Expansion Of Medical Education Research Articles

Negative Impact of Smaller Hometown Size on the Educational Experience of Medical Students: A Nationwide Study in Saudi Arabia.

Background and objective Saudi Arabia's rapid medical education expansion has posed unique challenges for its students, particularly concerning specialty selection. Having broad exposure to medical specialties is crucial for making informed decisions. This study explores how the size of students' hometowns influences their exposure to their preferred specialty, thereby affecting their choice. Methods Our cross-sectional study collected data from medical students in their 4th and 5th years, interns, and graduates across Saudi Arabia. An electronic survey gathered information about medical specialty choice, interest levels, students' self-ranking compared to their peers, and level of exposure to the chosen specialty. Overall exposure to specialties was quantified by tallying participants' experiences in preclinical observerships, didactic lectures, research projects, core and elective rotations, and attended conferences. We divided the students into three city sizes: primary urban centers, intermediate urban cities, and small townships and compared the outcomes between these three groups. Results Responses were obtained from 1,072 participants, with 424 (39.6%) from primary urban centers, 367 (34.2%) from intermediate urban cities, and 281 (26.2%) from small townships. Student hometown size was an independent predictor of specialty exposure, with students from smaller cities reporting lower exposure scores (OR = 0.73, (0.63-0.84), p<0.01). The study also identified gender disparities in exposure, with female students found to be correlated with a lower exposure score (OR = 0.72, (0.58-0.89), p<0.01). Conclusion City size is a significant determinant of specialty exposure for Saudi medical students. These findings highlight the need for initiatives that promote equal educational experiences, ensuring comprehensive specialty exposure to all students.

The expansion of medical education in the Dutch East Indies and the formation of the Indonesian medical profession.

In 1851, the colonial administration of the Dutch East Indies established a two-year program to educate young Javanese men to become vaccinators in Batavia (today's Jakarta). During the following sixty years, the medical curriculum was expanded several times; in 1913, it consisted of a ten-year program. In 1927, the Batavia Medical School, granting degrees equivalent to those of Dutch university-affiliated medical schools, commenced operations. Consequently, a steadily increasing number of Indonesian physicians with various credentials were employed by the colonial health service, plantations, sugar factories and mines, or established private practices. They became a social group that occupied an ambiguous and even paradoxical position somewhere between Europeans and the indigenous population. During the 1910s, this inspired these physicians to obtain credentials and professional recognition equal to those of their European colleagues. Several of them became active in journalism, politics and social movements. During the 1920s, several became radicalised and criticised the nature of colonial society. In the 1930s, following the increasingly repressive nature of colonial society, most of them remained active in the public sphere while a small group dedicated itself to improving medical research and health care. After the transfer of sovereignty from the Netherlands to Indonesia on 27 December 1949, this small cadre reestablished medical education and health care, and built the Indonesian medical profession.

Lessons Learned From State-Based Efforts to Leverage Medicaid Funds for Graduate Medical Education.

Total Medicaid funds invested in graduate medical education (GME) increased from $3.78 billion in 2009 to $7.39 billion in 2022. States have flexibility in designing Medicaid GME payments to address population health needs. This study assessed states' impetus for using Medicaid funds for GME, structure of state Medicaid payments, composition and charge of advisory bodies that guide these investments, and degree of transparency and accountability to track whether Medicaid GME investments achieved desired workforce outcomes. Structured interviews were conducted in 2015 to 2016 and 2020 to 2021 with subject matter experts representing 10 states. Interview transcripts were analyzed and coded in 6 thematic areas: impetus for using Medicaid funds, the structure of state Medicaid payments, the composition of advisory bodies, the degree of transparency of Medicaid investments, accountability of Medicaid investments, and challenges and changes. States used Medicaid GME funding to address maldistribution of physicians by geography, setting, and specialty, respond to population growth and undergraduate medical education expansion, offset potential loss of teaching health center program funds, and launch new programs and sustain existing ones. States leveraged Medicaid funding by modifying state plan amendments and redesigning funding formulas to meet specific health workforce needs. Many states had advisory bodies to educate legislators, reach consensus on workforce needs, recommend how to disburse funds, and navigate competing stakeholder interests. States identified a need for improved data and analytic systems to understand workforce needs and monitor the outcomes of GME investments. Determining which accountability measures to use and implementing metrics were challenges. States have much to learn from each other about strategies to best leverage Medicaid funds to develop and sustain residency programs to meet population health needs. Learning collaboratives should be developed to provide a forum for states to share best practices and strategies for overcoming challenges.

Escalating competition in NHS: implications for healthcare quality and workforce sustainability.

The UK's National Health Service (NHS) faces escalating competition ratios for specialty training positions, with application rates dramatically outpacing the growth in available posts. This trend contributes to systemic bottlenecks and challenges traditional career progression pathways within medicine. In this evolving landscape, the once-certain career progression within medicine is now increasingly uncertain. This commentary explores the complex dynamics of increased medical school admissions against stagnant specialty training placements and the broader strategic implications for workforce planning within the NHS. It critically evaluates the implications of current funding policies, which seem to prioritise an expansion of nondoctor healthcare roles over the development of specialist training, raising concerns about the long-term patient care quality and safety. Key recommendations include a reassessment of medical education expansion, a review of funding allocation, increased support for specialty training, and government accountability for healthcare workforce planning. The urgent need for strategic policy reform is underscored to ensure that NHS can sustain a high-quality, specialist-led healthcare provision in the face of rising competition and workforce pressures.

On expansion of medical education in India

On expansion of medical education in India

Expansion of Medical Education in India

Expansion of Medical Education in India

Flexibility in primary medical programs: A scoping review

Introduction: Students and universities increasingly seek flexibility in learning options, however terms such as flexible are not consistently defined in the medical education literature. This review aimed to 1) propose a definition for flexibility in medical education and 2) create a typology of contemporary examples of how flexibility has been operationalised in medical education. Method: A systematic scoping review of papers published in English since 2009 was undertaken. The focus was on papers reporting initiatives to create flexibility in primary medical programs. Results: Based on review of 1,641 search returns and 140 full-text articles, two interconnected concepts were identified: flexibility and individualisation. Flexibility describes mechanisms that allow students choice in how they allocate time and resources to meet the requirements of their course, including time-variable progression, acceleration, deceleration, articulated degree entry and exit options, and pedagogical approaches that reduce time required in classrooms. Individualisation describes options that enable student-driven direction, extension or expansion of medical education into special interest areas, including dual degrees, breadth subjects, curriculum tracks, elective service-learning pathways, electives and selectives. Conclusions: Though not always clearly defined as such, international medical education literature describes a rich variety of flexibility and individualisation initiatives. While the constructs of flexibility and individualisation are interconnected, they can assist curriculum designers to differentiate between the mechanisms that enable flexibility in how students meet course requirements and the mechanisms that enable individual choice in what students study. Flexibility and individualisation initiatives target different needs, including both students’ needs and medical workforce needs; they also suggest different institutional and financial implications. Consensus on and consistent use of common terminology about flexibility and individualisation initiatives will improve the “searchability” and synthesis of research on such initiatives and their impacts and enablers, as well as encourage further research, publication and synthesis of outcomes of such initiatives.

Veterans Affairs Graduate Medical Education Expansion Addresses U.S. Physician Workforce Needs.

The United States has a well-trained, highly specialized physician workforce yet continues to have care gaps across the nation. Deficiencies in primary care and mental health specialties are most frequently cited, though critical shortages in multiple disciplines exist, particularly in rural areas. Sponsoring institutions of physician graduate medical education (GME) have created rural residency tracks with modest federal funding and minimal incentives, though efforts targeting shortages in these specialties and geographic locations have been limited. In response to access problems in the Veterans Health Administration, Department of Veterans Affairs (VA), the second largest federal funder of GME with the most expansive clinical education platform, Congress passed the Veterans Access, Choice, and Accountability Act of 2014. This act directed the VA and provided funding to establish 1,500 new positions, a 15% expansion of VA-funded positions at the time. Priority for position selection was given to primary care, mental health, and any other specialties the secretary of VA determined appropriate. Importantly, priority was also given to VA facilities with documented physician shortages, those that did not have GME training programs, those in communities with high concentrations of veterans, and those in health profession shortage areas. Many rural facilities match this profile and were targeted for this initiative. At the conclusion of fiscal year 2021, 1,490 positions had been authorized, and 21 of the 22 VA medical centers previously without GME activity had added residents or were planning to soon. Of the authorized positions, 42% are in primary care, 24% in mental health, and 34% in critically needed additional specialties. Targeted GME expansion in the VA, the largest integrated health care system in the nation, has been successful in addressing physician GME training that aligns with physician shortages and may serve as a model to address national physician specialty and geographic workforce needs.

Recognition of the Expansion of Medical Education in Dental Schools by Persons Responsible for Education: A Nationwide Questionnaire Survey

Recognition of the Expansion of Medical Education in Dental Schools by Persons Responsible for Education: A Nationwide Questionnaire Survey

Financialization and oligopolization of private teaching institutions in Brazil: the case of medical schools

There is a global trend towards the private sector's growing participation in training healthcare professionals, influenced by public policies. In Brazil, private medical schools have developed and expanded with government financing, more recently with support from the More Doctors Program. The study aimed to describe and analyze movements in the corporate reconfiguration of the educational sector, with trends towards oligopolization and financialization related to the recent expansion of medical education in Brazil. An exploratory qualitative and quantitative approach was used, associated with various methodological strategies, to overcome the limitations in access to information, with data collection from open-access secondary databases. The private sector now accounts for 60% of the course supply and 69% of enrollment in medicine, 31% of which is supplied by ten educational groups. The groups studied here highlight the dynamic educational market, mechanisms of financialization and concentration, and formation of an oligopoly in the supply of higher education, particularly in medical training. There has been a trend towards concentration of the supply of institutions of higher learning since 2000. The largest groups employ similar management strategies, expansion of their market share, shareholder format, business diversification, and uptake of investors and financial capital. Government programs like the More Doctors Program helped expand and concentrate the private educational sector with government transfers or advance financing. The trend has been towards oligopolization and financialization.

Development and application of digital assistive teaching system for anatomy

BackgroundAnatomy is a required course for all medicine-related industries. In recent decades, the teaching quality and effect of anatomy have been compromised by factors including a decrease in human body specimens, dampened enthusiasm for the discipline, reduced teaching hours of anatomy, scale expansion of medical education, and obstacles in performing field autopsies and observations. MethodsBased on China's digitalized visible human research achievements, this article extracts the boundary information of anatomic structures from tomographic images, constructs threedimensional (3D) digital anatomical models with authentic texture information, and develops an anatomy assistive teaching system for teachers and students based on the knowledge points of anatomy, to meet the anatomy teaching requirements of different majors at various levels. ResultsThis scientific, complete, and holistic system has produced over 6000 3D digital anatomical models, 5000 anatomy knowledge points, 50 anatomical operation videos, and 150 micro demonstration classes, with teaching contents for different majors and levels, such as systematic anatomy, topographic anatomy, sectional anatomy, anatomy of motion, and virtual anatomical operation table. Ranging from network terminals, desktops, touchscreen 3D displays, desktops, and projection 3D volumetric displays to augmented reality, its diversified interactive forms meet the requirements for a learning environment in different settings. ConclusionsWith multiple teaching and learning links covered, such as teaching environment, teaching resources, instructional slides, autonomous learning, and learning effect evaluation, this novel teaching system serves as a vital component and a necessary resource in anatomy teaching and functions as an important supplement to traditional anatomy teaching. Applied and promoted in most medical colleges and schools in China, this system has been recognized and approved by anatomy teachers and students, and plays a positive role in guaranteeing the effect and quality of anatomy teaching.

Graduate Medical Education Expansion to Rural Community Hospitals: Residency Training Beyond the Academic Health Center.

Graduate Medical Education Expansion to Rural Community Hospitals: Residency Training Beyond the Academic Health Center.

Factors influencing to study medicine: a survey of first-year medical students from India.

PurposeStudents joining medical studies may be motivated by many factors. However, there may also be some factors which may concern them. Although, it can be assumed that those joining medical studies would have largely been influenced positively, how the factors interact in different groups of students has not been studied adequately.MethodsWe conducted a questionnaire-based survey in first-year medical students. Besides the demographics and intentions about their future career plans, students rated a list of positively influencing items and a list of negatively affecting items relevant to our context that influenced their decision. We performed factor analysis followed by clustering of study participants.ResultsNinety-seven students participated in the survey which comprised of 59% females with mean age of 18.6 years. The factors extracted were named as ‘personal growth factor,’ ‘professional calling factor,’ ‘personal concerns factor,’ and ‘professional concerns factor.’ Four distinct clusters of participants differing in their average ratings to each of the above factors were identified.ConclusionThis study provides information on the factors that influence students to join medical studies from an Indian context. The motivational patterns were varied in different sub-groups of students. The data obtained from this study may provide pointers to educators to plan training of students, changes in curricular structure that takes into account the expansion of medical education into specialties and beyond.

Desenvolvimento e expansão do ensino médico no Brasil

Desenvolvimento e expansão do ensino médico no Brasil

A Methodology for Using Workforce Data to Decide Which Specialties and States to Target for Graduate Medical Education Expansion.

To outline a methodology for allocating graduate medical education (GME) training positions based on data from a workforce projection model. Demand for visits is derived from the Medical Expenditure PanelSurvey and Census data. Physician supply, retirements, and geographic mobility are estimated using concatenated AMA Masterfiles and ABMS certification data. The number and specialization behaviors of residents are derived from the AAMC's GMETrack survey. We show how the methodology could be used to allocate 3,000 new GME slots over 5years-15,000 total positions-by state and specialty to address workforce shortages in 2026. We use the model to identify shortages for 19 types of health care services provided by 35 specialties in 50 states. The new GME slots are allocated to nearly all specialties, but nine states and the District of Columbia do not receive any new positions. This analysis illustrates an objective, evidence-based methodology for allocating GME positions that could be used as the starting point for discussions about GME expansion or redistribution.

A Methodology for Using Workforce Data to Decide Which Specialties and States to Target for Graduate Medical Education Expansion

A Methodology for Using Workforce Data to Decide Which Specialties and States to Target for Graduate Medical Education Expansion

History of the medical licensing examination (&lt;i&gt;uieop&lt;/i&gt;) in Korea’s Goryeo Dynasty (918-1392)

This article aims to describe the training and medical licensing system (uieop) for becoming a physician officer (uigwan) during Korea’s Goryeo Dynasty (918-1392). In the Goryeo Dynasty, although no license was necessary to provide medical services to the common people, there was a licensing examination to become a physician officer. No other national licensing system for healthcare professionals existed in Korea at that time. The medical licensing examination was administered beginning in 958. Physician officers who passed the medical licensing examination worked in two main healthcare institutions: the Government Hospital (Taeuigam) and Pharmacy for the King (Sangyakguk). The promotion and expansion of medical education differed depending on the historical period. Until the reign of King Munjong (1046-1083), medical education as a path to licensure was encouraged in order to increase the number of physician officers qualifying for licensure by examination; thus, the number of applicants sitting for the examination increased. However, in the late Goryeo Dynasty, after the officer class of the local authorities (hyangri) showed a tendency to monopolize the examination, the Goryeo government limited the examination applications by this group. The medical licensing examination was divided into two parts: medicine and ‘feeling the pulse and acupuncture’ (jugeumeop). The Goryeo Dynasty followed the Chinese Dang Dynasty’s medical system while also taking a strong interest in the Chinese Song Dynasty’s ideas about medicine.

Medical education in India: Current challenges and the way forward

Medical education in India is suffering from various shortcomings at conceptual as well as implementation level. With the expansion in medical education, the doctor to patient ratio has increased but these numbers do not align well with the overall quality of medical care in the country. To address this issue, a comprehensive analysis of various associated factors is essential. Indian medical education is suffering from a maldistribution of resources, unregulated growth in the private sector, lack of uniform admission procedures and traditional curricula lacking innovative approaches. To achieve higher standards of medical education, our goal should be to re-evaluate each and every aspect; create an efficient accreditation system; promote an equal distribution of resources, redesign curricula with stricter implementation and improved assessment methodologies; all of which will generate efficient medical graduates and consequently better health care delivery, and resulting in desired change within the system.

Las nuevas carreras de medicina como símbolo: entre la legitimidad académica y la señalización de mercado

La educación médica es compleja, altamente regulada, y generalmente deficitaria. ¿Por qué una universidad habría de abrir una escuela de Medicina? Entre 1990 y 2010, el número de escuelas de Medicina en Chile aumentó de 6 a 28. Este crecimiento tuvo lugar conjuntamente con un aumento de cuatro veces en la matrícula total en educación superior, y un aumento de tres veces en los estudiantes de Medicina. La expansión de la educación médica no puede explicarse solamente en base al aumento en el acceso a la educación superior y a un incremento en la demanda por estudios de Medicina. También se requirió un aumento en la oferta de estudios de este tipo. ¿Por qué se crearon nuevas escuelas de Medicina en las universidades chilenas? ¿Sólo para crear más plazas para futuros médicos? A través de este estudio basado en entrevistas, buscamos recuperar la justificación de la creación de nuevas escuelas de Medicina en Chile en las últimas dos décadas, e interpretar los resultados bajo dos prismas teóricos: el nuevo institucionalismo organizacional, por un lado, y la teoría de la señalización (signaling), por el otro. En los relatos de los protagonistas de estos procesos encontramos evidencia tanto de la búsqueda de legitimidad académica como de la intención de dar una señal al mercado, así como una comprensión de la manera en que estos propósitos se apoyan recíprocamente, en tanto el principal beneficio anticipado por los promotores de las nuevas escuelas de Medicina fue el aumento en la reputación académica de la universidad, la cual, a su vez, serviría para reforzar su posición competitiva con respecto a otras universidades.

Challenges and Opportunities in Building a Sustainable Rural Primary Care Workforce in Alignment With the Affordable Care Act

The authors examine the potential impact of the Patient Protection and Affordable Care Act (ACA) on a large medical education program in the Northwest United States that builds the primary care workforce for its largely rural region. The 42-year-old Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) program, hosted by the University of Washington School of Medicine, is one of the nation's most successful models for rural health training. The program has expanded training and retention of primary care health professionals for the region through medical school education, graduate medical education, a physician assistant training program, and support for practicing health professionals.The ACA and resulting accountable care organizations (ACOs) present potential challenges for rural settings and health training programs like WWAMI that focus on building the health workforce for rural and underserved populations. As more Americans acquire health coverage, more health professionals will be needed, especially in primary care. Rural locations may face increased competition for these professionals. Medical schools are expanding their positions to meet the need, but limits on graduate medical education expansion may result in a bottleneck, with insufficient residency positions for graduating students. The development of ACOs may further challenge building a rural workforce by limiting training opportunities for health professionals because of competing demands and concerns about cost, efficiency, and safety associated with training. Medical education programs like WWAMI will need to increase efforts to train primary care physicians and increase their advocacy for student programs and additional graduate medical education for rural constituents.