Recruitment Of Doctors Research Articles

Female interns are not choosing radiology as a career-national survey providing insights into gender imbalance.

Women are under-represented in Radiology, both globally and in Ireland. An annual review of the medical workforce in Ireland for the year 2021-2022 revealed that although the overall gender breakdown of trainees is similar, with 56% female and 44% male trainees, certain specialities have disproportionate numbers of a given gender. Females only account for 38% of Irish Radiology trainees, one of the lowest of all the specialties. The cause for this disparity is likely multifactorial, but a lack of interest inapplying for Radiology training by female doctors is a possible cause. The objectives of this study were to identify specific factors that attract or deter intern doctors from considering a career in Radiology and to identify underlying gender-specific differences. Anonymous online surveys were distributed to 50% of the intern population in Ireland between May and June 2022. The survey included questions on demographics, prior radiology exposure, and dedicated multiple-choice questions for those either considering or not considering radiology, which were subdivided into potentially influencing factors. Two-hundred-seven interns responded giving a response rate of 48.3%, which totalled almost 25% of the interns in Ireland. For those interns considering radiology, significantly more male interns (n = 24/67, 35.8%) are considering radiology compared with females (n = 26/139, 18.71%), (p < 0.009). Significantly more females were deterred by the perception of radiology as a male-based speciality (p < 0.004). Significantly fewer females are considering radiology, deterred by physics knowledge, use of technology, and, significantly, by the perception of radiology as a male-dominated speciality. This survey highlights important reasons that female interns are deterred from radiology. It will help direct future medical training and doctor recruitment policies, with a view to addressing the ongoing gender disparity in the Irish radiology workforce. Women are under-represented in the Irish and global Radiology workforce. Female interns are dissuaded from Radiology as a career by their perception of Radiology as male-dominated. This survey will shape medical training and doctor recruitment policies to improve gender diversity in radiology.

Exploring recent patterns of migration of doctors to the United Kingdom: a mixed-methods study

IntroductionA shortage of doctors is currently one of the biggest challenges faced by the healthcare workforce in the United Kingdom (UK). While plans are in place to increase the number of medical school places, in the short-term this gap will need to continue to be filled by the international recruitment of doctors. The aim of this study is to identify key factors that explain the patterns of migration of doctors to the UK, in order to aid the development of policies to recruit and retain a sustainable workforce.MethodsWe analysed General Medical Council (GMC) secondary data on the patterns of migration of internationally trained doctors (2009–2019). Qualitative interviews were conducted with 17 stakeholders by videoconferencing which were audio-recorded, transcribed and thematically analysed using NVivo.ResultsIn 2019, 34.5% of UK doctors were trained internationally mainly in India, Pakistan, Italy, Nigeria, Greece, Romania and Egypt. Most new registrations by internationally trained doctors from 2009–2019 did not have a specialty at the time of initial registration (96.2% in 2019). Only a relatively small number of these doctors go on to gain specialist or GP registration (11.6% within 5 years and 27.2% within 10 years of registration). The stakeholder interviews highlighted training opportunities and career progression as the main drivers of migration. The barriers internationally trained doctors face regarding specialty training included differences between UK and destination health systems, systematic bias, bureaucracy and selection processes not being accessible.ConclusionThis study makes a contribution to the literature by identifying recent patterns in the migration of doctors to the UK. The UK’s dependence on internationally trained doctors has important global implications as source countries are losing skilled health workers which is undermining their health systems. In keeping with the WHO Global Code on the International Recruitment of Healthcare Personnel, policymakers need to consider how to reduce the UK’s reliance on internationally trained doctors, particularly from countries on the safeguard list whilst continuing the drive to increase medical school places. Additional support is required for internationally trained doctors, to ensure that they get on the training programmes they seek, enabling their career progression.

Harnessing the force of post-F2 doctors – a medical clinical fellow post that transformed locally employed doctor recruitment

In 2018, North Bristol Trust (NBT) faced difficulties recruiting clinical fellows. In response, a new programme was introduced that includes opportunities for non-clinical time, supervision, and a study budget, as well as flexibility of contract duration and on-call commitment. This has significantly improved the application ratios, with a 94% fill rate in August 2021 and competition ratios of 2.5:1. Not only has it been successful for staffing medical rotas, but clinical fellows also report positive experiences, have gained opportunities that would not be available in a training role and feel the role will benefit their future job applications. This report outlines the new programme and analyses it from the clinical fellow and Trust perspective. We hope that by sharing this successful new programme, other organisations can take inspiration to harness the potential of the high proportion of doctors taking a break from training post-foundation programme.

A163 INFECTION WITH HYMENOLEPIS DIMINUTA ELICITS A TH2 IMMUNITY AND ALLEVIATES DNBS-COLITIS IN A MOUSE MODEL WITH MINIMAL INTESTINAL MICROBIOTA

Abstract Background Immunocompetent mice infected with the rat tapeworm Hymenolepis diminuta are protected from dinitrobenzene sulphonic-acid (DNBS)-induced colitis that was accompanied by the increased relative abundance of short-chain fatty acid (SCFA)-producing bacteria and fecal SCFA levels at 8 days post-infection (dpi). These changes were not observed in antibiotic-treated BALB/c mice or germ-free mice. To further characterize the host-parasite-microbiota interaction in the control of colitis, experiments have been conducted in a reductionist system in which the H. diminuta anti-colitic response was tested in mice colonized with 12 commensal bacteria representing the major five phyla of the mouse gut. Purpose To identify key bacterial species and microbe-derived mediators involved in the H. diminuta-induced protection from DNBS-induced colitis. Method OligoMM12 (Oligo-Mouse-Microbiota) mice (n=4-8/group) were infected with 10 viable antibiotic-treated H. diminuta cysticercoids eight days prior to challenge with DNBS (3mg, i.r.). Mice were monitored daily and necropsied 72h post-DNBS. Disease was assessed by a macroscopic disease activity score, colon length and histopathology on H&amp;E sections of mid-colon. Production of IL-4, -5, -10 and -13 by concanavalin-A treated spleen cells by ELISA was used as an index of successful helminth infection. Result(s) OligoMM12 mice treated with DNBS developed acute colitis, with 3/8 mice requiring humane euthanization, while all mice infected with H. diminuta survived the DNBS challenge. Successful infection was confirmed by statistically significant increases in splenic output of the Th2-cytokines in response to mitogenic stimulation and efficient expulsion of the worms burden by 11 dpi. The severity of DNBS-induced colitis was reduced in H. diminuta-infected mice (n=4), although additional experiments are required to confirm the statistical significance of these data. Conclusion(s) Reproducible DNBS-induced colitis in mice with the simplified OligoMM12 consortium of bacteria and reduced disease in H. diminuta-infected mice has created a model by which the participation of exact bacterial groups or species in H. diminuta-induced suppression of colitis can be tested. This is of translational value, since the failure of helminth therapy in IBD could be predicated by dysbiosis in the patient, and therefore potentially overcome by combination therapy of ‘probiotic’ and helminth. Please acknowledge all funding agencies by checking the applicable boxes below CIHR, Other Please indicate your source of funding; NSERC-CGS D, Eyes High doctoral Recruitment Scholarship Disclosure of Interest None Declared

Are In-Person Trainee Interviews a Relic of the Past?

Are In-Person Trainee Interviews a Relic of the Past?

Maintaining acomprehensive provision of inpatient child and adolescent mental health services in the years to come-aGerman perspective

Aconsiderable number of child and adolescent psychiatry inpatient units in Germany suffer from asignificant shortage of doctors, which endangers the current system of nation-wide availability of high-quality child and adolescent inpatient services. Drawing on recent data, this article pictures the status quo of child and adolescent psychiatry inpatient services in Germany. The authors then discuss the pros and cons of different suggestions of how to cope with the doctor shortage crisis in child and adolescent psychiatry. The following options for action are suggested: reduction of service provision across the board, shift from personnel-intensive inpatient towards home-based treatment, trans-sectoral cooperation by means of tele-psychiatry, delegation of clinical responsibilities to psychologists, limiting ward physicians' tasks to mere medical care of patients, improvement of working conditions in inpatient units, recruitment of doctors from abroad, and increased recruiting efforts at medical school level. From the authors' viewpoint, the latter option offers the best chance of lasting success; however, this requires along-term, nationwide approach and considerable efforts of all departments involved.

A brief discussion on the characteristics of the recruitment methods of Chinese universities for doctoral students

The way of doctoral recruitment has always been a common concern in Chinese higher education and even in the whole society. Since the establishment of the doctoral degree system in 1980, China has been improving its doctoral recruitment methods. At present, there are four types of doctoral recruitment methods in China, namely, general recruitment, direct doctorate, master's degree and "application-assessment" system. In the evolution and development of doctoral recruitment methods, a series of characteristics have been presented, forming a diversified system of doctoral recruitment methods with different characteristics and obvious differences.

Educational interventions to ensure provision of doctors in rural areas - a systematic review.

Recruiting doctors in rural areas is challenging, and various educational interventions to ensure the provision of doctors in rural areas have been introduced in many countries. This study aimed to collect knowledge about the undergraduate medical education interventions that have been introduced in order to recruit doctors to rural areas, and the results of these interventions. We undertook a systematic search in the databases Cinahl, Eric, Medline and PsycInfo using the search words rural, remote, workforce, physicians, recruitment and retention. We included articles that met the following criteria: the educational interventions were clearly described, the study population consisted of medical graduates, and outcome measures included place of work (rural/non-rural) after graduation. The analysis included 58 articles and encompassed educational interventions in ten countries. There were five main types of interventions, often used in combination: preferential admission from rural areas, curriculum relevant to rural medicine, decentralised education, practice-oriented learning in rural areas, and compulsory service periods in rural areas after graduation. The majority of the studies (42) compared place of work (rural/non-rural) of doctors who had graduated with and without these interventions - only two of the studies reported non-significant differences in place of work. In 26 studies, the odds ratio for rural place of work was significant at a level of 5%, with odds ratios between 1.5 and 17.2. In 14 studies there were significant differences in the proportion with a rural/ non-rural place of work, with differences ranging from 11 to 55 percentage points. Changing the focus of undergraduate medical education towards the development of knowledge, skills and teaching arenas that equip doctors with competencies to work in rural areas has an impact on the recruitment of doctors in rural areas.

Why the Faculty of Medicine, University of Gezira (FMUG), Sudan has the potential to lead in social accountability: reflections, opportunities and future directions

Social accountability is an essential component for all medical schools as it deals with education, research and services. In this mini-review, we have discussed why the Faculty of Medicine, University of Gezira (FMUG), Sudan, can lead in social accountability in Africa and the Middle East. This critical analysis is based on searching the literature published in PubMed, Medline, Scopus and Google scholar. We added sections about reflection on opportunities and future direction for FMUG on social accountability. Many unique features in the curriculum that led to excellence in teaching, research and service, will qualify FMUG to lead in social accountability. The location in the heart of Sudan and being community-oriented medical education meant that FMUG, over the last 45 years, gained and mastered the art of social accountability. FMUG continues to be a leader in medical education and has a pioneer master's program in medical education. The majority of the graduates who are not staff members continued to support the medical school many years after their graduation (teaching, research and donation) and promote the concept of social accountability at the national and international level. The curriculum meets all of the competencies of social medicine. Hence, graduates are influential leaders in all medical specialties, and most importantly, in addressing the priority health concerns of the community in rural and urban areas. Therefore, through research and innovations, FMUG can establish social accountability alliance for medical schools and consider adding more unique components to the concept of social accountability (promotion of concept health made at home, especially during COVID-19 pandemic). For instance, retention and recruitment of doctors (training and promotion) and brain drain are main challenges to many health authorities in African and Middle East countries. Another area of innovation, is environmental social accountability of medical schools in order to develop environmentally sustainable solutions to address health concerns especially during the COVID-19 pandemic. This of considerable importance as Gezira state has one of the largest irrigation agriculture schemes in the world. We believe that medical schools' concept of social accountability will continue to evolve, likely depending on the community's needs. © Journal of Public Health and Emergency. All rights reserved.

General Medical Council report exposes unethical recruitment of doctors in the UK from low-resource countries

General Medical Council report exposes unethical recruitment of doctors in the UK from low-resource countries

Facio‐genital dysplasia 5 (FGD5) regulates G‐protein coupled receptors (GPCRs) signaling to phosphatidylinositol 3 kinase (PI3K) pathway

IntroductionDrugs targeting the VEGF‐pathway have been approved to treat various cancers. However, tumors become resistant to this therapy due to the recruitment of alternative growth factors, acting via cognate endothelial cells (EC) receptor tyrosine kinases (RTK) or g‐protein coupled receptors (GPCR), to cue neo‐angiogenesis. Facio‐genital dysplasia 5 (FGD5) regulates vascular endothelial growth factor (VEGF)‐mediated angiogenesis, and VEGF receptor‐2 trafficking at the endosome. However, the role of FGD5 to regulate other pro‐angiogenic signaling pathways that co‐operate with VEGF has not been explored. Here, we identify a novel role of FGD5 to control G protein‐coupled receptor (GPCR) signaling.MethodsHuman umbilical vein endothelial cells (HUVEC) were mounted on microcarrier beads, suspended in fibrin gels, then co‐cultured with freshly harvested patient‐derived renal cell carcinoma (PD‐RCC) samples. The effect of FGD5 loss on sprouting angiogenesis was evaluated using RNAi against FGD5 in HUVEC. Stromal cell derived factor (SDF)‐1 was used as a model GPCR ligand to study the role of FGD5 in endothelial angiogenesis and PI3K signaling. Further, FDG5 domain‐deletant mutants were transiently overexpressed to rescue the effect of FGD5 knockdown on endothelial PI3K signaling. Western blot and confocal imaging were performed to readout the role of FGD5 in the GPCR/PI3K signaling pathway.ResultsLoss of FGD5 in HUVEC decreased sprouting angiogenesis stimulated by growth factors released from PD‐RCCs. The defect in angiogenesis was accompanied by downregulation of the expression of endothelial tip cell specific marker genes. Knockdown of endothelial FGD5 abolished the SDF‐1 angiogenic effect and SDF‐1 signaling to PI3K‐β and Akt. Inhibition of Rac1, a Rho GTP‐binding protein required for PI3K‐β activity, recapitulated the signaling defects of FGD5 deficiency, suggesting that FGD5 may control PI3K‐β activity through Rac1‐GTP. Overexpression of Dbl (Rho guanine nucleotide exchange factor) domain‐deleted FGD5 (FGD5ΔDbl) reduced SDF‐1‐stimulated Akt phosphorylation, and failed to rescue defective PI3K signalling in FGD5‐deficient cells, indicating that the Dbl domain of FGD5 regulates the activity of PI3K‐β. PI3K‐β and phosphorylated Akt localized to early endosomes after SDF‐1 stimulation, but loss of FGD5 decreased endosomal phosphorylated‐Akt. Failure of Akt activation at PI3K‐β‐positive endosomes suggests a defect in PI3K‐β activity after FGD5 loss.ConclusionsWe identify a novel role of FGD5 to regulate GPCR signaling to PI3K‐β. FGD5 acts at an endosomal convergence node regulating RTK and GPCR angiogenic pathways that may serve as a target for anti‐angiogenic therapy.Support or Funding InformationUniversity of Alberta Doctoral Recruitment Scholarship, Translational Medicine Research Award, Alberta Graduate Excellence Scholarship, Canadian Cancer Society, Division of Nephrology

Recruiting people with HIV to an online self-management support randomised controlled trial: barriers and facilitators.

Recruitment involved a three-step process. Study sites were recruited, followed by doctors caring for PWHIV at study sites and finally PWHIV. Data were collected from study sites, doctors and patient participants. Factors associated with site enrolment and patient participant recruitment were investigated using regression models. Thirteen study sites, 63 doctor participants and 728 patient participants were recruited to the study. Doctors having a prior relationship with the study investigators (odds ratio (OR) 13.3; 95% confidence interval (CI) 3.0, 58.7; P = 0.001) was positively associated with becoming a HealthMap site. Most patient participants successfully recruited to HealthMap (80%) had heard about the study from their HIV doctor. Patient enrolment was associated with the number of people with HIV receiving care at the site (β coefficient 0.10; 95% CI 0.04, 0.16; P = 0.004), but not with employing a clinic or research nurse to help recruit patients (β coefficient 55.9; 95% CI -2.55, 114.25; P = 0.06). Despite substantial investment in online promotion, a previous relationship with doctors was important for doctor recruitment, and doctors themselves were the most important source of patient recruitment to the HealthMap trial. Clinic-based recruitment strategies remain a critical component of trial recruitment, despite expanding opportunities to engage with online communities.

Geographical mobility of UK trainee doctors, from family home to first job: a national cohort study

BackgroundThe UK faces geographical variation in the recruitment of doctors. Understanding where medical graduates choose to go for training is important because doctors are more likely to consider practicing in areas where they completed postgraduate training. The wider literature also suggests that there is a relationship between origin and background, and where doctors wish to train/work. Thus, the purpose of this paper is to investigate the geographical mobility of UK medical graduates from different socio-economic groups in terms of where they wish to spend their first years of postgraduate training.MethodsThis was an observational study of Foundation Programme (FP) doctors who graduated from 33 UK medical schools between 2012 and 2014. Data was accessed via the UK medical education database (UKMED: https://www.ukmed.ac.uk/). Chi-square tests were used to examine the relationships between doctor’s sociodemographic characteristics and the dependent variable, average driving time from parental home to foundation school/region. Generalised Linear Mixed Models (GLMM) were used to estimate the effects of those factors in combination against the outcome measure.ResultsThe majority of doctors prefer to train at foundation schools that are reasonably close to the family home. Those who attended state-funded schools, from non-white ethnic groups and/or from lower socio-economic groups were significantly more likely to choose foundation schools nearer their parental home. Doctors from disadvantaged backgrounds (as determined by entitlement to free school meals, OR = 1.29, p = 0.003 and no parental degree, OR = 1.34, p < 0.001) were associated with higher odds of selecting a foundation schools that were closer to parental home.ConclusionThe data suggests that recruiting medical students from lower socioeconomic groups and those who originate from under-recruiting areas may be at least part of the solution to filling training posts in these areas. This has obvious implications for the widening access agenda, and equitable distribution of health services.

Examining the Basic Psychological Needs of Library and Information Science Doctoral Students

Aim/Purpose: The purpose of this study was to examine how the basic psychological needs of self-determination theory are reflected in doctoral students’ motivation to earn the PhD. Background: As isolating as the doctoral experience seems, it is one that occurs in a social-cultural environment that can either support or hinder the student. This research highlights the motivational influences of library and information science doctoral students regarding experiences of autonomy, competence, and relatedness. Methodology: Qualitative data were collected from seven (7) enrolled doctoral students at library and information science programs in the United States and Canada. Transcripts from semi-structured interviews and students’ personal admission statements were subjected to deductive content analysis for emphasis on three basic psychological needs: autonomy, competence, and relatedness. Contribution: Findings illustrate the role faculty play in student motivation and satisfaction with the doctoral experience. There are implications for faculty, mentors, and advisors working with current and former graduate students who may be considering a PhD. The findings have implications for doctoral recruitment, advising, and student services of interest to faculty and administrators across disciplines. It also shows the applicability of self-determination theory in the examination of the doctoral student experience and overall motivation. Findings: Deductive analysis based on self-determination theory (SDT) demonstrates factors related to self-determination theory’s basic psychological needs – autonomy, competence, and relatedness – as relevant to participants’ motivation to pursue a doctoral degree and to the examination of doctoral student initial motivation. Doctoral students are motivated by multiple factors including their interactions with and encouragement received from current and former faculty. Students report experiences related to autonomy, competence, and relatedness that energized them to pursue a doctoral degree and that have positively influenced their doctoral experience thus far. Recommendations for Practitioners: Faculty and program administrators may use this data to inform their understanding of the expectations of today’s doctoral students and motivational drivers of prospective students and to tailor support services accordingly. Recommendation for Researchers: This is a preliminary investigation of doctoral student motivation in relation to the basic psychological needs. More research is needed on a larger sample of students to more fully understand the influence of autonomy, competence, and relatedness on doctoral student initial and ongoing motivation. Impact on Society: This research is an important step in bridging faculty and student perceptions of what is important to their initial and ongoing enrollment in a doctoral program. By improving students’ experiences of autonomy, competence, and relatedness, it may be possible to improve the overall doctoral experience leading to completion of the PhD. Future Research: Future research will expand to include doctoral students farther along in their doctoral programs, the administration of the Basic Psychological Needs Scale, and may examine faculty perceptions of the three basic psychological needs.

Implementation of the Referral System Policy in the National Health Insurance Scheme at Community Health Centers, Ngawi District, East Java

Background : It has been reported that there are some obstacles in the implementation of the National Health Insurance, one of which is its referral system. Community Health Center is expected to serve as a gatekeeper, such that most of the health problems can be tackled at the Community Health Center. However, anecdotal evidences had shown that the referral system did not run as expected. This study aimed to examine the implementation of the referral system in the National Health Insurance scheme with special attention on the policy context and resources availability at Community Health Centers in Ngawi, East Java. Subjects and Method : This was a qualitative study conducted in Ngawi, East Java. The institutions under study included 3 Community Health Centers of different strata Geminggar Community Health Center (highest strata), Ngawi Community Health Center (medium strata), Kasreman Community Health center (lowest strata). The other institution under study was Ngawi District Health Office. The informants for this study included 24 patients of various categories at Community Health Center: subsidy recipients, class I, class II, and class III. The other informants included 1 staff from District Health Office and 6 staff from Community Health Center. The data were collected by in-depth interview, observation, and document review. The data were analyzed by data reduction, presentation, and verification. Results : The policy on the referral system of the National Health Insurance (NHI) was good but its implementation was poor. Outpatient referral was still high because of community ignorance regarding referral system. It was often the case the referral was based on patient request. The referral system problem also stemmed from the shortage of medical doctors and health equipment at the Community Health Center. Nevertheless, the availability of medicine and funding at Community Health Center were sufficient. The sources of funding included General Allocation Fund (DAU), Special Allocation Fund (DAK), Special Allocation Fund for Operational Affairs (BOK), and capitation. Community Health Center only managed capitation and BOK. Conclusion : There is a need for socialization to the community regarding the current referral system of the National Health Insurance either through the media or the BPJS representative at the Community Health Center. In addition, there is a need for recruitment of doctors with a clear salary regulation, and health equipment upgrade at Community Health Center. Keywords : Referral system, resources, National Health Insurance Correspondence: Maria Yeny Eskawati. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Mobile: 082230898979. Journal of Health Policy and Management (2017), 2(2): 102-111 https://doi.org/10.26911/thejhpm.2017.02.02.01

Mais Médicos (More Doctors) Program - a view from England.

The Programa Mais Medicos (PMM) is a national strategy to increase the numbers of Brazilian trained doctors entering primary care and is possibly the most significant human resource intervention in Latin America in recent years. From an English perspective, there are clearly opportunities to learn the PMM. First, PAHO's role in the PMM provides an exemplar for an overarching human resource migration and recruitment role throughout the EU. The role of the WHO in influencing and overseeing the recruitment of doctors throughout the EU could be an opportunity for improved distribution, avoiding a reliance on market forces. Secondly, a centrally-coordinated and governed process following well-established criteria and guidance laid out in law has helped to ensure that doctors are allocated to regions of the greatest need. Finally, the deployment of primary care doctors to ensure that the needs of the whole population are met, including in hard-to-reach areas. However, Brazil should not fall into the trap of doing much, and evaluating little. Brazil is in an exciting position to conduct robust before-after studies regarding the improvement in access, outcomes and equity that the ESF has already been credited with. Evaluation must include the impact of the PMM on Cuba.

Issues and challenges in recruitment for government doctors in Gujarat, India.

BackgroundIndia faces a critical shortage of government doctors in rural and underserved areas. Several measures have been introduced to address the shortage, but significant problems still remain. The main aim of the current research was to understand the existing recruitment-related policies and systems in place for government doctors in Gujarat and to identify issues that prevent effective recruitment of doctors that could have implications for doctors’ shortage in the state. The research also aims to fill the knowledge gap in the existing literature on why recruitment in civil services is an important HR function to address the shortage of doctors.MethodsThe study aimed at identifying the existing recruitment policies and practices for government Medical Officers (MOs) from Gujarat state in India. The analysis is based on document review to understand the existing policies, 19 in-depth interviews with MOs to understand the systems in place for recruitment of MOs, construction of job histories from interviews to understand various nuances in the recruitment system and five interviews with Key Informants to understand recruitment policies and their actual implementation. Thematic framework approach was used to analyse qualitative data using NVivo.ResultsWhile the state has general recruitment guidelines called the Recruitment Rules (RRs), these rules are very wide-ranging and fragmented. The MOs were neither briefed about them nor received copies of the rules at any time during the service suggesting that RRs were not transparent. The recruitment system was considered to be slow and very sporadic having possible implications for attraction and retention of MOs. The study results indicate several other system inefficiencies such as a long time taken by the health department to provide salary benefits and service regularization that has a negative effect over MOs’ motivation. The study also found unequal opportunities presented to different categories of MOs in relation to job security, salary benefits and in recognizing their previous work experience leaving MOs unclear about their future thereby influencing the attraction and retention of MOs to government jobs negatively.ConclusionsIf long-term solutions are to be sought, the health department needs to have an effective recruitment system in place with the aim to (1) address the slow and sporadic nature of the recruitment system (that is likely to attract more doctors and prevent loss of any doctors during recruitment) and (2) address the job insecurity issue that MOs have which also influences their other employment benefits such as salary, pension and recognition for the years of service they have given to the health department. Addressing these issues can improve motivation among doctors and prevent loss of doctors through voluntary turnover leading to better retention.

Recruitment of doctors to work in 'our hinterland': first results from the Swansea Graduate Entry Programme in Medicine

Recruitment and retention of doctors to rural and remote areas is a well-known problem to which very few countries are immune. Planning effective interventions to enable appropriate recruitment to rural areas requires an understanding of the specificities of each country and region, understanding 'what works' and 'why' in each specific context and then consideration of what that might mean in the context of neighbouring countries. In order to inform local policy makers and stakeholders, this study aimed to investigate 'how and why students elect to study in Wales, UK' and, more importantly, 'what influences students' choices about either staying, or leaving Wales, after graduation'. 'Our hinterland', in the title of this article, refers to the more rural parts of the country. Two cohorts of medical graduates at different stages of their training (one cohort approaching the first year and the other approaching the third year of postgraduate training) were recruited as participants. A mixed-method, sequential study was conducted by means of an online questionnaire (phase 1) followed up by semi-structured telephone interviews (phase 2). Phase 1 results informed the interview schedule for phase 2. A thematic analysis of the interview transcripts was conducted using QSR NVivo v10. The results show that students elect to study in Wales (Swansea in this case) for a variety of reasons that include liking key features of the course, the attractive location and being able to pursue and maintain ties with family and others. Despite some identified challenges for long-term career prospects, early exposure to clinical placements in rural areas seems to be regarded as a rich, enjoyable learning opportunity that can constitute valuable preparation for future practice as a doctor. Participants also revealed how their choices were made as a result of balancing career aspirations, perceived opportunities and personal factors or circumstances. All seem to be determinants for medical career decision-making and reveal the complexities underlying these life choices. Despite the many positive aspects of studying in Wales and of having placements in rural areas emphasised by study participants, the prospect of entering postgraduate training in those regions is, for some, inhibited by feelings of social isolation and lack of opportunities. Some students still perceive rural locations as a backward step in the natural progression of their work and career. Graduates are concerned about discontinuity with family ties (for example stemming from the unpredictability of job allocation) and tend to gravitate to where family members, including life partners, reside. In line with international concerns and local efforts about these issues, the Swansea Graduate Entry Programme in Medicine will continue to monitor students' opinions and attitudes towards career pathways and training locations to maximise the likelihood of high-quality healthcare provision to rural communities.

Recruitment “disaster” may occur if Shape of Training review is poorly implemented, trainees say

Poor implementation of last year’s major review of postgraduate medical education and training could have “a disastrous impact” on the future recruitment of doctors, trainees have warned. Doctors on the trainee committees of four royal medical colleges have published a joint statement in response to the UK-wide Shape of Training review, which was led by David Greenaway, vice chancellor of Nottingham University, and published in October 2013.1 The trainees welcomed many aspects of the review, including its recommendations for broad based training and increased flexibility during training. But they warned that …

The Structure of Clinical Consultation: A Case of Non-Native Speakers of English as Participants

Background:In many parts of the world, patients may find it difficult to visit doctors who share the same language and culture due to the intermingling of people and international recruitment of doctors among many other reasons. In these multilingual multicultural settings (MMSs), doctor-patient interactions face new communication challenges. This study aims to identify the structure of clinical consultation and its phases in an MMS where both doctors and patients are non-native speakers (NNSs) of English.Method:This study takes on a discourse analytic approach to examine the structure of clinical consultation as an activity type. 25 clinical consultation sessions between non-native speakers of English in a public healthcare centre in Malaysia were audio-recorded.Findings and Discussion:The results show that there are some deviations from the mainstream structure of clinical consultations although, in general, the pattern is compatible with previous studies. Deviations are particularly marked in the opening and closing phases of consultation.Conclusion:In almost all interactions, there is a straightforward manner of beginning medical consultations. The absence of greetings may have naturally reduced the length of talk. Hence, by directly entering medical talks, the doctors voice their concern on the curing aspects of the consultation rather than its caring facets. The preference of curing priority to caring is more goal-oriented and in alignment with the consultation as an activity type.