Physicians

The peculiarities of the scattered small states of the Caribbean region call for a model of training practitioners that is effective, relevant and sustainable. Distance education (DE) as an approach offers advantages that meet some of the challenges inherent in training family physicians for the region. This paper examines some of these challenges and shows where DE is being used to structure delivery of the programme. In particular, the need for context-specific training, managing time strictures and the cost issues of training are discussed. [from abstract]

A central part of the World Federation for Medical Education strategy is to give priority to specification of international standards and guidelines for medical education, comprising both institutions and their educational programmes. Adoption of international standards will constitute a new framework for medical schools to measure themselves. Furthermore, internationally accepted standards could be used as a basis for national and regional recognition and accreditation of medical schools’ educational programs. [from introduction]

The shortage of trained health professionals is among the main obstacles to strengthening low-income countries health systems and to scaling up HIV/AIDS control efforts. Traditional health practitioners are increasingly depicted as key resources to HIV/AIDS prevention and care. An appropriate and effective response to the HIV/AIDS crisis requires reconsideration of the collaboration between traditional and biomedical health providers (THPs and BHPs). The aim of this paper is to explore biomedical and traditional health practitioners experiences of and attitudes towards collaboration and to identify obstacles and potential opportunities for them to collaborate regarding care for patients with sexually transmitted infections (STIs) and HIV/AIDS. [author’s description]

This paper analyzes China’s current health workforce in terms of quantity, quality, and distribution. Unlike most countries, China has more doctors than nurses. Doctor density in urban areas was more than twice that in rural areas, with nurse density showing more than a three-fold difference. Over the past decade there has been a massive expansion of medical education, with an excess in the production of health workers over absorption into the health workforce.

The objectives of the study were to identify exemplary medical and nurse practitioners in primary health care, to document their practices and perceptions with regard to their community involvement, to analyse the common themes arising from the findings, and to present recommendations based on the findings. The lack of a clearly defined role in the community outside of the clinical role that deals with the individual patient who presents for care is discussed in relation to the policy of the primary health care approach. The concept of community-oriented primary care provides a framework for a more systematic approach to community engagement, and this study serves as a basis for further research into the subject.

The standards provide a new framework against which individual doctors and the medical profession can assess themselves in a voluntary self-evaluation and self-improvement process. The standards should form the basis for continuted professional development (CPD) providers in designing CPD activities. Depending on local needs and traditions, the standards can also be used by national or regional agencies engaged in monitoring, recognition, and accreditation of CPD. [from introduction]

One of the challenges of continuing professional development (CPD) is to ensure that members of the medical profession maintain and improve the competencies in medical practice. CPD is an evolving system and different countries in Africa are at different levels of development. This article focuses on the developments and challenges of CPD among medical and dental practitioners in Africa. [abstract]

This article describes the experience of Guatemalan students at Cuba’s Latin American Medical School. The students’ education emphasizes health problems and diseases characterizing the epidemiological situation in their home country and in-depth courses in disaster management, as well as clinical experience in Guatemala. [adapted from author]

This article describes the Cuban medical education system. The role of Cuban physicians internationally is discussed, as well as the placement of international students in Cuban medical schools.

There has been a lively debate in the media about working conditions in rural South African Hospitals, with a particular focus on staffing and quality of care. From a medical perspective, it has been stated that poorly equipped and managed hospitals, inappropriate training and an excessive workload are significant contributors to the problem. This study was conducted to investigate the experiences of medical practitioners in performing their professional duties in rural district hospitals in the Western Cape. [from abstract]

There are four types of health providers at present in China. These are defined in terms of differences in ownership. Private practice in the health sector was reintroduced from 1980, when China began its economic reform from a planned economy to a market economy. Dual practice (DP) is quite common and a major concern from the point of view of health policy-making as little is known about it. The aim of this study was to describe policies and regulations of DP, the current situation, its impact on access to services and physician behaviour, and to provide evidence for future policy decisions. This study was conducted in two provinces, Shandong and Sichuan.

To explore the extent, characteristics, incentives, effects and possible regulation of private medical practice in public facilities this study undertook a cross sectional quantitative – qualitative analysis. Results from the survey and focus groups reveal that DP is mainly a strategy to obtain better incomes in the face of low public salaries. Furthermore this situation is influenced by the Peruvian macroeconomic environment characterised by an oversupply of doctors caused by the deregulation medical practice and education. DP is common in all types of health facilities and working institutions, and it is closely associated to clinical practices.

International recognition that the growing shortage of health workers poses a major threat to fighting diseases such as HIV/AIDS and tuberculosis has prompted a flurry of measures to stem the exodus of health professionals from developing countries. The initiatives — such as ethical recruitment codes to try to limit damage inflicted by the brain drain, and exchange and training programmes and projects to tap the resources of what has become known as the diaspora of migrant health workers — remain fragmented but at least mark a start in the search for solutions to the crisis. [autho

Beginning in 1992, JHPIEGO worked in close collaboration with the Bolivia Ministry of Health (MOH) to develop an integrated family planning/reproductive health (FP/RH) training network throughout the country. The focus of the assistance was the establishment of nine national training centers (NTCs) for inservice training conducted by physician-nurse teams and located at departmental maternity hospitals in departmental capitals. By 2000, the government of Bolivia and other stakeholders had shifted the training emphasis to preservice education efforts. JHPIEGO preservice assistance focused on improving FP/RH education in three medical and nine nursing schools, and the role of the training teams at the NTCs moved toward supporting the preservice education efforts.

Recent studies involving physicians in training have shown that excessive work hours are associated with an increased rate of medical errors and adverse events. The problem of excessive work hours of physicians in training in El Salvador has political and economic roots that need to be addressed by politicians and public health policy makers. [adapted from author]

The availability of medical human resource supply is a growing concern for rural and remote communities in many countries. In the last decade, various telehealth experiences in Canada have highlighted the potential impact of this technology on professional practice. The purpose of this study was to explore physicians’ and managers’ perceptions regarding the potential of telehealth to support recruitment and retention of physicians in remote and rural regions. [abstract]

West African-trained physicians have been migrating from the sub-continent to rich countries, primarily the US and the UK, since medical education began in Nigeria and Ghana in the 1960s. In 2003, we visited six medical schools in West Africa to investigate the magnitude, causes and consequences of the migration. We conducted interviews and focus groups with faculty, administrators (deans and provosts), students and post-graduate residents in six medical schools in Ghana and Nigeria. In addition to the migration push and pull factors documented in previous literature, we learned that there is now a well-developed culture of medical migration.

Using the most updated information on the supply of physicians over a 20-year period, this paper projects the size of the future global need for, demand for and supply of physicians to year 2015, the target date for the Millennium Development Goals. [adapted from abstract]

Healthcare providers (HCPs) play a central role in the provision of prevention and care services for people with sexually transmitted infections (STIs), including HIV/AIDS. However, the degree of readiness for this role through appropriate training and experience is not clear. In 2002, the India-Canada Collaborative HIV/AIDS Project conducted a study in an urban area and a rural district of the state of Karnataka, collecting information from 998 care providers regarding attitudes, knowledge and practices related to STI care and HIV/AIDS care in particular. This paper analyses and compares the three different types of HCPs with respect to these parameters and discusses implications for STI/HIV/AIDS prevention and care programs.

This study analyzes the Lithuanian family physician (FP) workforce to determine if an adequate supply of FPs will be available in the future to take over emerging tasks. The authors conclude that despite the rapid expansion of the FP workforce during the last fifteen years, forecasts of supply and demand indicate that the number of FPs in 2015 will not be sufficient. [adapted from author]

This document is an environmental policy scan of activity in three areas related to physicians, nurses and pharmacists: education and training initiatives; recruitment and retention and work place initiatives; and capacity to do national health human resource planning. [adapted from introduction]

This study shows that graduates from higher quality institutions account for a disproportionately large share of emigrating physicians in India. Even within high-end institutions, better physicians are more likely to emigrate. Interventions should focus on the highly trained individuals in the top institutions that contribute disproportionately to the loss of human resources for health. The findings suggest that affirmative-action programmes may have an unintended benefit in that they may help retain a subset of such personnel. [adapted from author]

The objective of this article is to explore the type of private practice supplementary income-generating activities of public sector doctors in the Portuguese-speaking African countries, and also to discover the motivations and the reasons why doctors have not made a complete move out of public services. [objective]

This chapter aims to determine the current demand for medical practitioners and nurses in South Africa by looking at the number of positions that are filled and the number that are currently vacant. It attempts to determine the number of medical practitioners and nursing positions that will be required until 2011, establishes the expected output from higher education over the next ten years, and determines the gap between supply and demand of health professionals. [adapted from introduction]

This study provides an overview of existing information on the migration of health workers, with an emphasis on related social and labour issues. It considers trends in migration, the working conditions of migrants, migration policies and recruitment practices, and the impact of international standards and trade agreements on conditions of migrant health workers. The study also outlines policies and practices associated with more socially acceptable forms of managed migration. It focuses on nurses and doctors, who have been in the forefront of current debate about health worker migration. [author’s description]

The consequences of health professional mobility have become a prominent public policy concern. This paper considers trends in mobility amongst doctors and nurses and the consequences for health systems. Policy responses are shifting from a reactive agenda that focuses on stemming migration towards a more active agenda of managed migration that benefits source and destination countries. Improved working conditions and effective human resource practice are required to encourage retention of health professionals in both source and destination countries. [abstract]

Human resources management in health often encounters problems related to workforce geographical distribution. The aim of this study was to investigate the internship workplace preferences of final-year medical students and the reasons associated with their choices. [from abstract]

A questionnaire survey was conducted on 50 primary health care physicians in Iraq to assess their knowledge and identify misperceptions about breastfeeding. Basic knowledge about the main processes of breastfeeding was good (when to start feeding, frequency of feeding, relactation, importance of psychological factors), but there were deficiencies in their ability to deal with some practical problems related to breastfeeding. Steps for improving the knowledge and training are addressed. [from abstract]

In issuing this statement, WHO, ICM and FIGO are advocating for skilled care during pregnancy, childbirth and the immediate postnatal period. This statement is especially aimed at countries in which the coverage of skilled attendance at birth is below 85%. The statement defines clearly who is a skilled attendant, what skills she/he should have and how she/he should be trained and supported. Thus a skilled attendant is an accredited health professional — such as a midwife, doctor or nurse — who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns.

This video clip is 9 minutes and 43 seconds and describes the community based medical education program for physican education in Malawi. The curiculum requires that doctors must be trained in the communities in which they will work to prevent brain drain. It also discusses the incentives Malawi uses to retain doctors in the rural areas.