Human Resources for Health最新文献

Background: While an intensifying workforce crisis and industrial action across the United Kingdom (UK) healthcare system has shed light on financial strains medics in the UK may face, there remains a lack of evidence on how various groups among an increasingly diversifying profession may be affected. This study explored experiences of financial difficulties and help-seeking behaviours across different demographic groups of medics.

Methods: The demographic characteristics, financial worries and difficulties, and help-seeking behaviours of 442 medical students and doctors in the UK were surveyed. Inferential statistics and regression analyses were undertaken in SPSS. Qualitative responses regarding improving help-seeking underwent content analysis.

Results: Over 80% of participants reported ever worrying about their finances. One-third had ever experienced financial difficulty. Of these, there were a higher percentage of medics with a disability (53.4%) than without a disability (30.4%); and with caring roles (47.2%) compared to those without (30.4%). LGBTQ + participants were 3.5 times more likely to have ever worried about their financial situation compared to those identifying as heterosexual. Those with a non-UK Primary Medical Qualification (PMQ) were twice as likely to experience financial difficulty compared to UK-PMQ respondents. Education and workplace sources of financial help were more likely to be sought by those without a disability, those with a UK-PMQ, participants in the ≤ 25 age bracket and students in comparison to doctors. Participants with a non-UK PMQ, participants aged 36-45 years, and doctors were more likely to seek external support. The most common responses to improving early help-seeking stemmed around improving understanding of the available support, and reducing stigma.

Conclusions: Experiences of financial insecurity among medics are extremely common. Our study has highlighted that LGBTQ + medics and those with a non-UK PMQ may be particularly vulnerable to financial problems as well as those with a disability or caring role. Education and workplace mechanisms of financial support may be underutilised by medics with disabilities, those with a non-UK PMQ, and those in postgraduate settings more broadly. Institutions should seek to improve awareness and accessibility of financial support.

Field epidemiology training programs (FETPs) are designed to equip public health professionals with the skills necessary to investigate, monitor, and respond to disease outbreaks and other public health emergencies. Since the 1950s, when the first FETP started in the United States, the training model has been adopted by numerous countries around the world. Today, there are 98 FETPs in operation, and over 20,000 graduates. This review assesses published studies that report on the evaluation of FETPs. A literature search yielded 402 records, with 16 publications meeting inclusion criteria after duplicate removal and eligibility screening. The 16 FETP evaluations encompassed 37 national and four regional assessments across 26 countries. Most of the evaluations were descriptive reviews using quantitative methods focusing on outputs and short- or medium-term outcomes. Only four published evaluations focused on longer term impacts of an FETP. The evaluations describe and quantify numerous outputs and outcomes, providing evidence of trainees and graduates applying skills to strengthen core health system functions. Several challenges were also identified, including poor utilisation of FETP graduates by senior management stemming from a limited understanding of what field epidemiologists can contribute to the health system. While these evaluations indicate that FETPs are successful training programs, there are relatively few published impact evaluations providing the level of evidence increasingly expected by funders and stakeholders. There is a need and opportunity to develop tools and resources to support FETP evaluators in the implementation of impact evaluations.

Background: The Spanish National Health System (NHS) faces a significant shortage of clinical psychologists with only 5.58 per 100,000 inhabitants. This study aimed to estimate the required number of specialists and residents in Clinical Psychology to provide adequate psychological treatments to the population in the NHS.

Methods: A needs-based model was adapted to forecast the required total number of clinical psychologists and the annual increase in the positions of residents in Clinical Psychology (PIR). This model followed five steps: (1) obtaining Spanish prevalence rates for three broad mental disorder categories (depression, anxiety, and others or severe mental disorders) from the 2017 National Health Survey (ENSE); (2) multiplying the prevalence rates by the Spanish population aged ≥ 15 years; (3) defining the percentage of cases eligible for treatment under three predefined scenarios (protocolized, intermediate, and adjusted); (4) operationalizing the characteristics of the three treatment scenarios (session number and duration); and (5) calculating the total number of clinical psychologists and the annual increase required for PIR positions.

Results: Depending on the treatment scenario, the estimations show a need for clinical psychologists ranging from 1665 to 13,527 for treating depressive disorders, 1792-9799 for anxiety disorders, and 2074-8294 specifically for severe mental disorders. On the other hand, depending on the treatment scenario and the timeframe to achieve the estimated number of professionals (within 3, 5, 8, or 10 years), for example, to achieve those estimations of professionals within 3 years, and according to the adjusted treatment scenario, the Spanish health system should offer approximately 481 PIR positions yearly during 3 years.

Conclusions: A significant increase in the number of PIR positions is necessary to meet the growing demand for psychological treatment in the Spanish NHS. Investing in a mental-health workforce can lead to substantial health and economic benefits. This study provides valuable insights for workforce planning and highlights the importance of addressing the shortage of clinical psychologists in the NHS.

Background: Nutrition professionals are expected to play a crucial role in providing appropriate nutrition interventions to patients. Globally, nutrition professionals in clinical settings are dietitians. However, many healthcare workers with different educational backgrounds are employed at nutrition departments of hospitals in Vietnam. No earlier study has attempted to evaluate the competence of the nutrition workforce. Our objective was to assess the knowledge, attitudes, and practices (KAPs) of the current nutrition workforce in Vietnam.

Methods: A cross-sectional healthcare facility-based study was conducted with 256 employees working at nutrition departments of 75 public hospitals from 7 October to 19 November 2023. Clinical nutritional KAP was evaluated via a questionnaire. KAP levels were categorized as ≥ 50% "adequate" and < 50% "inadequate". The chi-square test and logistic regression were used for bivariate analyses of categorical independent variables. T tests and Mann‒Whitney U tests were used for bivariate analyses of interval ratio variables. Multivariate analysis was performed to identify the determinants of KAP. The significance level was defined as p < 0.05.

Results: The proportion of the nutrition workforce with adequate clinical nutrition knowledge, attitudes, and practices was 62.9%, 65.2%, and 62.9%, respectively. Compared with non-qualified nutrition professional (non-QNPs), QNPs accounted for a significantly greater proportion of those with adequate clinical knowledge (80.2% vs. 54.1%, p < 0.001) and practice (86.1% vs. 51.2%, p < 0.001). The determinants of having adequate clinical nutrition knowledge were identified: (i) being responsible for clinical nutrition; (ii) being responsible for food safety and hygiene monitoring; (iii) working at a high-level hospital; and (iv) working at hospitals in Hanoi. Adequate clinical nutrition practices were determined by (i) serving as a dietetic preceptor; (ii) having adequate clinical nutrition knowledge; and (iii) working at hospitals in Hanoi. Undergraduate educational background was the only determinant of having adequate positive attitudes of the nutrition workforce.

Conclusions: Non-QNPs had slightly poorer clinical nutrition knowledge and practice than QNPs. Medical doctors and preventative medicine doctors demonstrated poorer attitudes toward nutrition-related tasks than dietitians. The study recommended that hospitals in Vietnam employ QNPs (dietitians) rather than recruiting non-QNPs. Alternatively, non-QNPs should be gradually replaced by QNPs.

Background: World Health Organization (WHO) projections point to an increasing global demand for nurses and midwives, leading to shortages in many countries, particularly in less developed regions. Ireland, the context for this study, currently relies heavily on foreign educated nurses and midwives to meet its demand, with Government policy moving towards a domestic recruitment model. This paper estimates the recruitment requirement and associated nursing and midwifery student intake over time under different reform scenarios. It also highlights policy considerations for countries, like Ireland, aiming to comply with the WHO Code of Conduct on the International Recruitment of Health Personnel.

Methods: This paper develops and applies a system dynamics model of the domestic and foreign educated workforce supply by age and gender and is based on regulatory data on stocks and flows from the national professional regulator for nurses and midwives. The model scope and design was informed by a problem statement developed in a series of workshops with officials in the Office of the Chief Nursing Officer. A range of scenario and sensitivity analyses are also undertaken.

Results: In 2021, the base year of our projection horizon, we estimate that Ireland needed to recruit 3019 professionally active whole-time-equivalent (WTE) nurses and midwives. This would have required 3965 student places four years earlier in 2017 to meet this demand domestically. This is 153% higher than the 1570 student places that were available in that year. The recruitment requirement rises to 4497 by 2051, a 49% increase on 2021 levels. Foreign educated nurses and midwives, in terms of WTEs, start at 45% of projected demand in 2021 and range from 57% in the baseline scenario to 16% in the most ambitious reform scenario in 2051.

Conclusions: The analysis suggests that Ireland requires a significant increase in nursing and midwifery student places to achieve self-sufficiency and that this will take time to achieve. Moreover, in addition to a sufficient domestic supply of nurses and midwives, self-sufficiency will also depend on managing demand volatility. Finally, countries anticipating a shift to a predominantly older population should ensure they have enough student places available before the demographic transition occurs to meet the associated health workforce requirements through the domestic education system.

Background: Women play a vital role in the healthcare sector, but the level of their involvement in leadership and the related challenges are not well-understood in the Iraqi context. Therefore, this study aimed to investigate women's experiences in healthcare leadership and identify the challenges and opportunities to improve their leadership roles.

Methods: This cross-sectional study was based on a self-administered questionnaire survey conducted from July to December 2024 in Erbil, Iraq, on a random sample of 371 female healthcare staff members selected from healthcare settings. Women's viewpoints and experiences were measured based on Likert-scale questions.

Results: Of the 371 participants, 13.2% had received training on leadership and 27% had been in leadership positions, most as heads of hospital and primary healthcare center units (72.3%), and most evaluated this experience as positive (92.1%). Most of the study participants had experienced a woman as a leader in the workplace (84.6%) and positively evaluated this experience (45.3%), with 13.5% reporting a negative experience. More than half of the participants (58.5%) were ready to take leadership positions. Most participants (69.6%) perceived women as successful leaders, with 63.3% accepting women in leadership roles and 82.8% believing women possess sufficient self-confidence for leadership. Most participants considered offering daycare services for mothers (89.2%) and providing leadership training programs (78.2%) essential opportunities for women to take leadership positions. Postgraduate education [OR = 2.7 (95%CI 1.1-6.3)], working in the directorate of health [OR = 5.3 (95%CI 2.2-13.0)], and receiving training [OR = 6.3 (95%CI 3.0-13.4)] were independent factors significantly associated with taking leadership positions by women.

Conclusions: This study highlights the untapped potential of women in healthcare leadership, with many women demonstrating readiness for leadership roles and reporting positive leadership experiences. Addressing societal barriers through institutional policies and leadership programs, including structured leadership training, and childcare support, is crucial to advancing women in healthcare leadership. Further in-depth investigations are critical to exploring the sociocultural and communal factors.

Ensuring professional competencies of medical specialists remains a major and ongoing concern. This study focuses on the historical evolution of personnel development in different countries, emphasizing postgraduate specialization and the educational models that emerged as a result. The study goes beyond a chronological analysis of events, seeking to identify and compare the major turning points in the postgraduate medical education (PGME) systems in different developed countries. In parallel, the events related to the formation of the postgraduate education system in Armenia were also considered, since a number of procedures related to the postgraduate education system are currently being revised in Armenia. This study also includes the overview of the Soviet educational model, since it also had a significant impact on the formation of the Armenian model. Such comparisons provide insight into the influence of these milestones on the development of modern educational models. Through a comprehensive analysis of various sources, including academic publications, reports, books, archival materials and legal documents related to the history of medicine, the study reveals significant historical trends, events and ideas in the field of medical education (ME). Models operating in different countries have undergone their own developmental journeys, during which they have been refined, improved, and shaped specific cultures and traditions. The historical analysis of PGME provided a broader understanding of the systems operating in different countries, revealing similarities, differences, and key lessons from each. Specific turning points in the different systems were identified that played a transformative role in the evolution of educational models and practices. A comparative analysis of models used in countries with developed PGME systems and the current structure of Armenian PGME system has identified key areas where revision could help shape the future of Armenian system and bring it in line with leading global educational standards.

Background: Population growth and aging are likely to increase demand for healthcare providers, even in countries with high provider-to-population ratios. To plan appropriate policy measures, detailed information on supply and demand trends in the physician workforce for each medical specialty is essential. This article assesses the current supply of all specialists in internal medicine (general and subspecialties) in Austria and projects future supply and demand until 2035.

Methods: Our analysis follows a framework for workforce planning consisting of four stages: (1) horizon scanning, (2) scenario generation, (3) workforce modelling, and (4) policy analysis. We use stakeholder workshops, interviews and an online survey (n = 484) in the first two stages. Future supply is modelled using stock-flow models, whereas demand is projected using regression modelling based on existing forecasts and extrapolations of historical care use. Different scenarios are used to account for uncertain developments. The two main settings of care in Austria-public hospitals and publicly financed outpatient care-are modelled separately.

Results: Overall, no severe shortage of specialists in internal medicine is expected in Austria until 2035. However, our analysis suggests that the two settings of care will experience very different developments: while the gap between supply and demand in public hospitals is expected to be small (± 5 percent), the supply of specialists in publicly financed outpatient care is projected to fall between 10 and 25 percent short of demand.

Conclusions: Without major reforms, capacity constraints will likely affect the publicly financed outpatient sector, hindering the desired shift from inpatient to outpatient care or driving patients into the private outpatient sector where higher user charges apply. Therefore, it is essential for policy makers to incentivize physicians to work in publicly financed outpatient care. Increasing enrolment in medical schools is not a suitable policy measure, as no significant shortage of specialists in internal medicine is expected overall.

Background: There have been a globally paucity of comprehensive quantitative studies on the physician turnover trends. This study aimed to investigate the trajectory and magnitude of Chinese physician turnover, as well as its influencing factors.

Methods: We established a retrospective cohort by combining annual physician surveillance data and annual medical institution report data between 2011 and 2021. Turnover was defined as physicians who changed their practice institution at least once between 2011 and 2021. We reported the national annual turnover rate, net turnover rate of different regions and types of healthcare institutions. The direction of turnover across provinces and institutions was exhibited using Sankey diagrams. A time-dependent Cox regression analysis was used to examine the factors that influence physician turnover.

Results: This study included 3.7 million physicians, with 19.4% changing practice institutions between 2011 and 2021. The national annual turnover rate has risen from 1.6% to 4.4%. The majority of turnover occurred within provinces and the same type of healthcare institutions. Eastern regions and urban areas experienced net turnover inflow. Factors that increased the likelihood of physician turnover include: being younger, male, more educated, having senior professional titles, having non-permanent employment contracts, working in rural, non-hospital, or private institutions, and working in institutions with relatively low revenue or high workload.

Conclusions: This study suggests that the physician turnover rate is rising in China. Polices should pay more attention to physician retention in less-developed regions. The underlying causes of physician turnover should be thoroughly investigated. Continuous monitoring of physician turnover is critical to leverage its potential positive impact on revitalizing the healthcare system and to avoid its possible negative impact on equal geographic distribution of physicians.

Background: Contributing to the high hospital-based maternal, neonatal, and child mortalities in low resource countries and conflict zones is a shortage of health workers, especially physicians. Training programs, conducted over 12 years, have enhanced the skills of midwives, and nurses, to provide high quality, hospital-based, care to pregnant women, newborn infants, children, and adolescents.

Methods: A task-shifting partnership between the Ministry of Health, World Health Organisation, United Nations Population Fund, United Nations Children's Emergency Fund and the charity Maternal and Childhealth Advocacy International was established in 2012. Rural county health teams selected 37 midwives, 20 nurses, 1 nurse/midwife and 2 physician assistants, for advanced training. They were appointed following a written examination and interview. Obstetric clinician trainees underwent a 3-year programme, which included operative procedures. The training programs for neonatal and paediatric clinician trainees were 2 years and 2.3 years, respectively. Training consisted of apprenticeship-based training and distance learning. It was delivered by Liberian and international specialists. Trainee competence was established by continuous clinical assessment, oral, and written clinical examinations. The programme also upgraded hospital buildings and provided essential equipment and drugs.

Results: 59 trainees completed training, 2 failed and 57 qualified in final examinations. 27 are working as obstetric clinicians, 15 are working as neonatal clinicians, and 11 are working as paediatric clinicians. Therefore, 53 are working in 18 hospitals and 4 Comprehensive Emergency Obstetric and Newborn Care (CEmONC) facilities. Obstetric clinicians manage major obstetric emergencies. They perform abdominal surgery, including the management of ruptured ectopic pregnancy and basic and complicated caesarean sections. Neonatal clinicians resuscitate and care for sick and premature babies to WHO Special Care Level 2. Paediatric clinicians manage the main paediatric emergencies that contribute to high mortality. Before the arrival of the international trainer, paediatric mortality in the training hospital was 9.5% and was 4.1% in the final year of training.

Conclusions: This task shifting programme in Liberia has shown that midwives and nurses can be trained to provide safe and effective hospital care for pregnant women, newborn infants and children. This approach is one solution to the health workforce problem in low resource and conflict settings.