Health professionals' licensing: the practice and its predictors among health professional hiring bodies in Ethiopia

BACKGROUND

Evidence suggests that not all human resource departments have hired their facility staff based on federal licensing standards, with some hiring without an active license. This is common in some, if not all, parts of the country. The paucity of healthcare experts, high turnover rates, employee burnout, and challenges in training and development issues were all key recruiting challenges globally.

OBJECTIVE

To assess the practice of health professionals' licensing and its predictors among hiring bodies in Ethiopia, March 24/2021-May 23/2021.

METHODS

A cross-sectional study was conducted in privately and publicly funded health facilities throughout Ethiopia. For each region, a stratified sampling strategy was utilized, followed by a simple random sampling method. Documents from the recruiting bodies for health professionals were reviewed. A pretested structured questionnaire and document review tool were used to extract data confidentially. A descriptive analysis of the basic hiring body characteristics was conducted. Hiring body characteristics were analyzed in bivariate and multivariate logistic regression to identify factors associated with best health professionals licensing practice. Data management and analysis were conducted with Epi-Data version 4.4.3.1 and SPSS version 23, respectively.

RESULTS

The analysis included 365 hiring bodies and 4991 files of health professionals (1581 from private and 3410 from public health organizations). Out of 365 hiring bodies studied, 66.3% practiced health professional licensing. A total of 1645 (33%) of the 4991 professionals whose files were reviewed were found to be working without any professional license at all. Furthermore, about 2733 (55%) have an active professional license, and about 603 (12%) were found to work with an expired license. Being a private facility (adjustedOR = 21.6; 95% CI = 8.85-52.55), obtaining supervision from a higher organ (adjustedOR = 19.7; 95%CI: 2.3-169.1), and conducting an internal audit (adjustedOR = 2.7; 95% CI: 1.15-6.34) were predictors of good licensing practice.

CONCLUSIONS

The licensing of health practitioners was poorly practiced in Ethiopia as compared to the expected proclamation of the country. A system for detecting fake licenses and controlling revoked licenses does not exist in all regions of the country.

Simulation-based clinical assessment identifies threshold competence to practise physiotherapy in Australia: a crossover trial

BACKGROUND

Although evidence exists for the efficacy of high-fidelity simulation as an educational tool, there is limited evidence for its application in high-stakes professional threshold competency assessment. An alternative model of simulation-based assessment was developed by the Australian Physiotherapy Council (APC), using purpose-written standardised patients, mapped to the appropriate threshold level. The aim of this two-phase study was to investigate whether simulation-based clinical assessments resulted in equivalent outcomes to standard, real-life assessments for overseas-trained physiotherapists seeking registration to practice in Australia.

METHODS

A randomised crossover trial comparing simulation-based assessment to real-life assessment was completed. Participants were internationally trained physiotherapists applying for registration to practice in Australia, voluntarily recruited from the Australian Physiotherapy Council (APC) assessment waiting list: study 1 n = 25, study 2 n = 144. Study 1 participants completed usual APC real-life assessments in 3 practice areas, completed on different days at APC partner healthcare facilities. Participants also underwent 3 practice area-matched simulation-based assessments, completed on the same day at purpose-designed simulation facilities. Study 2 participants completed 3 simulation-based assessments and 1 real-life assessment that was randomly allocated for order and practice area. Assessment of competency followed the standard APC procedure of 90-minute examinations using The Moderated Assessment Form (MAF).

RESULTS

The overall pass rate was higher for real-life assessments in both studies: study 1, 50% versus 42.7%; study 2, 55.6% versus 44.4%. Chi-square analysis showed a high to moderate level of exact matching of pass/fail grades across all assessments: study 1, 73.4% (p < 0.001); study 2, 58.3% (p = 0.027). Binary logistic regression showed that the best predictors of real-life pass/fail grade were simulation-based MAF pass/fail grade (study 1, OR 7.86 p < 0.001; study 2, OR 2.037, p = 0.038) and simulation-based total MAF score (study 1, OR 1.464 p < 0.001; study 2, OR 1.234, p = 0.001).

CONCLUSION

Simulation-based assessment is a significant predictor of clinical performance and can be used to successfully identify high stakes threshold competence to practice physiotherapy in Australia.

Credentialing and privileging the preventive medicine physician

The practice of preventive medicine remains ill-defined, and the specialty is threatened by a void in the definition of the specialty's practice. The authors propose a cohesive, active identification of skills provided by trained preventive medicine physicians through the credentialing and privileging process. The privileging process should incorporate clinical skills specific to the provider and non-clinical skills based on preventive medicine residency training competency requirements, preventive medicine board certification examination requirements, and the ten essential public health services. The specialty may benefit from development of clinical training based on public health clinical services as well as privileging of physicians in health organization leadership positions.

Internationally educated nurses' and medical graduates' experiences of getting a license and practicing in Sweden - a qualitative interview study

BACKGROUND

The Swedish healthcare system has an increased need for nurses and physicians, and the number of International Educated Nurses (IENs) and International Medical Graduates (IMGs) seeking job opportunities and a license to practice in Sweden is rising. This study explored how IENs and IMGs describe their experience of getting a license to practice, their perceptions of working in Sweden and of how their intercultural competence is utilized.

METHOD

A qualitative study based on semi-structured interviews with 11 IENs and 11 IMGs. The interviews were conducted between 2015 and 2017. The data were analyzed using qualitative content analysis.

RESULTS

Three main themes were identified: 'Getting a license - a different story,' 'The work is familiar, yet a lot is new,' 'Trying to master a new language.' The time to obtain a license to practice and finding a job was shorter for IENs and IMGs coming from European countries than for those from non-European countries. Some of the experiences of getting a license to practice and of entering a new workplace in another country were the same for nurses and physicians. In general, both IENs and IMGs felt welcomed and used their intercultural competence at work. Lack of language skills was regarded as the main problem for both professions, while workplace introduction was shorter for IMGs than for IENs.

CONCLUSIONS

Problems related to language and culture are often underestimated, therefore organizations and managers employing IENs and IMGs should provide longer workplace introduction to facilitate the acculturation process. More time-efficient language courses specifically adapted to IENs and IMGs could make the transition easier and shorten the time to obtain a license to practice for both professions.

Do preventive medicine physicians practice medicine?

As some preventive medicine physicians have been denied medical licenses for not engaging in direct patient care, this paper attempts to answer the question, "Do preventive medicine physicians practice medicine?" by exploring the requirements of licensure, the definition of "practice" in the context of modern medicine, and by comparing the specialty of preventive medicine to other specialties which should invite similar scrutiny. The authors could find no explicit licensure requirement for either a certain amount of time in patient care or a number of patients seen. No physicians board certified in Public Health and General Preventive Medicine sit on any state medical boards. The authors propose that state medical boards accept a broad standard of medical practice, which includes the practice of preventive medicine specialists, for licensing purposes.

CRISPR Cas9 - Licensing the unlicensable

A new gene engineering technology has recently made it through the media, not only because of its technical advantages, but also because it is in the focus of an epic patent battle between two academic institutions. The technology bears the cryptic name "CRISPR Cas9", and allows the manipulation of genes (so called "gene editing") with so far unseen simplicity and efficacy. Dana Carroll of the University of Utah said for this reason that CRISPR Cas9 has brought about the "democratization of gene targeting". However, due to legal battles and conflicting patent estates, third parties may find it difficult to decide where to acquire licenses. This article gives an overview.

Unlicensed motorcycling of high school adolescents in Dehaghan county (Isfahan Province of Iran)

BACKGROUND

Unlicensed motorcycling increases the chances of accidents in adolescents. There are many behavioral and non-behavioral factors involved in adolescents' unlicensed motorcycling which were not addressed in research yet completely.

METHODS

The cross-sectional study aimed to determine prevalence and related factors of unlicensed motorcycling on 500 unlicensed male high school adolescents in Dehaghan, who entered in the study by census. Demographic and motorcycling information were collected via self-report questionnaire, and its content validity was approved by a panel of experts. The statistical analyses of the data included Pearson Correlation Coefficient, chi-square, independent samples t-test and ANOVA with Tukey post hoc test.

RESULTS

The prevalence of unlicensed motorcycling among participants was 74.2% and mean age at first motorcycling experience was 11.97±1.97 years ranged from 8 to 17. Of the motorcyclist participants, 59.6% owned their personal motorcycle. Most motorcycle passengers (62.8%) were adolescent's friends, and the most frequently expressed reason for use of motorcycle was fun and entertainment (54.2%). Age at first motorcycling experience was lower among rural adolescents than urban adolescents. However, unlicensed motorcycling was more prevalent among urban adolescents than rural ones. The relationship between living status, father's job, mother's job and age at first motorcycling experience was insignificant (P>0.05). However, mean age at first motorcycling experience among students of humanities, technical disciplines, and general first year was lower than that among students of natural sciences and math.

CONCLUSION

High prevalence of unlicensed motorcycling and significant role of family and social environments on adolescents' high-risk motorcycling without license, is indicative of the need for interventions at all levels of peers, family, and schools and also establishing new driving regulations in Iran.

Diplopia and driving: a problematic issue

The aim of this article was to review the literature regarding diplopia and driving license and to review the West European legislations about this topic, in order to obtain appropriate indications for hospitals specialists and patients. A systematic review of articles published about diplopia and driving was performed. In addition a review of West European national legislations about driving license regulations for medical illnesses was performed, in addition to the European Union Directive on driving licenses. In the literature, the presence of diplopia has not been considered a reliable predictor of the safety of driving behavior, or it has not appeared to be a contraindication for driving according to some authors who were unable to demonstrate significant differences on driving simulator performance between subjects with chronic stable diplopia and control subjects. Nevertheless, in all western European legislations, acute diplopia constitutes an important limitation for driving, thus making the knowledge of current regulations fundamental for specialists involved in managing patients with diplopia. Ophthalmologists and maxillofacial/head and neck surgeons, may advise patients before hospital discharge about current legislations in their respective countries.