Abstract
Abstract: This is an international narrative review study, which had the objectives of identifying and understanding the determining educational aspects for the retention of physicians in remote and unassisted areas. Through search on databases, we selected ten articles about medical education institutions and programs that increased the recruitment and retention levels for their alumni in areas where there was shortage of professionals, which clarified the educational aspects associated to such results, and which were considered as predictors for the retention of physicians. The main predictors found were: selection processes that prioritized the admission of students who were previously linked to places where there was a shortage of physicians; the creation of curricular frameworks based on problem-based methodologies focused on local health issues, with an emphasis in primary care and Family and Community Medicine approaches; and the quality of the educational experiences, especially in the primary care environment in rural or remote areas, which, in turn, involve the educational trajectory and experience of professors, as well as the infrastructure and localization of the medical schools in strategic areas. The placement of school is such areas allow close proximity between the professors to the reality of the vulnerable communities. The results of the review still point out that the retention of physicians in unassisted areas demands the confrontation of social, cultural, economic and political factors, which frequently transcend the governability of educational institutions. They also reiterate the need for a wider conceptual uniformity among research studies in order to ensure more solid scientific evidence about the subject, and the importance of conducting studies that contemplate the Latin-American context, specifically Brazil, where the literature on the topic is still scarce.
Highlights
The quantitative deficit and inequalities in the qualification and geographic distribution of health professionals characterize what is conventionally called the global health workforce crisis[1,2]
The challenges related to doctors are even greater, since in addition to the already mentioned aspects, there are the specificities of their work process, especially disparities in the distribution between different medical specialties and levels of health care, with enormous damage to Primary Health Care (PHC), which in many countries has not been consolidated as an attractive field of work 2,8
Medical schools play an essential role in the adequacy of professional training and in the production of scientific evidence that contribute to the effectiveness of health systems and to the improvement of the population’s living and health conditions . 9,11,12
Summary
The quantitative deficit and inequalities in the qualification and geographic distribution of health professionals characterize what is conventionally called the global health workforce crisis[1,2]. This problem has increased since the 1990s, due to changes in the demographic and epidemiological profile of the world population, the underfunding of health systems and the displacement of people and information intra- and internationally, resulting in migratory flows of these professionals from lowincome and middle income countries for those with high income 3-7. Medical schools play an essential role in the adequacy of professional training and in the production of scientific evidence that contribute to the effectiveness of health systems and to the improvement of the population’s living and health conditions . 9,11,12
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