The socio-economic transition and health professions education in Mongolia: a qualitative study.

BACKGROUND: Former socialist countries have undergone a socio-economic transition in recent decades. New challenges for the healthcare system have arisen in the transition economy, leading to demands for better management and development of the health professions. However, few studies have explored the effects of this transition on health professions education. Thus, we investigated the effects of the socio-economic transition on the health professions education system in Mongolia, a transition economy country, and to identify changes in requirements. METHODS: We used a multi-level perspective to explore the effects of the transition, including the input, process, and output levels of the health professions education system. The input level refers to planning and management, the process level refers to the actual delivery of educational services, and the output level refers to issues related to the health professionals, produced by the system. This study utilized a qualitative research design, including document review and interviews with local representatives. Content analysis and the constant comparative method were used for data analysis. RESULTS: We explored tensions in the three levels of the health professions education system. First, medical schools attained academic authority for planning and management without proper regulation and financial support. The government sets tuition fees, which are the only financial resource of medical schools; thus, medical schools attempt to enroll more students in order to adapt to the market environment. Second, the quality of educational services varies across institutions due to the absence of a core curriculum and differences in the learning environment. After the transition, the number of private medical schools rapidly increased without quality control, while hospitals started their own specialized training programs. Third, health professionals are struggling to maintain their professional values and development in the market environment. Fixed salaries lead to a lack of motivation, and quality evaluation measures more likely reflect government control than quality improvement. CONCLUSIONS: Mongolia continues to face the consequences of the socio-economic transition. Medical schools' lack of financial authority, the varying quality of educational services, and poor professional development are the major adverse effects. Finding external financial support, developing a core curriculum, and reforming a payment system are recommended.

Applying a mixed methods design for needs assessment of an international fellowship training program for Mongolian health professions.

PURPOSE: Continuing professional development is essential for improving health care services, especially in developing countries. Most of the training programs in Mongolia were not based on a targeted needs assessment. Therefore, we aimed to apply a mixed methods design to assess the training needs of Mongolian health professions. METHODS: We conducted a needs assessment using a convergent parallel mixed methods design in two steps. The survey and interview questions were developed to identify priority areas, targeted trainees, and effective training methods. A survey on 60 respondents, 15 individual interviews, and a focus group interview with 14 participants were conducted in the first step. In the second step, 12 representatives of key stakeholders were invited to a second focus group interview. RESULTS: Current health policy areas, areas related to future national plans, and areas not currently receiving governmental or international support were suggested as the main priorities. The stakeholder suggested that trainees should be selected based on their professional experience and language level, as well as each hospital's needs. Building teams including various professions, such as nurses, technicians, and biomedical engineers, was recommended as a way to exchange ideas with each other and to build teamwork for future collaboration. CONCLUSION: Medical training needs are dynamic and complex; therefore, a deep understanding of the context and setting is necessary. In this study, we assessed the targeted training needs of Mongolian health professions through a mixed methods design, which could be an effective way to conduct needs assessments for training programs.

Gender differences and burden of chronic conditions: impact on quality of life among the elderly in Taiwan.

BACKGROUND: Multiple chronic conditions affect people's health-related quality of life (QoL) and the distributions of the conditions may differ between genders. Our goal was to examine gender differences in chronic conditions and QoL among community-living elderly in Taiwan and to examine whether differences in QoL between genders, if present, were attributable to the distribution of chronic conditions. METHODS: We used data from the Nutrition and Health Survey in Taiwan (NAHSIT, 2005-2008), which interviewed a representative sample of the Taiwanese population. The survey questions included the SF-36 questionnaire to assess participants' QoL and items for participants' medical history. We used multiple linear regressions to examine the difference in QoL between genders. RESULTS: We included 1179 elders for our analysis; men accounted for 52% (612/1179). The mean age was 73; women were slightly younger. The mean (standard deviation) of SF-36 physical and mental health component score (PCS and MCS) was 44.5 (11.1) and 55.6 (9.0), respectively, and women reported a significantly lower PCS than men (difference - 4.85, p < 0.001). Urinary incontinence, arthritis, stroke, and kidney disease were associated with a clinically meaningful decrease in PCS (≤ - 6.5 points). The difference in PCS between genders was not attenuated after we accounted for chronic conditions in regression analysis. CONCLUSIONS: Our findings suggest that women tend to report that their physical health-related QoL is poorer than that of men, and such a difference does not seem to be attributable to the distribution of chronic conditions. Elderly men and women may perceive health-related QoL differently.

Use of best-worst scaling to estimate the magnitude of stressful life events in older adults.

AIM: The magnitude of stressful life events can be measured by using rating scales such as the Social Readjustment Rating Scale. This study aimed to estimate the magnitude of stressful life events by using a best-worst scaling approach in a sample of community-dwelling older persons in Taiwan. METHODS: Participants aged 55 years or older were asked to rate the stressfulness of 11 life events on a scale from 0 to 10 and the best-worst scaling. We used the case one (object case) best-worst scaling design: each task on a list of events was presented to participants, and they were asked to indicate the events that they considered most and least stressful. RESULTS: A total of 61 persons (66% women) provided valid responses for analysis; the mean age was 64.8 ± 8.6 years. For best-worst scaling, 'major illness of family member' (mean best-minus-worst score = 128) was rated the most stressful, and 'sexual difficulties' was rated the least stressful (mean best-minus-worst score = -153). For the rating scale, 'major personal illness' was rated the most stressful (mean rating = 6.95), and 'sexual difficulties' was again the least stressful (mean rating = 2.05). Rankings of events based on both methods were similar but were different from ratings based on the Social Readjustment Rating Scale. CONCLUSION: The current study explored using BWS to estimate the magnitude of stressful life events. The magnitude of events estimated in our study was found to differ from the magnitude estimated previously by some common scales for assessing stressful life events.

Methods to perform systematic reviews of patient preferences: a literature survey.

BACKGROUND: Systematic reviews are a commonly used research design in the medical field to synthesize study findings. At present-although several systematic reviews of patient preference studies are published-there is no clear guidance available for researchers to conduct this type of systematic review. The aim of our study was to learn the most current practice of conducting these systematic reviews by conducting a survey of the literature regarding reviews of quantitative patient preference studies. METHODS: Our survey included systematic reviews of studies that used a stated quantitative preference design to elicit patient preferences. We identified eligible reviews through a search of the PubMed database. Two investigators with knowledge of the design of patient preference studies independently screened the titles and abstracts, and where needed, screened the full-text of the reviews to determine eligibility. We developed and pilot-tested a form to extract data on the methods used in each systematic review. RESULTS: Our search and screening identified 29 eligible reviews. A large proportion of the reviews (19/29, 66%) were published in 2014 or after; among them, nine reviews were published in 2016. The median number of databases searched for preference studies was four (interquartile range = 2 to 7). We found that less than half of the reviews (13/29, 45%) clearly reported assessing risk of bias or the methodological quality of the included preference studies; not a single review was able to perform quantitative synthesis (meta-analysis) of the data on patient preferences. CONCLUSION: These results suggest that several methodological issues of performing systematic reviews of patient preferences are not yet fully addressed by research and that the methodology may require future development.

Transnational collaboration for faculty development in health professions education in Mongolia.

PURPOSE: The Mongolian National University of Medical Sciences is the only national university in Mongolia and has produced more than 90% of health professionals in the country. Experts from Mongolia and Korea embarked on a collaborative effort to develop educational programs for faculty development based on the personal and professional needs of faculty members. This study aimed to evaluate the outcomes of those educational programs to determine whether this transnational collaboration was successful. METHODS: A needs assessment survey was conducted among 325 faculty members. Based on the results of this survey, the joint expert team developed educational programs on seven core topics: clinical teaching, curriculum development, e-learning, item writing, medical research, organizational culture, and resident selection. Surveys evaluating the satisfaction and the attitudes of the participants were conducted for each program. RESULTS: Throughout the 17-day program, 16 experts from Korea and 14 faculty members from Mongolia participated as instructors, and a total of 309 participants attended the program. The average satisfaction score was 7.15 out of 8.0, and the attitudes of the participants towards relevant competencies significantly improved after each educational program. CONCLUSION: The faculty development programs that were developed and implemented as part of this transnational collaboration between Mongolia and Korea are expected to contribute to the further improvement of health professions education in Mongolia. Future studies are needed to evaluate the long-term outcomes of these educational programs.