Medical Workforce Research Articles

Racial Disparities in Sports Cardiology

ImportanceRacial disparities in cardiovascular health, including sudden cardiac death (SCD), exist among both the general and athlete populations. Among competitive athletes, disparities in health outcomes potentially influenced by social determinants of health (SDOH) and structural racism remain inadequately understood. This narrative review centers on race in sports cardiology, addressing racial disparities in SCD risk, false-positive cardiac screening rates among athletes, and the prevalence of left ventricular hypertrophy, and encourages a reexamination of race-based practices in sports cardiology, such as the interpretation of screening 12-lead electrocardiogram findings.ObservationsDrawing from an array of sources, including epidemiological data and broader medical literature, this narrative review discusses racial disparities in sports cardiology and calls for a paradigm shift in approach that encompasses 3 key principles: race-conscious awareness, clinical inclusivity, and research-driven refinement of clinical practice. These proposed principles call for a shift away from race-based assumptions towards individualized, health-focused care in sports cardiology. This shift would include fostering awareness of sociopolitical constructs, diversifying the medical team workforce, and conducting diverse, evidence-based research to better understand disparities and address inequities in sports cardiology care.Conclusions and RelevanceIn sports cardiology, inadequate consideration of the impact of structural racism and SDOH on racial disparities in health outcomes among athletes has resulted in potential biases in current normative standards and in the clinical approach to the cardiovascular care of athletes. An evidence-based approach to successfully address disparities requires pivoting from outdated race-based practices to a race-conscious framework to better understand and improve health care outcomes for diverse athletic populations.

Doctors',Patients' and Physician Associates' Perceptions of the Physician Associate Role in the Emergency Department.

The Emergency Department (ED) has seen increased patient attendance and difficultymeeting demands. New healthcare professions such as Physician Associates (PAs) are being utilised to complement the existing medical workforce. Despite the growth of their professions in the United Kingdom, little evidence is available about the perceptions of their roles. This study aims to provide evidence of doctors', PAs' and patients'perceptions of the PA role in the UK ED. A mixed methods approach consisted of the following: 1. An online exploratory survey of ED doctors at one English EDover 1 month (February-March 2022). 2. Post consultation semi-structured patient questionnaires over 2 weeks (April 2022). 3. Semi-structured virtual interviews with ED consultants across thefour regions of theUnited Kingdom (3 months in 2022). 4. Semi-structured virtual interviews with ED PAs across thefour regions of theUnited Kingdom(3 months in 2022). The analysis methods that were used includedfrequency counts and percentages from closed questions, andhybrid thematic analysis of free text and interview transcripts. Four ED consultants and four ED PAs across the United Kingdom were interviewed. Twenty-eight ED doctors participated in the online survey. Fifty-seven patients completed the post consultation questionnaire. Four main themes (PAs being fit for purpose; patient recognition of PAs, PAs providing continuity of care, and future PAs and regulation) were deduced as per the General Medical Council, Good Medical Practice domains (knowledge, skillsand development; patients, partnership and communication; colleagues, culture and safety; and trust and professionalism). Other subthemes were induced via hybrid thematic analysis. In this study, doctors and patients had mixed comments about the role of PAs. Most of them were positive as doctor participants perceived PAs to be knowledgeable, highly skilled, with mostly good communication skills, team players, providing continuity of care and overall being fit for purpose. However, some doctor participants commented negatively about PAsfor providing little quality healthcare and being inexperienced. There was a desire for career progression amongthe PA participants and a need to work to their full potential. Although the clinicians of this study displayed a clear understanding of the PA role in the ED,a high frequency of surveyed patients mistook PAs for doctors. It was suggested that future PAs could complete a postqualification programme in emergency medicine, combine roles, be paid on an alternative scaleand be formally regulated. In this study, mixed views were expressed by ED consultants, ED junior doctorsand patients regarding the role of the PA in the ED. Stakeholders can use the information presented to develop a better understanding of the perceptions of the PA role within the UK ED. The Patient and Public Involvement and Engagement (PPIE) group, led by Healthwatch, made significant contributions to the study's design by providing valuable feedback on the information sheets and consent forms utilised. The patients' responses helped guide the study's direction and shape its future work. As part of the dissemination activities, the study findings was shared with both the PPIE team and Healthwatch media production team.

Navigating identity dissonance: subjectification to balance socialization.

One of the main goals of medical education is to facilitate the development of a professional identity. As part of this effort, trainees are exposed to the values and cultures of the profession in a process known as socialization. Learners must then negotiate incongruent aspects between their preexisting identities and nascent professional identities. Individuals from historically underrepresented ethnic groups often undergo more significant changes due to their values and culture not being as prevalent within the dominant ideology of medicine. This transformative process can lead to identity dissonance and manifest as an internal discomfort resulting from perceived contradictions between one's existing identity and the required professional identity. Identity dissonance may be traumatic and pose a threat to the academic performance and professional integration of trainees. These detrimental effects harm the medical workforce by depriving it of a group crucial in addressing health inequities. Educators tasked with facilitating the professional development of learners must consider their implicit expectations about professionalism, explore the distinct challenges experienced by individuals from underrepresented backgrounds in their professional development, and work to develop strategies to help trainees navigate identity dissonance. Subjectification, an education philosophy that focuses on compelling individuals to explore the new possibilities and responsibilities imparted to them by their education, provides a theoretical framework to help educators guide learners through identity dissonance.

Universal versus Targeted Stipends: How to Reduce Inequity While Avoiding Stigma in Medical Education

Medical education pathway programs address disparity in the medical workforce, particularly in rural areas, but inequity between program participants detracts from the goal. Universal, rather than targeted, stipends overcome this inequity. We report an evaluation of a universal stipend program for undergraduate students in a medical education pathway program. The stipend covers costs associated with preparing to take the MCAT exam. Findings reveal that students who are less advantaged, have lower income, and whose parents have less education, received more benefits from the stipend than those from advantaged backgrounds. The universal stipend design avoids stigmatizing recipients while it helps grow the medical education pathway.

Advanced nurse practitioner well‐being: A 4‐year cohort mixed methods study

AbstractAimsTo examine changes in advanced nurse practitioner (ANP) well‐being, satisfaction and motivation over a four‐year period.DesignLongitudinal Cohort study.MethodsSurveys were carried out each year from 2019 to 2022 with the same cohort of ANPs in the United Kingdom (UK). The survey consisted of demographics, questions on contemporary issues in advanced practice, National Health Service (NHS) staff survey questions and validated questionnaires. A core set of questions were asked every year with some changes in response to the COVID‐19 pandemic.ResultsResponse rate ranged from 40% to 59% and appeared to be affected by COVID‐19. Staff satisfaction with pay and the well‐being score were stable throughout. Other questions on well‐being, job satisfaction and motivation saw statistically significant reductions after 4 years. Open‐ended questions about ongoing well‐being concerns show participants are concerned about exhaustion levels caused by workload, staffing issues, abuse from patients and colleagues' mental health.ConclusionThe findings highlight a decline in ANP well‐being, job satisfaction and motivation post‐COVID‐19. Reasons for this, explored in the qualitative data, show that ANPs have faced extremely difficult working conditions. Urgent action is required to prevent a workforce retention crisis as many nursing staff are close to retirement and may not be motivated to remain in post.ImpactThis study has followed ANPs through the most challenging years the NHS has ever seen. Job satisfaction, motivation and enjoyment of the job all significantly reduced over time. In many areas, the ANP role has been used to fill medical workforce gaps, and this will become harder to do if ANPs are dissatisfied, disaffected and struggling with stress and burnout. Addressing these issues should be a priority for policymakers and managers.Patient or public contributionNone as this study focussed on staff. Staff stakeholders involved in the design and conduct of the study.

Can compassionate leadership of senior hospital leaders help retain trainee doctors?

BackgroundHigh burnout and low retention rates among trainee doctors threaten the future viability of the UK medical workforce. This study empirically examined factors that can sustain trainee doctors.MethodA total of...

Mentoring to address differential attainment of international medical graduates in GP training

ABSTRACT Introduction International Medical Graduates (IMGs) form an important and valued part of the United Kingdom’s (UK) medical workforce but many experience difficult transitions into the National Health Service workforce. Mentoring could support IMGs as they transition into their role as General Practice (GP) trainees but there is a lack of evidence about whether mentoring is an effective intervention for this group. Aim To evaluate the effectiveness of the NHS Education for Scotland (NES) GP mentoring programme from the perspective of mentors and mentees. Method Twelve medical educators (the mentors) provided mentoring to 19 IMG GP trainees (the mentees) who were within their first six months of entering GP training in Scotland. Each mentee received four 60-minute mentoring sessions via video conferencing. Results Mentoring provided tailored support to assist IMG GP trainees’ holistic transition into UK General Practice. Mentees appreciated talking to a non-supervisor, receiving non-judgemental support and protected time with a supportive listener to overcome challenges. This had a positive impact, even for those who did not anticipate the need for such support. Mentors supported diverse needs and tailored meetings, experiencing a distinct shift from previous supervisor roles. Their diverse experience enhanced their role and they developed new skills. Conclusion Mentoring could provide significant support to IMG GP trainees but comes with certain challenges. Future research should evaluate the long-term impact of the NES GP IMG mentoring programme.

Isu Etika dalam Pemanfaatan Tenaga Kesehatan Warga Negara Asing di Indonesia: Perspektif Keberlanjutan Pelayanan Kesehatan

The phenomenon of globalization has transformed the world's landscape, connecting nations, and inspiring the concept of Special Economic Zones (SEZs). The utilization of Foreign National Health Workers (FHNWs) has become a strategy to address the shortage of medical personnel and enhance healthcare services, particularly in remote regions. However, the implementation of this policy also faces several ethical, cultural, and linguistic challenges. The ethical aspect takes center stage in the utilization of FHNWs. Patient rights, professionalism, and cross-cultural collaboration are crucial focal points in healthcare service practices. Despite its benefits, the utilization of FHNWs encounters communication hurdles, especially when the employed language is unfamiliar. Additionally, the integration of local cultural values becomes a pivotal aspect in delivering sensitive and patient-centered care. This paper analyzes policy documents related to the utilization of Foreign National Health Workers (FHNWs) in Indonesia through normative and predictive approaches. The objective is to comprehend the concepts and regulatory implementations concerning the ethics of FHNW utilization within the context of Indonesian healthcare services. The phenomena of globalization and efforts to expedite economic growth through Special Economic Zones (SEZs) have influenced these policies. The analysis involves various policy documents relevant to FHNW utilization. In facing the ethical dilemmas arising in the practice of healthcare services by foreign medical personnel, it is imperative for them to adapt to the local culture without compromising the principles of medical ethics. Moreover, competition within the job market and cultural disparities between foreign and local medical personnel also present challenges that need to be addressed. In dealing with competition, a holistic approach involving the government, relevant institutions, and professional training for local medical personnel is required. Overall, the utilization of FHNWs holds potential benefits in addressing medical workforce shortages and enhancing healthcare access. However, this utilization must be carried out with ethical responsibility, respecting patient rights, and considering cultural and professional aspects. With a prudent approach, the utilization of FHNWs can contribute to improving the quality of healthcare services and the well-being of local medical personnel, in line with ethical principles and national interests.

Gender representation in Canadian surgical leadership and medical faculties: a cross-sectional study

BackgroundOver the past two and half decades, Canadian medical school students have become majority female, and the medical workforce is therefore increasingly comprised of female physicians. Whether this change, however, has been reflected in the gender balance within medical school faculty positions and leadership has not been well studied in Canada.MethodsThis cross-sectional study examined the genders of full-time faculty members from the most recently available AFMC data, the current heads of departments of medicine and surgery from department websites and confirmed with respective universities.ResultsOverall, women held 40.5% of full-time faculty positions in Canadian faculties of medicine. Female representation decreased with increasing academic rank, from 57.8% of instructors to 50.8% of assistant, 39.2% of associate, and 28.1% of full professors, respectively, with the greatest rate of increase over the past decade among full professors (0.75% per year). The heads of departments of family medicine were majority female (67%), and heads internal medicine at parity (50% female), consistent with numbers of practicing physicians. However, the heads of surgical divisions were majority male (86% overall). Accounting for the gender balance of practicing surgeons, male compared to female surgeons were 2.9 times as likely to be division head (95% CI 1.78–4.85, p < 0.0001).ConclusionsWomen remain underrepresented in Canadian faculties of medicine in leadership positions. Leadership in departments of surgery has particularly low female representation, even relative to the proportion of practicing female surgeons within the respective discipline.

Rural generalist medicine: a developing approach to health care in rural and island Japan.

Despite universal health coverage and high life expectancy, Japan faces challenges in health care that include providing care for the world's oldest population, increasing healthcare costs, physician maldistribution and an entrenched medical workforce and training system. Primary health care has typically been practised by specialists in other fields, and general medicine has only been certified as an accredited specialty since 2018. There are continued challenges to develop an awareness and acceptance of the primary health medical workforce in Japan. The impact of these challenges is highest in rural and island areas of Japan, with nearly 50% of rural and remote populations considered 'elderly'. Concurrently, these areas are experiencing physician shortages as medical graduates gravitate to urban areas and choose medical specialties more commonly practised in cities. This study aimed to understand the views on the role of rural generalist medicine (RGM) in contributing to solutions for rural and island health care in Japan. This was a descriptive qualitative study. Data were collected via semi-structured interviews with 16 participants, including Rural Generalist Program Japan (RGPJ) registrars and supervisors, the RGPJ director, government officials, rural health experts and academics. Interviews were of 35-50 minutes duration and conducted between May and July 2019. Some interviews were conducted in person at the WONCA Asia-Pacific Conference in Kyoto, some onsite in hospital settings and some were videoconferenced. Interviews were recorded and transcribed. All transcripts were analysed through an inductive thematic process based on the grouping of codes. From the interview analysis, six main themes were identified: (1) key issues facing rural and island health in Japan; (2) participant background; (3) local demography and population; (4) identity, perception and role of RGM; (5) RGPJ experience; and (6) suggested reforms and recommendations. The RGPJ was generally considered to be a positive step toward reshaping the medical workforce to address the geographic inequities in Japan. While improvements to the program were suggested by participants, it was also generally agreed that a more systematic, national approach to RGM was needed in Japan. Key findings from this study are relevant to this goal. This includes considering the drivers to participating in the RGPJ for future recruitment strategies and the need for an idiosyncratic Japanese model of RGM, with agreed advanced skills and supervision models. Also important are the issues raised by participants on the need to improve community acceptance and branding of rural generalist doctors to support primary care in rural and island areas. The RGPJ represents an effort to bolster the national rural medical workforce in Japan. Discussions from participants in this study indicate strong support to continue research, exploration and expansion of a national RGM model that is contextualised for Japanese conditions and that is branded and promoted to build community support for the role of the rural generalist.

Predictability of the emergency department triage system during the COVID-19 pandemic.

Emergency department (ED) triage systems are used to classify the severity and urgency of emergency patients, and Korean medical institutions use the Korean Triage and Acuity Scale (KTAS). During the COVID-19 pandemic, appropriate treatment for emergency patients was delayed due to various circumstances, such as overcrowding of EDs, lack of medical workforce resources, and increased workload on medical staff. The purpose of this study was to evaluate the accuracy of the KTAS in predicting the urgency of emergency patients during the COVID-19 pandemic. This study retrospectively reviewed patients who were treated in the ED during the pandemic period from January 2020 to June 2021. Patients were divided into COVID-19-screening negative (SN) and COVID-19-screening positive (SP) groups. We compared the predictability of the KTAS for urgent patients between the two groups. From a total of 107,480 patients, 62,776 patients (58.4%) were included in the SN group and 44,704 (41.6%) were included in the SP group. The odds ratios for severity variables at each KTAS level revealed a more evident discriminatory power of the KTAS for severity variables in the SN group (P<0.001). The predictability of the KTAS for severity variables was higher in the SN group than in the SP group (area under the curve, P<0.001). During the pandemic, the KTAS had low accuracy in predicting patients in critical condition in the ED. Therefore, in future pandemic periods, supplementation of the current ED triage system should be considered in order to accurately classify the severity of patients.

Are Doctors Equally Distributed Throughout the World?

As the vital and scarce resource of the health system, physicians are responsible for treating patients and saving lives and the equitable distribution of physicians among the whole population is a prerequisite to achieving health for all. We aimed to investigate inequality in physician distribution in the world using the Gini coefficient. This descriptive-analytical study was conducted in 2021. The number of physicians and the population of countries were obtained from the WHO and United Nations (UN) databases. The Gini coefficient was calculated in three different modes and the distribution of physicians among countries in various Human Development Index (HDI) groups was determined using the physician ratio per 10,000 population. There were generally more than 13 million doctors in the world. About 43% of the world's physicians were available to 20% of the world's population in very high HDI countries, and 12% of the population had access to about 1% of physicians in low HDI countries. An average of 19.5 physicians are distributed per 10,000 population worldwide. The Gini coefficient between the four groups of HDI countries was 0.55, and that of all countries in the world was 0.640. There was a shortage and inequality in the distribution of physicians worldwide. Governments should eliminate inequality in the distribution of the medical workforce, in particular physicians, by redoubling their efforts and accurate planning.

Enhancing Our Workforce: Recruitment and Retention in Anesthesiology.

Increasingly, both healthcare leaders and studies of healthcare outcomes recommend a medical workforce that is representative of the patient population as a method to reduce health disparities and medical costs. Anesthesiology remains a specialty with lower proportions of women and underrepresented in medicine (URiM) physicians as compared to the overall physician workforce, with 26.1% of anesthesiologists identifying as women and 31.3% of anesthesiologists as URiM. Two areas of focus are commonly identified when discussing inadequate representation in the workforce: recruitment into the specialty and retention in the profession. Asmedical educators, we provide a critical role in the recruitment and retention of women and URiM anesthesiologists, through implementation of processes, programs, and cultural change. Here, we will discuss the current problems of recruitment and retention of women and URiM anesthesiologists and suggest action plans for now and the future to enhance our specialty's diversity.

Exploring how Australian general practice registrars define cultural safety with Aboriginal and Torres Strait Islander patients: a mixed method study

BackgroundUnderstanding how the general practice medical workforce defines cultural safety may help tailor education and training to better enable community-determined culturally safe practice. This project seeks to explore how Australian general practice registrars define cultural safety with Aboriginal and Torres Strait Islander patients and alignment with an Australian community derived definition of cultural safety.MethodsThis mixed method study involved a survey considering demographic details of general practice registrars, questionnaire, and semi-structured interviews to explore how general practice registrars defined cultural safety and a culturally safe consultation.ResultsTwenty-six registrars completed the survey. Sixteen registrars completed both the survey and the interview.ConclusionThis study shows amongst this small sample that there is limited alignment of general practice registrars’ definitions of cultural safety with a community derived definition of cultural safety. The most frequently cited aspects of cultural safety included accessible healthcare, appropriate attitude, and awareness of differences.

Social accountability in a medical school: is it sufficient? A regional medical school curriculum and approaches to equip graduates for rural and remote medical services

BackgroundSocial accountability is increasingly integral to medical education, aligning health systems with community needs. Universitas Pattimura’s Faculty of Medicine (FMUP) enhances this through a curriculum that prepares graduates for rural and remote (RR) medical practice, exceeding national standards. The impact of this curriculum on graduate readiness in actual work settings remains unassessed.ObjectiveThis study was conducted to capture the perspectives of FMUP medical graduates in a rural-centric curriculum, focusing on the teaching and learning opportunities afforded to them during their medical education. These insights are crucial for evaluating the accountability of regional medical schools in delivering quality service, particularly in underserved areas.MethodsSemistructured interviews were conducted with nine FMUP graduates employed in the RR areas of Maluku Province. A qualitative analysis was employed to examine graduates’ views on the curriculum concerning medical school accountability.ResultsThe FMUP curriculum, informed by social accountability principles, partially prepares graduates to work under Maluku’s RR conditions. However, it was reported by participants that their skills and preparedness often fall short in the face of substandard working environments.ConclusionsThe FMUP curriculum supports the government’s aim to develop an RR medical workforce. However, the curriculum’s social accountability and rural emphasis fall short of addressing community health needs amid inadequate practice conditions. Political investment in standardizing medical facilities and equipment is essential for enhancing graduates’ effectiveness and health outcomes in RR communities.

Where’s the beef?: the politics of health care reform in South Korea

Background: In February 2024, the South Korean government released a policy proposal for healthcare reform, with one of the main pillars being increased medical school admissions. This policy has sparked intense opposition from the physicians’ top association. Most importantly, interns and residents—the bedrock of the medical workforce in Korean hospitals—began to leave en masse. Consequently, a medical crisis emerged, in which many medical and surgical procedures were delayed.Current Concepts: According to studies on comparative health policy and systems, the crisis could be attributed to the unique characteristics of the Korean healthcare system, in which the administration and doctors have failed to establish a substantive dialogue through which policy options are examined and deliberated. These dynamics necessitated the establishment of an institutional space for interest group politics, causing both to suffer from a lack of action repertoires. The stalemate we witness reflects the enduring patterns of the same issue.Discussion and Conclusion: To ensure the success of the current initiative, institutional arrangements must be established in which policymakers and physicians make a credible commitment to each other. Alternatives, for instance, include reactivating and regularizing the Health and Medical Services Policy Deliberation Committee, which could pave the way for establishing a venue where key stakeholders can discuss future agendas, such as how to ensure improved accessibility to “essential” care and mitigate its subnational variation, thereby creating a long-term vision for new health system governance in South Korea.

Return on Investment of Three-Year Accelerated Programs for Students, Medical Schools, Departments, and Community

Building on the initial accelerated pathway programs in the 1970s to increase workforce, nearly 30 schools have launched accelerated 3-year pathways (A3YP) during the past decade. The authors based on their educational roles, experiences, and scholarship with A3YP provide this perspective of the argument for A3YP and potential disadvantages for each group—students, schools, residencies, departments, and community. When schools consider innovations, they might consider A3YPs for multiple reasons; this perspective helps provide justification for the program and broadly considers return on investment (ROI). The ROI for students includes decreased debt, reduced costs and stress associated with the fourth-year residency applications, and a directed pathway with facilitated transition into a residency program with accompanying professional identity development. Disadvantages for students include early specialty commitment, risk of deceleration, and condensed curriculum. The ROI for schools includes recruiting and retaining students, who will then transition more easily into residency and stimulating innovation. Residency programs gain residents with known skills, who have been a part of the department for 3 years. In addition, fewer residency slots for interviewing leads to saving recruitment administrative costs and time. Finally, many programs are intended to increase the workforce, since students who come to the region for medical school and transition directly into residency are likely to stay in the region. Disadvantages include increased curricular complexity for the medical school, increased administrative support, and advising resources. Finally, several of the accelerated programs attract matriculants from diverse backgrounds contributing to the diversity of the medical school, residency program, and community workforce.

Are Polish doctors ready to start working right after graduation? The 2023 modification to physicians’ postgraduate internship and possible paths forward

The Polish healthcare system faces many problems, among which the shortage of healthcare professionals is one of the most urgent. In less than ten years, more than twenty Higher Education Institutions (HEIs) have been allowed to add medical programmes to their offer, aiming to increase the number of doctors in Poland. Recently, the healthcare system was faced with a proposal to abolish the mandatory postgraduate internship which has been a mandatory component of medical training for years.Two main reforms were considered. The first one focused on the programme of the internship and aimed to update it. The second one recommended an abolition of the internship. The authors of this article analysed the opinions and positions of key players within the system regarding the postgraduate internship.Opinions in this regard are diverse, leading to the conclusion that additional actions would be required prior to the internship abolition. Undergraduate training has changed and currently students are taught in modern facilities, using new teaching methods. On the other hand, internship allows trainees to improve or even acquire skills they may not have obtained during their studies. The postgraduate internship is an essential part of doctors’ training. However, in Poland, there is still a lack of a well-thought, long-term policy or strategy for physicians' workforce development. Our study presents a Polish perspective on common challenges in medical training and workforce policy, highlighting the clash over the growing demand for physicians and the limitations of the existing system.

Policy perception, job satisfaction and intentions to remain in rural area: evidence from the National Compulsory Service Programme in China

BackgroundExploring factors that may influence general practitioners (GPs)’ intentions to remain in rural area is necessary to inform the training and placement of future medical workforce in rural area. However, little is known about how GPs’ perception towards the National Compulsory Service Programme (NCSP) and job satisfaction impact their turnover intention. This paper explores GPs’ intentions to remain in rural China and how their policy perception and job satisfaction predict the intentions.MethodsWe conducted a cross-sectional, online survey from December 2021 to February 2022 to investigate GPs’ perception towards NCSP, job satisfaction, and intentions to remain in rural area. Eligible participants were GPs who were required to provide health services as part of NCSP at township health centres of 9 provinces which could represent all NCSP GPs in China. Multinomial logistic regression analyses were performed to explore the associations between policy perceptions, job satisfaction, and intentions to remain.ResultsOf 3615 GPs included in the analysis, 442 (12.2%) would like to remain in rural area and 1266 (35.0%) were unsure. Results of the multinomial logistic regression analyses showed that compared with GPs who would leave, GPs with higher perception scores for the restriction on taking postgraduate exam (RRR: 1.93, 95% CI 1.72, 2.16) and the commitment to work for six years (RRR: 1.53, 95% CI 1.31, 1.78) were more likely to remain. In contrast, GPs who had higher perception scores for completing standardised residency training (RRR: 0.75, 95% CI 0.64, 0.88) and passing National Medical Licensing Examinations (RRR: 0.74, 95% CI 0.62, 0.87) were more likely to leave. GPs who were satisfied with the freedom of choosing work methods (RRR: 1.52, 95% CI 1.25, 1.84) and chances of promotion (RRR: 1.60, 95% CI 1.32, 1.94) were more likely to remain.ConclusionsThis study highlights the significance of policy perception and job satisfaction on GPs’ intentions to remain in rural area. Factors such as career advancement and the empowerment of GPs to build on and use their skills and abilities should be taken into account when designing rural placement programmes.

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.