Cambodia's health professionals and the ASEAN Mutual Recognition Arrangements: registration, education and mobility.

BACKGROUND: From 2006, the Association of South East Asian Nations (ASEAN) has been developing Mutual Recognition Arrangements (MRAs) across key professions, including medicine, dentistry and nursing, that would facilitate the development of an ASEAN Economic Community, with shared regional standards and easier mobility of the workforce. This paper examines the interface between those agreements and the registration, professional education and mobility of health personnel in Cambodia. METHODS: This qualitative health policy analysis combined documentary and policy review with key informant interviews with 16 representatives of agencies relevant to the development and implementation of the MRAs in health. Thematic analysis identified three themes: registration, education and mobility. RESULTS: Cambodia is an active participant in the ASEAN MRA processes for doctors, dentists and nurses reporting progress annually. Education of health professionals has been increasingly formalised in the past 25 years, with nursing moving towards a 4-year bachelor degree. The private university sector has substantially increased, with English increasingly used as a language of instruction. Recent legislation provides for enforcement through fines and/or imprisonment to ensure all practising health professionals hold initial registration as a health professional and a renewable licence to practise as a health practitioner. Continuing Professional Development is a mandatory requirement for licence renewal. This is consistent with the MRA guidelines, though the capacity for enforcement appears limited. The Medical Council of Cambodia (MCC), and more recently, the Dental and Nursing Councils, have introduced continuing professional development initiatives, using them strategically as a positive reinforcer of registration. Midwifery education and registration in Cambodia does not conform with ASEAN guidelines. In education, course durations in medicine and dentistry are longer than regional counterparts, though anxiety around maintaining clinical standards has resulted in the introduction of a National Exit Examination and reluctance to abbreviate courses. The introduction of reforms appears to reference regional standards, though parity is still some way off. Mobility at present is infrequent and more likely to result from informal mechanisms than through the MRA mechanisms. CONCLUSION: The Royal Government of Cambodia is committed to the ASEAN MRA process. Developments in registration appear to use regional standards as benchmarks, as do reforms in the education of health professionals, though domestic factors appear to more directly impact on developments. Informal mechanisms facilitate the limited mobility currently occurring, with little formal application of the MRA provisions evident at this point.

A representação de educação linguística de imigrantes no Brasil / The Representation of Linguistic Education of Immigrants In Brazil

O presente artigo teve como objetivo explicar a representação de educação linguística de imigrantes no Brasil. A base teórica do estudo é a Historiografia Linguística (HL), cujas pesquisas visam à reconstrução do conhecimento sobre as línguas e linguagem humana em diferentes recortes temporais. Do tipo documental, o estudo tem como corpus as narrativas jornalísticas veiculadas durante o período de 1900 a 2015 na imprensa catarinense. Os jornais escolhidos como fontes para a obtenção dos dados foram: O Estado e Diário Catarinense. Adotou-se, para o tratamento dos dados, a técnica de análise de conteúdo. Os resultados foram analisados em três seções distintas. A primeira seção referiu-se ao período da Primeira Campanha de Nacionalização, na qual se discutiu a representação de educação linguística: escolas nacionalizadoras para assimilação do imigrante. A segunda referiu-se ao período da Segunda Campanha de Nacionalização, tendo como categorias: as práticas monoculturais e monolíngues nas escolas nacionalizadoras. A terceira intitulou-se a redemocratização, com as categorias: bilinguismo na escola e bilinguismo fora da escola. Os resultados indicam a superação de um passado em que se silenciava, por meio de medidas coercitivas, para dar lugar a um contexto em que se presenciam certa tolerância e proteção da diversidade linguístico-cultural existente no país.

This article explains the representation of linguistic education of immigrants in Brazil. The theoretical framework of the study is based on Linguistic Historiography (LH), which addresses the reconstruction of knowledge about languages and human language in different periods of time. This is a documentary type study, with a corpus consisting of journalistic narratives published between 1900 to 2015 in the Santa Catarina press. The newspapers chosen as sources for the document corpus were: O Estado and Diário Catarinense. For the data processing, the technique of content analysis. The results were analyzed in three distinct sections. The first section focuses on the First Nationalization Campaign period, in which we discuss the representation of inguistic education: nationalizing schools for the assimilation of immigrants. The second section focuses on the Second Nationalization Campaign. The categories discussed in this section are the representation of linguistic education; and monocultural and monolingual practices in nationalizing schools. The third section refers to the period from redemocratization. The categories addressed in this section are representation of linguistic education: bilingualism in school and out of school. The results indicate the legislative policies of recent years have overcome a past that was silenced through coercive policies, replacing it with a context marked by a certain tolerance and protection of the linguistic and cultural diversity that exist in the country.

Professional integration as a process of professional resocialization: internationally educated health professionals in Canada.

This paper examines the process of professional resocialization among internationally educated health care professionals (IEHPs) in Canada. Analyzing data from qualitative interviews with 179 internationally educated physicians, nurses, and midwives and 70 federal, provincial and regional stakeholders involved in integration of IEHPs, we examine (1) which aspects of professional work are modified in transition to a new health care system; (2) which aspects of professional practice are learned by IEHPs in the new health environment, and (3) how IEHPs maintain their professional identity in transition to a new health care system. In doing so, we compare the accounts of IEHPs with the policy stakeholders' positions and analyze the similarities and the differences across three health care professions (medicine, nursing, and midwifery). This enables us to explore the issue of professional resocialization from the analytical intersection of gender, professional dominance, and institutional/organizational lenses.

Comparing the treatment provided by UK and non-UK trained health professionals: dentists in Scotland.

OBJECTIVES: To examine differences in the amount of treatment provided by UK and non-UK trained dentists in the Scottish National Health Service. METHODS: Using a unique administrative data set, we utilize multivariate fixed effects regression models that control for patient characteristics and unobserved heterogeneity across dentists to explore the extent of treatment delivered. RESULTS: Non-UK trained dentists initially provide more treatment than UK-trained dentists, but over approximately two years of practice their treatment converge. CONCLUSIONS: As with many OECD countries, the UK relies on foreign-trained health professionals to address workforce shortages and one concern is whether they provide equivalent health care to their domestically trained counterparts. Whilst there is a difference in the amount of treatment provided by UK and non-UK trained dentists, the effect is modest and transitory.

Rediscovering nursing: a study of overseas nurses working in Western Australia.

The shortage of nurses worldwide has taken its toll on the Australian healthcare system and, as a result, there is an increased migration of overseas-qualified nurses, some of them with a non-English-speaking background. Despite Australia's regulations that assess the eligibility for nursing registration, many migrant nurses who have been successful in gaining their nursing license feel only partially prepared to work. This article presents the findings of a study, based on Husserlian phenomenology, that describes the work experience of 13 female nurses who were working in Western Australia, Australia. The participants, who could recognize the core components of nursing, were taken aback by the way that nursing is practised in Western Australia. The major differences that they encountered were related to clinical skills, holistic care, the work dynamic with doctors and patients, and the overall societal status of the nursing profession. As a result, they had to adjust their practice to conform to the new work environment. In this study, the participants elaborated on some positive and some not-so-positive aspects of their experiences in their endeavor to integrate into the Western Australian metropolitan hospital setting.

Midwives on the move: comparing the requirements for practice and integration contexts for internationally educated midwives in Canada with the U.S., U.K. and Australia.

Midwives have long been internationally mobile, but there has been relatively little attention paid to the requirements that internationally educated midwives (IEMs) must meet to practice and become integrated into the health-care systems of their destination country. This paper examines from a comparative perspective the policy context and integration procedures that IEMs must follow in order to practice in Canada and how this compares with the U.S., the U.K., and Australia. The data upon which this paper is based are largely derived from an analysis of documents and websites for key organisations involved in the integration process supplemented with interviews with key informants influential in the assessment and integration of IEMs. What these data reveal is that the challenges for IEMs derive in large part from the differences in entry to practice requirements-midwifery and nursing training in three of the cases, baccalaureate training in one. Another critical factor is whether bridging or adaptation programmes are available (rarely in the U.S.), and whether they focus more on orientation objectives (as they do in the U.K. and Australia) or also the upgrading of skills (as they do in Canada) critical for IEM professional integration. These different approaches to the integration of IEMs have important implications for the 'brain drain' and 'brain waste' of much needed midwifery skills in both source and destination countries.

Finding a way: the experiences of U.K. educated midwives finding their place in the midwifery workforce in Australia.

BACKGROUND: The number of midwives and nurses migrating from the United Kingdom (U.K.) and seeking registration in Australia is growing annually. Studies examining nurse migration have yet to identify features of the experience that apply specifically to the midwifery workforce. This information is vital to inform future international recruitment practice and to promote midwifery retention. This paper reports on a study examining the experiences of a group of midwives from the United Kingdom settling into the workforce within one state in Australia. DESIGN: This descriptive phenomenological study examined the lived experience of U.K. migrant midwives practising in Queensland using open ended interviews and reflective journaling. Data analysis was conducted following the guidance of Moustakas, adapted from the van Kaam method of analysis of phenomenological data. SETTING: All data gathered from midwives living and working in Queensland. PARTICIPANTS: Midwives (n=18) working in Queensland who had left the U.K. after 1 January 2000. FINDINGS: A central theme emerging from participants' experiences is described as 'finding a way'. Their experience was encompassed in a model of acculturation used by the midwives to find their way through the health-care systems in Queensland to be the kind of midwife that suited them and their life style. The three ways of being were influential association, capitulation and detachment. The most common feature of the experience was that of influential association. KEY CONCLUSIONS: Midwives need to be well informed to provide realistic expectations prior to migration. Recruitment and management personnel should seek to match midwifery capacity with roles where their skills will be maximised.

The nursing workforce in Kuwait to the year 2020.

BACKGROUND: The study addresses the supply and demand for nurses in Kuwait in the light of emerging variables such as increasing population, economic growth, changes in healthcare strategies and expansion of healthcare facilities. OBJECTIVE: To project the future demand for nurses in Kuwait for the years 2007-2020 based on the period 1994-2006. METHODS: Population projections were derived using the average annual natural increase rate of the 1994-2006 populations. The future demand for nurses was projected using the average nurse to population ratios for the years 1994-2006. FINDINGS: The number of Kuwaiti indigenous nurses is declining at an average decrement rate of 3.3% per annum. There is a gap between the numbers of native and migrant nurses, which will be wider with time. In 2006, native nurses constituted only 6.6% of the nursing workforce; this affects the quality of provided health care owing to language, religions and socio-cultural barriers between foreign nurses and patients. CONCLUSIONS: The supply of indigenous nurses in Kuwait should be increased in order to deliver effective nursing care with shared culture and language in the modern healthcare system of Kuwait. This can be achieved through an improvement in recruitment and retention of indigenous nurses and nursing students.

An exploratory survey of Spanish and English nursing students' views on studying or working abroad.

BACKGROUND: Student mobility within Europe is encouraged by the EU's 'Bologna process' and financially supported by the Socrates programme. However, relatively few UK nursing students travel to Europe for study. AIMS: To compare the willingness to study or work abroad and the perceived barriers and benefits of doing so, amongst students in England and Spain. METHODS: Third year nursing students completed a 15 item questionnaire on work and study abroad. RESULTS: Spanish students were younger than UK students, had fewer family commitments, and better language skills. There was little difference between Spanish and UK students in wanting to study abroad, UK students named English speaking countries as likely destinations. Spanish students named Italy; the UK and USA were also popular. Perceived barriers for UK students were funding, family, and language. Family commitments were not a major problem for Spanish students. Spanish were more likely than English students to see language as a problem. CONCLUSIONS: UK and Spanish Nursing students are equally enthusiastic about studying or working abroad but UK students have limited language skills, are less able to access Socrates funding for European destinations, and given their age and family commitments, funding is a barrier for 'non-Socrates' destinations.