[Teaching assistants in Argentina have greater intentions to migrate abroad as physicians than other medical students] / Los ayudantes de cátedra en Argentina tienen mayores intenciones de migrar al extranjero como médicos que otros estudiantes de Medicina.

Introduction: The brain drain of physicians from lower-middle-income countries to high-income countries is a growing phenomenon that contributes to global health inequalities. Retention strategies are difficult to implement locally and to specifically target the population at risk of migrating. We hypothesize that medical students who are teaching assistants have greater intentions to migrate to practice Medicine abroad. Methods: Medical students from Argentina were invited to an online survey of 22 multiple-choice questions based on the LIRHUS Network survey, previously used in Latin America. Results: 2,301 medical students were enrolled. Most were young (23 [20-25] years old), single (90%), and female (79%). The majority studied at public universities (87%). The intention to migrate to practice Medicine abroad was more frequent among teaching assistants (36% vs 31%; χ2 = 4.4982; p = 0.0339). After adjusting for sex and age, being a teaching assistant was associated with the intention to migrate to practice Medicine abroad (OR = 1.26; 95% CI 1.02 - 1.55; p = 0.002). Conclusions: Argentine teaching assistants have a greater risk of migrating to practice Medicine abroad. Given their high academic profile, these are valuable human resources trained using the public financing of low-middle-income countries. The loss of these resources could contribute to health inequalities. This is an easily identifiable and accessible subgroup toward which local retention policies could be directed.

Introducción: La fuga de cerebros de médicos de países de ingresos medianos- bajos a países de ingresos altos es un fenómeno creciente que contribuye a las desigualdades mundiales en salud. Las estrategias de retención son difíciles de implementar localmente y de dirigir específicamente a la población en riesgo de migrar. Hipotetizamos que los estudiantes de Medicina que son ayudantes tienen mayores intenciones de migrar para ejercer la Medicina en el extranjero. Métodos: Estudiantes de Medicina de Argentina fueron invitados a una encuesta online de 22 preguntas de opción múltiple basada en la encuesta de la Red LIRHUS, previamente utilizada en América Latina. Resultados: Se enrolaron 2.301 estudiantes de Medicina. La mayoría eran jóvenes (23 [20-25] años), solteras (90%) y mujeres (79%). La mayoría estudiaba en universidades públicas (87%). La intención de migrar para ejercer la Medicina en el extranjero fue más frecuente entre los ayudantes (36% vs 31%; χ2 = 4,4982; p = 0,0339). Después de ajustar por sexo y edad, ser ayudante se asoció con la intención de migrar para ejercer la Medicina (OR = 1,26; IC 95% 1,02 - 1,55; p = 0,002). Conclusiones: Los ayudantes argentinos tienen mayor riesgo de migrar para ejercer la Medicina en el exterior. Dado su alto perfil académico, se trata de recursos humanos valiosos formados con la financiación pública de un país de ingresos medianos-bajos, cuya pérdida puede contribuir a las desigualdades en salud. Es un subgrupo fácilmente identificable y accesible hacia el que se pueden dirigir políticas de retención locales.

Where are they working? A case study of twenty Cuban-trained South African doctors.

BACKGROUND: The year 2017 marked the 21st anniversary of the South African Cuban Medical Collaboration (SACMC) programme that offers disadvantaged South African (SA) students an opportunity for medical training in Cuba. Graduates are expected to return to practice at a primary care level in rural communities; however, little is known about the professional trajectories and career choices of graduates from the programme. AIM: This study explored the reasons why students enrolled in the programme, their professional and career choices as graduates and their career intentions. SETTING: The study setting was the whole of SA although participants were primarily drawn from KwaZulu-Natal. METHODS: An exploratory, qualitative case study used a purposive sampling strategy to gather data through semi-structured interviews from participants. RESULTS: Graduates (N = 20) of the SACMC programme were all practicing in local SA settings. Participants preferred the SACMC programme as it offered them a full scholarship for medical training. Nineteen doctors had fulfilled their obligation to work in rural areas. Thirteen doctors are engaged in primary healthcare practice, either as private practice generalists or as public service medical officers. Three doctors had completed specialty training: one doctor was training towards specialisation, one doctor was employed at national government and two doctors were employed as medical managers. At the time of the study, 11 doctors were practicing in rural locations and 19 had indicated a long-term intention to work and live within South Africa. CONCLUSION: The participants of this study who graduated from the SACMC programme are fulfilling their obligations in rural communities. They all intend to contribute to the SA medical workforce in the long-term.

Global Health Education at Home: Canadian Medical Students' Perspectives After Learning Alongside Haitian Peers.

PURPOSE: To explore how host medical students learn from visiting foreign students, by reporting on a global health program that has invited two or three Haitian medical students each year since 2013 to a Canadian medical school for a summer anatomy program. METHOD: In 2017, the authors conducted a qualitative descriptive study that collected data through one-on-one, semistructured interviews with 10 Canadian students, who participated in the Université Quisqueya-McGill University collaborative, a bidirectional global health education initiative, 2013-2016. The authors' critical constructivist thematic analysis, while exploratory, was sensitized by their knowledge of contemporary frameworks of global health competencies, a postcolonial understanding of power relations, and three key concepts (agency, cultural humility, and reflexivity). RESULTS: The authors found two phenomena related to bidirectional exchange: the nature of the relationship between Canadian and Haitian students, and elements of the learning experience that facilitated transformation and growth. There were three important components to the nature of the relationship between Canadian and Haitian students-reflection on practices and privilege, negotiation of power dynamics, and perception of Haitian students as agents-and three components of the learning experience that facilitated transformation and growth-working in groups, common learning objectives, and informal social gatherings. CONCLUSIONS: Bidirectional programs may have implications for Canadian students' perception of the agency of international medical learners and may prompt self-reflection that manifests in a range of ways, including an experience of culture shock at home. These tensions seemed to create space to practice reflexivity and cultural humility.

Riesgos psicosociales e integración profesional de médicos extranjeros: Un estudio sobre el manejo del conflicto en Chile / Psychosocial risks and professional integration of foreign physicians: a study on conflict management in Chile

Background: The way in which communicative conflicts are confronted, as part of the acculturation process, can constitute a psychosocial risk factor that may affect the effectiveness of health care delivery. Aim: To describe the levels of dominance, adaptability and evasion as indicators of the way in which conflict situations are faced in the workplace by foreign physicians in the management of communicative conflicts. Materials and Methods: A self-report questionnaire was answered by 51 foreign physicians (63% women, 76% Venezuelans, 64% aged between 31 and 40 years old) who work in public healthcare institutions in a southern region of Chile. Results: The highest scores were recorded for the adaptable style of conflict management (69%), while the lowest scores were recorded for the evasive style (6%). Higher levels of dominance were identified for women than for men. There was a positive association between dominance and time progression, where the level of dominance increased as participants gained greater professional experience and workplace seniority. Conclusions: The foreign physicians who participated in this study have a clear constructive attitude towards the negotiation of conflicts. However, this effort to adapt can also become a psychosocial risk factor that affects professional integration in intercultural workplace contexts.

Medical education accreditation in Mexico and the Philippines: impact on student outcomes.

CONTEXT: Accreditation of medical education programmes is becoming increasingly prevalent worldwide, but beyond the face validity of these quality assurance methods, data linking accreditation to improved student outcomes are limited. Mexico and the Philippines both have voluntary systems of medical education accreditation and large numbers of students who voluntarily take components of the United States Medical Licensing Examination (USMLE). We investigated the examination performance of Mexican and Philippine citizens who attended medical schools in their home countries by medical school accreditation status. METHODS: The sample included 5045 individuals (1238 from Mexico, 3807 from the Philippines) who took at least one of the three USMLE components required for Educational Commission for Foreign Medical Graduates (ECFMG) certification. We also separately studied 2702 individuals who took all three examinations (589 from Mexico, 2113 from the Philippines). The chi-squared statistic was used to determine whether the associations between outcomes (first attempt pass rate on USMLE components and rate of ECFMG certification) and medical school accreditation (yes/no) were statistically significant. RESULTS: For the sample of registrants who took at least one USMLE component, first attempt pass rates on all USMLE components were higher for individuals attending accredited schools, although there were differences in pass rates among the components and between the two countries. The distinction was greatest for USMLE Step 1, for which attending an accredited school was associated with increases in first attempt pass rates of 15.9% for Mexican citizens and 29.2% for Philippine citizens. In registrants from the Philippines who took all three examinations, attending an accredited medical school was also associated with increased success in obtaining ECFMG certification. CONCLUSIONS: These findings support the value and usefulness of accreditation in Mexico and the Philippines by linking accreditation to improved student outcomes.

Physician migration: views from professionals in Colombia, Nigeria, India, Pakistan and the Philippines.

There has been much debate recently about several issues related to the migration of physicians from developing to developed countries. However, few studies have been conducted to address these issues in a systematic fashion. In an attempt to begin the process of generating systematic data, we designed and distributed a questionnaire addressing several core issues surrounding physician migration to respondents selected on the basis of their special expertise or experience in India, Nigeria, Pakistan, Colombia, and the Philippines. The issues addressed relate to the reasons physicians migrate to developed countries, how migration is related to the structure of medical education, the effect that migration has on the health care infrastructure of developing countries, and various policy options for dealing with physician migration. Though responses varied somewhat by country, a desire for increased income, greater access to enhanced technology, an atmosphere of general security and stability, and improved prospects for one's children were the primary motivating factors for physician migration. A majority of respondents believed that physicians in developing counties are provided with highly specialized skills that they can better utilize in developed countries, but respondents were ambivalent with respect to the utility of educational reform. Responses varied significantly by country with regard to whether physician migration results in physician shortages, but there was widespread agreement that it exacerbates shortages in rural and public settings. With respect to policy options, increasing physician income, improving working conditions, requiring physicians to work in their home countries for a period following graduation from medical school, and creating increased collaboration between health ministries in developed and developing countries found the most favor with respondents.