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Stulberg EL, Lyden SM, Majersik JJ. A Call to Action to Provide Poststroke Care for Impoverished and Rural Patients. Stroke 2023; 54:3138-3140. [PMID: 37942642 PMCID: PMC10772670 DOI: 10.1161/strokeaha.123.045342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
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de Figueiredo AM, de Labry Lima AO, de Figueiredo DCMM, Neto AJDM, Rocha EMS, de Azevedo GD. Educational Strategies to Reduce Physician Shortages in Underserved Areas: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5983. [PMID: 37297587 PMCID: PMC10252282 DOI: 10.3390/ijerph20115983] [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: 03/29/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
The shortage of physicians in rural and underserved areas is an obstacle to the implementation of Universal Health Coverage (UHC). We carried out a systematic review to analyze the effectiveness of initiatives in medical education aimed to increase the supply of physicians in rural or underserved areas. We searched for studies published between 1999 and 2019 in six databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Interventional or observational controlled studies were defined as inclusion criteria. A total of 955 relevant unique records were selected for inclusion, which resulted in the identification of 17 articles for analysis. The admission of students from rural areas associated with a rural curriculum represented 52.95% of the interventions. Medical practice after graduation in rural or underserved areas was the most evaluated outcome, representing 12 publications (70.59%). Participants of these educational initiatives were more likely to work in rural or underserved areas or to choose family medicine, with significant differences between the groups in 82.35% of the studies. Educational strategies in undergraduate and medical residencies are effective. However, it is necessary to expand these interventions to ensure the supply of physicians in rural or urban underserved areas.
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Affiliation(s)
- Alexandre Medeiros de Figueiredo
- Department of Health Promotion, Federal University of Paraíba, Campus I, Jardim Universitário, S/N, Castelo Branco, João Pessoa 58051-900, Paraiba, Brazil
- Health Sciences Postgraduate Program, Federal University do Rio Grande do Norte, Campus Universitário Lagoa Nova, Natal 59078-900, Rio Grande do Norte, Brazil
| | - Antonio Olry de Labry Lima
- Andalusian School of Public Health, Cuesta del Observatorio 4, Campus Universitario de Cartuja, 18011 Granada, Andalusia, Spain
| | | | - Alexandre José de Melo Neto
- Department of Health Promotion, Federal University of Paraíba, Campus I, Jardim Universitário, S/N, Castelo Branco, João Pessoa 58051-900, Paraiba, Brazil
| | - Erika Maria Sampaio Rocha
- Health Science Training Center, Federal University of Espírito Santo, Av. Fernando Ferrari, 514, Goiabeiras, Vitória 29075-910, Espirito Santo, Brazil
| | - George Dantas de Azevedo
- Multicampi School of Medical Sciences, Federal University of Rio Grande do Norte, Av. Cel Martiniano, 541, Caico 59300-000, Rio Grande do Norte, Brazil
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Aggarwal M, Abdelhalim R. Are early career family physicians prepared for practice in Canada? A qualitative study. BMC MEDICAL EDUCATION 2023; 23:370. [PMID: 37226128 DOI: 10.1186/s12909-023-04250-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/11/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND In Canada, the College of Family Physicians of Canada (CFPC) introduced Competency Based Medical Education to prepare and train family medicine residents to be competent to enter and adapt to the independent practice of comprehensive family medicine. Despite its implementation, the scope of practice is narrowing. This study aims to understand the degree to which early career Family Physicians (FPs) are prepared for independent practice. METHOD A qualitative design was used for this study. A survey and focus groups were conducted with early-career FPs who completed residency training in Canada. The survey and focus groups examined the degree of preparedness of early career FPs in relation to 37 core professional activities identified by the CFPC's Residency Training Profile. Descriptive statistics and qualitative content analysis were conducted. RESULTS Seventy-five participants from across Canada participated in the survey, and 59 participated in the focus groups. Early career FPs reported being well prepared to provide continuous and coordinated care for patients with common presentations and deliver various services to different populations. FPs were also well prepared to manage the electronic medical record, participate in team-based care, provide regular and after-hours coverage, and assume leadership and teaching roles. However, FPs reported being less prepared for virtual care, business management, providing culturally safe care, delivering specific services in emergency care hospitals, obstetrics, self-care, engaging with the local communities, and conducting research activities. CONCLUSIONS Early career FPs do not feel fully prepared for practice in all 37 core activities in the Residency Training Profile. As part of the introduction of the three-year program by the CFPC, the postgraduate family medicine training should consider providing more exposure to learning opportunities and developing curricula in the areas where FPs are unprepared for practice. These changes could facilitate the production of a FP workforce better prepared to manage the dynamic and complex challenges and dilemmas faced in independent practice.
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Affiliation(s)
- Monica Aggarwal
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Reham Abdelhalim
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Casapulla S, Longenecker R. An Integrated Rural and Urban Underserved Pathway in Medical School. TEACHING AND LEARNING IN MEDICINE 2023; 35:206-217. [PMID: 35133935 DOI: 10.1080/10401334.2022.2028262] [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: 04/21/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
Problem: The need to increase the number of culturally responsive physicians, particularly primary care physicians, serving in rural and urban underserved communities is well documented. To address this need, an increasing number of medical schools are implementing separate rural or urban underserved training programs or tracks. Intervention: The Rural and Urban Scholars Pathways program is designed as an integrated program, not as separated tracks, and includes critical reflection groups, professional development workshops, individual coaching, a scholarly project, and immersion experiences. The program does not separate students by initial interest in either rural or urban underserved practice settings, but rather promotes their interactions across all four years. Students can join (or leave) RUSP in any year of medical school and, although strongly encouraged toward eventual practice in an underserved community, students are not committed to a specific specialty or practice location. Context: The RUSP program was developed and implemented at the Heritage College of Osteopathic Medicine at Ohio University in 2013 with a grant from the Osteopathic Heritage Foundations. The program resides within the Office of Rural and Underserved Programs at the Heritage College and is one of many medical school programs across the country aimed at producing more physicians for rural and urban underserved communities. RUSP is now funded by the College. Impact: Overall, based on a 60% return rate in 2019-2020, students in all four years report that the RUSP program enhances their professional, personal, social, and academic development. Cumulatively, 67% have matched into specialties with primary care potential, including family medicine, pediatrics, general internal medicine and internal medicine-pediatrics. Of the 14 RUSP graduates in practice, six are practicing primary care in rural locations and five are practicing primary care in urban locations. Five of the fourteen are practicing in communities officially designated as underserved. Lessons Learned: Offering flexibility via a pathways model promotes continuing individual and program growth and expansion. A co-curricular strategy allows for nimble program refinement but requires significant volunteer time commitment from faculty and staff. Having clear program goals, a logic model, and mechanisms for gathering and analyzing student experiences help to maintain program focus and allow for ongoing formative and periodic summative evaluation of short-term and long-term objectives.
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Affiliation(s)
- Sharon Casapulla
- Office of Rural and Underserved Programs, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
- Department of Primary Care, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Randall Longenecker
- Office of Rural and Underserved Programs, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
- Department of Primary Care, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
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Residents' choice of a placement in periphery hospitals in Israel: the significance of personal/family and professional considerations. Health Policy 2023; 132:104795. [PMID: 36990021 DOI: 10.1016/j.healthpol.2023.104795] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 01/11/2022] [Accepted: 03/08/2023] [Indexed: 03/22/2023]
Abstract
Physician maldistribution affects remote and rural population health indicators and as such constitutes a major concern for health systems. Various countries, including Israel, have sought to remedy this problem, often by implementing more than one intervention simultaneously. In this paper, we explored the considerations that motivated Israeli residents to opt for a position in the periphery, as well as potential factors that could facilitate their retention in these underserved areas. We found that the motivation driving young physicians to specialize in a specific hospital includes personal- and family-oriented considerations (proximity to the nuclear family, perceived quality of life and lifestyle) as well as professional considerations (prior acquaintance with a hospital and a specific hospital department, department characteristics, availability of a residence position in a preferred specialty, prospective professional advancement). We therefore argue that the key to recruitment and retention of young physicians in remote areas lies in tailored interventions that take personal, professional and regional issues into account, preferably in consultation with the physicians themselves. The prominence of personal issues in the interviews with young physicians suggests that effective interventions should support a work-life balance. Hence success in attracting residents as a first step towards correcting physician maldistribution hinges upon coordinating policies in the medical field with policies in non-medical arenas - education, welfare, local authorities.
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Noya F, Carr S, Freeman K, Thompson S, Clifford R, Playford D. Strategies to Facilitate Improved Recruitment, Development, and Retention of the Rural and Remote Medical Workforce: A Scoping Review. Int J Health Policy Manag 2022; 11:2022-2037. [PMID: 34973053 PMCID: PMC9808272 DOI: 10.34172/ijhpm.2021.160] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 11/14/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Medical workforce shortages in rural and remote areas are a global issue. High-income countries (HICs) and low- and middle-income countries (LMICs) seek to implement strategies to address this problem, regardless of local challenges and contexts. This study distilled strategies with positive outcomes and success from international peer-reviewed literature regarding recruitment, retention, and rural and remote medical workforce development in HICs and LMICs. METHODS The Arksey and O'Malley scoping review framework was utilised. Articles were retrieved from electronic databases Medline, Embase, Global Health, CINAHL Plus, and PubMed from 2010-2020. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guideline was used to ensure rigour in reporting the methodology in the interim, and PRISMA extension for scoping review (PRISMA-ScR) was used as a guide to report the findings. The success of strategies was examined against the following outcomes: for recruitment - rural and remote practice location; for development - personal and professional development; and for retention - continuity in rural and remote practice and low turnover rates. RESULTS Sixty-one studies were included according to the restriction criteria. Most studies (n=53; 87%) were undertaken in HICs, with only eight studies from LMICs. This scoping review found implementation strategies classified as Educational, Financial, and Multidimensional were successful for recruitment, retention, and development of the rural and remote medical workforce. CONCLUSION This scoping review shows that effective strategies to recruit and retain rural and remote medical workforce are feasible worldwide despite differences in socio-economic factors. While adjustment and adaptation to match the strategies to the local context are required, the country's commitment to act to improve the rural medical workforce shortage is most critical.
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Affiliation(s)
- Farah Noya
- Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Sandra Carr
- Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Kirsty Freeman
- Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, WA, Australia
- Duke National University Singapore Medical School, Singapore, Singapore
| | - Sandra Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, WA, Australia
| | - Rhonda Clifford
- School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Denese Playford
- The Rural Clinical School of WA, School of Medicine, The University of Western Australia, Perth, WA, Australia
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Noya F, Carr S, Thompson S, Clifford R, Playford D. Factors associated with the rural and remote practice of medical workforce in Maluku Islands of Indonesia: a cross-sectional study. HUMAN RESOURCES FOR HEALTH 2021; 19:126. [PMID: 34627282 PMCID: PMC8502290 DOI: 10.1186/s12960-021-00667-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Many factors contribute to engagement in rural and remote (RR) medical practice, but little is known about the factors associated with rural and remote medical practice in such remote locations as the Maluku Province of Indonesia. This study describes factors associated with actual RR practice, preferred RR practice, and intention to remain practice in Maluku Province. METHODS An online survey of work-related experience and intentions for future rural work was administered to 410 doctors working in the Maluku province of Indonesia. Participant characteristics were described using descriptive statistics, associations between the independent variables with the location of the workforce, intention to remain practice in Maluku, preference for future RR practice in Maluku were analysed using Chi-square tests and logistic regression. RESULTS A total of 324 responses (79% response rate) were recorded, comprising 70% females and 30% Pattimura University graduates of doctors employed in Maluku. Doctors working in RR areas were more likely to be a GP (OR 3.49, CI 1.03-11.8), have a monthly salary of more than IDR 6 million (OR 11.5, CI 4.24-31.1), and have no additional practice (OR 2.78, CI 1.34-5.78). Doctors intended to stay practice in Maluku were more likely to be born in Maluku (OR 7.77, CI 3.42-17.7) and have graduated from Pattimura University (OR 3.06, CI 1.09-8.54), and less likely to be a temporary employee (OR 0.24, CI 0.10-0.57). Doctors who prefer future RR practice in Maluku were more likely to experience rural living (OR 2.05 CI 1.05-3.99), have a positive indication of the impact of community exposure during medical schools on their current practice (OR 2.08, CI 1.06-4.09), currently practising in RR Maluku (OR 8.23, CI 3.27-20.8); and less likely to have bigger take-home pay (OR 0.30, CI 0.13-0.70). CONCLUSION This study indicates that special attention should be given to recruiting doctors with a rural background and ongoing support through attractive opportunities to build a sustainable RR workforce. Since a regional medical school helps supply doctors to the RR areas in its region, a sustained collaboration between medical schools and local government implementing relevant strategies are needed to widen participation and improve the recruitment and retention of RR doctors.
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Affiliation(s)
- Farah Noya
- Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, Australia
- Medical Education Unit, Faculty of Medicine, Pattimura University, Ambon, Indonesia
- Health Professions Education Building, The University of Western Australia, Crawley Avenue (off Mounts Bay Road-next to CAR PARK 25), Nedlands, WA 6009 Australia
| | - Sandra Carr
- Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, Australia
| | - Rhonda Clifford
- School of Allied Health, University of Western Australia, Perth, Australia
| | - Denese Playford
- The Rural Clinical School of WA, School of Medicine, The University of Western Australia, Perth, Australia
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Shen Y, Huang X, Li H, Chen E, Kong Y, Yu J, Liu X, Mobarak SA, Zuo Y. Early outcomes of a rural-oriented physician education programme against rural physician shortages in Guangxi province: a prospective cohort study. BMJ Open 2021; 11:e049274. [PMID: 34493517 PMCID: PMC8424837 DOI: 10.1136/bmjopen-2021-049274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to investigate early outcomes of one of the first medical undergraduate education programmes with a goal of mitigating severe rural physician shortages in China, which was developed by Guangxi Medical University (GXMU) and was called the Rural-oriented Free Tuition Medical Education (RTME)-GXMU programme. DESIGN A prospective cohort study comprising a baseline investigation and follow-up research was conducted to dynamically observe the evolution of the RTME-GXMU programme that began since 2010. PARTICIPANTS 380 RTME-GXMU graduates and 383 non-RTME-GXMU graduates from GXMU who completed trainings between 2015 and 2018 were recruited in the baseline investigation. Among them, 285 RTME-GXMU and 283 non-RTME-GXMU graduates responded to the follow-up research. MAIN OUTCOME MEASURES Graduate practice location, registered specialty, passing rate of the National Medical Licensing Examination (NMLE), specialty of residency programme and contract compliance for the RTME-GXMU graduates. RESULTS By the end of 2018, 100% of the 2015 RTME-GXMU graduates enrolled in this study practised in rural township health centres and registered themselves as general practitioners (GPs). All the RTME-GXMU graduates had completed or were attending residency programmes of general practice (GP). The above data stood in stark contrast to that of the non-RTME-GXMU graduates among whom as few as 1.06% worked in rural areas, 2.13% registered as GPs and less than 3% chose GP residency programmes. No significant differences were detected on passing rates of the NMLE between the two groups. Only one RTME-GXMU graduate broke the contract and dropped off the programme. CONCLUSIONS The RTME-GXMU programme has achieved encouraging early outcomes. Reduced entry score and proper usage of urban primary care institutions are two key approaches contributing to these positive early results.
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Affiliation(s)
- Ying Shen
- School of General Practice, Guangxi Medical University, Nanning, Guangxi, China
| | - Xing Huang
- Division of Teaching Affairs, Guangxi Medical University, Nanning, Guangxi, China
| | - Hong Li
- School of General Practice, Guangxi Medical University, Nanning, Guangxi, China
| | - Enran Chen
- School of General Practice, Guangxi Medical University, Nanning, Guangxi, China
| | - Yan Kong
- School of General Practice, Guangxi Medical University, Nanning, Guangxi, China
| | - Jia Yu
- School of General Practice, Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaoyun Liu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Siam Ai Mobarak
- The Department of Cardiology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Yanli Zuo
- School of General Practice, Guangxi Medical University, Nanning, Guangxi, China
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Casapulla S. Asset-Based and Narrative-Oriented Medical Education for Rural and Urban Underserved Practice. HEALTH COMMUNICATION 2021; 36:789-794. [PMID: 31931617 DOI: 10.1080/10410236.2020.1712529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This essay describes a medical education program model that is place-focused, asset-driven, project-based and narratively oriented. The author discusses the various ways this model can frame programming in undergraduate medical education and foster resilience for rural and urban underserved practice. Medical students preparing for practice in rural or urban underserved communities engage with communities from an asset-based perspective, by learning in communities and with community members. Medical students participate in longitudinal small group experiences which employ narrative pedagogy to build relationships through vulnerability with each other, with faculty, and with community members. In the proposed model, scholarly projects are community-responsive and reflect a commitment to local residents. Student voices are integrated through the essay to provide insight into the impact this model can have in medical education.
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Affiliation(s)
- Sharon Casapulla
- Office of Rural and Underserved Programs, Heritage College of Osteopathic Medicine, Ohio University
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Jungbauer D, Glasser M, MacDowell M. Perceptions and Attitudes toward Community Health and Interprofessional Education in Students with and without an Additional Community Medicine-Focused Program. MEDICAL SCIENCE EDUCATOR 2021; 31:535-547. [PMID: 34457911 PMCID: PMC8368662 DOI: 10.1007/s40670-021-01210-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 06/13/2023]
Abstract
The Rural Medical Education (RMED) Program at the University of Illinois College of Medicine Rockford campus, and part of the National Center for Rural Health Professions, strives to recruit students from rural areas, who, after completing residency, return to rural Illinois as primary care physicians. RMED students meet monthly to learn about the community and public health in rural communities. Furthermore, they complete a 16-week rural preceptorship during their fourth year. During the fourth year of medical school, all RMED students, as well as the students following the regular curriculum, are asked to complete a survey, related to the understanding of medical students' views of community and interprofessional education. We aimed to identify how the community-based curriculum affects the students' understanding and appreciation of community as they go into rural health practice. The results showed that students in the RMED Program are more aware of the community they are part of, as well as being more interested in becoming part of their community. RMED students reported a statistically significantly higher rating of feeling appreciated and accepted by their community and rated their confidence in their abilities in the community statistically significantly higher. Interestingly, RMED students were not more likely to be more familiar with several health professions and programs within their community, compared to non-RMED students. Results comparing self-rated capabilities for RMED students within the community both before and after adding components of an interprofessional education curriculum showed no statistically significant changes. These results support previous research, while also providing more support for the development of successful interprofessional education courses.
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Affiliation(s)
- Dana Jungbauer
- National Center for Rural Health Professions, University of Illinois College of Medicine at Rockford, 1601 Parkview Ave., Rockford, IL 61107 USA
| | - Michael Glasser
- National Center for Rural Health Professions, University of Illinois College of Medicine at Rockford, 1601 Parkview Ave., Rockford, IL 61107 USA
| | - Martin MacDowell
- National Center for Rural Health Professions, University of Illinois College of Medicine at Rockford, 1601 Parkview Ave., Rockford, IL 61107 USA
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Meyers P, Wilkinson E, Petterson S, Patterson DG, Longenecker R, Schmitz D, Bazemore A. Rural Workforce Years: Quantifying the Rural Workforce Contribution of Family Medicine Residency Graduates. J Grad Med Educ 2020; 12:717-726. [PMID: 33391596 PMCID: PMC7771603 DOI: 10.4300/jgme-d-20-00122.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/27/2020] [Accepted: 08/12/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Rural regions of the United States continue to experience a disproportionate shortage of physicians compared to urban regions despite decades of state and federal investments in workforce initiatives. The graduate medical education system effectively controls the size of the physician workforce but lacks effective mechanisms to equitably distribute those physicians. OBJECTIVE We created a measurement tool called a "rural workforce year" to better understand the rural primary care workforce. It quantifies the rural workforce contributions of rurally trained family medicine residency program graduates and compares them to contributions of a geographically matched cohort of non-rurally trained graduates. METHODS We identified graduates in both cohorts and tracked their practice locations from 2008-2018. We compared the average number of rural workforce years in 3 cross sections: 5, 8, and 10 years in practice after residency graduation. RESULTS Rurally trained graduates practicing for contributed a higher number of rural workforce years in total and on average per graduate compared to a matched cohort of non-rural/rural training tack (RTT) graduates in the same practice intervals (P < .001 in all 3 comparison groups). In order to replace the rural workforce years produced by 1 graduate from the rural/RTT cohort, it would take 2.89 graduates from non-rural/RTT programs. CONCLUSIONS These findings suggest that rural/RTT-trained physicians devote substantially more service to rural communities than a matched cohort of non-rural/RTT graduates and highlight the importance of rural/RTT programs as a major contributor to the rural primary care workforce in the United States.
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Affiliation(s)
- Peter Meyers
- Full-Time Physician, Minnesota Community Care (previously West Side Community Health Services)
| | - Elizabeth Wilkinson
- Junior Analyst, Robert Graham Center for Policy Studies in Family Medicine and Primary Care
| | - Stephen Petterson
- Research Director, Robert Graham Center for Policy Studies in Family Medicine and Primary Care
| | - Davis G Patterson
- Research Associate Professor, Department of Family Medicine, University of Washington School of Medicine
| | - Randall Longenecker
- Professor of Family Medicine and Assistant Dean, Rural and Underserved Programs, Ohio University Heritage College of Osteopathic Medicine
| | - David Schmitz
- Chair, Department of Family and Community Medicine, University of North Dakota School of Medicine and Health Sciences
| | - Andrew Bazemore
- Senior Vice President of Research and Policy, American Board of Family Medicine, and Co-Director, Center for Professionalism & Value in Healthcare
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Longenecker RL, Andrilla CHA, Jopson AD, Evans DV, Schmitz D, Larson EH, Patterson DG. Pipelines to Pathways: Medical School Commitment to Producing a Rural Workforce. J Rural Health 2020; 37:723-733. [DOI: 10.1111/jrh.12542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Randall L. Longenecker
- Office of Rural and Underserved Programs Heritage College of Osteopathic Medicine, Ohio University Athens Ohio
| | - C. Holly A. Andrilla
- Department of Family Medicine University of Washington School of Medicine Seattle Washington
| | - Andrew D. Jopson
- Department of Family Medicine University of Washington School of Medicine Seattle Washington
| | - David V. Evans
- Department of Family Medicine University of Washington School of Medicine Seattle Washington
| | - David Schmitz
- Department of Family & Community Medicine University of North Dakota School of Medicine Grand Forks North Dakota
| | - Eric H. Larson
- Department of Family Medicine University of Washington School of Medicine Seattle Washington
| | - Davis G. Patterson
- Department of Family Medicine University of Washington School of Medicine Seattle Washington
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Witter S, Hamza MM, Alazemi N, Alluhidan M, Alghaith T, Herbst CH. Human resources for health interventions in high- and middle-income countries: findings of an evidence review. HUMAN RESOURCES FOR HEALTH 2020; 18:43. [PMID: 32513184 PMCID: PMC7281920 DOI: 10.1186/s12960-020-00484-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/28/2020] [Indexed: 05/28/2023]
Abstract
Many high- and middle-income countries face challenges in developing and maintaining a health workforce which can address changing population health needs. They have experimented with interventions which overlap with but have differences to those documented in low- and middle-income countries, where many of the recent literature reviews were undertaken. The aim of this paper is to fill that gap. It examines published and grey evidence on interventions to train, recruit, retain, distribute, and manage an effective health workforce, focusing on physicians, nurses, and allied health professionals in high- and middle-income countries. A search of databases, websites, and relevant references was carried out in March 2019. One hundred thirty-one reports or papers were selected for extraction, using a template which followed a health labor market structure. Many studies were cross-cutting; however, the largest number of country studies was focused on Canada, Australia, and the United States of America. The studies were relatively balanced across occupational groups. The largest number focused on availability, followed by performance and then distribution. Study numbers peaked in 2013-2016. A range of study types was included, with a high number of descriptive studies. Some topics were more deeply documented than others-there is, for example, a large number of studies on human resources for health (HRH) planning, educational interventions, and policies to reduce in-migration, but much less on topics such as HRH financing and task shifting. It is also evident that some policy actions may address more than one area of challenge, but equally that some policy actions may have conflicting results for different challenges. Although some of the interventions have been more used and documented in relation to specific cadres, many of the lessons appear to apply across them, with tailoring required to reflect individuals' characteristics, such as age, location, and preferences. Useful lessons can be learned from these higher-income settings for low- and middle-income settings. Much of the literature is descriptive, rather than evaluative, reflecting the organic way in which many HRH reforms are introduced. A more rigorous approach to testing HRH interventions is recommended to improve the evidence in this area of health systems strengthening.
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Affiliation(s)
- Sophie Witter
- Queen Margaret University, Edinburgh, United Kingdom
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Reeves NS, Cheek C, Hays R, Sargent A, McComiskie A, Santini C, Nguyen J, Chalwe K, Mubarak A. Increasing interest of students from under‐represented groups in medicine—A systematised review. Aust J Rural Health 2020; 28:236-244. [DOI: 10.1111/ajr.12609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 12/01/2019] [Accepted: 02/11/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Nicole S. Reeves
- College of Health and Medicine Rural Clinical School University of Tasmania Burnie TAS Australia
| | - Colleen Cheek
- Tasmanian Health Service—North West Burnie TAS Australia
| | - Richard Hays
- College of Health and Medicine Rural Clinical School University of Tasmania Burnie TAS Australia
| | - Aryelle Sargent
- College of Health and Medicine Rural Clinical School University of Tasmania Burnie TAS Australia
| | - Alice McComiskie
- College of Health and Medicine Rural Clinical School University of Tasmania Burnie TAS Australia
| | - Carlos Santini
- College of Health and Medicine Rural Clinical School University of Tasmania Burnie TAS Australia
| | - Jamie Nguyen
- College of Health and Medicine Rural Clinical School University of Tasmania Burnie TAS Australia
| | - Khezia Chalwe
- College of Health and Medicine Rural Clinical School University of Tasmania Burnie TAS Australia
| | - Adil Mubarak
- College of Health and Medicine Rural Clinical School University of Tasmania Burnie TAS Australia
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Rogers AJG. Medical student volunteerism and interest in working with underserved and vulnerable populations. BMC MEDICAL EDUCATION 2020; 20:133. [PMID: 32349741 PMCID: PMC7191812 DOI: 10.1186/s12909-020-02048-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 04/21/2020] [Indexed: 06/01/2023]
Abstract
BACKGROUND The desire of medical students to eventually work with underserved and vulnerable populations (hereafter 'service interest'), has been shown to be shaped by individual factors including job satisfaction and financial considerations. School-level factors such as required longitudinal primary care experiences and the availability of extracurricular opportunities to work with underserved patients also affect service interest, but little is known about the impact of student volunteer activities. METHODS This cross-sectional study gathered data from preclinical medical students via an online questionnaire. The data were linked to academic records, deidentified, and analysed using an ordinal logistic regression model with interest in caring 'primarily for underserved or vulnerable populations' as the outcome variable. RESULTS Of 121 respondents (33% response rate), 24.8% expressed a definite interest, 55.3% expressed possible interest, and 19.9% expressed no service interest. Intent to work with the underserved was not related to age, sex, race/ethnicity, being from a rural hometown, academic qualifications prior to medical school, or anticipated debt at medical school graduation. Students with no service interest had a higher average academic performance in medical school and plans of subspecialising. When considering volunteerism prior to medical school, students in the highest and middle volunteerism tertiles had 5.68 (95% CI: 1.63, 19.81) and 4.34 (1.32, 14.32) times the odds, respectively, of having definite or possible service interest relative to those who were in the lowest volunteerism tertile, after adjusting for potential confounders. Volunteerism in a student-run clinic for the underserved during medical school was not correlated with service interest. CONCLUSIONS Medical schools looking to enroll more students interested in working with underserved or vulnerable populations may choose to emphasise applicant premedical volunteerism record in their admissions decisions.
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Affiliation(s)
- Anna Joy G Rogers
- College of Medicine, University of Tennessee Health Science Center, 853 Jefferson Avenue, Suite E102, Memphis, TN, 38163, USA.
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McGrail MR, O’Sullivan BG, Russell DJ. Rural training pathways: the return rate of doctors to work in the same region as their basic medical training. HUMAN RESOURCES FOR HEALTH 2018; 16:56. [PMID: 30348164 PMCID: PMC6198494 DOI: 10.1186/s12960-018-0323-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/10/2018] [Indexed: 05/28/2023]
Abstract
BACKGROUND Limited evidence exists about the extent to which doctors are returning to rural region(s) where they had previously trained. This study aims to investigate the rate at which medical students who have trained for 12 months or more in a rural region return to practice in that same region in their early medical career. A secondary aim is to investigate whether there is an independent or additional association with the effect of longer duration of rural exposure in a region (18-24 months) and for those completing both schooling and training in the same rural region. METHODS The outcome was rural region of work, based on postcode of work location in 2017 for graduates spanning 1-9 years post-graduation, for one large medical program in Victoria, Australia. Region of rural training, combined with region of secondary schooling and duration of rural training, was explored for its association with region of practice. A multinomial logistic regression model, accounting for other covariates, measured the strength of association with practising in the same rural region as where they had trained. RESULTS Overall, 357/2451 (15%) graduates were working rurally, with 90/357 (25%) working in the same rural region as where they did rural training. Similarly, 41/170 (24%) were working in the same region as where they completed schooling. Longer duration (18-24 vs 12 months) of rural training (relative risk ratio, RRR, 3.37, 1.89-5.98) and completing both schooling and training in the same rural region (RRR: 4.47, 2.14-9.36) were associated with returning to practice in the same rural region after training. CONCLUSIONS Medical graduates practising rurally in their early career (1-9 years post-graduation) are likely to have previous connections to the region, through either their basic medical training, their secondary schooling, or both. Social accountability of medical schools and rural medical workforce outcomes could be improved by policies that enable preferential selection and training of prospective medical students from rural regions that need more doctors, and further enhanced by longer duration of within-region training.
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Affiliation(s)
- Matthew R. McGrail
- University of Queensland, Rural Clinical School, 78 on Canning Street, Rockhampton, QLD 4700 Australia
| | - Belinda G. O’Sullivan
- Monash Rural Health, Monash University, 26 Mercy Street, Bendigo, VIC 3550 Australia
| | - Deborah J. Russell
- Flinders University, Northern Territory, PO Box 41326, Casuarina, NT 0815 Australia
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Johnson GE, Wright FC, Foster K. The impact of rural outreach programs on medical students' future rural intentions and working locations: a systematic review. BMC MEDICAL EDUCATION 2018; 18:196. [PMID: 30107795 PMCID: PMC6092777 DOI: 10.1186/s12909-018-1287-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 07/19/2018] [Indexed: 05/07/2023]
Abstract
BACKGROUND Significant investment has been undertaken by many countries into 'Rural Clinical Training Placement Schemes' for medical students in order to deal with shortages of trained health care professionals in rural and remote locations. This systematic review examines the evidence base of rural educational programs within medical education and focusses on workforce intentions and employment outcomes. The study provides a detailed description of the methodological characteristics of the literature, thematic workforce outcomes and key related factors are identified, study quality is assessed, and the findings are compared within an international context. METHODS A systematic review looking at international literature of rural placement programs within medical education between January 2005 to January 2017 from databases including; Medline, Embase, NursingOVID, PubMed and Cochrane. The study adopted the PRISMA protocol. A quality assessment of the literature was conducted based on the Health Gains Notation Framework. RESULTS Sixty two papers met the inclusion criteria. The review identified three program classifications; Rural Clinical Placement Programs, Rural Clinical Placement Programs combined with a rural health educational curriculum component and Rural Clinical School Programs. The studies included were from Australia, United States, Canada, New Zealand, Thailand and Africa. Questionnaires and tracking or medical registry databases were the most commonly reported research tools and the majority were volunteer programs. Most studies identified potential rural predictors/confounders, however a number did not apply control groups and most programs were based on a single site. There was a clear discrepancy in the ideal rural clinical placement length. Outcomes themes were identified related to rural workforce outcomes. Most studies reported that an organised, well-funded, rural placement or rural clinical school program produced positive associations with increased rural intentions and actual graduate rural employment. CONCLUSIONS Future research should focus on large scale methodologically rigorous multi-site rural program studies, with longitudinal follow up of graduates working locations. Studies should apply pre-and post-intervention surveys to measure change in attitudes and control for predictive confounders, control groups should be applied; and in-depth qualitative research should be considered to explore the specific factors of programs that are associated with encouraging rural employment.
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Affiliation(s)
- George E. Johnson
- Sydney Medical School, University of Sydney, Sydney, NSW 2050 Australia
| | - Fredrick Clive Wright
- Concord Clinical School, University of Sydney, Sydney, Australia
- Centre for Education and Research on Ageing, Sydney, NSW 2139 Australia
| | - Kirsty Foster
- Sydney Medical School, Northern & Kolling Institute, University of Sydney, Sydney, NSW Australia
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Casapulla SL. Self-efficacy of Osteopathic Medical Students in a Rural-Urban Underserved Pathway Program. J Osteopath Med 2017; 117:577-585. [PMID: 28846124 DOI: 10.7556/jaoa.2017.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Context Self-efficacy has been shown to play a role in medical students' choice of practice location. More physicians are needed in rural and urban underserved communities. Ohio University Heritage College of Osteopathic Medicine has a co-curricular training program in rural and urban underserved practice to address this shortage. Objective To assess whether participation in the co-curricular program in rural and urban underserved practice affects self-efficacy related to rural and underserved urban practice. Methods This cross-sectional study explored self-efficacy using Bandura's 5 sources of self-efficacy (vicarious learning, verbal persuasion, positive emotional arousal, negative emotional arousal, and performance accomplishments). A validated scale on self-efficacy for rural practice was expanded to include self-efficacy for urban underserved practice and e-mailed to all 707 medical students across 4 years of medical school. Composite rural and urban underserved self-efficacy scores were calculated. Scores from participants in the rural and urban underserved training program were compared with those who were not in the program. Results Data were obtained from 277 students. In the overall sample, students who indicated that they grew up in a rural community reported significantly higher rural self-efficacy scores than those who did not grow up in a rural community (F1,250=27.56, P<.001). Conversely, students who indicated that they grew up in a nonrural community reported significantly higher urban underserved self-efficacy scores than those who grew up in a rural community (F1,237=7.50, P=.007). The participants who stated primary care as their career interest (n=122) had higher rural self-efficacy scores than the participants who reported a preference for generalist specialties (general surgery, general psychiatry, and general obstetrics and gynecology) or other specialties (n=155) (F2,249=7.16, P=.001). Students who participated in the rural and urban underserved training program (n=49) reported higher rural self-efficacy scores (mean [SD], 21.06 [5.06]) than those who were not in the program (19.22 [4.22]) (t65=2.36; P=.022; equal variances not assumed). The weakest source of self-efficacy for rural practice in participants was vicarious experience. The weakest source of urban underserved self-efficacy was verbal persuasion. Conclusion Opportunities exist for strengthening weaker sources of self-efficacy for rural practice, including vicarious experience and verbal persuasion. The findings suggest a need for longitudinal research into self-efficacy and practice type interest in osteopathic medical students.
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Wheat JR, Leeper JD, Murphy S, Brandon JE, Jackson JR. Educating Physicians for Rural America: Validating Successes and Identifying Remaining Challenges With the Rural Medical Scholars Program. J Rural Health 2017; 34 Suppl 1:s65-s74. [PMID: 28318061 DOI: 10.1111/jrh.12236] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/17/2017] [Accepted: 02/01/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the Rural Medical Scholars (RMS) Program's effectiveness to produce rural physicians for Alabama. METHODS A nonrandomized intervention study compared RMS (1997-2002) with control groups in usual medical education (1991-2002) at the University of Alabama School of Medicine's main and regional campuses. Participants were RMS and others admitted to regular medical education, and the intervention was the RMS Program. Measures assessed the percentage of graduates practicing in rural areas. Odds ratios compared effectiveness of producing rural Alabama physicians. FINDINGS The RMS Program (N = 54), regional campuses (N = 182), and main campus (N = 649) produced 48.1% (odds ratio 6.4, P < .001), 23.8% (odds ratio 2.5, P < .001), and 11.2% (odds ratio 1.0) rural physicians, respectively. CONCLUSIONS The RMS Program, contrasted to other local programs of medical education, was effective in producing rural physicians. These results were comparable to benchmark programs in the Northeast and Midwest USA on which the RMS Program was modeled, justifying the assumption that model programs can be replicated in different regions. However, this positive effect was not shared by a disparate rural minority population, suggesting that models for rural medical education must be adjusted to meet the challenge of such communities for physicians.
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Affiliation(s)
- John R Wheat
- University of Alabama College of Community Health Sciences, Tuscaloosa, Alabama
| | - James D Leeper
- University of Alabama College of Community Health Sciences, Tuscaloosa, Alabama
| | - Shannon Murphy
- University of Alabama Institute for Social Science Research, Tuscaloosa, Alabama
| | | | - James R Jackson
- Department of Medical Education, University of Alabama School of Medicine, Birmingham, Alabama
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Leong SL, Cangiarella J, Fancher T, Dodson L, Grochowski C, Harnik V, Hustedde C, Jones B, Kelly C, Macerollo A, Reboli AC, Rosenfeld M, Rundell K, Thompson T, Whyte R, Pusic M. Roadmap for creating an accelerated three-year medical education program. MEDICAL EDUCATION ONLINE 2017; 22:1396172. [PMID: 29117817 PMCID: PMC5706474 DOI: 10.1080/10872981.2017.1396172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
UNLABELLED Medical education is undergoing significant transformation. Many medical schools are moving away from the concept of seat time to competency-based education and introducing flexibility in the curriculum that allows individualization. In response to rising student debt and the anticipated physician shortage, 35% of US medical schools are considering the development of accelerated pathways. The roadmap described in this paper is grounded in the experiences of the Consortium of Accelerated Medical Pathway Programs (CAMPP) members in the development, implementation, and evaluation of one type of accelerated pathway: the three-year MD program. Strategies include developing a mission that guides curricular development - meeting regulatory requirements, attaining institutional buy-in and resources necessary to support the programs, including student assessment and mentoring - and program evaluation. Accelerated programs offer opportunities to innovate and integrate a mission benefitting students and the public. ABBREVIATIONS CAMPP: Consortium of accelerated medical pathway programs; GME: Graduate medical education; LCME: Liaison committee on medical education; NRMP: National residency matching program; UME: Undergraduate medical education.
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Affiliation(s)
- Shou Ling Leong
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
- CONTACT Shou Ling Leong, Penn State College of Medicine, 500 University Drive, H154, Hershey, PA17033, USA
| | - Joan Cangiarella
- Department of Pathology, NYU School of Medicine, New York, NY, USA
| | - Tonya Fancher
- Davis, School of Medicine, Office of Medical Education, University of California, Sacramento, CA, USA
| | - Lisa Dodson
- Department of Family and Community Medicine, Medical College of Wisconsin, Wausau, WI, USA
| | - Colleen Grochowski
- Office of Curricular Affairs, Duke University School of Medicine, Durham, NC, USA
| | - Vicky Harnik
- Department of Pathology, NYU School of Medicine, New York, NY, USA
| | - Carol Hustedde
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Betsy Jones
- Departments of Medical Education and Family Medicine, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA
| | - Christina Kelly
- Department of Family Medicine, Memorial Health Family Medicine Residency Program, Savannah, GA, USA
| | - Allison Macerollo
- Department of Family Medicine, Family Medicine at Care Point East, Ohio State University, Columbus, OH, USA
| | - Annette C. Reboli
- Department of Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Melvin Rosenfeld
- Department of Pathology, NYU School of Medicine, New York, NY, USA
| | - Kristen Rundell
- Department of Family Medicine, The Ohio State University, Columbus, OH, USA
| | - Tina Thompson
- Office of Medical Education, Mercer University School of Medicine, Savannah, GA, USA
| | - Robert Whyte
- Office of Undergraduate Medical Education, McMaster University, Hamilton, ON, Canada
| | - Martin Pusic
- NYU School of Medicine, Institute for Innovations in Medical Education, New York, NY, USA
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Playford D, Puddey IB. Interest in rural clinical school is not enough: Participation is necessary to predict an ultimate rural practice location. Aust J Rural Health 2016; 25:210-218. [DOI: 10.1111/ajr.12324] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2016] [Indexed: 12/01/2022] Open
Affiliation(s)
- Denese Playford
- The Rural Clinical School of Western Australia; SPARHC; Crawley Western Australia Australia
| | - Ian B. Puddey
- School of Medicine and Pharmacology; The Faculty of Medicine, Dentistry and Health Sciences; The University of Western Australia; Crawley Western Australia Australia
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Goodfellow A, Ulloa JG, Dowling PT, Talamantes E, Chheda S, Bone C, Moreno G. Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:1313-21. [PMID: 27119328 PMCID: PMC5007145 DOI: 10.1097/acm.0000000000001203] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE The authors conducted a systematic review of the medical literature to determine the factors most strongly associated with localizing primary care physicians (PCPs) in underserved urban or rural areas of the United States. METHOD In November 2015, the authors searched databases (MEDLINE, ERIC, SCOPUS) and Google Scholar to identify published peer-reviewed studies that focused on PCPs and reported practice location outcomes that included U.S. underserved urban or rural areas. Studies focusing on practice intentions, nonphysicians, patient panel composition, or retention/turnover were excluded. They screened 4,130 titles and reviewed 284 full-text articles. RESULTS Seventy-two observational or case-control studies met inclusion criteria. These were categorized into four broad themes aligned with prior literature: 19 studies focused on physician characteristics, 13 on financial factors, 20 on medical school curricula/programs, and 20 on graduate medical education (GME) programs. Studies found significant relationships between physician race/ethnicity and language and practice in underserved areas. Multiple studies demonstrated significant associations between financial factors (e.g., debt or incentives) and underserved or rural practice, independent of preexisting trainee characteristics. There was also evidence that medical school and GME programs were effective in training PCPs who locate in underserved areas. CONCLUSIONS Both financial incentives and special training programs could be used to support trainees with the personal characteristics associated with practicing in underserved or rural areas. Expanding and replicating medical school curricula and programs proven to produce clinicians who practice in underserved urban or rural areas should be a strategic investment for medical education and future research.
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Affiliation(s)
- Amelia Goodfellow
- A. Goodfellow is a medical student, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California. J.G. Ulloa is a VA/Robert Wood Johnson Foundation Clinical Scholar, UCLA, Los Angeles, California and Surgery Resident, Department of Surgery, University of California, San Francisco, San Francisco, California. P.T. Dowling is professor and chair, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. E. Talamantes at the time of this research was primary care research fellow, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, and is now assistant professor, Division of General Internal Medicine, Department of Internal Medicine, University of California, Davis, School of Medicine, Sacramento, California. S. Chheda is research assistant, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. C. Bone at the time of this research was a third-year resident physician, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. G. Moreno is assistant professor, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
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Kamitani S, Nakamura F, Itoh M, Sugiyama T, Toyokawa S, Kobayashi Y. Differences in medical schools' regional retention of physicians by school type and year of establishment: effect of new schools built under government policy. BMC Health Serv Res 2015; 15:581. [PMID: 26714625 PMCID: PMC4696324 DOI: 10.1186/s12913-015-1240-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Physician maldistribution is an ongoing concern globally. The extent of medical schools retaining graduates within their geographical areas has rarely been explored in Japan or in other countries. This study aimed to investigate whether the proportion of medical school graduates practicing in the vicinity of medical school (retention rate) differs by the year of the school’s establishment and by the school’s funding source. Methods This cross-sectional study used a set of databases on medical institutions and personnel. We analyzed a sample of 168,594 clinically active physicians practicing in institutions as of May 2014, who passed the National Medical Practitioners Examination between 1985 and 2013. We assessed the retention rate and the schools’ establishment period and funding source (pre-1970/post-1970, private/public), using a hierarchical regression model with random intercept unique to each medical school. We used the following factors as covariates: gender, physicians’ length of professional experience, and the geographical features of the medical schools. Results The retention rate was widely distributed from 16.2 to 81.5 % (median: 48.4 %). Physicians who graduated from post-1970 medical schools were less likely to practice in the prefecture of their medical school location, relative to those who graduated from pre-1970 medical schools (adjusted odds ratio: 0.75; 95 % confidence interval: 0.62–0.90). Physicians who graduated from private medical schools were also less likely to practice in the prefecture of their medical school location, relative to those who graduated from public medical schools (adjusted odds ratio: 0.63; 95 % confidence interval: 0.51–0.77). In addition, the ability to retain graduates varied by school according to the school’s characteristics. Conclusions There was a considerable difference between medical schools in retaining graduates locally. The study results may have significant implications for government policy to alleviate maldistribution of physicians in Japan. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1240-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Satoru Kamitani
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Fumiaki Nakamura
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Mitsuko Itoh
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan.
| | - Takehiro Sugiyama
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Clinical Study and Informatics, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Satoshi Toyokawa
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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Grobler L, Marais BJ, Mabunda S. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database Syst Rev 2015; 2015:CD005314. [PMID: 26123126 PMCID: PMC6791300 DOI: 10.1002/14651858.cd005314.pub3] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The inequitable distribution of health professionals, within countries, poses an important obstacle to the optimal functioning of health services. OBJECTIVES To assess the effectiveness of interventions aimed at increasing the proportion of health professionals working in rural and other underserved areas. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, including specialised register of the Cochrane Effective Practice and Organisation of Care Group; March 2014), MEDLINE (1966 to March 2014), EMBASE (1988 to March 2014), CINAHL (1982 to March 2014), LILACS (February 2014), Science Citation Index and Social Sciences Citation Index (up to April 2014), Global Health (March 2014) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (June 2013). We also searched reference lists of all papers and relevant reviews identified, and contacted authors of relevant papers regarding any further published or unpublished work. SELECTION CRITERIA Randomised trials, non-randomised trials, controlled before-and-after studies and interrupted time series studies evaluating the effects of various interventions (e.g. educational, financial, regulatory or support strategies) on the recruitment or retention, or both, of health professionals in underserved areas. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts and assessed full texts of potentially relevant studies for eligibility. Two review authors independently extracted data from eligible studies. MAIN RESULTS For this first update of the original review, we screened 8945 records for eligibility. We retrieved and assessed the full text of 125 studies. Only one study met the inclusion criteria of the review. This interrupted time series study, conducted in Taiwan, found that the implementation of a National Health Insurance scheme in 1995 was associated with improved equity in the geographic distribution of physicians and dentists. We judged the certainty of the evidence provided by this one study very low. AUTHORS' CONCLUSIONS There is currently limited reliable evidence regarding the effects of interventions aimed at addressing the inequitable distribution of health professionals. Well-designed studies are needed to confirm or refute findings of observational studies of educational, financial, regulatory and supportive interventions that might influence healthcare professionals' decisions to practice in underserved areas. Governments and medical schools should ensure that when interventions are implemented, their impacts are evaluated using scientifically rigorous methods to establish the true effects of these measures on healthcare professional recruitment and retention in rural and other underserved settings.
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Affiliation(s)
- Liesl Grobler
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesPO Box 241TygerbergCape TownWestern CapeSouth Africa8000
| | - Ben J Marais
- University of SydneyMarie Bashir Institute for Infectious Diseases and BiosecuritySydneyAustralia
- University of SydneyChildren’s Hospital at WestmeadSydneyAustralia
| | - Sikhumbuzo Mabunda
- University of Cape Town/Western Cape Department of HealthP.O. Box 768RondeboschSouth Africa7701
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Farmer J, Kenny A, McKinstry C, Huysmans RD. A scoping review of the association between rural medical education and rural practice location. HUMAN RESOURCES FOR HEALTH 2015; 13:27. [PMID: 25943870 PMCID: PMC4436115 DOI: 10.1186/s12960-015-0017-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 04/18/2015] [Indexed: 05/07/2023]
Abstract
BACKGROUND Inequitable distribution of the medical workforce is an international problem that undermines universal access to healthcare. Governments in many countries have invested in rural-focused medical education programs to increase the supply of rural doctors. METHODS Using a structured five-step approach, a scoping review was conducted to map the existing evidence on the relationship between professional entry-level, pre-vocational medical education delivered in rural settings and rural workforce outcomes. Key search terms were developed, with database searches yielding 37 relevant articles. During data charting, a set of types of studies emerged, and we developed a typology to assist with article sorting and information structuring. RESULTS Medical students attending a rural campus or spending time in a rural area are more likely to practise in non-metropolitan areas upon graduation than students studying at a city campus. In many cases, these positive findings could be confounded by students having a rural origin or being predisposed to want rural work. There is some evidence to suggest that the longer a person spends time as a medical student in a rural area, the more likely they are to work rurally following graduation. Overall, the articles located had limitations related to small sample size, inconsistent definition of rurality and lack of attention to controlling for variables that might influence rural practice decision, for example, rural background. Comparative data were lacking, and most studies were conducted by staff from the medical schools that were the focus of the research. There was no consideration given in any study found to the cost-effectiveness of entry-level medical education delivered in rural settings versus other ways of producing rural practitioners. CONCLUSIONS Given limitations, available evidence suggests that medical education in a rural location does increase the number of medical graduates that will work in a rural place. There are indications of a gradient effect where increased rural practice exposure during medical education leads to more rurally located graduates; however, robust studies are needed to verify this finding. Given the significant funding being directed to universities to increase graduates that will work rurally, appropriate future research is recommended.
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Affiliation(s)
- Jane Farmer
- College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Amanda Kenny
- La Trobe Rural Health School, La Trobe University, Bendigo, VIC, 3550, Australia.
| | - Carol McKinstry
- Department of Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, 3550, Australia.
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Aaraas IJ, Halvorsen PA, Aasland OG. Supply of doctors to a rural region: Occupations of Tromsø medical graduates 1979-2012. MEDICAL TEACHER 2015; 37:1078-1082. [PMID: 25811323 DOI: 10.3109/0142159x.2015.1009427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The aim of establishing the medical school in Tromsø in 1973 was to improve access to doctors and standards of health care for the previously underprivileged rural population of Northern Norway. In this study we examine how the aim of supplying doctors to the north has been achieved. MATERIAL AND METHODS By utilising a cross-sectional design we have analysed 34 classes of Tromsø medical graduates (1979-2012) with regard to occupations in 2013 by the year of graduation and by successive pools of cohorts. RESULTS In 2013 altogether 822 of 1611 doctors (51%) were working in Northern Norway. The proportions working in the north for old, intermediate and young cohorts were 37%, 48% and 60%, respectively. Doctors graduating during recent years tended to start their careers in the north to a higher degree than doctors graduating in previous periods. Among doctors from the older classes a relatively large minority have their end-careers in Northern Norway, with a noticeable inclination for long term work in primary care. CONCLUSION Our results support that the first rural oriented medical education model in Europe established in Tromsø 40 years ago is sustainable, achieving its aims.
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Affiliation(s)
- Ivar J Aaraas
- a University of Tromsø - The Arctic University of Norway , Norway and
| | - Peder A Halvorsen
- a University of Tromsø - The Arctic University of Norway , Norway and
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Gofin J, Gofin R, Stimpson JP. Community-oriented primary care (COPC) and the affordable care act: an opportunity to meet the demands of an evolving health care system. J Prim Care Community Health 2014; 6:128-33. [PMID: 25351764 DOI: 10.1177/2150131914555908] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Community-oriented primary care (COPC) is a model of health care delivery that tightly integrates primary care and public health. This model of care, applied around the globe, could be more widely adopted in the United States as clinical delivery systems respond to the growing demand for population health management, which has been driven largely by various provisions of the Affordable Care Act (ACA). For that purpose, there is need for changes in capacitating health professionals and changes in organizational structures that will address the needs and health priorities of the population, considering individual care management in the context of population health for a defined population. This article presents how the Affordable Care Act is an appropriate framework for COPC to succeed and the way forward to develop COPC through practical alternatives for the delivery of primary care within a population context.
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Affiliation(s)
- Jaime Gofin
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Rosa Gofin
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jim P Stimpson
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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