Building excellence into medical and health professional education programs.

There is a need for schools that train medical and health professionals to reflect on whether their education program is aligned to current demands and challenges. Such a reflection is not a luxury but a necessity, as achieving minimum standards is not enough. A school should aim for excellence and incorporate best practice in their education program. The ASPIRE-to-Excellence award panels have elaborated on examples of excellence in a number of themes in medical and health professional education. These are presented in a series of articles to be published in Medical Teacher in 2024 and 2025. The frameworks and critical elements described in these articles may be used by institutions as a first step in an evaluation of their program. The frameworks and elements described and examples can be used as a resource for schools and other healthcare learning organizations to consider as they endeavor to improve their education program.

Virtual adaptation of traditional healthcare quality improvement training in response to COVID-19: a rapid narrative review.

BACKGROUND: Information and communication technology are playing a major role in ensuring continuity of healthcare services during the COVID-19 pandemic. The pandemic has also disrupted healthcare quality improvement (QI) training and education for healthcare professionals and there is a need to rethink the way QI training and education is delivered. The purpose of this rapid evidence review is to quickly, but comprehensively collate studies to identify what works and what does not in delivering QI training and education using distance learning modalities. METHODS: Three healthcare databases were searched along with grey literature sources for studies published between 2015 and 2020. Studies with QI training programmes or courses targeting healthcare professionals and students with at least one component of the programme being delivered online were included. RESULTS: A total of 19 studies were included in the review. Most studies had a mixed methods design and used blended learning methods, combining online and in-person delivery modes. Most of the included studies reported achieving desired outcomes, including improved QI knowledge, skills and attitudes of participants and improved clinical outcomes for patients. Some benefits of online QI training delivery include fewer required resources, reduced need for on-site instructors, increased programme reach, and more control and flexibility over learning time for participants. Some limitations of online delivery modes include limited learning and networking opportunities, functional and technical problems and long lead time for content adaptation and customisation. DISCUSSION: The review highlights that distance learning approaches to QI help in overcoming barriers to traditional QI training. Some important considerations for those looking to adapt traditional programmes to virtual environments include balancing virtual and non-virtual methods, using suitable technological solutions, customising coaching support, and using multiple criteria for programme evaluation. CONCLUSION: Virtual QI and training of healthcare professionals and students is a viable, efficient, and effective alternative to traditional QI education that will play a vital role in building their competence and confidence to improve the healthcare system in post-COVID environment.

Violence against trainees: urgent ethical challenges for medical educators and academic leaders in perinatal medicine.

Objectives Violence against medical trainees confronts medical educators and academic leaders in perinatal medicine with urgent ethical challenges. Despite their evident importance, these ethical challenges have not received sufficient attention. The purpose of this paper is to provide an ethical framework to respond to these ethical challenges. Methods We used an existing critical appraisal tool to conduct a scholarly review, to identify publications on the ethical challenges of violence against trainees. We conducted web searches to identify reports of violence against trainees in Mexico. Drawing on professional ethics in perinatal medicine, we describe an ethical framework that is unique in the literature on violence against trainees in its appeal to the professional virtue of self-sacrifice and its justified limits. Results Our search identified no previous publications that address the ethical challenges of violence against trainees. We identified reports of violence and their limitations. The ethical framework is based on the professional virtue of self-sacrifice in professional ethics in perinatal medicine. This virtue creates the ethical obligation of trainees to accept reasonable risks of life and health but not unreasonable risks. Society has the ethical obligation to protect trainees from these unreasonable risks. Medical educators should protect personal safety. Academic leaders should develop and implement policies to provide such protection. Institutions of government should provide effective law enforcement and fair trials of those accused of violence against trainees. International societies should promulgate ethics statements that can be applied to violence against trainees. By protecting trainees, medical educators and academic leaders in perinatology will also protect pregnant, fetal, and neonatal patients. Conclusions This paper is the first to provide an ethical framework, based on the professional virtue of self-sacrifice and its justified limits, to guide medical educators and academic leaders in perinatal medicine who confront ethical challenges of violence against their trainees.

Conference Report on First Certificate Course in Health Professions Educationat College of Medicine, University of Kerbala, Iraq.(September 2019).

The current status of medical education in Iraq requires complete transformation to conform to the latest trends of modern education. Presently it is compromised due to the influence of political factors, finances, weakness or fragility of planning and security. It has to be re-shaped for the future of medical education to produce good and efficient medical professionals. It is necessary to reform and revise the curriculum as accreditation in accordance with international medical universities. The initial requirement is faculty development in areas including but not limited to, curriculum development, teaching and learning improvement, research capacity building, and leadership development. The capacity building of faculty at College of Medicine, University of Kerbala (CMUCK) has been initiated in collaboration with Medics International at a local and the government level. Medics International conducted the current Course on Certificate in Health Professions Education (CHPE) programme in September, 2019 to facilitate the faculty to revise their curriculum and improve their current educational practices. Further steps will be taken to develop the faculty for Masters in Medical Education (MME), PhD, and fellowship programmes. To face the on-going challenges in the medical and health care system, continous efforts are required for faculty education. Medics International has volunteered to begin a series of Webinars through its global faculty to reach out to the Iraqi Board followed by engagement of the Arab Board covering 18 countries.

Mentorship of US Medical Students: a Systematic Review.

BACKGROUND: Mentoring of medical students remains a core pillar of medical education, yet the changing landscape of medicine has called for new and innovative mentoring models to guide students in professional development, career placement, and overall student well-being. The objective of this review is to identify and describe models of mentorship for US medical students. METHODS: We searched PubMed, PsycINFO, Education Resources Information Center, and Cochrane Databases of Systematic Reviews following PRISMA guidelines. We included original, English-language studies of any research design including descriptive studies that described a mentorship program at a US medical school designed for medical students. RESULTS: Our search yielded 3743 unique citations. Thirty articles met our inclusion criteria. There was significant diversity of the identified programs with regard to program objectives and size. The traditional dyad model of mentorship was the most frequently cited model, with a combination of models (dyad and group mentorship) cited as the second most common. Outcome measures of the programs were largely survey based, with satisfaction being the most measured outcome. Overall, satisfaction was highly rated throughout all the measured mentoring programs. Seven programs provided objective outcomes measures, including improved residency match data and increased scholarly productivity. The programs with objective outcomes measures were smaller, and 6/7 of them focused on a specific clinical area. Five of these programs relied on the traditional dyad model of mentorship. Cost and faculty time were the most frequently cited barriers to these programs. DISCUSSION: Our review demonstrates that mentoring programs for medical students can positively improve medical school satisfaction and career development. These results underscore the need for continued innovative mentoring programs to foster optimal student development in the setting of the increasingly competitive residency match process, growing expectations about student research productivity, and the national focus for overall student wellness.

The multi-tiered medical education system and its influence on the health care market-China's Flexner Report.

BACKGROUND: Medical education is critical and the first step to foster the competence of a physician. Unlike developed countries, China has been adopting a system of multi-tiered medical education to training physicians, which is featured by the provision of an alternative lower level of medical practitioners, or known as a feldsher system since the 1950s. This study aimed to illustrate the impact of multi-tiered medical education on both the equity in the delivery of health care services and the efficiency of the health care market. METHODS: Based on both theoretical reasoning and empirical analysis, this paper documented evidence upon those impacts of the medical education system. RESULTS: First, the geographic distribution of physicians in China is not uniform across physicians with different educational training. Second, we also find the evidence that high-educated doctors are more likely to be hired by larger hospitals, which in turn add the fuel to foster the hospital-center health care system in China as patients choose large hospitals to chase good doctors. Third, through the channels of adverse selection and moral hazard, the heterogeneity in medical education also imposes costs to the health care market in China. DISCUSSION: Overall, the three-tiered medical education system in China is a standard policy trade-off between quantity and quality in training health care professionals. On the one hand, China gains the benefit of increasing the supply of health care professionals at lower costs. On the other hand, China pays the price for keeping a multi-tiered medical education in terms of increasing inequality and efficiency loss in the health care sector. Finally, we discuss the potential policy options for China to mitigate the negative impact of keeping a multi-tiered medical education on the performance of health care market.

Public private partnership in the training of doctors after the 1990s' health sector reforms: the case of Tanzania.

Similar to many other low- and middle-income countries, public private partnership (PPP) in the training of the health workforce has been emphasized since the launch of the 1990s' health sector reforms in Tanzania. PPP in training aims to contribute to addressing the critical shortage of health workforce in these countries. This study aimed to analyse the policy process and experienced outcomes of PPP for the training of doctors in Tanzania two decades after the 1990s' health sector reforms. We reviewed documents and interviewed key informants to collect data from training institutions and umbrella organizations that train and employ doctors in both the public and private sectors. We adopted a hybrid thematic approach to analyse the data while guided by the policy analysis framework by Gagnon and Labonté. PPP in training has contributed significantly to the increasing number of graduating doctors in Tanzania. In tandem, undermining of universities' autonomy and the massive enrolment of medical students unfavourably affect the quality of graduating doctors. Although PPP has proven successful in increasing the number of doctors graduating, unemployment of the graduates and lack of database to inform the training needs and capacity to absorb the graduates have left the country with a health workforce shortage and maldistribution at service delivery points, just as before the introduction of the PPP. This study recommends that Tanzania revisit its PPP approach to ensure the health workforce crisis is addressed in its totality. A comprehensive plan is needed to address issues of training within the framework of PPP by engaging all stakeholders in training and deployment starting from the planning of the number of medical students, and when and how they will be trained while taking into account the quality of the training.

[Lack of doctors, but for what System? Shortage of clinicians in Italy and Lombardy and reflections on structural constrains in training]. / Carenza di medici: ma per quale SSN? Dati, riflessioni e proposte dalla formazione.

A lack of physicians is a major threat in many health care systems. Italy is coping with this problem, by increasing the number of residency training positions for medical graduates. Nevertheless, analysis of data and a critical review of organisational aspects of the system seem to suggest that structural changes are also needed. Eight areas are discussed: 1. The (very high) age of physicians in the country; 2. The (problematic) organisation of the health care delivery system; 3. The (uneven) distribution of residency training positions across the regions; 4. The (inadequate) mix of workforce between physicians and nurses; 5. The (biased) preferences for choosing a medical specialty; 6. The (emblematic) case of training for Gps; 7. The (unprecedent) growth of life expectancy and comorbidity; 8. The (absence of a) plan and method for recruiting workforce in health care at national level. The authors conclude that the solution for the lack of medical specialists is less a matter of increasing the number of residency training positions and more a matter of solving some structural constraints of the system. Solutions might have to do - for instance - with the introduction of the recognition of the professional role of physicians in residency training (especially for GPs - like in UK). Another aspect to be taken in consideration is also the professional role and competencies of nurses, that could be widened.

Assessment of health professional education across five Asian countries-a protocol.

BACKGROUND: There is an increasing consensus globally that the education of health professionals is failing to keep pace with scientific, social, and economic changes transforming the healthcare environment. This catalyzed a movement in reforming education of health professionals across Bangladesh, China, India, Thailand, and Vietnam who jointly volunteered to implement and conduct cooperative, comparative, and suitable health professional education assessments with respect to the nation's socio-economic and cultural status, as well as domestic health service system. METHODS: The 5C network undertook a multi-country health professional educational study to provide its countries with evidence for HRH policymaking. Its scope was limited to the assessment of medical, nursing, and public health education at three levels within each country: national, institutional, and graduate level (including about to graduate students and alumni). RESULTS: This paper describes the general issues related to health professional education and the protocols used in a five-country assessment of medical, nursing, and public health education. A common protocol for the situation analysis survey was developed that included tools to undertake a national and institutional assessment, and graduate surveys among about-to-graduate and graduates for medical, nursing, and public health professions. Data collection was conducted through a mixture of literature reviews and qualitative research. CONCLUSIONS: The national assessment would serve as a resource for countries to plan HRH-related future actions.

Educational renewal of physician training in Australia and New Zealand: Multiple educational innovations in a complex environment.

AIM: The Royal Australasian College of Physicians is renewing its specialty training programs and shifting towards competency-based medical education. Our aim is to improve the quality and rigor of training and graduate outcomes, and promote high standards of physician practice to serve the health of patients, families, and communities in a changing healthcare environment. METHODS: We are progressing holistic change and multiple educational innovations in a complex environment. Numerous stakeholders, a disparate training landscape and a largely volunteer supervisor workforce pose challenges in supporting effective implementation. This paper describes our progress and experience with three key components of our education renewal program: curricular renewal, a new selection process and faculty development. It offers reflections on the practical challenges, lessons learned and factors critical for success. CONCLUSIONS: Our experience highlights opportunities for training organizations to maximize their influence over workplace training experiences and outcomes by taking a systems approach to the design, delivery and evaluation of the components of education renewal. We found that design, development and delivery of our multiple educational innovations have benefited from co-design approaches, progressive and concurrent development, continual exploration of new strategies, and implementation as soon as viable with a commitment to iterative improvements over time.

Achieving educational mission and vision with an educational scorecard.

BACKGROUND: Achieving an academic section's educational mission and vision is difficult, particularly when individual faculty contributions may be self-directed and uncoordinated. Balanced scorecards have been used in other environments; however, a process for developing one focusing on the educational mission of an academic medical section has not previously been described. We aimed to develop and use an educational scorecard to help our academic clinical section achieve its educational mission and vision. METHODS: Six medical educators participated in a task force that developed, implemented, and evaluated an educational scorecard that incorporates four domains of educational value and six stakeholder perspectives. A modified Delphi process using 14 experts built expert consensus on the most valuable metrics. The task force then developed performance targets for each metric. RESULTS: Review of the scorecard at the sectional level resulted in both sectional and individual strategies which lead to a more balanced educational impact, including service structure changes and increased mentorship. Our section has used the scorecard and metrics to evaluate performance since 2014. CONCLUSION: An educational scorecard is a feasible way for academic groups to communicate educational goals, engage faculty, and provide objective information with which to base strategic decisions affecting their educational mission.

Labor Unionization Among Physicians in Training.

This study examines the number of unique unions and characteristics of unionization elections among physicians in training in the US.

A community-based strategy in medical education of the university of the philippines manila-school of health sciences - Lessons from innovations in human resources for health development in a developing country.

Background: After nearly four decades of testing an innovative model for training health workers for marginalized communities, the evidence base for the impact of University of the Philippines Manila-School of Health Sciences (UPM-SHS) medical program needs to address important gaps. Has it succeeded in contributing toward socially accountable medical education where medical schools will be evaluated in terms of their contribution to society's health outcomes? To answer this question, this study examined human resources for health (HRH) inequity in the Philippines and reviewed the medical school's performance in terms of addressing HRH distribution. Methods: The evaluation of the school's performance was done through two phases. Phase 1 involved generating HRH inequity metrics for the Philippines through secondary data. Phase 2 involved gathering primary data and generating performance metrics for UPM-SHS. Results: We found challenges that UPM-SHS needs to address based on the analysis of its student admissions from 1976 to 2011: targeting the right underserved communities, especially at the municipal level; addressing issues of high leakage and undercoverage rates in the program; ensuring mechanisms for return service are in place at the community level; and tracking and measuring program outputs and impact on community health outcomes. Discussion: Given this study on the performance of UPM-SHS to produce a broad range of health workforce to address the needs of marginalized communities in the Philippines and in similarly situated countries, there is a need to reassess its HRH development strategy. If it wants to build a critical mass of transformational health leaders to meet the needs of poor communities as part of its social accountability mandate, it needs to accelerate this development process.

The Education of American Surgeons and the Rise of Surgical Residencies, 1930-1960.

In the first half of the twentieth century, the training of American surgeons changed from an idiosyncratic, often isolated venture to a standardized, regulated, and mandated regimen in the form of the surgical residency. Over the three critical decades between 1930 and 1960, these residencies developed from an extraordinary, unique opportunity for a few leading practitioners to a widespread, uniform requirement. This article explores the transformation of surgical education in the United States, focusing on the standardization and dissemination of residencies during this key period. Utilizing the archives of professional organizations, it shows how surgical societies initiated and forced reform in the 1930s. It demonstrates the seminal and early role taken by the federal government in the expansion of surgical residencies through incentivized policies and, especially, the growth of the Veterans Administration health system after World War II. Finally, an examination of intra-professional debates over this process illustrates both the deeper struggles to control the nature of surgical training and the importance of residency education in defining the midcentury American surgeon.

Enhancing health professional education capacity in the Western Pacific region.

In the past 5 years there has been a rapid rise in numbers of foreign-trained medical graduates returning to their countries to work as interns across the Western Pacific. These graduates were found to have a varied and different level of clinical knowledge and skill from that previously experienced in the region. This change in workforce profile led to an urgent need for upskilling clinicians as educators and supervisors. A team of clinical education facilitators were invited to design and deliver context-specific professional education workshops to address this need. These workshops were designed to equip clinical staff with education and supervision skills to optimise teaching and learning opportunities in clinical settings for these new graduates of foreign medical programs. Embracing a collaborative approach and addressing learning needs in local contexts has enabled the team to enhance medical education capacity in the Western Pacific region. This article presents the context of the need for and development of clinical education workshops for intern supervisors in the Western Pacific.

The evolution of the Community Health Worker program in Papua New Guinea.

New Guinea (PNG) has a special history in regard to the training of Community Health Workers (CHWs) and is currently preparing its frontline health workforce to serve the 85% of the total PNG population of 7.3 million people who live in rural and remote settings. This article identifies and explains the five major developmental stages in the current CHW training program, as well as the changes that have occurred over the past century. The developmental stages are: (1) traditional; (2) early contact; (3) innovation; (4) the 1980s; and (5) new millennium. These developmental stages are discussed in the context of the early literature and investigation by the primary author and examination of the lived experiences of early missionary health workers and local people. This paper documents the development of a CHW program in PNG from the colonisation period, which began in 1883, to the present day. As a developing nation, PNG has gone through many challenges and changes to its healthcare system and has gradually developed an effective program to train its frontline primary health care (PHC) workforce. This article contributes new information with regard to the past and current development of CHW programs in PNG as well as in other developing countries. The training of competent CHWs with the essential skills and knowledge may help deliver quality and cost-effective PHC services to the rural majority and the urban disadvantaged, thereby fulfilling the PNG government's National Health Plan for 2011-2020. Systematic evaluation of the effectiveness of the CHW program will provide guidance for continued development of this frontline health workforce. Improving and introducing a competency-based curriculum is an essential step towards building a healthier nation.

[The problems of professional competence in the complementary professional forensic medical expertise programs of advanced training and professional requalification]. / Professional'nye kompetentsii v dopolnitel'nykh professional'nykh programmakh po spetsial'nosti «Sudebno-meditsinskaia ékspertiza¼ (povyshenie kvalifikatsii i professional'naia perepodgotovka).

This article reports the results of the analysis of the new tendencies and normatives of the working legislation in the field of additional professional education in the speciality of «forensic medical expertise¼ and the application of the competency-based approach to the training of specialists in the framework of professional requalification and advanced training programs. Special attention is given to the problems of organization of the educational process and the elaboration of additional training programs based on the competency approach to the training of specialists at the Department of Forensic Medicine and Law with the professor V.N. Kryukov Course of Advanced Professional Training and Professional Requalification of Specialists at the state budgetary educational Institution of higher professional education «Altai State Medical University¼, Russian Ministry of Health. The study revealed the problems pertaining to the development of professional competencies in the framework of educational programs for the professional requalification and advanced training in the speciality «forensic medical expertise¼. The authors propose the legally substantiated approaches to the solution of these problems.

India's foreign medical graduates: an opportunity to correct India's physician shortage.

BACKGROUND: India's current estimated doctor-population ratio of 1:1700 against targeted ratio of 1: 1000 shows a clear shortage. A mismatch in number of medical aspirants and available seats, intense competition and unaffordable costs of medical education prompt many Indian students to pursue training opportunities abroad. Many later return to India, and these foreign medical graduates (FMGs) must pass a qualification test which is a required to practice medicine in India. This review undertakes a situational analysis of FMGs in India and suggests a roadmap to better utilize this resource pool of physicians. METHODS: A thorough literature search was carried out using Google Scholar, PubMed and websites of the Central Board of Secondary Education and Medical Council of India. Foreign Medical Graduate Examination (FMGE) data was obtained from India's National Board of Examinations. RESULTS: From 2002 to 2014, growth was seen in the number of FMGs who took the FMGE, with more having trained in China than any other country. However, typically only 25% of FMGs pass the FMGE. In 2013, 9,700 FMGs were unable to pass the FMGE to enter practice in India. At least 7,500 FMG physicians are unable to become licensed each year for failure to pass the FMGE, including those who retake and again fail the exam. DISCUSSION: There are possible solutions. Additional training and hands-on apprenticeships can be introduced to help FMGs build their skills to then be able to pass the FMGE. FMGs can now learn by participating as observers in the established programs. Opportunities also exist for FMGs to work outside of clinical care, including in research, hospital administration and public health. As of now, FMGs are an untapped resource and lost opportunity to a country with shortages of physicians.

Primary care education: medical student and young doctors' perspective from Brazil, India and Portugal.

This opinion paper is a collaborative effort describing recent developments in primary care education in three different countries; representing diverse socioeconomic and political systems. The authors describe their respective perspectives from the point of student (Brazil), trainee (Portugal) and young doctor (India). The section on Brazil focuses on the response of the medical education system to the developments before and after political reforms, leading to creation of the Unified Health System. The Indian experience focuses on the challenges faced by recently qualified doctors and ongoing debates about the medical education system in a highly populated but rapidly growing economy. The Portuguese section presents an evolving primary care education system for family doctors and describes the detail of the training programme. Education in primary care is an ever-evolving process that needs to be adequate for each country's health care system. Reading and learning from other experiences may highlight education strategies that may be adopted by peers from other countries. Medical students, doctors in training and recently qualified doctors are the key stakeholders in this process.