International health experiences in postgraduate medical education: A meta-analysis of their effect on graduates’ clinical practice among underserved populations

Abstract

Background: International health experiences (IHEs) are popular among medical learners and provide a valuable learning experience. IHE participants have demonstrated an increased intention to care for underserved populations in the future, but what is its actual impact on practice? This study evaluates the effect of postgraduate IHE participation on the future careers of clinicians regarding their work among underserved populations.
 Methods: We conducted a systematic review and meta-analysis of peer-reviewed articles comparing the populations served by physicians who had participated in an IHE with those of physicians who had not participated in an IHE.
 Results: 764 titles were scanned, 28 articles were reviewed, with an eventual 3 studies of fair-good or good quality identified. These addressed physicians’ service to domestic underserved populations, and also addressed future service in a low- or middle-income country (LMIC). Meta-analysis demonstrated a statistically-significant increase in service by IHE graduates to domestic underserved populations (OR = 2.12; CI = 95%; P = 0.03). The certainty of the evidence was low due to limitations in study design (non-randomised studies) and inconsistency in effects.
 Conclusion: Participation in an IHE may cause an increase in care for domestic underserved populations in future clinical practice, though further research from high quality randomised trials is needed to increase the certainty of the effect. Further study is needed to establish whether there is a similar effect with increased future service in a LMIC setting

Afghan medical students’ perceptions, and experiences of their medical education and their professional intentions: a cross-sectional study

“…The findings of this study suggest that policymakers should prioritize and allocate extra resources to quality postgraduate training across the country and develop motivational and support strategies for enticing medical graduates to pursue diverse specialties and subspecialties. Our findings reveal that the emigration intentions of Afghan medical students (51.3%) correspond to those of medical students from other developing countries [14,17,19]. Advanced and quality medical education and yearning for a decent personal life were the most frequent motives influencing the respondent's emigration intentions.…”

“…Finally, leaving your comfort zone and living in a socio-culturally different environment is a pretty enriching and globally favored life experience. Studies have shown that postgraduate training enrollment influences students' decisions concerning permanent residency in their host country [14][15][16][17][18][19]. Internal medicine and surgery were typical career choices reported by medical students.…”

“…Furthermore, nearly half (44.5%) of the students reported that at least one of their faculty members had moved overseas. Studies with analog findings show that postgraduate training and career opportunities, perceived higher level of income, along with favorable working and living conditions influence opting for career paths of both medical students and qualified physicians [14][15][16][17][18][19].…”