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Kupis R, Perera I, Targowski T, Gąsowski J, Piotrowicz K. Is geriatric medicine teaching homogeneous? The analysis of geriatric medicine courses at Polish undergraduate medical programmes. Eur Geriatr Med 2024:10.1007/s41999-024-01004-y. [PMID: 38898185 DOI: 10.1007/s41999-024-01004-y] [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: 02/22/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE We aimed to analyse the characteristics of geriatric courses offered to undergraduate medical students in higher educational institutions (HEIs) in Poland. METHODS We searched the official websites of the HEIs offering the medical degree programmes and directly contacted the dean's offices and HEIs representatives to retrieve the relevant information. The documents were analysed for course content, teaching methods, duration, and recommended texts. We also checked the obtained curricula for the reference to of the learning objectives related to geriatric medicine, selected from the currently endorsed Polish educational standards (ES) provided by the Ministry of Science and Higher Education. RESULTS Geriatric medicine courses were obligatory at all included HEIs (n = 19), but the courses differed in structure and content. The courses varied in duration from 11 to 60 h and were primarily lecture based. Simulation was utilized at only one HEI and e-learning at two institutions. Out of 315 learning objectives, we acknowledged only 9 as geriatric. They were not always found in all curricula. Two HEIs included self-described learning objectives in their curricula. Across all HEIs, a total of 29 recommended texts (published between 1995 and 2021) were identified, including 2 English-language texts. CONCLUSION Geriatric medicine was a mandatory subject for medical students of the included HEIs. However, there was a lack of uniformity in the offered courses. This leaves room for the development of a unified undergraduate geriatrics curriculum to effectively address diverse geriatric issues across Europe. The importance of this matter is highlighted by demographic trends and workforce challenges.
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Affiliation(s)
- Robert Kupis
- Department of Medical Education, Centre of Innovative Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Ian Perera
- Department of Medical Education, Centre of Innovative Medical Education, Jagiellonian University Medical College, Kraków, Poland
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Targowski
- Department of Geriatrics, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Karolina Piotrowicz
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.
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Jinah N, Abdullah Sharin I, Bakit P, Adnan IK, Lee KY. Overview of Retention Strategies for Medical Doctors in Low- and Middle-Income Countries and Their Effectiveness: Protocol for a Scoping Review. JMIR Res Protoc 2024; 13:e52938. [PMID: 38190235 PMCID: PMC10804252 DOI: 10.2196/52938] [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: 09/21/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND The global shortage and maldistribution of health care workers, especially medical doctors, pose a significant threat to achieving the United Nations' sustainable development goal 3 of ensuring well-being and healthy lives for all. Low- and middle-income countries (LMICs) are disproportionately affected by this crisis, with a high rate of brain drain from rural to urban areas, as well as to high-income countries. Various retention strategies have been implemented in different settings and organizations. However, their effectiveness remains underexplored, particularly in LMICs. OBJECTIVE We aim to review the available retention strategies for medical doctors in LMICs and to determine the effectiveness of the various strategies. This review aims to compile relevant research findings on this issue to generate a thorough summary of all the retention strategies practiced in LMICs and, more importantly, to provide the current state of evidence of the effectiveness of these strategies in retaining medical doctors in countries with limited resources and high disease burden. METHODS The structured framework given by Arksey and O'Malley will serve as the basis for conducting this scoping review. A comprehensive search strategy will be conducted across 4 electronic databases (PubMed, EBSCOHost, Scopus, and ScienceDirect). A systematic approach following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines will be executed to search, screen, review, and extract data from studies that meet predefined inclusion criteria. Data encompassing bibliographical information, study location, retention strategies, influencing factors, and outcomes (effectiveness) will be obtained from the selected studies using standardized data extraction. Endnote and Microsoft Excel will be used for reference management and removal of duplicate studies. A narrative synthesis will be performed after categorizing and analyzing all the extracted data to identify recurrent themes. RESULTS This ongoing review will generate a comprehensive compilation of retention strategies implemented in LMICs to prevent brain drain among medical doctors. Data extraction is currently in progress, and completion is expected by early 2024. Themes regarding the types of strategies, influencing factors, and outcomes will be synthesized. The findings will highlight effective retention strategies, gaps, and challenges in implementation for the benefits of future research. By identifying common barriers and facilitators, this review will provide insights into enhancing the policies and initiatives for doctor retention in LMICs. CONCLUSIONS This scoping review explores the retention strategies practiced in LMICs and attempts to identify effective strategies from existing research. By evaluating the barriers and challenges that influence the effectiveness of these strategies, policymakers and health care leaders can strive to obtain balanced and optimal health human resources in their respective organizations and countries. TRIAL REGISTRATION Malaysian National Medical Research Register (NMRR) ID-23-01994-OGW; https://nmrr.gov.my/research-directory/ac4f5b88-8619-4b2b-b6c7-9abcef65fdcd. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52938.
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Affiliation(s)
- Norehan Jinah
- Centre of Leadership & Professional Development, Institute for Health Management, National Institutes of Health Malaysia, Shah Alam, Malaysia
| | - Ili Abdullah Sharin
- Centre of Leadership & Professional Development, Institute for Health Management, National Institutes of Health Malaysia, Shah Alam, Malaysia
| | - Pangie Bakit
- Centre of Leadership & Professional Development, Institute for Health Management, National Institutes of Health Malaysia, Shah Alam, Malaysia
| | - Izzuan Khirman Adnan
- Centre of Leadership & Professional Development, Institute for Health Management, National Institutes of Health Malaysia, Shah Alam, Malaysia
| | - Kun Yun Lee
- Centre of Leadership & Professional Development, Institute for Health Management, National Institutes of Health Malaysia, Shah Alam, Malaysia
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Venturoso Gongora Buckeridge Serra M, Montesanti AP, Brunherotti MAA, Martínez-Riera JR. Health indicators in Brazil and Spain: strategies for health promoting universities. Glob Health Promot 2023:17579759231213852. [PMID: 38142294 DOI: 10.1177/17579759231213852] [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: 12/25/2023]
Abstract
AIMS The study aims to identify and compare health indicators collected by national research in Spain and in Brazil that can generate action strategies for health promoting universities. METHODS This is an epidemiological, descriptive, cross-sectional study that uses the database of the Secretariat of Health Surveillance of the Brazilian Ministry of Health and the database of the National Statistics Institute of Spain. Based on the National Health Promotion Policy, the analyzer axis prioritizes defined themes; percentage of physical exercise, daily smokers, sedentary lifestyle, obesity and self-perception of health status were evaluated. The data were collected from 2014 to 2020. RESULTS In Brazil, physical exercise is the highest percentage indicator, whereas in Spain, sedentary lifestyle is the highest. Regarding the age group, Brazil presented the lowest prevalence of daily smokers in the age group from 18 to 24, with little increase in older age groups; in Spain, older age groups presented the highest rates of sedentary lifestyle and obesity. In 2020, 4.5% of Brazilians reported a negative self-perception of health and in Spain 6.6%. CONCLUSION The indicators 'physical exercise', 'daily smokers' and 'sedentary lifestyle' presented better results in Brazil than in Spain. Brazil presents a better perspective on health when compared with Spain, as the results showed that older ages present higher rates of sedentary lifestyle and obesity. Our study results also show that Brazilians report better self-perception in health, which can be interpreted by health promotion strategies.
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Affiliation(s)
| | | | | | - José R Martínez-Riera
- University of Alicante, Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Spain
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Guimarães RA, Silva ALGDFE, Naghettini AV, Neves HCC, Arantes FP, Borges Junior CV, Silva Filho AID, de Castro ARM. Overview on and Contextual Determinants of Medical Residencies in North Brazil. Healthcare (Basel) 2023; 11:healthcare11081083. [PMID: 37107917 PMCID: PMC10137331 DOI: 10.3390/healthcare11081083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 04/29/2023] Open
Abstract
The aim of this study was to analyze the scenario of medical residency programs (MRPs) in the north region of Brazil as well as the contextual determinants (socioeconomic, structural, and epidemiological) influencing the number of MRPs in this region. An ecological study was conducted using MRPs data from 2022. This study used multiple data sources. MRP indicators were described based on the Brazilian state and specialty. The dependent variable was the number of MRPs. The independent variables included sociodemographic, structural, and epidemiological factors. Poisson regression was performed to analyze the association between contextual variables and the number of MRPs. The results showed that only 3.6% of the municipalities had authorized MRPs. The idleness rate in the region was 46.0%, with family and community medicine as the specialties with the greatest idleness. The total density of authorized vacancies in the MRPs was 14.0 vacancies per 100,000 inhabitants. The models showed that with each increase of one unit of the vulnerability index (Socioeconomic Index in the Geographic Context for Health Studies-GeoSES), the number of MRPs increased, ranging from 8122 (p value < 0.001) to 11,138 (p value < 0.001). With each increase in undergraduate degrees in medicine, the number of MRPs increased by 0.945 (p value < 0.001). With each increase of 1 physician per 1000 population, the number of MRPs increased from 0.537 (p value < 0.001) to 0.845 (p value < 0.001). With each increase of one unit in general hospitals, specialized hospitals, teaching hospitals, and primary healthcare units, the number of MRPs increased by 0.176 (p value < 0.001), 0.168 (p value < 0.001), 0.022 (p value < 0.001) and 0.032 (p value < 0.001), respectively. Finally, with each increase of one death per 100,000 inhabitants, the overall mortality rate increased, ranging from 0.006 (p value < 0.001) to 0.022 (p value < 0.001). The study showed a low supply of MRPs in the northern region, a high rate of idleness, and important socioeconomic, structural, and epidemiological determinants of the number of MRPs.
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Affiliation(s)
- Rafael Alves Guimarães
- Nursing School, Federal University of Goiás, Goiânia 74690-900, Brazil
- Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia 74690-900, Brazil
- Center for Innovation in Education and Health Work Management, Federal University of Goiás, Goiânia 74690-900, Brazil
| | - Ana Luísa Guedes de França E Silva
- Center for Innovation in Education and Health Work Management, Federal University of Goiás, Goiânia 74690-900, Brazil
- Medical School, Federal University of Goiás, Goiânia 74690-900, Brazil
| | - Alessandra Vitorino Naghettini
- Center for Innovation in Education and Health Work Management, Federal University of Goiás, Goiânia 74690-900, Brazil
- Medical School, Federal University of Goiás, Goiânia 74690-900, Brazil
| | - Heliny Carneiro Cunha Neves
- Nursing School, Federal University of Goiás, Goiânia 74690-900, Brazil
- Center for Innovation in Education and Health Work Management, Federal University of Goiás, Goiânia 74690-900, Brazil
| | - Fernanda Paula Arantes
- Center for Innovation in Education and Health Work Management, Federal University of Goiás, Goiânia 74690-900, Brazil
- Business, Accounting, and Economic Sciences Schools, Federal University of Goiás, Goiânia 74690-900, Brazil
| | - Cândido Vieira Borges Junior
- Center for Innovation in Education and Health Work Management, Federal University of Goiás, Goiânia 74690-900, Brazil
- Business, Accounting, and Economic Sciences Schools, Federal University of Goiás, Goiânia 74690-900, Brazil
| | - Antônio Isidro da Silva Filho
- Center for Innovation in Education and Health Work Management, Federal University of Goiás, Goiânia 74690-900, Brazil
- Business, Accounting, Economics, and Public Management Schools, University of Brasília, Brasília 70910-900, Brazil
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Russo G, Cassenote A, De Oliveira BLCA, Scheffer M. Demographic and professional risk factors of SARS-CoV-2 infections among physicians in low- and middle-income settings: Findings from a representative survey in two Brazilian states. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000656. [PMID: 36962544 PMCID: PMC10021204 DOI: 10.1371/journal.pgph.0000656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/15/2022] [Indexed: 11/05/2022]
Abstract
Health workers (HWs) are a key resource for health systems worldwide, and have been affected heavily by the COVID-19 pandemic. Evidence is consolidating on incidence and drivers of infections, predominantly in high-income settings. It is however unclear what the risk factors may be for specific health professions, particularly in low- and middle-income countries (LMICs). We conducted a cross-sectional survey in a representative sample of 1,183 medical doctors registered with Brazil's Federal Council of Medicine in one developed (São Paulo) and one disadvantaged state (Maranhão). Between February-June 2021, we administered a telephone questionnaire to collect data on physicians' demographics, deployment to services, vaccination status, and self-reported COVID-19 infections. We performed descriptive, univariate, and multilevel clustered analysis to explore the association between physicians' infection rates, and their sociodemographic and employment characteristics. A generalized linear mixed model with a binomial distribution was used to estimate the adjusted odds ratio. We found that 35.8% of physicians in our sample declared having been infected with SARS-CoV-2 virus during the first year of the pandemic. The infection rate in Maranhão (49.2%) [95% CI 45.0-53.4] was almost twice that in São Paulo (24.1%) [95% CI 20.8-27.5]. Being a physician in Maranhão [95% CI 2.08-3.57], younger than 50 years [95% CI 1.41-2.89] and having worked in a COVID-19 ward [95% CI 1.28-2.27], were positively associated with the probability of infection. Conversely, working with diagnostic services [95% CI 0.53-0.96], in administrative functions [95% CI 0.42-0.80], or in teaching and research [95% CI 0.48-0.91] were negatively associated. Based on our data from Brazil, COVID-19 infections in LMICs may be more likely in health systems with lower physician-to-patient ratios, and younger doctors working in COVID-19 wards may be infected more frequently. Such findings may be used to identify policies to mitigate COVID-19 effects on HWs in LMICs.
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Affiliation(s)
- Giuliano Russo
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Alex Cassenote
- Department of Preventive Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Mário Scheffer
- Department of Preventive Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
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Leite APT, Mai S, Waquil AP, Cordero EAA, Rosa VSD, Daudt CVG, Wander B, Pinto MEB, Correia IB, Sarti TD. Profile and Migration of Members of Residency Programs in Family Medicine. Rev Saude Publica 2022; 56:21. [PMID: 35476099 PMCID: PMC9004701 DOI: 10.11606/s1518-8787.2022056003450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the sociodemographic profile and analyze the migratory characteristics of the members of the Residency Programs in Family Medicine in 2020 in Brazil. METHODS The study follows a cross-sectional observational design of a quantitative nature from the perspective of the members of the Residency Programs in Family Medicine. Questionnaires adapted for each participating group were developed, applied through an online platform. RESULTS Most participants are female and white. Most supervisors and preceptors were residents of Residency Programs in Family Medicine, however, there are some who are not specialists in the field. Most participants are based in capitals or metropolitan regions. In relation to retention, 41.1% of supervisors and 73.1% of preceptors are affiliated to a program in the same municipality where they lived. For most resident physicians, the place of residence coincides with the place of birth and/or graduation (57.4%), and 48.5% are in the same place of graduation. CONCLUSIONS The research reinforces the need for policies to promote the migration of residents to Residency Programs in Family Medicine outside capital cities and metropolitan regions, as well as encouraging the retention of graduates trained outside large urban centers so that they can contribute to distribution and provision of doctors where they are still needed.
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Affiliation(s)
- Ana Paula Tussi Leite
- Hospital Moinhos de Vento. Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde. Porto Alegre, RS, Brasil
| | - Scheila Mai
- Universidade do Vale do Rio dos Sinos. Escola de Saúde. São Leopoldo, RS, Brasil
| | - Alice Paul Waquil
- Hospital Moinhos de Vento. Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde. Porto Alegre, RS, Brasil
| | - Elvira Alicia Aparicio Cordero
- Hospital Moinhos de Vento. Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde. Porto Alegre, RS, Brasil
| | - Vitória Silva da Rosa
- Hospital Moinhos de Vento. Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde. Porto Alegre, RS, Brasil
| | - Carmen Vera Giacobbo Daudt
- Hospital Moinhos de Vento. Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde. Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre. Departamento de Saúde Coletiva. Porto Alegre, RS, Brasil
| | - Brenda Wander
- Hospital Moinhos de Vento. Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde. Porto Alegre, RS, Brasil
| | - Maria Eugênia Bresolin Pinto
- Universidade Federal de Ciências da Saúde de Porto Alegre. Departamento de Saúde Coletiva. Porto Alegre, RS, Brasil
| | | | - Thiago Dias Sarti
- Universidade Federal do Espírito Santo, Departamento de Medicina Social. Vitória, ES, Brasil
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Biazotto MLDSH, Bittencourt FV, de Araújo GR, Soares Fernandes SE, Göttems LBD, Rodrigues CML, Neves FDAR, Amorim FF. Comparison Between Students Admitted Through Regular Path and Affirmative Action Systems in a Brazilian Public Medical School. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:251-263. [PMID: 35309740 PMCID: PMC8932646 DOI: 10.2147/amep.s347387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/01/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Affirmative action policies to provide access to higher education for socially vulnerable students have been implemented in several countries and have faced many questions nowadays. The aim of the study was to compare the socioeconomic background and performance during and after completing the undergraduate course of students admitted through the regular path and social quota systems in a public medical school in Brazil. METHODS A retrospective cohort study including students admitted to a medical school within the School of Health Sciences (ESCS), in Brazil, between 2005 and 2012, and followed until May 2020. In the first phase, data collection was performed by analyzing documents from the ESCS academic management system and Brazilian government agencies. In the second phase, a survey with 12 questions was sent to the medical school alumni. The social quota system criteria were the public school attendance in all primary and secondary education levels. RESULTS Among 707 students, 204 (28.9%) were from the social quota and 503 (78.5%) from the regular path system. The place of residence of social quota students had a lower Human Development Index (p < 0.001) and per capita income (p < 0.001) when compared to regular path students. Regular path students were associated with the highest dropout from medical school (OR: 50.552, 95% CI: 12.438-205.453, p < 0.001). There was no difference between regular path and social quota students attending medical residency programs (OR: 1.780, 95% CI: 0.957-3.309, p = 0.069). Out of the 308 alumni who completed the survey, regular path students had more family members who were health professionals than social quota students (p < 0.001). There were no significant differences regarding monthly income, job satisfaction, employment, or management activities. CONCLUSION Affirmative action targeted students with a disadvantaged socioeconomic background. Regular path students had a higher dropout rate than social quota students.
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Affiliation(s)
- Marize Lima de Sousa Holanda Biazotto
- School of Medicine, School of Health Sciences (ESCS), Brasília, Federal District, Brazil
- Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, Federal District, Brazil
| | | | - Gilson Roberto de Araújo
- Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, Federal District, Brazil
| | | | | | | | | | - Fábio Ferreira Amorim
- School of Medicine, School of Health Sciences (ESCS), Brasília, Federal District, Brazil
- Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, Federal District, Brazil
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Burrows AM, Laupland KB. Comprehensiveness of distributed medical education systems: a regional population-based perspective. BMC MEDICAL EDUCATION 2021; 21:42. [PMID: 33422086 PMCID: PMC7796546 DOI: 10.1186/s12909-020-02466-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/21/2020] [Indexed: 06/01/2023]
Abstract
BACKGROUND The core business of medical schools includes clinical (education and service) and academic (research) activities. Our objective was to assess the degree to which these activities exist in a distributed medical education system in Canada. METHODS A population-based design was utilized. Programs were contacted and public records were searched for medical trainees and faculty positions within a province in Canada during the 2017/2018 academic year. Data were expressed as positions per 100,000 residents within the Lower Mainland, Island, and Northern and Southern interior geographical regions. RESULTS Substantial differences in the distribution of medical students by region was observed with the highest observed in the Northern region at 45.5 per 100,000 as compared to Lower Mainland, Island, and Southern regions of 25.4, 16.8, 16.0 per 100,000, respectively. The distribution of family medicine residents was less variable with 14.9, 10.7, 8.9, and 5.8 per 100,000 in the Northern, Island, Southern, and Lower Mainland regions, respectively. In contrast, there was a marked disparity in distribution of specialty residents with 40.8 per 100,000 in the Lower Mainland as compared to 7.5, 3.2, and 1.3 per 100,000 in the Island, Northern, and Southern regions, respectively. Clinical faculty were distributed with the highest observed in the Northern region at 180.4 per 100,000 as compared to Southern, Island, and Lower Mainland regions of 166.9, 138.5, and 128.4, respectively. In contrast, academic faculty were disproportionately represented in the Lower Mainland and Island regions (92.8 and 50.7 per 100,000) as compared to the Northern and Southern (1.4 and 1.2 per 100,000) regions, respectively. CONCLUSIONS While there has been successful redistribution of medical students, family medicine residents, and clinical faculty, this has not been the case for specialty residents and academic faculty.
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Affiliation(s)
- Andrea M Burrows
- Research and Knowledge Translation, Royal Inland Hospital and Interior Health Authority, 311 Columbia Street, British Columbia, V2C 2T1, Kamloops, Canada.
| | - Kevin B Laupland
- Queensland University of Technology (QUT), Queensland, Brisbane, Australia
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Queensland, Brisbane, Australia
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