Correction to: Exploring burnout and the association with the educational climate in pediatric residents in Thailand.

Following publication of the original article.

Exploring burnout and the association with the educational climate in pediatric residents in Thailand.

BACKGROUND: This study, undertaken in Bangkok, Thailand, explored the extent to which paediatric residents in a non-Western setting experienced burnout and the potential association with factors in the medical educational climate and work-related quality of life. METHODS: An exploratory sequential mixed methods design was employed in a cross-sectional study. The initial, quantitative phase used the validated Maslach Burnout Inventory, the Postgraduate Hospital Educational Environmental Measure (PHEEM) and Work-Related Quality of Life scale (WRQoL). Regression analysis was used to identify the correlation between burnout and educational climate. Thereafter, residents in all years with high levels of burnout on subscales were interviewed individually. RESULTS: Forty-one paediatric residents completed the three questionnaires. None had high levels related to burnout in all three domains (emotional exhaustion, high level of depersonalization and perceived low personal accomplishment), seven (17%) showed high levels in two out of three domains. Emotional exhaustion and educational climate (perceptions of role autonomy, perceptions of teaching, perceptions of social support) were correlated with work-related quality of life. In the interviews, the main themes related to burnout were inappropriate tasks, teachers and teaching styles, the perception of knowledge insecurity relating to task performance, time dimensions, life crisis during training, role expectations and work allocation clarity, and facilities such as accommodation. CONCLUSIONS: The study, in a non-Western setting, demonstrated a positive relation between educational climate and work-related quality of life. To help reduce the risk of burnout, the following factors were identified: minimize unnecessary or duplicated workload, schedule time arrangements to avoid extension of regular duty hours, and clearly define role expectations. The impact of inappropriate tasks, teachers and teaching styles (including unsafe environment) on the incidence of burnout was also highlighted. Additional studies focusing on teaching styles, safe learning climate and mistreatment in a non-Western context are needed.

Future doctors' perspectives on health professionals' responsibility regarding nutrition care and why doctors should learn about nutrition: A qualitative study.

Background: Improved dietary and nutrition behavior may help reduce the occurrence of noncommunicable diseases which have become global public health emergencies in recent times. However, doctors do not readily provide nutrition counseling to their patients. We explored medical students' perspectives on health professionals' nutrition care responsibility, and why doctors should learn about nutrition and provide nutrition care in the general practice setting. Methods: Semistructured interviews were conducted among 23 undergraduate clinical level medical students (referred to as future doctors). All interviews were recorded and transcribed verbatim with data analysis following a comparative, coding, and thematic process. Results: Future doctors were of the view that all health professionals who come into contact with patients in the general practice setting are responsible for the provision of nutrition care to patients. Next to nutritionists/dieticians, future doctors felt doctors should be more concerned with the nutrition of their patients than any other health-care professionals in the general practice setting. Reasons why doctors should be more concerned about nutrition were as follows: patients having regular contacts with the doctor; doctors being the first point of contact; patients having more trust in the doctors' advice; helping to meet the holistic approach to patient care; and the fact that nutrition plays an important role in health outcomes of the patient. Discussion: Future doctors perceived all health professionals to be responsible for nutrition care and underscored the need for doctors to learn about nutrition and to be concerned about the nutrition of their patients.

Why nutrition education is inadequate in the medical curriculum: a qualitative study of students' perspectives on barriers and strategies.

BACKGROUND: The provision of nutrition care by doctors is important in promoting healthy dietary habits, and such interventions can lead to reductions in disease morbidity, mortality, and medical costs. However, medical students and doctors report inadequate nutrition education and preparedness during their training at school. Previous studies investigating the inadequacy of nutrition education have not sufficiently evaluated the perspectives of students. In this study, students' perspectives on doctors' role in nutrition care, perceived barriers, and strategies to improve nutrition educational experiences are explored. METHODS: A total of 23 undergraduate clinical level medical students at the 5th to final year in the School of Medicine and Health Sciences of the University for Development Studies in Ghana were purposefully selected to participate in semi-structured individual interviews. Students expressed their opinions and experiences regarding the inadequacy of nutrition education in the curriculum. Each interview was audio-recorded and later transcribed verbatim. Using the constant comparison method, key themes were identified from the data and analysis was done simultaneously with data collection. RESULTS: Students opined that doctors have an important role to play in providing nutrition care to their patients. However, they felt their nutrition education was inadequate due to lack of priority for nutrition education, lack of faculty to provide nutrition education, poor application of nutrition science to clinical practice and poor collaboration with nutrition professionals. Students opined that their nutrition educational experiences will be improved if the following strategies were implemented: adoption of innovative teaching and learning strategies, early and comprehensive incorporation of nutrition as a theme throughout the curriculum, increasing awareness on the importance of nutrition education, reviewing and revision of the curriculum to incorporate nutrition, and involving nutrition/dietician specialists in medical education. CONCLUSION: Though students considered nutrition care as an important role for doctors they felt incapacitated by non-prioritisation of nutrition education, lack of faculty for teaching of nutrition education, poor application of nutrition science and poor collaboration with nutrition professionals. Incorporation of nutrition as a theme in medical education, improving collaboration, advocacy and creating enabling environments for nutrition education could address some of the barriers to nutrition education.

Orchestration of secretory protein folding by ER chaperones.

The endoplasmic reticulum is a major compartment of protein biogenesis in the cell, dedicated to production of secretory, membrane and organelle proteins. The secretome has distinct structural and post-translational characteristics, since folding in the ER occurs in an environment that is distinct in terms of its ionic composition, dynamics and requirements for quality control. The folding machinery in the ER therefore includes chaperones and folding enzymes that introduce, monitor and react to disulfide bonds, glycans, and fluctuations of luminal calcium. We describe the major chaperone networks in the lumen and discuss how they have distinct modes of operation that enable cells to accomplish highly efficient production of the secretome. This article is part of a Special Issue entitled: Functional and structural diversity of endoplasmic reticulum.

Does community health care require different competencies from physicians and nurses?

BACKGROUND: Recently competency approach in Health Professionals' Education (HPE) has become quite popular and for an effective competency based HPE, it is important to design the curriculum around the health care needs of the population to be served and on the expected roles of the health care providers. Unfortunately, in community settings roles of health providers tend to be described less clearly, particularly at the Primary Health Care (PHC) level where a multidisciplinary and appropriately prepared health team is generally lacking. Moreover, to tailor the education on community needs there is no substantial evidence on what specific requirements the providers must be prepared for. METHODS: This study has explored specific tasks of physicians and nurses employed to work in primary or secondary health care units in a context where there is a structural scarcity of community health care providers. In-depth Interviews of 11 physicians and 06 nurses working in community settings of Pakistan were conducted along with review of their job descriptions. RESULTS: At all levels of health settings, physicians' were mostly engaged with diagnosing and prescribing medical illness of patients coming to health center and nurses depending on their employer were either providing preventive health care activities, assisting physicians or occupied in day to day management of health center. Geographical location or level of health facility did not have major effect on the roles being expected or performed, however the factors that determined the roles performed by health providers were employer expectations, preparation of health providers for providing community based care, role clarity and availability of resources including health team at health facilities. CONCLUSIONS: Exploration of specific tasks of physicians and nurses working in community settings provide a useful framework to map competencies, and can help educators revisit the curricula and instructional designs accordingly. Furthermore, in community settings there are many synergies between the roles of physicians and nurses which could be simulated as learning activities; at the same time these two groups of health providers offer distinct sets of services, which must be harnessed to build effective, non-hierarchal, collaborative health teams.

Competence, commitment and opportunity: an exploration of faculty views and perceptions on community- based education.

BACKGROUND: Community-Based Education (CBE) is an instructional approach designed and carried out in a community context and environment in which not only students, but also faculty and Health Professionals' Education (HPE) institutions must be actively engaged throughout the educational experience. Despite the growing evidence of CBE being an effective approach for contemporary HPE, doubts about its successful implementation still exist. This study has explored HPE structure, policies and curriculum from the point of view of faculty members to gain understanding about the prevailing practices and to propose recommendations that nurtures and promotes CBE. METHOD: A purposive sample was drawn from three major cities of Pakistan- Karachi, Rawalpindi and Islamabad. Out of twelve HPE institutions present in these cities we selected six, which provided a sound representation of medical and nursing colleges around the country. At each institution we had two Focus Group Discussions; in addition we interviewed registrars of medical and nursing councils and two CBE experts. RESULTS: The factors effecting implementation of CBE as perceived by study participants are categorized as: preparation of faculty members; institutional commitment and enthusiasm; curricular priorities and external milieu. Within each theme, participants recurrently described structural and curricular deficiencies, and lack of commitment and appreciation for community based teaching, service and research permeating at all levels: regulatory bodies, institutional heads and faculty members. CONCLUSIONS: The factors highlighted by our study and many others suggest that CBE could not perpetuate effectively within HPE. To enhance the effectiveness of CBE approach in a way that mutually benefits local communities as well as HPE institutions and health professionals, it is important that reforms in HPE must be strategized in a holistic fashion i.e. restructuring and aligning its polices, curriculum and research priorities.

Phytochemical and biological investigations on Centranthus kellereri (Stoj., Stef. & T. Georgiev) Stoj. & Stef. and C. ruber (L.) DC. and their potential as new medicinal and ornamental plants.

INTRODUCTION: Centranthus kellereri is a Bulgarian endemic plant species, found only in two locations in the world: The Balkans Mountains (Stara Planina), above the town of Vratsa, and The Pirin Mountains, above the town of Bansko, Bulgaria. Being endemic and endangered species precluded any significant research on it. The hypothesis of this study was that the populations of C. kellereri may represent genetically, phytochemically, and morphologically distinct forms and these will differentiate from C. ruber. Furthermore, C. kellereri possibly imperfect embryology may preclude its more widespread distribution under natural conditions. RESULTS: This study revealed the phytochemical profile, antioxidant activity, embryology, surface microstructural morphological traits, and genetic differences between the C. kellereri plants from the only two natural populations and compares them to the ones of the related and better-known plant C. ruber. The essential oil (EO) content in aboveground plant parts and in roots was generally low and the EO composition varied significantly as a function of plant part, year of sampling, location, and species. Methylvaleric acid was a major EO constituent in the C. kellereri EO, ranging between 60.2% and 71.7% of the total EO. The EO included monoterpenes, sequiterpenes, long-chain alkanes and fatty acids. Phytochemical analyses of plant tissue revealed the occurrence of 32 compounds that were tentatively identified as 6 simple phenolics, 18 flavonoids, 1 quinone, 1 lipid, 1 alkaloid, 2 diterpenes, and 3 triterpenes. There were differences in detected compounds between the C. kellereri plants at the two locations and between the roots and shoots in both species. The total phenols and flavonoids varied between the two species but were also dissimilar between the plants from the two populations of C. kelleri. Free radical scavenging activity, measured with ABTS and DPPH in aqueous and methanol extracts, had similar values; however, overall, C. kellereri from Vratsa showed the highest antioxidant activity while C. ruber had the lowest activity. Genetic analyses showed a clear differentiation between C. kellereri and C. ruber, and between the two populations of C. kellereri. Embryological studies revealed the peculiarities of the male and female generative spheres of the two species that were defined as being sexually reproducing. The pollen had high viability; however, the low viability of seeds demonstrated possible high sensitivity of C. kellereri to the environmental conditions, perhaps the main factor modifying and restricting the population sizes. The SEM analyses exposed differences in surface microstructural traits between the species (C. kellereri and C. ruber) but also between the two populations of C. kellereri. The observed dissimilarities in genetic makeup, micromorphological characteristics, and phytochemical composition strongly indicate that the two populations can be classified as distinct subspecies or varieties of C. kellereri; var. pirinensis and var. balkanensis. Further research is needed to introduce C. kellereri into culture and develop it as a high-value specialty crop or ornamental in order to conserve C. kellereri natural populations. C. kellereri may be utilized as a source for phytochemicals of interest and as an ornamental plant like C. ruber; however, it may have a greater environmental plasticity and adaptation as evidenced by its current locations.

Globalization and the modernization of medical education.

BACKGROUND: Worldwide, there are essential differences underpinning what educators and students perceive to be effective medical education. Yet, the world looks on for a recipe or easy formula for the globalization of medical education. AIMS: This article examines the assumptions, main beliefs, and impact of globalization on medical education as a carrier of modernity. METHODS: The article explores the cultural and social structures for the successful utilization of learning approaches within medical education. Empirical examples are problem-based learning (PBL) at two medical schools in Jamaica and the Netherlands, respectively. RESULTS: Our analysis shows that people do not just naturally work well together. Deliberate efforts to build group culture for effective and efficient collaborative practice are required. Successful PBL is predicated on effective communication skills, which are culturally defined in that they require common points of understanding of reality. Commonality in cultural practices and expectations do not exist beforehand but must be clearly and deliberately created. CONCLUSIONS: The globalization of medical education is more than the import of instructional designs. It includes Western models of social organization requiring deep reflection and adaptation to ensure its success in different environments and among different groups.

Competencies for undergraduate community-based education for the health professions--a systematic review.

BACKGROUND: Community-based education (CBE) along with competency approach is increasingly becoming popular. However, there appears to be lack of evidence on CBE competencies for undergraduate curriculum, therefore this systematic review attempted to identify and categorize CBE competencies to determine the ones used frequently. AIMS: The systematic review aimed at identifying and categorizing CBE competencies implemented in nursing and medical schools to inform all stakeholders of health professional's education. METHOD: A systematic review of electronic databases including MEDLINE, CINAHL, and ERIC and manual search of four medical education journals was carried out. Search was restricted to original research, published in English language between January 2000 and December 2009. RESULTS: Nineteen studies fulfilled the search criteria. The competencies identified were categorized under six themes: Public Health; Cultural Competence; Leadership and Management; Community Development; Research; and Generic Competencies. Moreover, a number of clinical competencies were also found to be overlapping with CBE. CONCLUSIONS: The literature on CBE competencies is limited in number and in its geographical span as most of the studies found was from developed countries; to expand the efforts to other institutions and countries, core competencies for CBE must be recognized and disseminated widely for its integration in health professionals' curriculum.

"For most of us Africans, we don't just speak": a qualitative investigation into collaborative heterogeneous PBL group learning.

Collaborative approaches such as Problem Based Learning (PBL) may provide the opportunity to bring together diverse students but their efficacy in practice and the complications that arise due to the mixed ethnicity needs further investigation. This study explores the key advantages and problems of heterogeneous PBL groups from the students' and teachers' opinions. Focus groups were conducted with a stratified sample of second year medical students and their PBL teachers. We found that students working in heterogeneous groupings interact with students with whom they don't normally interact with, learn a lot more from each other because of their differences in language and academic preparedness and become better prepared for their future professions in multicultural societies. On the other hand we found students segregating in the tutorials along racial lines and that status factors disempowered students and subsequently their productivity. Among the challenges was also that academic and language diversity hindered student learning. In light of these the recommendations were that teachers need special diversity training to deal with heterogeneous groups and the tensions that arise. Attention should be given to create 'the right mix' for group learning in diverse student populations. The findings demonstrate that collaborative heterogeneous learning has two sides that need to be balanced. On the positive end we have the 'ideology' behind mixing diverse students and on the negative the 'practice' behind mixing students. More research is needed to explore these variations and their efficacy in more detail.

Dirofilaria immitis infection in dogs from underserved, Native American reservations in the United States.

Blood samples from 1,822 dogs residing on Native American reservations in 10 states were collected between February 2004 and August 2007. Samples were examined using a commercial enzyme-linked immunosorbent assay (ELISA) antigen capture test. All ELISA-positive samples were subsequently examined for microfilaremia. All dogs were asymptomatic for Dirofilaria immitis infection, resided outside (except for winter in the Northern latitudes), not on prophylaxis for D. immitis, and had not traveled off of the reservation. Reservations were characterized by degrees of north latitude, true prevalence of D. immitis, and a reproductive index calculated by multiplying the number of months of the year in which infective stage larvae (L(3)) could develop in 30 days or less for each reservation by the 30 yr mean annual rainfall in centimeters recorded for that community. The prevalence of heartworm was directly related to the reproductive index on each reservation.

Traditional ELISA methods for antibody affinity determination fail to reveal the presence of low affinity antibodies in antisera: an alternative approach.

Traditionally used methods of antibody affinity determination either by ELISA or by the surface plasmon resonance technique do not allow detection of the presence of low-affinity antibodies in samples of high-affinity antibodies. In this paper we demonstrate the possibility to reveal their presence and to determine the affinities of both categories of antibodies as well as the ratio of their concentrations. This is especially important since by using traditional methods for antibody affinity evaluation the admixture of low-affinity antibodies in a sample diminishes the accuracy in determination of specific antibody affinity. In addition, the presence of an admixture of low-affinity antibodies may be an important biological characteristic of the system under study; their revelation and the evaluation of their binding parameters may be valuable in many cases for obtaining a more complete characterization of the binding properties of the multiple antibodies generated in an immune response.

Depressive disorders in Thai medical students: an exploratory study of institutional, cultural, and individual factors.

OBJECTIVES: This exploratory qualitative study conducted among Thai medical students aimed to investigate factors related to the development of medical students' depression and how these factors interact in contributing to depressive disorders. METHODS: Forty-three undergraduate medical students of the six-year Doctor of Medicine program were identified as having moderate to severe depression on an annual depression screening. From these, eighteen students agreed to participate in individual in-depth interviews. Transcriptions of the interviews were analyzed by independent reviewers using a thematic analysis approach. RESULTS: Among 43 participants screened as having moderate-to-severe depression, major depressive disorder and adjustment disorder were 9.3% and 14.0%, respectively. Reported factors related to medical students' disorders were personal vulnerabilities, medical educational administration, academic achievement, learning environment, intrinsic motivation, self-care and self-management, relationship, and community. In particular, lack of social support and relationship problems were mentioned among those with more severe and persistent symptoms. Protective factors were social support, positive relationships, a growth mindset, spiritual and mindfulness practices, and an adequate mentoring program. CONCLUSIONS: Medical students' depression and suicidal ideations are significant concerns in Thai medical education. Besides personal vulnerabilities, high expectations, the value placed on academic achievement, and relationship problems can precipitate the onset of depressive disorders, if not being properly addressed. The 4P framework of predisposing, precipitating, perpetuating, and protective factors are suggested to understand the onset and development of students' depressive disorders and to identify targets for institutional and educational intervention.

The development of PIPA: an integrated and automated pipeline for genome-wide protein function annotation.

BACKGROUND: Automated protein function prediction methods are needed to keep pace with high-throughput sequencing. With the existence of many programs and databases for inferring different protein functions, a pipeline that properly integrates these resources will benefit from the advantages of each method. However, integrated systems usually do not provide mechanisms to generate customized databases to predict particular protein functions. Here, we describe a tool termed PIPA (Pipeline for Protein Annotation) that has these capabilities. RESULTS: PIPA annotates protein functions by combining the results of multiple programs and databases, such as InterPro and the Conserved Domains Database, into common Gene Ontology (GO) terms. The major algorithms implemented in PIPA are: (1) a profile database generation algorithm, which generates customized profile databases to predict particular protein functions, (2) an automated ontology mapping generation algorithm, which maps various classification schemes into GO, and (3) a consensus algorithm to reconcile annotations from the integrated programs and databases.PIPA's profile generation algorithm is employed to construct the enzyme profile database CatFam, which predicts catalytic functions described by Enzyme Commission (EC) numbers. Validation tests show that CatFam yields average recall and precision larger than 95.0%. CatFam is integrated with PIPA. We use an association rule mining algorithm to automatically generate mappings between terms of two ontologies from annotated sample proteins. Incorporating the ontologies' hierarchical topology into the algorithm increases the number of generated mappings. In particular, it generates 40.0% additional mappings from the Clusters of Orthologous Groups (COG) to EC numbers and a six-fold increase in mappings from COG to GO terms. The mappings to EC numbers show a very high precision (99.8%) and recall (96.6%), while the mappings to GO terms show moderate precision (80.0%) and low recall (33.0%). Our consensus algorithm for GO annotation is based on the computation and propagation of likelihood scores associated with GO terms. The test results suggest that, for a given recall, the application of the consensus algorithm yields higher precision than when consensus is not used. CONCLUSION: The algorithms implemented in PIPA provide automated genome-wide protein function annotation based on reconciled predictions from multiple resources.

Beyond host-pathogen interactions: microbial defense strategy in the host environment.

Many extracellular pathogenic bacteria colonize human or animal bodies through evasion of the host immune system, a process called host-pathogen interaction. What happens when other intruders try to invade the same host and try to establish themselves in the same niche is largely unknown. In one well-studied case, Pseudomonas aeruginosa is known to secrete the protein azurin as a weapon against such invaders as cancers, parasites and viruses. The production of such weapons by pathogenic bacteria could provide important insights into how a pathogen responds in the post-colonization state to impede other intruders for its own survival. Moreover, these molecules might find use in the pharmaceutical industry as next-generation therapeutics.

The impact of clerkships on students' specialty preferences: what do undergraduates learn for their profession?

OBJECTIVE: Clinical experiences and gender have been shown to influence medical students' specialty choices. It remains unclear, however, which aspects of experiences make students favour some specialties and reject others. This study aimed to clarify the effects of clerkships on specialty choice and to identify explanatory factors. METHODS: We carried out a longitudinal cohort study to collect data on career preferences and attitudes towards future careers among 3 cohorts of students before and after clerkships in surgery (n = 200), internal medicine (n = 277) and general practice (n = 184). Regression analyses were performed to identify the determinants of career choice and the role of gender. RESULTS: Exposure to clinical settings encourages students to opt for a career in the corresponding specialty. Men were more stimulated than women by the general practice clerkship. Gender had no clear role as a predictor of career preference. The major predictor of career choice in all 3 specialties was positive evaluation of work-intrinsic factors. A preference for working with acute patients and technology-oriented work, prestige orientation and insignificance of a controllable lifestyle were determinants of a preference for surgery. Students with a preference for general practice had almost opposite preferences. Those who chose internal medicine favoured a controllable lifestyle. DISCUSSION: Factors other than gender appear to drive specialty decisions. Work content, type of patients and lifestyle options play major roles. Consequently, along with teaching about the practice of medicine, the matching of specialty preferences with reality is an essential outcome of clerkships.

Shortage in general practice despite the feminisation of the medical workforce: a seeming paradox? A cohort study.

BACKGROUND: Female medical students often prefer primary care specialties, while male students appear to be attracted to hospital specialties. Notwithstanding the steady feminisation of medicine, in many countries there are still difficulties in recruiting trainees for general practice. This seeming paradox raises the question on what specific role gender plays in a specialty choice. The authors looked at the (a) the role of gender in general practice specialty choice of Dutch medical students, (b) the decisive factors in career choice and relation of gender to these, and (c) differences in how male and female students are influenced by the GP clerkship. METHODS: A cohort of 206 final year medical students at the Maastricht University, the Netherlands were asked to complete a questionnaire focusing on career preferences before and after a 12-week general practice clerkship and at graduation, a couple of months later. RESULTS: Gender was significantly related to willingness to become a GP in bivariate analysis. Adding variables in multivariate analysis made this effect disappear. While females expressed overall higher preference for general practice than males, after the GP clerkship likelihood of choosing general practice increased with 38% among male and 22% among female students. After graduation, interest in general practice had dropped, mainly among females. Attitudes predicting a GP career choice were: extrinsic career motivation before the clerkship, and the content of GP work (patient contacts, treatments) and motivation to work with chronic and palliative patients after the clerkship. CONCLUSION: Gender 'as such' appeared not to be a distinctive predictor of specialty choice. It is students' attitudes towards GP work and preferred patient category that determine the career choice in general practice. However, more male students were positively influenced by the GP clerkship than female students. The motivating effect of the clerkship is not long lasting. Especially female graduates change their interest in favour of other specialties, which may explain why eventually few students choose general practice. It might be worthwhile to reinforce an initial preference for general practice by motivational guidance throughout the whole period of clerkships.

Gender shift in realisation of preferred type of GP practice: longitudinal survey over the last 25 years.

BACKGROUND: An increasing number of newly trained Dutch GPs prefer to work in a group practice and as a non-principal rather than in a single-handed practice. In view of the greater number of female doctors, changing practice preferences, and discussions on future workforce problems, the question is whether male and female GPs were able to realise their initial preferences in the past and will be able to do so in the future. METHODS: We have conducted longitudinal cohort study of all GPs in the Netherlands seeking a practice between 1980 and 2004. The Netherlands Institute of Health Services Research (NIVEL) in Utrecht collected the data used in this study by means of a postal questionnaire. The overall mean response rate was 94%. RESULTS: Over the past 20 years, an increasing proportion of GPs, both male and female, were able to achieve their preference for working in a group practice and/or in a non-principal position. Relatively more women than men have settled in group practices, and more men than women in single-handed practices; however, the practice preference of men and women is beginning to converge. Dropout was highest among the GPs without any specific practice preference. CONCLUSION: The overwhelming preference of male and female GPs for working in group practices is apparently being met by the number of positions (principal or non-principal) available in group practices. The preference of male and female GPs regarding the type of practice and job conditions is expected to converge further in the near future.

Master of Public Health programmes in South Africa: issues and challenges.

BACKGROUND: The demand for highly skilled public health personnel in low- and middle-income countries has been recognised globally. In South Africa, the need to train more public health professionals has been acknowledged. The Human Resource for Health (HRH) Strategy for South Africa includes the establishment of public health units at district and provincial levels. Programmes such as Master of Public Health (MPH) programmes are viewed as essential contributors in equipping health practitioners with adequate public health skills to meet the demands of the health care system. All MPH programmes have been instituted independently; there is no systematic information or comparison of programmes and requirements across institutions. This study aims to establish a baseline on MPH programmes in South Africa in terms of programme characteristics, curriculum, teaching workforce and graduate output. METHODS: A mixed method design was implemented. A document analysis and cross-sectional descriptive survey, comprising both quantitative and qualitative data collection, by means of questionnaires, of all MPH programmes active in 2014 was conducted. The MPH programme coordinators of the 10 active programmes were invited to participate in the study via email. Numeric data were summarized in frequency distribution tables. Non-numeric data was captured, collated into one file and thematically analysed. RESULTS: A total of eight MPH programmes responded to the questionnaire. Most programmes are affiliated to medical schools and provide a wide range of specialisations. The MPH programmes are run by individual universities and tend to have their own quality assurance, validation and assessment procedures with minimal external scrutiny. National core competencies for MPH programmes have not been determined. All programmes are battling to provide an appropriate supply of well-trained public health professionals as a result of drop-out, low throughput and delayed time to completion. CONCLUSION: The MPH programmes have consistently graduated MPH candidates, although the numbers differ by institution. The increasing number of enrolments coupled by insufficient teaching personnel and low graduate output are key challenges impacting on the production of public health professionals. Collaboration amongst the MPH programmes, standardization, quality assurance and benchmarking needs considerable attention.