Nepal, as a nation with limited resources and a large number of poor people, needs far more well-trained, committed general practitioners. The aim of this study was to understand medical career choices and the factors that influence medical students’ and young doctors’ career choices in Nepal and to understand what would encourage them to work in rural areas as generalists.
This was a cross-sectional study of 1137 medical students (first and final year) and young doctors (interns and residents) from six medical colleges in Nepal who completed a voluntary questionnaire, with some also participating in structured focus groups – 170 first years, 77 final years and 80 graduates – with an additional 28, 44 and 49 written responses respectively.
Without selective admissions policies, 41.7% (464/1112) of respondents had a rural background – most significant in Year 1 students, males and in colleges outside of Kathmandu. Of the respondents, 569 (50.9%) had a specialty choice starting medical school – the greatest proportion in Year 1. Medicine (especially cardiology) and surgery (particularly among males) were most significant choices at all stages. Only five participants initially and four during their course chose general practice. There appears no interest in, recognition of, significant exposure to, or role models in general practice.
Serving the sick, personal interest and social prestige were the most significant influencing factors – consistent across all groups. Course availability was also a factor. To attract doctors to work in rural areas most respondents affirmed the need for a good salary, infrastructure and facilities, scholarships and career development opportunities.
Challenges include raising generalists’ profiles within the medical community, government and patient community; changing undergraduate curricula to include greater exposure to good models of rural generalist practice; and providing incentives and attractions for post-graduate training and service.
Career choice; Medical students; Generalists; General practitioners
The transition from medical student to junior doctor in postgraduate training is a critical stage in career progression. We report junior doctors' views about the extent to which their medical school prepared them for their work in clinical practice.
Postal questionnaires were used to survey the medical graduates of 1999, 2000, 2002 and 2005, from all UK medical schools, one year after graduation, and graduates of 2000, 2002 and 2005 three years after graduation. Summary statistics, chi-squared tests, and binary logistic regression were used to analyse the results. The main outcome measure was the level of agreement that medical school had prepared the responder well for work.
Response rate was 63.7% (11610/18216) in year one and 60.2% (8427/13997) in year three. One year after graduation, 36.3% (95% CI: 34.6, 38.0) of 1999/2000 graduates, 50.3% (48.5, 52.2) of 2002 graduates, and 58.2% (56.5, 59.9) of 2005 graduates agreed their medical school had prepared them well. Conversely, in year three agreement fell from 48.9% (47.1, 50.7) to 38.0% (36.0, 40.0) to 28.0% (26.2, 29.7). Combining cohorts at year one, percentages who agreed that they had been well prepared ranged from 82% (95% CI: 79-87) at the medical school with the highest level of agreement to 30% (25-35) at the lowest. At year three the range was 70% to 27%. Ethnicity and sex were partial predictors of doctors' level of agreement; following adjustment for them, substantial differences between schools remained. In years one and three, 30% and 34% of doctors specified that feeling unprepared had been a serious or medium-sized problem for them (only 3% in each year regarded it as serious).
The vast knowledge base of clinical practice makes full preparation impossible. Our statement about feeling prepared is simple yet discriminating and identified some substantial differences between medical schools. Medical schools need feedback from graduates about elements of training that could be improved.
Despite Hong Kong government's official commitment to the development of traditional Chinese medicine (TCM) over the last ten years, there appears to have been limited progress in public sector initiated career development and postgraduate training (PGT) for public university trained TCM practitioners. Instead, the private TCM sector is expected to play a major role in nurturing the next generation of TCM practitioners. In the present study we evaluated TCM graduates' perspectives on their career prospects and their views regarding PGT.
Three focus group discussions with 19 local TCM graduates who had worked full time in a clinical setting for fewer than 5 years.
Graduates were generally uncertain about how to develop their career pathways in Hong Kong with few postgraduate development opportunities; because of this some were planning to leave the profession altogether. Despite their expressed needs, they were dissatisfied with the current quality of local PGT and suggested various ways for improvement including supervised practice-based learning, competency-based training, and accreditation of training with trainee involvement in design and evaluation. In addition they identified educational needs beyond TCM, in particular a better understanding of western medicine and team working so that primary care provision might be more integrated in the future.
TCM graduates in Hong Kong feel let down by the lack of public PGT opportunities which is hindering career development. To develop a new generation of TCM practitioners with the capacity to provide quality and comprehensive care, a stronger role for the government, including sufficient public funding, in promoting TCM graduates' careers and training development is suggested. Recent British and Australian experiences in prevocational western medicine training reform may serve as a source of references when relevant program for TCM graduates is planned in the future.
Today universities have to compete for the best brains more than ever before. The issues of reconciliation of work/study and family and the work-life balance have become increasingly important recently in higher education policy development as higher education institutions in the competition for the best minds are already forced to tackle these issues, some of which are still novel to them, as they are faced with demographic change. High dropout rates among students with children, increasing shortages of physicians and high sector emigration and high levels of childlessness among graduates serve as indicators for urgent action towards more family-oriented university and faculty strategies.
But how can medical schools, hospitals and (teaching) hospitals achieve a family-oriented profile? Which key players, which areas of higher education management are relevant to management and decision-making structures? What exemplary measures for designing family-friendly medical studies and work places offer success?
The underrepresentation of women in the next generation of scientists also poses an additional challenge to the development of an innovative higher education policy if it is to be sustainable. Thus strategies promoting the next generation and family orientation are key factors for a future-oriented higher education policy. These factors should therefore be seen as leadership strategies which will introduce measures that will make (re)design the university’s profile. To this end, a holistic approach which will lead to fundamental reforms of higher education structures which are outlined below and illustrated with examples are a prerequisite for successful implementation.
Work-Life-Balance; family-friendliness; medical studies; study design; equality
To report on the current career destination of the University of Ghana Medical School (UGMS) qualified doctors in the year groups, 1998, 2000, 2003, 2005 and 2008.
Interview of doctors from each year group currently working at the Korle-Bu Teaching Hospital corroborated by phone calls to the doctors.
All Ghanaian doctors from each graduating year group.
Main Outcome Measures
1. Current location of employment in Ghana or abroad, 2. Gender ratios of the doctors retained in Ghana
Three hundred and seventy-two (372) UGMS doctors consisting of 353 Ghanaians and 19 foreign students graduated over the five year groups. Of the 353 Ghanaians, 113 emigrated, while all but one of the 240 living in Ghana, practice medicine. The retention rate improved from 54.2% in 1998 to 86.3% in 2008. The overall retention rate however is 68.0% while the retention rates for the male and female doctors were 69.3% and 64.6% respectively. Of the 177 doctors practicing in Ghana from the first 4 year-groups (i.e. 1998, 2000, 2003 and 2005,) 139 (i.e. 31, 31, 34 and 43 from the respective year groups) have either completed postgraduate training or are in the residency training programme. Thus 78.5% of these doctors working in Ghana have opted for postgraduate training.
The establishment of the GCPS and to a lesser extent the introduction of the ADHA before it appear to have slowed down the medical brain drain as more and more doctors avail themselves of the local opportunities. The GCPS therefore needs supporting effectively in order to continue to be a strong incentive for the retention of doctors in Ghana, apart from helping to staff district general hospitals with specialists.
Career destinations; University of Ghana; Ghanaian doctors; specialist training; medical emigration
Dentistry in the UK has a number of new graduate-entry programmes. The aim of the study was to explore the motivation, career expectations and experiences of final year students who chose to pursue a dental career through the graduate entry programme route in one institution; and to explore if, and how, their intended career expectations and aspirations were informed by this choice.
In-depth interviews of 14 graduate entry students in their final year of study. Data were transcribed verbatim and analysed using framework analysis.
There were three categories of factors influencing students' choice to study dentistry through graduate entry: 'push', 'pull' and 'mediating'. Mediating factors related to students' personal concerns and circumstances, whereas push and pull factors related to features of their previous and future careers and wider social factors. Routes to Graduate Entry study comprised: 'early career changers', 'established career changers' and those pursuing 'routes to specialisation'. These routes also influenced the students' practice of dentistry, as students integrated skills in their dental studies, and encountered new challenges.
Factors which students believed would influence their future careers included: vocational training; opportunities for specialisation or developing special interests and policy-related issues, together with wider professional and social concerns.
The graduate entry programme was considered 'hard work' but a quick route to a professional career which had much to offer. Students' felt more could have been made of their pre-dental studies and/or experience during the programme. Factors perceived as influencing students' future contribution to dentistry included personal and social influences. Overall there was strong support for the values of the NHS and 'giving back' to the system in their future career.
Graduate entry students appear to be motivated to enter dentistry by a range of factors which suit their preferences and circumstances. They generally embrace the programme enthusiastically and seek to serve within healthcare, largely in the public sector. These students, who carry wider responsibilities, bring knowledge, skills and experience to dentistry which could be harnessed further during the programme. The findings suggest that graduate entry students, facilitated by varied career options, will contribute to an engaged workforce.
dental; graduate; graduate-entry; career; motivation; workforce
In the context of inadequacy of neurology workforce in India, it is important to understand factors that post-graduate medical students consider for and against choosing neurology as their career option. Understanding these factors will help in planning strategies to encourage students to pursue a career in neurology. At present, there is a paucity of studies addressing this issue in India.
Aims and Objectives:
(1) To analyze factors, which post-graduate students consider for and against choosing neurology as a career specialty. (2) To access the level and quality of neurology exposure in the current MBBS and MD curricula.
Materials and Methods:
Statewide questionnaire based study was conducted in the state of Maharashtra for students eligible to take DM neurology entrance examination (MD Medicine and MD Pediatrics).
In this survey, 243 students were enrolled. Factors bringing students to neurology were - intellectual challenge and logical reasoning (72%), inspired by role model teachers (63%), better quality-of-life (51%) and scope for independent practice without expensive infrastructure (48%). Factors preventing students from taking neurology were - perception that most neurological diseases are degenerative (78%), neurology is mainly an academic specialty (40%), neurophobia (43%) and lack of procedures (57%). Inadequate exposure and resultant lack of self-confidence were common (31%, 70-80%). 84% of the students felt the need for a short term certification course in neurology after MD.
To attract more students to neurology, “role model” teachers of neurology could interact and teach students extensively. Neurologists’ efforts to shed their diagnostician's image and to shift their focus to therapeutics will help change the image of neurology. Out-patient neurology clinics should be incorporated early in the student's career. Procedures attract students; hence, they should be made conversant with procedures and interventions. Increasing the level of neurological exposure in our current MBBS and MD curriculum is necessary. A case could be made for consideration of short certification course in neurology for physicians.
Career; neurology; postgraduate; students
Malawi has a critical human resources problem particularly in the health sector. There is a severe shortage of doctors; there are only few medical specialists. The College of Medicine (COM) is the only medical school and was founded in 1991. For senior staff it heavily depends on expatriates. In 2004 the COM started its own postgraduate training programme (Master of Medicine) in the clinical specialties.
We explore to what extent a brain drain took place among the COM graduates by investigating their professional development and geographical distribution. Using current experience with the postgraduate programme, we estimate at what point all senior academic positions in the clinical departments could be filled by Malawians. We demonstrate the need for expatriate staff for its most senior academic positions in the interim period and how this can be phased out. Lastly we reflect on measures that may influence the retention of Malawian doctors.
Since the start of the COM 254 students have graduated with an average of 17 students per year. Most (60%) are working in Malawi. Of those working abroad, 60% are in various postgraduate training programmes.
In 2015, adequate numbers of Malawi senior academics should be available to fill most senior positions in the clinical departments, taking into account a 65% increase in staff to cope with increasing numbers of students.
There seems to be no significant brain drain among graduates of the COM. The postgraduate programme is in place to train graduates to become senior academic staff. In the interim, the COM depends heavily upon expatriate input for its most senior academic positions. This will be necessary at least until 2015 when sufficient numbers of well trained and experienced Malawian specialists may be expected to be available. Improved pay structure and career development perspectives will be essential to consolidate the trend that most doctors will remain in the country.
Less than one-third of newly qualified doctors in the UK want a career in general practice. The English Department of Health expects that half of all newly qualified doctors will become GPs.
To report on the reasons why doctors choose or reject careers in general practice, comparing intending GPs with doctors who chose hospital careers.
Design and setting
Questionnaire surveys in all UK medical graduates in selected qualification years.
Questions about specialty career intentions and motivations, put to the qualifiers of 1993, 1996, 1999, 2000, 2002, 2005, 2008, and 2009, 1 year after qualification, and at longer time intervals thereafter.
‘Enthusiasm for and commitment to the specialty’ was a very important determinant of choice for intending doctors, regardless of chosen specialty. ‘Hours and working conditions’ were a strong influence for intending GPs (cited as having had ‘a great deal’ of influence by 75% of intending GPs in the first year after qualification), much more so than for doctors who wanted a hospital career (cited by 30%). Relatively few doctors had actually considered general practice seriously but then rejected it; 78% of the doctors who rejected general practice gave ‘job content’ as their reason, compared with 32% of doctors who rejected other specialties.
The shortfall of doctors wanting a career in general practice is not accounted for by doctors considering and rejecting it. Many do not consider it at all. There are very distinctive factors that influence choice for, and rejection of, general practice.
career choice; general practice; medical education; workforce, medical
Factors influencing specialty choice have been studied in an attempt to find incentives to enhance the workforce in certain specialties. The notion of “controllable lifestyle (CL) specialties,” defined by work hours and income, is gaining in popularity. As a result, many reports advocate providing a ‘lifestyle-friendly’ work environment to attract medical graduates. However, little has been documented about the priority in choosing specialties across the diverse career opportunities.
This nationwide study was conducted in Japan with the aim of identifying factors that influence specialty choice. It looked for characteristic profiles among senior students and junior doctors who were choosing between different specialties.
We conducted a survey of 4th and 6th (final)-year medical students and foundation year doctors, using a questionnaire enquiring about their specialty preference and to what extent their decision was influenced by a set of given criteria. The results were subjected to a factor analysis. After identifying factors, we analysed a subset of responses from 6th year students and junior doctors who identified a single specialty as their future career, to calculate a z-score (standard score) of each factor and then we plotted the scores on a cobweb chart to visualise characteristic profiles.
Factor analysis yielded 5 factors that influence career preference. Fifteen specialties were sorted into 4 groups based on the factor with the highest z-score: “fulfilling life with job security” (radiology, ophthalmology, anaesthesiology, dermatology and psychiatry), “bioscientific orientation” (internal medicine subspecialties, surgery, obstetrics and gynaecology, emergency medicine, urology, and neurosurgery), and “personal reasons” (paediatrics and orthopaedics). Two other factors were “advice from others” and “educational experience”. General medicine / family medicine and otolaryngology were categorized as “intermediate” group because of similar degree of influence from 5 factors.
What is valued in deciding a career varies between specialties. Emphasis on lifestyle issues, albeit important, might dissuade students and junior doctors who are more interested in bioscientific aspects of the specialty or have strong personal reasons to pursue the career choice. In order to secure balanced workforce across the specialties, enrolling students with varied background and beliefs should be considered in the student selection process.
Career choice; Medical student; Junior doctor
The six year medical programme at the University of the Witwatersrand admits students into the programme through two routes – school entrants and graduate entrants. Graduates join the school entrants in the third year of study in a transformed curriculum called the Graduate Entry Medical Programme (GEMP). In years I and 2 of the GEMP, the curriculum is structured into system based blocks. Problem-based learning, using a three session format, is applied in these two years. The curriculum adopts a biopsychosocial approach to health care, which is implemented through spiral teaching and learning in four main themes – basic and clinical sciences, patient-doctor, community- doctor and personal and professional development. In 2010 this programme produced its fifth cohort of graduates.
We undertook a qualitative, descriptive and contextual study to explore the graduating students’ perceptions of the programme. Interviews were conducted with a total of 35 participants who volunteered to participate in the study. The majority of the participants interviewed participated in focus group discussions. The interviews were transcribed verbatim and analysed thematically, using Tesch’s eight steps. Ethics approval for the study was obtained from the Human Research Ethics Committee of the University of the Witwatersrand. Participants provided written consent to participate in the interviews and for the interviews to be audio-taped.
Six themes were identified. These were: two separate programmes, problem-based learning and Garmins® (navigation system), see patients for real, being seen as doctors, assessment: of mice and MCQ’s, a cry for support and personal growth and pride. Participants were vocal in their reflections of experiences encountered during the programme and made several insightful suggestions for curriculum transformation. The findings suggest that graduates are exiting the programme confident and ready to begin their internships.
The findings of this study have identified a number of areas which need attention in the curriculum. Specifically attention needs to be given to ensuring that assessment is standardized; student support structures and appropriate levels of teaching. The study demonstrated the value of qualitative methods in obtaining students’ perceptions of a curriculum.
BACKGROUND AND AIMS: General practice in the UK is experiencing difficulty with medical staff recruitment and retention, with reduced numbers choosing careers in general practice or entering principalships, and increases in less-than-full-time working, career breaks, early retirement and locum employment. Information is scarce about the reasons for these changes and factors that could increase recruitment and retention. The UK Medical Careers Research Group (UKMCRG) regularly surveys cohorts of UK medical graduates to determine their career choices and progression. We also invite written comments from respondents about their careers and the factors that influence them. Most respondents report high levels of job satisfaction. A noteworthy minority, however, make critical comments about general practice. Although their views may not represent those of all general practitioners (GPs), they nonetheless indicate a range of concerns that deserve to be understood. This paper reports on respondents' comments about general practice. ANALYSIS OF DOCTORS' COMMENTS: Training Greater exposure to general practice at undergraduate level could help to promote general practice careers and better inform career decisions. Postgraduate general practice training in hospital-based posts was seen as poor quality, irrelevant and run as if it were of secondary importance to service commitments. In contrast, general practice-based postgraduate training was widely praised for good formal teaching that met educational needs. The quality of vocational training was dependent upon the skills and enthusiasm of individual trainers. Recruitment problems Perceived deterrents to choosing general practice were its portrayal, by some hospital-based teachers, as a second class career compared to hospital medicine, and a perception of low morale amongst current GPs. The choice of a career in general practice was commonly made for lifestyle reasons rather than professional aspirations. Some GPs had encountered difficulties in obtaining posts in general practice suited to their needs, while others perceived discrimination. Newly qualified GPs often sought work as non-principals because they felt too inexperienced for partnership or because their domestic situation prevented them from settling in a particular area. Changes to general practice The 1990 National Health Service (NHS) reforms were largely viewed unfavourably, partly because they had led to a substantial increase in GPs' workloads that was compounded by growing public expectations, and partly because the two-tier system of fund-holding was considered unfair. Fund-holding and, more recently, GP commissioning threatened the GP's role as patient advocate by shifting the responsibility for rationing of health care from government to GPs. Some concerns were also expressed about the introduction of primary care groups (PCGs) and trusts (PCTs). Together, increased workload and the continual process of change had, for some, resulted in work-related stress, low morale, reduced job satisfaction and quality of life. These problems had been partially alleviated by the formation of GP co-operatives. Retention difficulties Loss of GPs' time from the NHS workforce occurs in four ways: reduced working hours, temporary career breaks, leaving the NHS to work elsewhere and early retirement. Child rearing and a desire to pursue interests outside medicine were cited as reasons for seeking shorter working hours or career breaks. A desire to reduce pressure of work was a common reason for seeking shorter working hours, taking career breaks, early retirement or leaving NHS general practice. Other reasons for leaving NHS general practice, temporarily or permanently, were difficulty in finding a GP post suited to individual needs and a desire to work abroad. CONCLUSIONS: A cultural change amongst medical educationalists is needed to promote general practice as a career choice that is equally attractive as hospital practice. The introduction of Pre-Registration House Officer (PRHO) placements in general practice and improved flexibility of GP vocational training schemes, together with plans to improve the quality of Senior House Officer (SHO) training in the future, are welcome developments and should address some of the concerns about poor quality GP training raised by our respondents. The reluctance of newly qualified GPs to enter principalships, and the increasing demand from experienced GPs for less-than-full-time work, indicates a need for a greater variety of contractual arrangements to reflect doctors' desires for more flexible patterns of working in general practice.
Objectives: To study the career development of male graduates of King Saud University (KSU), College of Dentistry in terms of pursuit of postgraduate dental education, higher degrees or Board Certification, choice of universities and countries of study, and place of work after qualification.
Methods: A questionnaire survey was carried out through face to face or telephone interview among 666 KSU graduates of 1982–2004.
Results: 80% (532 graduates) response rate. (77%) finished postgraduate dental education. 17% specialized in Prosthodontics, 16% in Saudi Board Advanced Restorative Dentistry, 14% in Advanced General Dentistry, 10.5% in Orthodontics, 10% in Oral and Maxillofacial Surgery, 8.3% in Pediatric Dentistry, 7.7% in Endodontics, 6% in Periodontics, 5.5% in Operative Dentistry, 5% in other Specialties. 61% had a Master’s degree and 16% had a Doctorate degree. 23% had Board Certificates and 8% had a Fellowship Certificate. (78%) are working in the government, 15% at the university and 6% in private, and 19% in administrative positions.
Conclusion: Most of the dental graduates were motivated and eager to continue their postgraduate education to get either clinical specialty or academic degrees from nationally and internationally well recognized and known Universities and programs.
Graduate; Dental; Specialty; Career; Education; Postgraduate
The interview and questionnaire responses of twenty-five graduate trainees, fifteen scientist advisors, and present employers are incorporated in this six-year review of the Postgraduate Training Program for Science Librarians at the University of Tennessee Medical Units. The program was supported by the National Library of Medicine.
In 1996 Liverpool reformed its medical curriculum from a traditional lecture based course to a curriculum based on the recommendations in Tomorrow's Doctors. A project has been underway since 2000 to evaluate this change. This paper focuses on the views of graduates from that reformed curriculum 6 years after they had graduated.
Between 2007 and 2009 45 interviews took place with doctors from the first two cohorts to graduate from the reformed curriculum.
The interviewees felt like they had been clinically well prepared to work as doctors and in particular had graduated with good clinical and communication skills and had a good knowledge of what the role of doctor entailed. They also felt they had good self directed learning and research skills. They did feel their basic science knowledge level was weaker than traditional graduates and perceived they had to work harder to pass postgraduate exams. Whilst many had enjoyed the curriculum and in particular the clinical skills resource centre and the clinical exposure of the final year including the "shadowing" and A & E attachment they would have liked more "structure" alongside the PBL when learning the basic sciences.
According to the graduates themselves many of the aims of curriculum reform have been met by the reformed curriculum and they were well prepared clinically to work as doctors. However, further reforms may be needed to give confidence to science knowledge acquisition.
The aim of this study was to examine the reasons why primary care doctors undertake postgraduate diploma studies in a mixed private/public Asian setting.
Twenty four past or current postgraduate diploma students of the family medicine unit (FMU) of the University of Hong Kong participated in three focus group interviews. A structured questionnaire was constructed based on the qualitative data collected and was sent to 328 former applicants of postgraduate diploma studies at FMU.
“Upgrading medical knowledge and skills” and “improving quality of practice” were two of the factors that most of the respondents considered to be significant in motivating them to undertake postgraduate diploma studies. “Time constraint” and “workload in practice” were however the most significant demotivating factors. Financial issues were more seriously considered by the junior than the senior doctors. To be able to “expand patient base and/or number” was considered to be a significant factor by the private doctors who were also keen to “improve communication and relationship with patients”.
These findings suggest that there are mixed reasons for primary care doctors to undertake postgraduate diploma studies. Course organisers should take into consideration these various reasons in planning their programmes.
Asia; general practitioners; postgraduate studies; primary care doctors
Veterinarians who graduated between 2000 and 2004, inclusive, were surveyed to determine the factors associated with career path (job) switching in the early postgraduate period. The sampling frame consisted of 348 veterinarians, 285 of whom were contacted and of these, 192 (67.4%) responded to the survey. Only 28.4% of respondents had remained with their initial employer. Three main factors were associated with employee retention: the type of practice/caseload, the workload (hours worked and number of nights on-call), and the level of mentorship and support provided by the practice. Workload and mentorship were also cited as the main reasons for leaving a place of employment. More than a third (38.0%) of respondents reported leaving a position solely because of inadequate mentorship and support. A third (33.7%) of respondents who began their careers in mixed or food animal practice were no longer in these types of practice; the main reasons for leaving were related to workload and mentorship.
Objective To determine, in one low income country (Nepal), which characteristics of medical students are associated with graduate doctors staying to practise in the country or in its rural areas.
Design Observational cohort study.
Setting Medical college registry, with internet, phone, and personal follow-up of graduates.
Participants 710 graduate doctors from the first 22 classes (1983-2004) of Nepal’s first medical college, the Institute of Medicine.
Main outcome measures Career practice location (foreign or in Nepal; in or outside of the capital city Kathmandu) compared with certain pre-graduation characteristics of medical student.
Results 710 (97.7%) of the 727 graduates were located: 193 (27.2%) were working in Nepal in districts outside the capital city Kathmandu, 261 (36.8%) were working in Kathmandu, and 256 (36.1%) were working in foreign countries. Of 256 working abroad, 188 (73%) were in the United States. Students from later graduating classes were more likely to be working in foreign countries. Those with pre-medical education as paramedics were twice as likely to be working in Nepal and 3.5 times as likely to be in rural Nepal, compared with students with a college science background. Students who were academically in the lower third of their medical school class were twice as likely to be working in rural Nepal as those from the upper third. In a regression analysis adjusting for all variables, paramedical background (odds ratio 4.4, 95% confidence interval 1.7 to 11.6) was independently associated with a doctor remaining in Nepal. Rural birthplace (odds ratio 3.8, 1.3 to 11.5) and older age at matriculation (1.1, 1.0 to 1.2) were each independently associated with a doctor working in rural Nepal.
Conclusions A cluster of medical students’ characteristics, including paramedical background, rural birthplace, and lower academic rank, was associated with a doctor remaining in Nepal and with working outside the capital city of Kathmandu. Policy makers in medical education who are committed to producing doctors for underserved areas of their country could use this evidence to revise their entrance criteria for medical school.
Objective. To determine graduate and postgraduate students’ perceptions of a drug use management and policy program that applied wide-ranging policy research skills to inform pharmaceutical decision-making.
Design. Nine cohorts of graduate and postgraduate students from diverse academic and professional backgrounds were paired with health-system preceptors for 4 months, and supported by faculty advisors and administrators, to complete research projects that generated evidence to inform policy decisions.
Assessment. A self-administered survey instrument was sent to all alumni of the program over the previous 10 years. The majority of respondents indicated: their prior academic coursework could be applied to everyday life; service-learning projects complemented university programs; participation led to greater awareness of decision-makers’ needs and appreciation of their tacit knowledge; and communication abilities were enhanced with decision-makers, and academics. Many also reported personal desire to fulfill healthcare-system research needs; personal belief in their ability to make a difference; and increased postgraduation marketability.
Conclusion. A drug use management and policy program allowed graduate students from various disciplines to develop new skills and collaborate with experts to produce research evidence that was relevant to drug policy that addressed real-world problems.
pharmaceutical policy; service-learning; assessment; engaged scholarship; residency; knowledge co-production
The career paths of 544 UK medical school graduates were followed for 10 years. Although general practice was not attractive to graduates initially, it became popular in subsequent years, mainly because it was seen as offering a superior quality of life. Once in general practice both men and women chose to work reduced hours and/or in non-principal posts. The findings suggest the need to look more closely at the nature of these trends and the implications for patient care and service provision.
family practice; motivation; workforce
The study investigated the extent to which approaches to work, workplace climate, stress, burnout and satisfaction with medicine as a career in doctors aged about thirty are predicted by measures of learning style and personality measured five to twelve years earlier when the doctors were applicants to medical school or were medical students.
Prospective study of a large cohort of doctors. The participants were first studied when they applied to any of five UK medical schools in 1990. Postal questionnaires were sent to all doctors with a traceable address on the current or a previous Medical Register. The current questionnaire included measures of Approaches to Work, Workplace Climate, stress (General Health Questionnaire), burnout (Maslach Burnout Inventory), and satisfaction with medicine as a career and personality (Big Five). Previous questionnaires had included measures of learning style (Study Process Questionnaire) and personality.
Doctors' approaches to work were predicted by study habits and learning styles, both at application to medical school and in the final year. How doctors perceive their workplace climate and workload is predicted both by approaches to work and by measures of stress, burnout and satisfaction with medicine. These characteristics are partially predicted by trait measures of personality taken five years earlier. Stress, burnout and satisfaction also correlate with trait measures of personality taken five years earlier.
Differences in approach to work and perceived workplace climate seem mainly to reflect stable, long-term individual differences in doctors themselves, reflected in measures of personality and learning style.
Objective. To investigate Syrian pharmacy students’ intentions and attitudes toward postgraduate study, and to determine and evaluate the factors that influence their preferences.
Methods. A questionnaire was developed and used to collect data from final-year bachelor of pharmacy (BPharm) students at Damascus University.
Results. Of the 265 students who responded to the survey, approximately 50% intended to work, 25% intended to pursue further study, and 25% were undecided. Personal fulfillment was the factor that most influenced students’ intentions concerning future education. Men were more concerned over their financial future, while women’s intentions were more influenced by scientific issues. The 3 most preferred pharmaceutical areas of further study were biochemistry and laboratory diagnosis, pharmaceutics and pharmaceutical industry, and clinical pharmacy. More students favored pursuing graduate school abroad rather than in Syria. The majority of those who intended to enroll in local graduate programs were interested in academic programs while less than a fifth favored residency programs.
Conclusions. The graduate programs in Syria do not appear to satisfy pharmacy students' ambitions or have the capacity to accommodate the growing demand associated with the rapid increase in the number of pharmacy graduates in the country. Consequently, a majority of students prefer to pursue postgraduate study abroad.
postgraduate study; graduate programs; pharmacy; bachelor of pharmacy students
Attracting doctors to rural posts is an ongoing challenge for health departments across different states in India. One strategy adopted by several states to make rural service attractive for medical graduates is to reserve post-graduate (PG) seats in medical colleges for doctors serving in the public sector.
This study examines the PG reservation scheme in Andhra Pradesh to understand its role in improving rural recruitment of doctors and specialists, the challenges faced by the scheme and how it can be strengthened.
Materials and Methods:
Qualitative case study methodology was adopted in which a variety of stakeholders such as government officials, health systems managers and serving Medical Officers were interviewed. This was supplemented with quantitative data on the scheme obtained from the Health, Medical and Family Welfare Department in Andhra Pradesh.
The PG reservation scheme appears to have been one of the factors responsible in attracting doctors to the public sector and to rural posts, with a reduction in vacancies at both the Primary Health Centre and Community Health Centre levels. Expectedly, in-service candidates have a better chance of getting a PG seat than general candidates. However, problems such as the mismatch of the demand and supply of certain types of specialist doctors, poor academic performance of in-service candidates as well as quality of services and enforcement of the post-PG bond need to be resolved.
The PG reservation scheme is a powerful incentive to attract doctors to rural areas. However, better monitoring of service quality, strategically aligning PG training through the scheme with the demand for specialists as well as stricter enforcement of the financial bond are required to improve the scheme's effectiveness.
Andhra Pradesh; bond; medical education; post-graduate; rural service
Objective. To determine the perceptions of junior pharmacy faculty members with US doctor of pharmacy (PharmD) degrees regarding their exposure to residency, fellowship, and graduate school training options in pharmacy school. Perceptions of exposure to career options and research were also sought.
Methods. A mixed-mode survey instrument was developed and sent to assistant professors at US colleges and schools of pharmacy.
Results. Usable responses were received from 735 pharmacy faculty members. Faculty members perceived decreased exposure to and awareness of fellowship and graduate education training as compared to residency training. Awareness of and exposure to academic careers and research-related fields was low from a faculty recruitment perspective.
Conclusions. Ensuring adequate exposure of pharmacy students to career paths and postgraduate training opportunities could increase the number of PharmD graduates who choose academic careers or other pharmacy careers resulting from postgraduate training.
pharmacy faculty members; residency programs; fellowships; graduate education; careers
In 1997, regional specialist training was established in Fiji, consisting of one-year Postgraduate Diplomas followed by three-year master’s degree programs in anesthesia, internal medicine, obstetrics/gynecology, pediatrics and surgery. The evolution of these programs during the first 12 years is presented.
A case study utilizing mixed methods was carried out, including a prospective collection of enrolment and employment data, supplemented by semi-structured interviews. Between 1997 and 2009, 207 doctors (113 from Fiji and 94 from 13 other countries or territories in the Pacific) trained to at least the Postgraduate Diploma level. For Fiji graduates, 29.2% migrated permanently to developed countries, compared to only 8.5% for regional graduates (P <0.001). Early years of the program were characterized by large intakes and enthusiasm, but also uncertainty. Many resignations took place following a coup d’etat in 2000. By 2005, interviews suggested a dynamic of political instability initially leading to resignations, leading to even heavier workloads, compounded by academic studies that seemed unlikely to lead to career benefit. This was associated with loss of hope and downward spirals of further resignations. After 2006, however, Master’s graduates generally returned from overseas placements, had variable success in career progression, and were able to engage in limited private practice. Enrolments and retention stabilized and increased.
Discussion and evaluation
Over time, all specialties have had years when the viability and future of the programs were in question, but all have recovered to varying degrees, and the programs continue to evolve and strengthen. Prospective clarification of expected career outcomes for graduates, establishment of career pathways for diploma-only graduates, and balancing desires for academic excellence with workloads that trainees were able to bear may have lessened ongoing losses of trainees and graduates.
Despite early losses of trainees, the establishment of regional postgraduate training in Fiji is having an increasingly positive impact on the specialist workforce in the Pacific. With forethought, many of the difficulties we encountered may have been avoidable. Our experiences may help others who are establishing or expanding postgraduate training in developing countries to optimize the benefit of postgraduate training on their national and regional workforces.
Education; Medical; Postgraduate; Developing countries; Pacific Islands; Human resources for health; Professional satisfaction; Case study; Qualitative research; Medical migration; Mixed methods research