Health professionals for a new century: transforming education to strengthen health systems in an interdependent world

Background: The paper examines external multiple job holding practices in public health training institutions based in prominent public universities in three sub-Saharan Africa countries (Rwanda, Ethiopia, Mozambique). Objective: The study aims to contribute to broadening understanding about multiple job holding (nature and scale, drivers and reasons, impact, and efforts to regulate) in public health training schools in public universities. Methods: A qualitative multiple case study approach was used. Data were collected through document reviews and in-depth interviews with 18 key informants. Data were then triangulated and analyzed thematically. Results: External multiple job holding practices among faculty of the three public health training institutions were widely prevalent. Different factors at individual, institutional, and national levels were reported to underlie and mediate the practice. While it evidently contributes to increasing income of academics, which many described as enabling their continuing employment in the public sector, many pointed to the negative effects as well. Similarities were found regarding the nature and drivers of the practice across the institutions, but differences exist with respect to mechanisms for and extent of regulation. Regulatory mechanisms were often not clear or enforced, and academics are often left to self-regulate their engagement. Lack of regulation has been cited as allowing excessive engagement in multiple job holding practice among academics at the expense of their core institutional responsibility. This could further weaken institutional capacity and performance, and quality of training and support to students. Conclusion: The research describes the complexity of external multiple job holding practice, which is characterized by a cluster of drivers, multiple processes and actors, and lack of consensus about its implication for individual and institutional capacity. In the absence of a strong accountability mechanism, the practice could perpetuate and aggravate the fledgling capacity of public health training institutions.

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“…It is argued that the practice further undermines the already weak capacity of health professional training [10]. …”

Section: Introductionmentioning

confidence: 99%

Exploring multiple job holding practices of academics in public health training institutions from three sub-Saharan Africa countries: drivers, impact, and regulation

Amde

Sanders

Chilundo

et al. 2018

Global Health Action

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“…We chose these goals for the association analysis without prior review of the quantitative data. We selected the seven program goals by considering themes currently prominent in the clinical medical education design literature, including educational continuity [5–8,21,26], longitudinal programs [13,23], LICs [15,16,18,27,28], and the future of medical education in the US [1–4]. The seven program goals selected were ‘exposure to specific patient populations,’ ‘exposure to social medicine,’ ‘exposure to primary care,’ ‘developing clinical skills,’ ‘developing professional skills,’ ‘understanding the patient experience,’ and ‘fostering longitudinal relationships.’…”

Section: Methodsmentioning

confidence: 99%

“…Academic leaders in medicine have called for the transformation of health professions education [1–4]. The Lancet Commission Report [1] urges educational leaders to develop curricula that will serve patient and population needs, foster better understanding of the clinical context, emphasize continuous care over episodic encounters, and broaden training venues beyond inpatient care.…”

Section: Introductionmentioning

confidence: 99%

“…The Lancet Commission Report [1] urges educational leaders to develop curricula that will serve patient and population needs, foster better understanding of the clinical context, emphasize continuous care over episodic encounters, and broaden training venues beyond inpatient care. To address these goals, medical schools are implementing curricular structures grounded in educational continuity [5–9], including longitudinal clinical programs (LCPs) [10–13] and a subset of LCPs, longitudinal integrated clerkships (LICs) [14–16].…”

Section: Introductionmentioning

confidence: 99%

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A review of longitudinal clinical programs in US medical schools

Gheihman

Jun

Young

et al. 2018

Medical Education Online

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Background: Longitudinal clinical experiences are a common component of undergraduate medical curricula, yet these programs have not been systematically characterized in US medical schools.Objective: Our study sought to identify and characterize longitudinal clinical programs (LCPs) in US medical schools and measure associations between programs’ structures and goals.Design: Using a mixed-methods approach, we conducted a secondary analysis of data from publicly available websites. We conducted a systematic keyword search of the websites of 137 LCME-accredited US medical schools to identify LCPs. We included programs with student–patient interactions of at least six months. We categorized programs using qualitative thematic analysis and compared associations between program structures and goals.Results: We identified 98 LCPs in 69 schools. Half (52.0%) of LCPs occurred during the core clinical year. Program structures included ‘clinic attachments’ (50.0%), ‘longitudinal integrated clerkships’ (26.5%), and ‘patient attachments’ (20.4%). We identified goals in 89 programs, including ‘exposing students to specific topics, patient demographics, or practice settings’ (78.7%); ‘clinical or professional skill development’ (65.2%); and ‘understanding the patient experience’ (19.1%). Patient attachments were associated with ‘exposure to specific patient demographics’ (P = .04) and ‘understanding the patient experience’ (P = .03). Pre-clinical programs were associated with clinical skills development (P = .01).Conclusions: Our study identifies the scope and nature of LCPs in US medical schools. Understanding connections between educational structures and goals may guide program design and research investigations of educational processes and outcomes.

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“…The ongoing emergence of disruptive technologies and systemic changes in personalized medicine, regulations, and reimbursement models present imminent and uncertain challenges for physicians beyond the basic and clinical sciences comprising traditional medical education [1–3]. Solving these new challenges will require not only clinical mastery, but also the ability to design, develop, and implement patient-centered solutions to complex problems [2,4]. Both the American Association of Medical Colleges (AAMC) and American Medical Association (AMA) recognize systems-level problem solving as a basic requirement of medical graduates, but there is little consensus regarding the key skills and knowledge needed to achieve this goal [5,6].…”

Section: Introductionmentioning

confidence: 99%

Innovation and entrepreneurship programs in US medical education: a landscape review and thematic analysis

Niccum

Sarker

Wolf

et al. 2017

Medical Education Online

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Background: Training in innovation and entrepreneurship (I&E) in medical education has become increasingly prevalent among medical schools to train students in complex problem solving and solution design. Objective: We aim to characterize I&E education in US allopathic medical schools to provide insight into the features and objectives of this growing field. Design: I&E programs were identified in 2016 via structured searches of 158 US allopathic medical school websites. Program characteristics were identified from public program resources and structured phone interviews with program directors. Curricular themes were identified via thematic analysis of program resources, and themes referenced by >50% of programs were analyzed. Results: Thirteen programs were identified. Programs had a median age of four years, and contained a median of 13 students. Programs were led by faculty from diverse professional backgrounds, and all awarded formal recognition to graduates. Nine programs spanned all four years of medical school and ten programs required a capstone project. Thematic analysis revealed seven educational themes (innovation, entrepreneurship, technology, leadership, healthcare systems, business of medicine, and enhanced adaptability) and two teaching method themes (active learning, interdisciplinary teaching) referenced by >50% of programs. Conclusions: The landscape of medical school I&E programs is rapidly expanding to address newfound skills needed by physicians due to ongoing changes in healthcare, but programs remain relatively few and small compared to class size. This landscape analysis is the first review of I&E in medical education and may contribute to development of a formal educational framework or competency model for current or future programs. Abbreviations: AAMC: American Association of Medical Colleges; AMA: American Medical Association; I&E: Innovation and entrepreneurship

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Health professionals for a new century: transforming education to strengthen health systems in an interdependent world

Abstract: Published Version

Cited by 4,441 publications

References 88 publications

Exploring multiple job holding practices of academics in public health training institutions from three sub-Saharan Africa countries: drivers, impact, and regulation

Exploring multiple job holding practices of academics in public health training institutions from three sub-Saharan Africa countries: drivers, impact, and regulation

A review of longitudinal clinical programs in US medical schools

Innovation and entrepreneurship programs in US medical education: a landscape review and thematic analysis

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