Physician migration at its roots: a study on the emigration preferences and plans among medical students in Romania.

BACKGROUND: Migration of healthcare workers is receiving increased attention worldwide. In Europe, the creation of a border-free labor market and its expansion with the EU enlargements of 2004, 2007, and 2013 endowed health professionals with the right to provide services and to relocate to another EU Member State. For the Romanian doctors, the EU-wide recognition of the medical degree obtained in Romania has created new opportunities, while inadequate working conditions and relatively low salaries pushed many of them to search for employment abroad. As there is considerable uncertainty about the magnitude of the Romanian physicians' exodus, we performed a survey to assess the emigration intention of future Romanian doctors. METHODS: The study was conducted over three consecutive years: 2013, 2014, and 2015 at the University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Romania. The self-administrated questionnaire included 19 questions regarding students' emigration intentions. RESULTS: All the 957 license-degree students participated in the study. In this study, 84.7% of subjects planned on seeking employment abroad after graduation. A large number of the students who have participated in the study have already started preparing for emigration, 21.7% of those who wished to migrate had already performed at least one Erasmus mobility in their country of choice, 44.5% have been enrolled in a language course, and 42.7% have searched for jobs on the Internet. CONCLUSIONS: The majority of Romanian medical students considering migration see it as a serious alternative to the continuation of their professional training started in Romania. The findings of this study are upsetting and can impact both policy crafting and future research. Structural reforms in the healthcare provisions are needed in order to facilitate the retention of medical personnel. Romanian policy makers need to devise a comprehensive national health workforce plan to deal with physician migration.

Shifting Horizons: The Impact of Global Events on the Intention to Migrate of the Next Generation Romanian Nurses.

BACKGROUND: This article investigates the determinants of the intention to migrate of nursing students at a major medical university in Romania and relates them to major international developments, specifically the Brexit referendum and the COVID-19 pandemic. METHODS: An online survey about the intention to migrate was made available to nursing students at the University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania, in 2016 (before Brexit) and again in 2016 (after Brexit), 2017, 2018, and 2021 and 2022 (during the pandemic). A total of 549 students responded (response rate: 84.6%). RESULTS: Before the Brexit referendum, 62.6% of the respondents had a plan to seek employment abroad, whereas after the Brexit referendum, only 34.7% indicated that they had such a plan after graduation. Before the pandemic, 43.6% of the students expressed an intention to work abroad, while during the pandemic, only 19.8% had such plans. CONCLUSIONS: This study documented the effect of significant international developments-such as the Brexit referendum and the COVID-19 pandemic-on decreasing the intention to migrate. As expected, the change in preference for the UK as a destination country changed dramatically. Additionally, the study provides both theoretical and empirical insights into the types of and the consistency of preparation for migration of nursing students.

Evaluation of Various Detection Strategies in the Assessment of Noncredible Memory Performance: Results of Two Experimental Studies.

OBJECTIVE: This article investigates the accuracy of individual and combined indicators based on different strategies for detecting noncredible performance as part of a new test for the continuous assessment of short-term memory. METHOD: In two independent studies, we assessed three groups of simulators, cognitively impaired patients, and nonimpaired community members with four tasks separated by a distractor. RESULTS: Pairwise comparisons between receiver operating characteristic (ROC) curves revealed significant differences between two clusters of indicators: mean recognition, inconsistent responses in recognition, and false positives (area under the ROC curves > .800) proved more accurate than delayed recall and false negatives (area under the ROC curves < .800) in discriminating simulators from patients. Likewise, both studies revealed that adding the false positives indicator based on cued recall to mean recognition incrementally improved classification accuracy (including sensitivity, positive predictive value, and negative predictive value ) compared with the recognition indicator alone. CONCLUSIONS: Our results support the association of two distinct indicators for the assessment of noncredible performance, of which one should be a forced-choice indicator.