Governance of skilled migration and registration of internationally qualified health practitioners: an Australian policy perspective.

This paper presents a policy perspective on the topical issue of migration and registration of internationally qualified health practitioners (IQHPs), with a focus on international medical graduates and internationally qualified nurses and midwives. Current views, regulatory governance and recommendations affecting skilled migration and registration of IQHPs were examined, specifically whether current and proposed practices are transparent, consistent, equitable, robust, cost-effective and assist in ensuring IQHPs demonstrate the necessary qualifications and experience for protection of the Australian public. The complexity of the current regulatory and administrative application and approval processes for IQHPs seeking to live and work in the Australian healthcare setting provides significant opportunities for future research, particularly those areas of reform under consideration by the Health Ministers' Advisory Council.

Saúde e empoderamento das mulheres: estudo de caso do Programa Mais Médicos em municípios com presença de médicos cubanos / Women's health and empowerment: a case study of the More Doctors Program in municipalities with Cuban physicians / Salud y empoderamiento de las mujeres: estudio de caso del programa Mais Médicos en municipios con presencia de médicos cubanos

Objetivo. Descrever as representações de ser mulher das usuárias do Programa Mais Médicos (PMM), com perspectiva de gênero e raça, e as mudanças que o PMM trouxe quanto ao empoderamento e cuidado da saúde. Métodos. Trata-se de um estudo de caso descritivo, de corte transversal. O trabalho de campo foi realizado mediante entrevistas semiestruturadas, aplicação de uma técnica evocativa de associação de palavras e grupos focais em municípios com médicos cubanos, com amostras de tipo nominal para escolha dos municípios e de tipo intencional para a escolha de participantes. O tamanho das amostras foi definido em campo com base na técnica da saturação teórica. Os dados foram analisados por meio de análise de conteúdo e análise prototípica. Resultados. A cobertura da atenção básica foi fortalecida com os aportes do programa, segundo os quatro gestores entrevistados. As mulheres (103 na técnica evocativa e 120 nos grupos focais) relataram mudanças no modelo de atendimento, que se tornou mais humanizado, com impacto sobre sua percepção sobre os serviços de saúde, sobre a consulta médica, sobre os médicos e sobre a imagem de si mesmas e, em menor medida, sobre as práticas de cuidado da saúde. Conclusões. O PMM trouxe ganhos no empoderamento individual das mulheres, com reflexos potencialmente positivos para os comportamentos em saúde.(AU)

Objective. To describe the representations of being a woman by users of the More Doctors Program (Programa Mais Médicos, PMM) in Brazil, exploring the perspectives of gender and race, and the changes produced by PMM in terms of empowerment and health care. Methods. This is a descriptive, cross-sectional study. The field work was performed using semi-structured interviews, with application of an evocative word technique and focal groups in municipalities with Cuban physicians, with nominal selection of municipalities and intentional selection of participants. The size of the sample was defined in the field based on saturation. The data were analyzed by content and prototypical analyses. Results. Primary health care coverage was strengthened by the PMM, according to the four municipal health secretaries interviewed. Participants (103 in the evocative technique and 120 from focal groups) reported changes in the model of care, which became more humanized, with impact on their perception of health care services, medical consultations, and physicians, on the image they had of themselves and, to a lesser extent, on their health care practices. Conclusions. PMM produced individual empowerment gains for study participants, with potentially positive impacts on health care behaviors.(AU)

Objetivo. Describir las representaciones de la condición de ser mujer hechas por las usuarias del programa Mais Médicos, con una perspectiva de género y raza, y los cambios producidos por este programa en materia de empoderamiento y cuidado de la salud. Métodos. Se trata de un estudio de caso descriptivo y transversal. El trabajo de campo se realizó mediante entrevistas semiestructuradas, con aplicación de una técnica evocadora de asociación de palabras y grupos focales en municipios con presencia de médicos cubanos, con muestras de tipo nominal para la selección de los municipios y de tipo intencional para la selección de las participantes. El tamaño de las muestras se definió sobre el terreno con base en la técnica de la saturación teórica. Los datos se sometieron a análisis prototípico y de contenido. Resultados. Los aportes del programa fortalecieron la cobertura de la atención básica, según lo expresado por los cuatro gestores entrevistados. Las mujeres (103 de las entrevistadas con la técnica evocadora y 120 de los grupos focales) relataron cambios en los modelos de atención que hicieron que la atención se torne más humanizada y que incidieron en su percepción de los servicios de salud, las consultas médicas, los médicos, la imagen de sí mismas y, en menor grado, las prácticas de cuidado de la salud. Conclusiones. El programa Mais Médicos implicó adelantos en materia de empoderamiento individual de las mujeres, con repercusiones potencialmente favorables en los patrones de comportamiento relacionados con la salud.(AU)

Interacciones socioculturales de los médicos cubanos participantes del Programa Más Médicos en Brasil / Sociocultural interactions of Cuban doctors participating in the More Doctors Program in Brazil

El Programa Más Médicos (PMM) fue creado en Brasil, en 2013, en el contexto de la necesidad de ampliar y garantizar el acceso y la cobertura de los cuidados básicos de salud, principalmente para la población con mayor vulnerabilidad social. Se trata de una iniciativa de carácter holístico, creada no sólo para resolver el problema de la escasez de médicos en el país, sino también para asegurar el desarrollo de las capacidades para la atención básica, además de invertir en la infraestructura necesaria y en la formación del personal de la salud, tanto en cantidad como en calidad. Finalmente, el reclutamiento de médicos tiene carácter de emergencial, pues pretende llenar vacíos de cobertura en municipios carentes. El PMM trajo impactos desde su inicio, percibido de forma positiva por las poblaciones objetivo, permitiendo así superar las fuertes críticas que recibió de algunos segmentos de la sociedad, incluso de la corporación médica. El hecho es que actualmente este programa se identifca como auténtica «marca¼ de salud pública, en términos de satisfacción de usuarios y gestores y de resolución de problemas de salud para la población brasileña. Este libro presenta una nueva visión sobre el PMM, aún poco explorada, al ingresar en los escenarios de práctica para responder preguntas importantes acerca de las interacciones socioculturales de los médicos cubanos reclutados, con el objetivo declarado de producir conocimiento, pero además para promover mejoras en la participación de extranjeros en la atención primaria que el SUS ofrece a la población, aún limitada. Su lectura presentará percepciones, memorias e incluso explicaciones para quien, de una forma u otra, está asociado con el desarrollo del PMM, particularmente aquellos en una posición comprometida con la salud y con el reconocimiento de los cuidados primarios de la salud como el verdadero camino para el desarrollo del sistema de salud.

What Do We Know and Not Know about the Professional Integration of International Medical Graduates (IMGs) in Canada?

BACKGROUND: The literature on international medical graduates (IMGs) in Canada is growing, but there is a lack of systematic analysis of the literature. OBJECTIVES: To examine (1) the major themes in academic and grey literature pertaining to professional integration of IMGs in Canada; and (2) the gaps in our knowledge on integration of IMGs. METHODS: This paper is based on the scoping review of academic and grey literature published during 2001-2013 about IMGs in Canada. RESULTS: The literature on IMGs focuses on (1) pre-immigration activities; (2) early-arrival activities; (3) credential recognition/professional recertification; (4) bridging and residency training; (5) workplace integration; and (6) alternative paths to integration. The gaps in the literature include pre-immigration and early-arrival activities, and alternative paths for integration for those IMGs who do not pursue medical license. CONCLUSION: Pre-immigration and early-arrival activities and alternative career paths for IMGs should be addressed in academic and policy research.

Supporting international medical graduates' transition to their host-country: realist synthesis.

CONTEXT: Many health services and systems rely on the contribution of international medical graduates (IMGs) to the workforce. However, concern has grown around their regulation and professional practice. There is a need, in the absence of strong evidence and a robust theoretical base, for a deeper understanding of the efficacy of interventions used to support IMGs' transition to their host countries. This study seeks to explore and synthesise evidence relating to interventions developed for IMGs. It aims to provide educators and policy makers with an understanding of how interventions should be developed to support IMGs in their transition to the workplace, particularly looking to identify how and why they are effective. METHODS: The realist synthesis involved an initial systematic search of the literature for the period January 1990 to April 2015. Secondary searches were conducted throughout the review in order to inform and test the developing programme theory. The context, mechanism and outcome data were extracted from all sources meeting the inclusion criteria. Fourteen case studies were included to further aid theory refinement. RESULTS: Sixty-two articles were identified, describing diverse interventions of varying intensity. A further 26 articles were identified through a secondary search. The findings illustrate that, alongside a developed programme, ongoing support and cultural awareness at organisational and training levels are crucial. Individual differences must also be taken into consideration. This will ensure that IMGs engage in transformative learning, increase their levels of self-efficacy and cultural health capital, and reduce feelings of stress and anxiety. These factors will have an impact on work, interactions and cultural adjustment. CONCLUSIONS: Organisational, training and individual contexts all play a role in IMGs' adjustment during the transition process. Establishing ongoing support is critical. A list of recommendations for implementation is given.

Cultural transition of international medical graduate residents into family practice in Canada.

OBJECTIVE: To identify the perceived strengths that international medical graduate (IMG) family medicine residents possess and the challenges they are perceived to encounter in integrating into Canadian family practice. METHODS: This was a qualitative, exploratory study employing focus groups and interviews with 27 participants - 10 family physicians, 13 health care professionals, and 4 family medicine residents. Focus group/interview questions addressed the strengths that IMGs possess and the challenges they face in becoming culturally competent within the Canadian medico-cultural context. Qualitative data were audiotaped, transcribed, and analyzed thematically. RESULTS: Participants identified that IMG residents brought multiple strengths to Canadian practice including strong clinical knowledge and experience, high education level, the richness of varied cultural perspectives, and positive personal strengths. At the same time, IMG residents appeared to experience challenges in the areas of: (1) communication skills (language nuances, unfamiliar accents, speech volume/tone, eye contact, directness of communication); (2) clinical practice (uncommon diagnoses, lack of familiarity with care of the opposite sex and mental health conditions); (3) learning challenges (limited knowledge of Canada's health care system, patient-centered care and ethical principles, unfamiliarity with self-directed learning, unease with receiving feedback); (4) cultural differences (gender roles, gender equality, personal space, boundary issues; and (5) personal struggles. CONCLUSIONS: Residency programs must recognize the challenges that can occur during the cultural transition to Canadian family practice and incorporate medico-cultural education into the curriculum. IMG residents also need to be aware of cultural differences and be open to different perspectives and new learning.

Offshore Medical Schools Are Buying Clinical Clerkships in U.S. Hospitals: The Problem and Potential Solutions.

U.S. medical education faces a threat from for-profit Caribbean medical schools which purchase clinical rotation slots for their students at U.S. hospitals. These offshore schools are monetizing a system that was previously characterized as a duty-the duty of the current generation of physicians to educate their successors. Offshore schools purchase clinical rotation slots using funds largely derived from federally subsidized student loans. This leads to pressure on U.S. schools to pay for clinical clerkships and is forcing some of them to find new clinical training sites.For-profit Caribbean schools largely escape the type of scrutiny that U.S. schools face from U.S. national accreditation organizations. They also enroll large classes of students with lower undergraduate GPAs and Medical College Admission Test scores than those of students at U.S. medical schools; their students take and pass Step 1 of the United States Medical Licensing Examination at a substantially lower rate than that of U.S. medical students; and their students match for residencies at a fraction of the rate of U.S. medical school graduates.Among the potential solutions proposed by the authors are passing laws to hold for-profit Caribbean schools to standards for board passage rates, placing restrictions on federal student loans, monitoring attrition rates, and denying offshore schools access to U.S. clinical training sites unless they meet accreditation standards equivalent to those of U.S. medical schools.

[Primary care in Sweden]. / La atención primaria en Suecia.

Sweden was one of the first European Union countries that saw the opportunity in the free movement of professionals. First offers for jobs were managed in 2000. Since then, a large number of professionals have taken the opportunity of a decent job and have moved from Spain to Sweden. The Swedish health care model belongs to the group of national health systems. The right to health care is linked to legal citizenship. Health is financed through regional taxes, but there is a compulsory co-payment regardless of the financial situation of the patient. The provision of health care is decentralised at a regional level, and there is a mixture of private and public medical centres. Primary care is similar to that in Spain. Health professionals work as a team with a division of tasks. Like in Spain, waiting lists and coordination between primary and specialised care are a great problem. Patients may register with any public or private primary care centre and hospital provider within their region. Access to diagnostic tests and specialists are restricted to those selected by specialists. Doctors are salaried and their job and salary depend on their experience, professional abilities and regional needs. Medicine is curative. General practitioners are the gateway to the system, but they do not act as gatekeeper. Hospitals offer a number of training post, and the access is through an interview. Continuing medical education is encouraged and financed by the health centre in order to increase its revenues.

Two wings and a prayer: should Canada make it easier for Canadian doctors trained abroad to enter practice here?

About 3,600 Canadians are currently studying medicine abroad (CSMAs). Most hope to return to practise in Canada. But the road back is not easy. These graduates must complete postgraduate residency training in Canada and alas, there are less openings than there are aspirants. One might have thought, amid the endless rhetoric of "physician shortages," that an obvious solution would be to increase the number of residency positions. But provincial governments are well aware, even if the media are not, that Canada is in the early stages of a dramatic expansion in physician supply fuelled by increased domestic training capacity. Last time the physician supply outpaced population growth, as it is doing today, governments choked off the entry of international graduates. It could happen again.

International medical graduates in transition.

BACKGROUND: Medical migration is now more frequent, and raises complex issues concerning the standards of practice and transitions required for doctors. The challenges faced by international medical graduates have been acknowledged through the proliferation of orientation programmes designed within hospitals. This paper discusses and evaluates a pilot orientation programme for doctors in Victoria, Australia, called Transition in Practice. METHODS: Drawing on theories of active reflection and situated learning, the programme entailed fortnightly meetings for new international medical graduates at a metropolitan hospital in Victoria. The programme comprised a series of informal discussion sessions where doctors were facilitated to actively reflect on everyday practical challenges in their hospital work. Local medical and non-medical staff were invited to each session. Data comprised doctors' reflections about new insights gathered at the conclusion of each session. RESULTS: Thematic analysis of 55 evaluation cards revealed that participants benefited from the programme by learning directly from invited staff members' descriptions of their roles and their specific areas of practice. Participants gained increased awareness of the differences between their past and present work environments, and greater insight into the complexities of the local system. Participating doctors became actively involved in their own orientation process, generating new topics for future discussions. CONCLUSION: This programme successfully integrated experiences and views of both international medical graduates and local hospital staff to generate a greater understanding of each other and of the workplace. The programme used simple, inexpensive methods that tapped into the resources that both international medical graduates and local staff bring to the workplace.

Child health in low-resource settings: pathways through UK paediatric training.

UK doctors training in paediatrics benefit from experience of child health in low-resource settings. Institutions in low-resource settings reciprocally benefit from hosting UK trainees. A wide variety of opportunities exist for trainees working in low-resource settings including clinical work, research and the development of transferable skills in management, education and training. This article explores a range of pathways for UK trainees to develop experience in low-resource settings. It is important for trainees to start planning a robust rationale early for global child health activities via established pathways, in the interests of their own professional development as well as UK service provision. In the future, run-through paediatric training may include core elements of global child health, as well as designated 'tracks' for those wishing to develop their career in global child health further. Hands-on experience in low-resource settings is a critical component of these training initiatives.

Pediatrician workforce policy statement.

This policy statement reviews important trends and other factors that affect the pediatrician workforce and the provision of pediatric health care, including changes in the pediatric patient population, pediatrician workforce, and nature of pediatric practice. The effect of these changes on pediatricians and the demand for pediatric care are discussed. The American Academy of Pediatrics (AAP) concludes that there is currently a shortage of pediatric medical subspecialists in many fields, as well as a shortage of pediatric surgical specialists. In addition, the AAP believes that the current distribution of primary care pediatricians is inadequate to meet the needs of children living in rural and other underserved areas, and more primary care pediatricians will be needed in the future because of the increasing number of children who have significant chronic health problems, changes in physician work hours, and implementation of current health reform efforts that seek to improve access to comprehensive patient- and family-centered care for all children in a medical home. The AAP is committed to being an active participant in physician workforce policy development with both professional organizations and governmental bodies to ensure a pediatric perspective on health care workforce issues. The overall purpose of this statement is to summarize policy recommendations and serve as a resource for the AAP and other stakeholders as they address pediatrician workforce issues that ultimately influence the quality of pediatric health care provided to children in the United States.

Retaining physicians in Lithuania: integrating research and health policy.

Many of the strategic planning studies worldwide have made recommendations to the policy makers on the steps to be taken in eliminating the perceived shortages of physician workforce or in improving their distribution and retention. Policy makers have also considered various policy interventions to ensure adequate numbers of physicians. This study reviewed the research evidence and health policy decisions taken from 2000 to 2010 in Lithuania and evaluated the chronological links over time between scientific recommendations and policy decisions. From the analysis it would seem that Lithuania's success in retaining physicians between 2000 and 2010 was influenced by the timely implementation of particular research recommendations, such as increased salaries and increased enrolment to physician training programmes. In addition were the health policy interventions such as health sector reform, change in the legal status of medical residents and establishment of professional re-entry programmes. Based on this evidence it is recommended that policy makers in Lithuania as well as in other countries should consider comprehensive and systematic health policy approaches that combine and address various aspects of physician training, retention, geographic mal-distribution and emigration. Implementation of such an inclusive policy however is impossible without the integration of research into strategic decision making in workforce planning and effective health policy interventions.

Supporting international medical graduates in rural Australia: a mixed methods evaluation.

INTRODUCTION: In Australia, international medical graduates (IMGs) make a substantial contribution to rural medical workforces. They often face significant communication, language, professional and cultural barriers, in addition to the other challenges of rural clinical practice. The Gippsland Inspiring Professional Standards among International Experts (GIPSIE) program was designed to provide educational support to IMGs across a large geographical region using innovative educational methods to ultimately build capacity in the provision of rural medical education. GIPSIE offered 5 sessions over 3 months. Simulation-based training was a prominent theme and addressed clinical knowledge, attitudes and skills and included a range of activities (eg procedural skills training with benchtop models, management of the acutely ill patient with SimMan, patient assessment skills with simulated patients). Diverse clinical communication skills were explored (eg teamwork, handover, telephone, critical information). Audiovisual review of performance was enabled through the use of iPod nano devices. GIPSIE was underpinned by a website offering diverse learning resources. Content experts were invited to lead sessions that integrated knowledge and skills reflecting local practice. METHODS: IMGs were recruited from hospitals (n = 15) and general practices (n = 2) across the region. It was aimed to evaluate the impact of GIPSIE on the clinical practice of IMG participants. Evaluation measures included pre- and post-program 15 item multisource feedback (MSF), post-program questionnaires and, in order to address retention, telephone interviews exploring participants' responses 3 months after the program finished. RESULTS: Fifteen participants completed GIPSIE and rated the program highly, especially the simulation-based activities with feedback and later audiovisual review on iPods and the GIPSIE website. Suggestions were made to improve several aspects of the program. Participants reported increased knowledge, skills and professionalism after the program. Although overall MSF scores showed no statistically significant changes, there were positive directional changes for the items 'technical skills appropriate to current practice', 'willingness and effectiveness when teaching/training colleagues' and 'communication with carers and family'. These developments were also supported in free-text comments. Learning was reported to be sustained 3 months after the program. CONCLUSIONS: GIPSIE was highly valued by participants who reported improvements in clinical knowledge and skills. A range of professional issues were raised and addressed. GIPSIE seemed to provide a platform for further development. Although new to many participants, simulation was embraced as an educational method. The relationship between regional clinicians and the medical school was pivotal to success. A feature of the study was tracking improvements in clinical practice as a consequence of participating in the GIPSIE program. Future work needs to focus on further promoting the transfer of learning to the workplace. However the sustainability of these programs requires significant commitment.

Professional challenges of non-U.S.-born international medical graduates and recommendations for support during residency training.

PURPOSE: Despite a long history of international medical graduates (IMGs) coming to the United States for residencies, little research has been done to find systematic ways in which residency programs can support IMGs during this vulnerable transition. The authors interviewed a diverse group of IMGs to identify challenges that might be eased by targeted interventions provided within the structure of residency training. METHOD: In a qualitative study conducted between March 2008 and April 2009, the authors contacted 27 non-U.S.-born IMGs with the goal of conducting qualitative interviews with a purposeful sample. The authors conducted in-person, in-depth interviews using a standardized interview guide with potential probes. All participants were primary care practitioners in New York, New Jersey, or Connecticut. RESULTS: A total of 25 IMGs (93%) participated. Interviews and subsequent analysis produced four themes that highlight challenges faced by IMGs: (1) Respondents must simultaneously navigate dual learning curves as immigrants and as residents, (2) IMGs face insensitivity and isolation in the workplace, (3) IMGs' migration has personal and global costs, and (4) IMGs face specific needs as they prepare to complete their residency training. The authors used these themes to inform recommendations to residency directors who train IMGs. CONCLUSIONS: Residency is a period in which key elements of professional identity and behavior are established. IMGs are a significant and growing segment of the physician workforce. Understanding particular challenges faced by this group can inform efforts to strengthen support for them during postgraduate training.