
| | - Rebecca A Malouin
- Department of Pediatrics and Human Development, Michigan State University
| | - Peter J Carek
- Department of Community Health and Family Medicine, College of Medicine, University of Florida
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Hedge ZN, Bossong F, Gordon-Ross PN, Kovacs SJ. Exploring the Effects of Participation in a Shelter Medicine Externship on Student Knowledge and Self-Confidence. JOURNAL OF VETERINARY MEDICAL EDUCATION 2018; 46:4-13. [PMID: 30418811 DOI: 10.3138/jvme.0417-056r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
With the recognition of shelter medicine as a sub-discipline of veterinary medicine, many veterinary programs are including clinical shelter experiences in their curricula. A concurrent mixed-methods study was designed with the aim to determine the effectiveness of a 4-week clinical shelter medicine program on students' perception of canine and feline surgical proficiency and shelter medicine knowledge as well as gain information on student attitudes toward shelter medicine and interest in pursuing this career path. Year 4 veterinary students at Western University of Health Sciences who were enrolled in a shelter medicine externship from 2014 to 2016 were invited to complete pre- and post-course online surveys. Of the 168 enrolled students, 77.4% were invited to participate, and 114 completed the survey. There was no statistically significant difference in student veterinary career interest before and after completing the externship. There was an overall increase in student rating of their ability to perform six shelter medicine tasks as well as ovariohysterectomy/ovariectomy (OVH/OE) and castration surgeries after completing their externship; all were statistically significant ( p < .001). There was a statistically significant difference in the proportion of students who were familiar with the Asilomar Accords and the Association of Shelter Veterinarians (ASV) Guidelines for Standards of Care in Animal Shelters after completion of their externship ( p < .001). Students largely supported pediatric spay and neuter, stating it was an effective means of population control. Based on the themes that emerged from the qualitative analysis, it appeared most students had an accurate understanding of the term no-kill.
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Affiliation(s)
- Zarah N Hedge
- Western University of Health Sciences College of Veterinary Medicine, 309 E. Second Street, Pomona, CA 91766 USA.
| | - Frank Bossong
- Western University of Health Sciences College of Veterinary Medicine 309 E. Second Street, Pomona, CA 91766 USA
| | - Paul N Gordon-Ross
- Western University of Health Sciences College of Veterinary Medicine 309 E. Second Street, Pomona, CA 91766 USA
| | - Suzie J Kovacs
- Western University of Health Sciences College of Veterinary Medicine 309 E. Second Street, Pomona, CA 91766 USA
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