International Medical Service Research Articles

A qualitative study of career decision making among African and Asian international medical students in China: process, challenges, and strategies.

China hosts around 68,000 international medical students (IMSs) primarily from lower income countries in Africa and Asia, who have the potential to contribute to international medical services. Understanding how these IMSs make career decisions can help better address the issue of global medical workforce shortage. However, such research is limited. Our study aims to explore the career decision-making process of China-educated IMSs, the challenges they experienced and the strategies they employed.In this exploratory qualitative study, we conducted semi-structured interviews with IMSs educated in China in 2022 using purposeful sampling. Twenty virtual one-on-one interviews were conducted, and data were analysed through directed qualitative content analysis. Cognitive Information Processing (CIP) theory was applied as the guiding framework for organising and analysing the data.The career decision-making process of the participants generally followed the stages of decision-making cycle in CIP theory, with a combination of urgent migration decisions and specialisation considerations adding layers of complexity to their career trajectories. Identified challenges encompassed lack of knowledge about oneself and career options, lack of decision-making skills, concerns of contextual complexities that limited the career decision-making process, low motivation and negative thoughts. Specific challenges due to their role as IMSs arose, which were related to career information access, self-capability evaluation, degree accreditation, employment competitiveness and mental states. Participants' proposed strategies were categorised into personal and institutional aspects, providing insights into addressing these challenges.This study substantiates and expands the application of the CIP theory within the sphere of the particular cultural and educational context of IMSs educated in China. It highlights the significance of integrating migration decision-making into career guidance for IMSs, and contributes to the literature by proposing an evidence-based tiered career intervention programme for IMSs.

Маркетинговая политика в поддержке развития международного медицинского туризма: кейс многопрофильного стационара

The article reveals an approach to the selection and design of marketing policies to support the development of international medical tourism services as a new autonomously managed product in the structure of medical care of a general hospital. The study of scientific discussion shows the key problems and challenges for the development of medical tourism today. Marketing policy is con-sidered as a way to differentiate from competitors and create a value proposition for the target au-dience success-fully. The article demonstrates that a specific functional policy with a focus on se-lected tools can be applied to implement a growth strategy. In the study suggested about the leading role of promotion tools and customer support in the content of marketing policy. Certain healthcare institution has been studied as a participant in the international tourism market. The study reflexes the relationship between functional policies and the framework of the strategic development pro-gram, results of situation analysis and provides arguments for the necessary guidelines for strategic development, first of all, the launch of an updated program for the development of international medical tourism. Despite the in-tense competition in the market, the general hospital has advantages in certain areas of treatment (cardiac surgery and neurosurgery), which are identified as a window of opportunity. The path of the marketing policy is to update maintenance tools for new treatment programs and to launch a campaign to promote international medical tourism services. The segmen-tation of the market of foreign medical tourists has been implemented, and target segments have been identified. Goals and programs for the implementation of the marketing strategy have been defined. The example of promotion tools shows how part of the marketing mix can be built. Indica-tors to monitor the achievement of marketing goals have been identified. The different arguments provide a key to understanding the important role of marketing policy in the successful implementation of the strategy and achievement of goals for sales, markets and consumers.

Experiences of oncology healthcare personnel in international medical service quality: a phenomenological study

BackgroundWith the globalization of medical services on the rise, Asia has ascended to a destination of choice for its high-quality medical services at very reasonable rates. Monitoring the quality of the international medical industry is vital to maintain service demand. The experiences of healthcare personnel (HCP) involved in international medical services (IMS) regarding the provision of services to international cancer patients have not yet been discussed. This study aimed to explore oncology HCP experiences of IMS quality in caring for international cancer patients in Taiwan.MethodsDescriptive phenomenological method and were analyzed through Colaizzi’s seven-step approach. In this study, 19 respondents were collected data by using in-depth semi-structured interviews. An average interview lasted approximately 45 min.ResultsFour major themes were identified from the interviews: patient selection, psycho-oncology care, predicaments, and promoting suggestions. Additionally, thirteen subthemes emerged, including necessary selection of patients, reasons for unwillingness to enroll international patients, helpless patients, emotional distress, care with warmth, insufficient manpower, an unfair reward mechanism, poor hardware equipment, the predicaments of oncology care, various publicity strategies, one-on-one service model, design of a designated area, and reasonable benefit distribution.ConclusionsThis study explored oncology HCP experiences of IMS quality in caring for international cancer patients, with implications for hospitals in developing high-quality IMS. Due to the fact that IMS is a global trend, HCPs, administrators, and policy-makers are advised to improve the quality of IMS in the oncology department, which has been the least studied field in IMS quality.

Research on Application of Health Medical Information Science Data Sharing Standard System in Sports Rehabilitation

The development of medical information technology has rapidly promoted the development of medical information technology towards intelligence. Health medical data provides basic data resource protection for intelligent medical services and smart medical services. This article abstracts the typical models of domestic and international health medical information management services, and provides theoretical basis and practical reference for the building of an evaluation index system for health management service capabilities. An system for health management service capabilities under a data sharing standard system was constructed, and the status and linkage of health management services were investigated and comprehensively evaluated to provide an index system and empirical data for evaluating hospital health management service capabilities. Finally, analyze the advantages and disadvantages of health management services under the medical consortium framework, propose countermeasures to improve the health management service system, provide decision-making references for units to improve their health management service capabilities, optimize health management service models, and formulate health management services for relevant government departments Provisional policies to promote the implementation of health management.

The clinical english communication situations and the requirement of nursing staff on improving their clinical english communication abilities

Background: Due to globalization, the frequency to stay in other countries has increased, resulting in more chances to nursing staff to communicate with foreign patients in English. However, English is not the native language in many countries, including Taiwan. Many nurses cannot communicate with foreign patients efficiently. Aim: This study aimed to identify the clinical English Communication Abilities of nurses and their willingness and requirements to improve, negative communication situations, and their influential factors. Methods: A questionnaire to conduct a descriptive, exploratory, cross-sectional survey was applied to 273 clinical nurses at a teaching hospital in Taiwan. Results: Most nurses stated that their English Communication Abilities was insufficient to cope with clinical requirements and were willing to improve this ability. In negative communication situations, the major problems included the nurses felt that they had to spend more time, were more stressed, and were not able to perform at a professional level when interacting with foreign patients, which would reduce interaction with patients. The factors that impact these problems include frequency of self-study and clinical English communicative abilities. English handout containing hygiene instructions was considered the most useful resource to facilitate clinical English conversation. Conclusions: Inadequate English Communication Abilities results in more time spent when communicating with foreign patients. Nurses who have better English Communication Abilities or have set hours for studying English may reduce the frequency of negative situations while communicating in English. Periodical advanced study of English might reduce the negative situation of nurse–patient communicated in English. To provide high-quality international medical service, the hospital managers have to offer appropriate assist strategies to improve nurses' clinical English communication abilities.

Case study: international healthcare service quality, building a model for cultivating cultural sensitivity.

In the context of medical tourism, cultural differences and language barriers are unneglectable factors, which compromise the shared decision-making between doctor and patients. This study constructs a cultural sensitivity cultivation (CSC) model that could be used to train medical professionals in the sector of medical tourism. Since 2016, there have been explorations in new strategies to offer better services. A critical step added is to include clients' perspectives in the re-examining process as a way to cultivate cultural sensitivity among the service providers. This practice expands to the sector of medical tourism. In our case study, we are able to conclude a new model that could yield quality international healthcare services. The steps of our CSC model include (i) 'Promote Awareness' for shifting mindset, (ii) 'Share Scenarios' for developing empathy and compassion, (iii) 'Review Process' for collecting detail feedback, (iv) 'Identify Gaps' for targeting areas for improvement and (v) 'Improve Systems,' for changing standard operation procedures (SOPs) based on the strategies through Assmann's theory with a cultural-anthropological approach. After Kuang Tien General Hospital (KTGH) implemented the new model for 1 year, the number of international patients has increased by 64%. More research could be done in the future to cover all the important aspects of providing international medical services and could apply the CSC model to different healthcare settings. To optimize the shared decision-making between the doctor and medical traveler patients, healthcare providers should not only overcome language and cultural barriers but also should avoid unnecessary gestures in terms of status respect. Inviting patients to be co-investigator for quality improvement is a viable solution.

Quality outcomes for pediatric colorectal surgery treated during short-term international medical service trips at a dedicated site in Honduras

IntroductionShort-term international medical service trips (MSTs) provide specialized care in resource-constrained countries. There are limited data on immediate and long-term reported outcomes following specialty MST. We hypothesized that dedicated collaborative MST team and host institution produce outcomes and results comparable to those of high-income settings. Our primary aim was to analyze the long-term surgical and functional outcomes of our specialty-specific MSTs following five years of annual MST in Honduras. MethodsWe performed a single-institution retrospective analysis of 56 children who underwent colorectal and pelvic reconstructive operations between 2014 and 2018.Demographics, diagnosis, comorbidities, type of repair, long-term complications, and functional bowel and bladder results were recorded. ResultsWe included a total of 56 children, 47 with ARM and 9 with HD, with a median age of 43.5 months (17–355) at the time of surgery. 25% (22) of the patients were lost to follow-up. Fecal continence was achieved by 23 (60%) patients <5 years who reported toilet training (n = 39) and by 5 (45%) patients >5 years (n = 11). Complications included constipation in 18 (42.9%) children with ARM and in 1 (12.5%) with HD. Eleven (19.6%) patients required revisional surgery for skin level anal stricture. Seventy-five percent of the patients with pediatric colorectal disorders attending the MST were compliant with continued long-term follow-up. ConclusionWe were able to demonstrate that with organized, dedicated site and surgeon, results achieved can be comparable to those in the high-income countries (HICs). We conclude that this type of specialized care is feasible and beneficial for affected pediatric colorectal patients in resource-limited settings, when a strong partnership with a system of preoperative assessments and peri- and postoperative care can be established. Level of evidenceLevel IV (retrospective cohort study).

The Effect of Pediatric Colorectal Short-Term Medical Service Trips on Self-Reported Confidence in Patient Care in Volunteers in the Home Country.

Introduction:Short-term international medical service trips (MST) are established means to access specialized medical aid in resource-limited areas. The field of pediatric colorectal surgery is a subspecialty in pediatric surgery that mainly treats anorectal malformations (ARM) and Hirschsprung disease (HD). This study aimed to investigate the impact of MST on the donors’ perception of competency concomitantly to the impact on patients in the donors’ home country. We also wanted to investigate whether the donors’ pre-existing experience in the field of ARM and HD affects the experience they gain during the MST, and the subjective perception in treating patients in their base country.Methods:We created a questionnaire for the international medical staff participating in MSTs on the unique topic of pediatric colorectal diseases. The questionnaire was split into three parts: essential experience (1) in the field of colorectal surgery of the participant, the experience and impact on patient care in the home country during and after the MST in ARM (2), and in HD (3).Results:We collected data from 20 participants (6 female, 14 male). The majority of them had prior experience with the MST program (75%) and came from institutions specialized in the treatment of pediatric colorectal disorders (80%). Participants felt that MST improved patient care in both the host country (p < 0.001) and their home country (p < 0.001). Experienced and less experienced participants did not differ in the overall MST evaluation (ps > 0.08). They reported that their competencies to treat ARM and HD improved significantly in response to the MST (ps < 0.001). Improvements in ARM and HD treatment were associated with the number of supervised HD surgeries during MST, while the other forms of participation were unrelated to the improvements.Conclusion:The results of our questionnaire indicate that participation in MST in the specialized field of pediatric colorectal surgery helps to improve confidence in the care and treatment of affected patients in both the host and donor countries, independent of previous surgical experience.

Development and Implementation of Short Courses to Support the Establishment of a Prehospital System in Sub-Saharan Africa: Lessons Learned from Tanzania.

Background Tanzania has no formal prehospital system. The Tanzania Ministry of Health launched a formal prehospital system to address this gap. The Muhimbili University of Health and Allied Sciences (MUHAS) was tasked by the Ministry of Health to develop and implement a multicadre/provider prehospital curriculum so as to produce necessary healthcare providers to support the prehospital system. We aim to describe the process of designing and implementing the multicadre/provider prehospital short courses. The lessons learned can help inform similar initiatives in low- and middle-income countries. Methods MUHAS collaborated with local and international Emergency Medicine and Emergency Medical Services (EMS) specialists to form the Emergency Medical Systems Team (EMST) that developed and implemented four short courses on prehospital care. The EMST used a six-step approach to develop and implement the curriculum: problem identification, general needs assessment, targeted needs assessment, goals and objectives, educational strategies, and implementation. The EMST modified current best EMS practices, protocols, and curricula to be context and resource appropriate in Tanzania. Results We developed four prehospital short courses: Basic Ambulance Provider (BAP), Basic Ambulance Attendant (BAAT), Community First Aid (CFA), and EMS Dispatcher courses. The curriculum was vetted and approved by MUHAS, and courses were launched in November 2018. By the end of July 2019, a total of 63 BAPs, 104 BAATs, 25 EMS Dispatchers, and 287 CFAs had graduated from the programs. The main lessons learned are the importance of a practical approach to EMS development and working with the existing government cadre/provider scheme to ensure sustainability of the project; clearly defining scope of practice of EMS providers before curriculum development; and concurrent development of a multicadre/provider curriculum to better address the logistical barriers of implementation. Conclusion We have provided an overview of the process of designing and implementing four short courses to train multiple cadres/providers of prehospital system providers in Tanzania. We believe this model of curricula development and implementation can be replicated in other countries across Africa.

Establishment of appropriate location for international medical service aftercare center - Application of Analytic Hierarchy Process &amp; deriving key indicators

Establishment of appropriate location for international medical service aftercare center - Application of Analytic Hierarchy Process &amp; deriving key indicators

A Model for Creating Opportunities in “Gιobal Outreach-based Activity Learning” (GιOBAL)

In our institution, medical students engage in international medical service trips that are inspired by their commitment to global causes. To support students interested in medical volunteerism, we sponsored pre-clerkship faculty to accompany them during the academic break to complete a week-long immersion in globally learned outreach-based experiences. Our student feedback suggests that participation in these experiences is meaningful, and we believe the international collaborations foster a sustainable educational model. We propose here a model for developing opportunities in Global Outreach-based Activity Learning (GιOBAL) experiences that involve pre-clerkship faculty and which can be helpful to new and established medical programs.

Leading and Participating in International Medical Service Trips.

In communities around the world, health professionals and students preparing for health careers are increasingly responding to global health needs stemming from natural disasters, infectious disease outbreaks, and inadequate resources. This has resulted in a wide range of faith-based and nonfaith-based health care organizations establishing international medical service programs. This article provides guidance for nursing professional development educators and faculty on leading and participating in these programs. The emphasis is on using best practice guidelines while engaging with the community and providing culturally appropriate and sustainable health care services within an international context. J Contin Educ Nurs. 2018;49(6):251-253.

ИССЛЕДОВАНИЕ УСЛОВИЙ, ФАКТОРОВ И ТЕНДЕНЦИЙ РАЗВИТИЯ МЕЖДУНАРОДНОГО РЫНКА МЕДИЦИНСКИХ УСЛУГ

Medical service is a process of interaction between a doctor and a patient in order to improve health outcomes. The quality of medical services is influenced by various factors: a lack of equipment in the preventive health care facilities, pharmaceutical products supply, coordination of appointments of the patients, etc.). Accordingly, there appears a tendency to increase the demands for provision of medical services. The social significance of healthcare services renders the process of their provision as the category of mandatory measures for governmental control and regulation in all countries, with the purpose to provide access for all strata of the population and maintain the appropriate quality level. Therefore, the standards of medical services have become the main line of activity for many specialized international organizations and governments (personnel requirements, medical products and medicines, regulation of medical insurance, etc.). In turn, standardization creates significant entry barriers in the market of medical services. The need of implementing international and national standards for the provision of medical services and their convergence are stipulated by the specificity of the healthcare sector. International medical service trade, implementation of telemedicine technologies and innovative methods of treatment, standardization of production and consumption of medical services are modern trends that lead to the formation of the international market for medical services. The provision of medical services to patients of other countries in more than 50 countries is defined as one of the main directions of national development. Since the cost factor is an important determinant of competitiveness, patients from countries with highly developed health care system go to developing countries where they receive medical services of good quality at lower prices. In light of the above, the article analyzes the stages of development of the medical service market depending on the level of economic development, preconditions for developing competitive advantages and the global factors that shape the trends of development of the international market of medical services.

НАПРАВЛЕНИЯ ИНТЕГРАЦИИ РОССИЙСКОЙ СИСТЕМЫ ЗДРАВООХРАНЕНИЯ В МЕЖДУНАРОДНЫЙ РЫНОК МЕДИЦИНСКИХ УСЛУГ

International healthcare service trade, standardization of production and consumption, implementation of telemedicine technologies and innovative methods of treatment are modern trends that lead to the formation of the international market of medical services. In terms of profound demographic shifts, all the aspects related to the improvement of the quality and extension of life of people acquire decisive importance for all countries. In this regard, the medical service market has huge growth potential. The dynamic development of international medical service trade actively involves Russia in this process. The article analyses the tendencies of development of Russian market of medical services in relation to global trends in the international market. Its consideration in this context will help to identify possible ways to deepen the further integration of Russian market into the global processes. The article considers the current situation at the medical service market in the Russian Federation and the ways of its adaptation to the requirements of the international market aiming to increase the level of integration in accordance with a key trend of the development (expansion of the use of telemedicine technologies; formation of the international medical specialization of the countries; active involvement of healthcare services into international exchange; to increase funding for medical services, etc.). Scientifically substantiated is the use of the trend to increase competitiveness of the Russian medical service market by providing information and consulting support to the Russian medical firms in order to give them a chance to be included in the international rating and accreditation processes. The findings and results of the study can be used by the executive authorities in the field of healthcare for substantiating effective ways of integration of the domestic medical service market into the global market.

Review of the Local Organizing Committee (LOC) medical services during the 12th FINA World Swimming Championships (25 m) in Doha, Qatar

BackgroundOne of the primary roles of Fédération Internationale de Natation (FINA) is to promote athlete health. The planning and delivery of major international event medical services is carried out in...

Stories from unaccompanied children in immigration detention: A composite account.

In March 2014 we spent a week on Christmas Island as medical consultants to the Australian Human Rights Commission (AHRC) Inquiry into the Impact of Immigration Detention on Children. The visit involved three Human Rights Commission staff as well as the authors, paediatrician Karen Zwi and child psychiatrist Sarah Mares, representing the Royal Australasian College of Physicians and the Royal Australian and New Zealand College of Psychiatrists respectively. Using interpreters, we spoke to over 40 unaccompanied children and service providers to ascertain processes and policies and to give feedback about detainees of immediate concern. We would like to honour the voices of the detainees; we have used their exact words where possible. In a separate paper, we focus on the families and children detained in immigration acilities on Christmas Island. Unaccompanied children are children under the age of 18 years who are seeking asylum from threatened or experienced danger. They arrive unaccompanied by a parent, legal guardian or adult relative over the age of 21 years. On arrival to Australia, unaccompanied children by law become the legal wards of the Department of Immigration and Border Protection (DIBP). The role of a legal guardian is commonly regarded internationally as one who ‘stands in loco parentis to the child’, which includes making decisions regarding the best interests of the child and providing for the child’s emotional and material needs. In Australia, the Minister’s role tends to be nominal without practical assistance offered to the children, which has been described as leaving them not only unaccompanied but also unrepresented. A DIPB officer is appointed locally as the children’s ‘Delegated Guardian’ as discussed below. Most unaccompanied children leave their homes as a desperate measure in search of protection, education and employ ment, and to contribute to the welfare of their family. They have often embarked on dangerous journeys, experienced war, the death of family members, persecution, violence, sexual abuse, escape from forced recruitment into armed organisations and forced domestic labour. These experiences occur during critical developmental periods, thus placing them at risk of mental health problems. Research is limited to a few cross-sectional or on-arrival studies, which have shown that around 25–50% have emotional and behavioural problems, anxiety, depression and post-traumatic stress disorder (PTSD), at higher rates than in accompanied asylum seeker children. However, consistent with other studies on refugee children, the majority of unaccompanied children score below clinical cut-offs for psychiatric disorder, thus displaying a marked resilience. The severity of psychiatric symptoms is likely to increase with more traumatic events experienced prior to forced migration, demonstrating the cumulative impact on well-being of traumatic exposure. Children exposed to adversity following migration, particularly those placed in prolonged detention, are more severely affected. Studies show increased symptoms for those exposed to rioting, fires, violence and self-harm attempts by parents or others in detention. Rapid resolution of asylum claims reduces the duration of uncertainty and associated distress for children, whereas insecure asylum status is associated with a range of psychological problems that can have long-lasting effects. Prompt access to services catering for physical and psychological health is important, as are long-term stability of residence and socially supportive environments. It is also known that PTSD symptoms are increased in lower-support living arrangements suggesting that foster family living and high support may improve outcomes.

Reflections on a Medical Service Trip: Did we do the right thing?

Medical service trips have a long and distinguished history. In the United States,interest in medical outreach trips has grown substantially, as medical schools andnon-governmental organizations support numerous overseas endeavors at an estimatedcost of 250 million dollars a year. Although providing care to those in need is arewarding experience, the question that needs to be answered is whether these tripsdo more harm than good. We describe our experience during a medical service trip toEnsenada, Mexico. We treated over 500 people for numerous problems, but due to thelack of services were not able to monitor or ensure follow-up. Did we do more harmby providing medications that can have serious side effects? Recommendations havebeen developed to help short-term international medical service trips provide the bestoverall experience for the participants and the best care for the patients.

Physicians' Participation in Practice of Knowledge Management Systems

Healthcare organisations are knowledge-based establishments. At a healthcare organisation, computer-based information systems (ISs) are powerful tools for improving care using decision support such as patient health data recording, storing, delivery and retrieval. This study investigates the physicians' perspective for the success of ISs, and the relationships between the users' satisfactions and intellectual capital. We adopted a questionnaire survey for the purpose of outcome assessment and the correlations among each dimension, from a sample of 181 physicians in Taiwan's international medical service centres. The results indicate that IS success is significantly related to intellectual capital. With regard to IS quality, system quality has no significant effects on information quality and patients' privacy protection. This research provides empirical evidence to evaluate IS success in healthcare organisations and suggestions for how to promote physicians using knowledge management systems.

Poverty, Disparities, Disasters and Global Burden of Disease

AbstractThe world socio‐economic situation contributes to increasing poverty, disparities and poor accces to health. Rising poverty levels and disparities continue to slow, and in some cases negate, the hard won achievement in global health. Natural disasters are also on the rise, killing people, destroying services, communities and medical infrastructure, and further exacerbating the plight of the poor and already medically underserved populations. A more efficient use, collaboration and integration of national and international medical and health resources and services will help improve health in vulnerable populations.

Medical tourism – unwrapping the gift of globalisation

Many countries of the world are now promoting themselves as international medical centres and attracting patients from across the globe. With competition in medical tourism intensifying further, India must conquer a share of the international medical services market to stay in the competition. The present study tries to find the reasons why the inbound patients, especially from the developed world (notably the USA, Europe, and Britain) consider India as a remedial destination. The study also tries to find how far the considerations of cost and quality in this sector matter to all inbound patients. The study has tried to identify important factors, like the low waiting time for seeking treatment, the potential for savings and the quality of medical facilities on offer, which patients from abroad consider decisive while choosing India for the purpose of medical aid.