Retention Of Doctors Research Articles

Emergency supply of doctors by the Mais Médicos (More Doctors) Program and the quality of the structure of primary health care facilities.

The health policy context in Brazil has featured a series of measures to improve primary health care (PHC), including a national access and quality improvement program (Programa Nacional de Melhoria do Acesso e Qualidade, PMAQ-AB) and the Mais Médicos Program (More Doctors, PMM) and upgrading PHC centers ('Requalifica UBS'). The paper examines the PMM's placement of doctors, by quality of PHC structure, in an endeavor to identify synergies among the three programs. It reports on a transverse study based on secondary data from PMAQ-AB Cycles 1 and 2, the PMM and 'Requalifica UBS'. The PHC facilities inventoried during PMAQ-AB Cycle 1 were classified, on pre-established typology, into five groups ranked from A (best) to E (failed). They were then compared in terms of PMM personnel allocated and Requalifica UBS proposals. The results point to convergences in investments by the three programs. Incentives targeted predominantly PHC facilities of types B and C, indicating a concentration of efforts on PHC facilities with potential for structural quality improvements. In addition to expanding access, the provision of doctors by the PMM, added to infrastructure upgrades and work process improvements, contributes to addressing high turnover and guaranteeing retention of doctors in PHC.

Is there a role for paediatric Sexual Assault Nurse Examiners in the management of child sexual assault in Australia?

In Australia, paediatricians and Child Protection Specialists provide the medical and forensic examinations of child victims of sexual assault. There are workforce challenges in the recruitment and retention of doctors to undertake child sexual assault (CSA) work particularly in remote and rural areas. Pediatric Sexual Assault Nurse Examiner (PSANE) programs have existed in the USA and the UK for many years. Using Rapid Evidence Assessment (REA) methodology, a systematic search of the literature was performed to ascertain what is known about SANE programs, to evaluate the evidence for their effectiveness across a number of domains (accessibility, health and legal outcomes and cost effectiveness) and to inform policy on models of care and elements of best practice which may be appropriate for local implementation in Australia. This review showed that despite the limited evidence available and significant gaps in the evidence, SANEs provide a high standard of medical care and are not detrimental to the legal process. By providing recommendations regarding the potential value, effectiveness and feasibility of establishing a PSANE program in Australia, this article may be of interest to other high income countries facing similar workforce challenges in meeting the needs of children with alleged sexual assault.

Rural exposure during medical education and student preference for future practice location - a case of Botswana.

BackgroundBotswana’s medical school graduated its first class in 2014. Given the importance of attracting doctors to rural areas the school incorporated rural exposure throughout its curriculum.AimThis study explored the impact of rural training on students’ attitudes towards rural practice.SettingThe University of Botswana family medicine rural training sites, Maun and Mahalapye.MethodsThe study used a mixed-methods design. After rural family medicine rotations, third- and fifth-year students were invited to complete a questionnaire and semi-structured interview. Data were analysed using descriptive statistics and thematic analysis.ResultsThe thirty-six participants’ age averaged 23 years and 48.6% were male. Thirty-three desired urban practice in a public institution or university. Rural training did not influence preferred future practice location. Most desired specialty training outside Botswana but planned to practice in Botswana. Professional stagnation, isolation, poorly functioning health facilities, dysfunctional referral systems, and perceived lack of learning opportunities were barriers to rural practice. Lack of recreation and poor infrastructure were personal barriers. Many appreciated the diversity of practice and supportive staff seen in rural practice. Several considered monetary compensation as an enticement for rural practice. Only those with a rural background perceived proximity to family as an incentive to rural practice.ConclusionThe majority of those interviewed plan to practice in urban Botswana, however, they did identify factors that, if addressed, may increase rural practice in the future. Establishing systems to facilitate professional development, strengthening specialists support, and deploying doctors near their home towns are strategies that may improve retention of doctors in rural areas.

Associations between perceived institutional support, job enjoyment, and intentions to work in the United Kingdom: national questionnaire survey of first year doctors.

BackgroundIdentifying factors that improve job satisfaction of new doctors and ease the difficult transition from student to doctor is of great interest to public health agencies. Studies to date have focused primarily on the value of changes to medical school curricula and induction processes in this regard, but have overlooked the extent to which institutional support can influence new doctors’ enjoyment of and attitude to work. Here, we examine variation in the perceived level of support received by new medical graduates in the United Kingdom (UK) from their employer and whether this influences enjoyment of and attitudes to the first postgraduate year, and whether doctors who perceived a lower level of support were less inclined to intend a long term career in medicine in the UK.MethodsAll UK medical graduates of 2012 were surveyed in 2013 in a cross-sectional study, towards the end of their first post-graduate year (the ‘F1’ year of the 2-year Foundation Training Programme for new UK doctors). We used linear regression to assess whether the level of support doctors reported receiving from their employing Trust (Very Good, Good, Adequate, Poor, or Very Poor) was associated with the extent to which they enjoyed their F1 year. Similarly, we assessed the strength of associations between self-reported level of Trust support and doctors’ responses to 12 statements about fundamental aspects of their working lives, each assessed on a 5-point scale of agreement. Using χ2 tests we examined whether doctors’ intentions to practise medicine in the UK varied with the level of support they reported receiving from their Trust.ResultsThe response rate was 45 % (2324/5171). Of 2324 responding junior doctors, 63.8 % reported receiving ‘Very Good’ (23.6 %) or ‘Good’ (40.2 %) initial support from their Trust, while a further 27.4 % stated they received ‘Adequate’ support. ‘Poor’ support was reported by 5.8 % and ‘Very Poor’ support by 2.2 %. We found very strong positive associations between the institutional support doctors reported receiving and their enjoyment of the F1 year and their self-expressed attitudes to aspects of their first year of work. Crucially, doctors who reported receiving lower levels of support (‘Poor’ or ‘Very Poor’) were significantly less likely to express intentions to continue practising medicine in the UK.ConclusionsThe provision of effective institutional support for graduate doctors may promote workplace satisfaction and could help safeguard the long-term retention of junior doctors.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0673-6) contains supplementary material, which is available to authorized users.

A systematic review of strategies to recruit and retain primary care doctors.

BackgroundThere is a workforce crisis in primary care. Previous research has looked at the reasons underlying recruitment and retention problems, but little research has looked at what works to improve recruitment and retention. The aim of this systematic review is to evaluate interventions and strategies used to recruit and retain primary care doctors internationally.MethodsA systematic review was undertaken. MEDLINE, EMBASE, CENTRAL and grey literature were searched from inception to January 2015. Articles assessing interventions aimed at recruiting or retaining doctors in high income countries, applicable to primary care doctors were included. No restrictions on language or year of publication. The first author screened all titles and abstracts and a second author screened 20 %. Data extraction was carried out by one author and checked by a second. Meta-analysis was not possible due to heterogeneity.ResultsFifty-one studies assessing 42 interventions were retrieved. Interventions were categorised into thirteen groups: financial incentives (n = 11), recruiting rural students (n = 6), international recruitment (n = 4), rural or primary care focused undergraduate placements (n = 3), rural or underserved postgraduate training (n = 3), well-being or peer support initiatives (n = 3), marketing (n = 2), mixed interventions (n = 5), support for professional development or research (n = 5), retainer schemes (n = 4), re-entry schemes (n = 1), specialised recruiters or case managers (n = 2) and delayed partnerships (n = 2).Studies were of low methodological quality with no RCTs and only 15 studies with a comparison group. Weak evidence supported the use of postgraduate placements in underserved areas, undergraduate rural placements and recruiting students to medical school from rural areas. There was mixed evidence about financial incentives. A marketing campaign was associated with lower recruitment.ConclusionsThis is the first systematic review of interventions to improve recruitment and retention of primary care doctors. Although the evidence base for recruiting and care doctors is weak and more high quality research is needed, this review found evidence to support undergraduate and postgraduate placements in underserved areas, and selective recruitment of medical students. Other initiatives covered may have potential to improve recruitment and retention of primary care practitioners, but their effectiveness has not been established.

Motivation and Retention of Physicians in Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan.

Workforce motivation and retention is important for the functionality and quality of service delivery in health systems of developing countries. Despite huge primary healthcare (PHC) infrastructure, Pakistan's health indicators are not impressive; mainly because of under-utilization of facilities and low patient satisfaction. One of the major underlying issues is staff absenteeism. The study aimed to identify factors affecting retention and motivation of doctors working in PHC facilities of Pakistan. An exploratory study was conducted in a rural district in Khyber Puktunkhwa (KP) province, in Pakistan. A conceptual framework was developed comprising of three organizational, individual, and external environmental factors. Qualitative research methods comprising of semi-structured interviews with doctors working in basic health units (BHUs) and in-depth interviews with district and provincial government health managers were used. Document review of postings, rules of business and policy actions was also conducted. Triangulation of findings was carried out to arrive at the final synthesis. Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies and medical facilities contributed to lack of motivation among both male and female doctors. The physicians accepted government jobs in BHUs with a belief that these jobs were more secure, with convenient working hours. Male physicians seemed to be more motivated because they faced less challenges than their female counterparts in BHUs especially during relocations. Overall, the organizational factors emerged as the most significant whereby human resource policy, career growth structure, performance appraisal and monetary benefits played an important role. Gender and marital status of female doctors was regarded as most important individual factor affecting retention and motivation of female doctors in BHUs. Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies, and medical facilities contributed to lack of motivation in physicians in our study. Our study advocates that by addressing the retention and motivation challenges, service delivery can be made more responsive to the patients and communities in Pakistan and other similar settings.

Strategic Onboarding of Online Doctoral Students: Creating a Pathway to Academic Persistence

An onboarding strategy can help online universities improve new doctoral student productivity, engagement, and retention. A prescribed plan is vital to ensure the onboarding process is aligned, and clear designed support is provided for students. Recent literature justifies strategic onboarding includes acquiring the necessary knowledge, skills and behaviors to become successful members of an organization (Beaver and Erdogan, 2011). Similarly, doctoral students may benefit from clearly designed rules, protocols, and practices exclusive to the online doctoral experience. This study presents the process of strategic onboarding strategies for that will provide a smart start for online doctoral students.

Factors influencing recruitment and retention of foundation doctors in geographically unpopular locations

The North West Foundation School is home to 1,100 foundation trainees employed at 12 hospital trusts. Despite oversubscription to the Foundation Programme every year since 2011, University Hospitals of Morecambe Bay Foundation Trust (UHMBFT) has struggled to fill foundation training posts relying on locum doctors to sustain service provision. We did a study to explore the reasons for this and identify possible solutions. Final year medical students at Lancaster University and foundation doctors based at UHMBFT and Central Manchester Foundation Trust were invited to complete a structured questionnaire and then attend a focus group to expand on their answers. Location was identified as the single biggest factor affecting where foundation applicants applied to, followed by perceived reputation of the hospital trust and job track. Participants identified free/heavily subsidised accommodation or the offer of additional qualifications in leadership or teaching as the main incentives that would have a positive effect on applications to geographically undesirable trusts. These incentives would need to be well publicised, particularly on foundation school websites, UK Foundation Programme websites and trust websites. Overall these efforts should lead to savings in recruitment costs, a reduction in vacant training posts and thus a decreased reliance on locum doctors, culminating in improved patient care.

Taking stock of evidence-based healthcare in the undergraduate medical curriculum at Stellenbosch University: Combining a review of curriculum documents and input from recent graduates

Background. The Stellenbosch University Rural Medical Educational Partnership Initiative (SURMEPI) aims to increase the quality and retention of medical doctors, and regionally relevant research. Strengthening evidence-based healthcare (EBHC) knowledge and skills at an undergraduate level is important within this context. Objectives. To assess and describe the current undergraduate medical EBHC curriculum in order to identify opportunities to enhance EBHC teaching, and to explore challenges related to EBHC experienced by recently graduated doctors. Methods. We used methodological triangulation to assess current EBHC teaching and learning through a document review and a survey of recent graduates. We extracted learning outcomes from module guides that related to prespecified EBHC competencies. Our electronic survey collected quantitative data, which were analysed with SPSS, and qualitative data, which were coded with ATLAS.ti and grouped into emerging themes. Results. EBHC teaching was fragmented and concentrated in the first and last phase of the medical curriculum. Most survey respondents agreed that it was important to learn EBHC at undergraduate level, and that there was a need for increased teaching of certain EBHC competencies. Recently graduated doctors identified lack of access to literature as the main challenge when practising EBHC. Other challenges included time constraints, work overload, lack of EBHC skills, lack of self-motivation, applicability of the evidence and the work environment. Conclusion. Recent graduates felt that they needed more EBHC learning opportunities within the undergraduate medical curriculum. Existing EBHC teaching and learning for undergraduate medical students need to be enhanced by integrating EBHC into clinical modules and scaffolding it throughout all the phases of the curriculum.

Glass half full: Survival analysis of new rural doctor retention in Western Australia.

To measure the time trends in retention of new rural doctors in Western Australia (WA) and identify factors associated with improved retention. Retrospective inception cohort study of the 1154 doctors first commencing rural practice in WA in 2004-2013, who provided 1222 tours of service consisting of up to eight attachments at different rural practice settings. Failure of doctor retention as evidenced by an absence from the rural medical workforce of greater than 1 year and analysed using actuarial survival methods and Cox proportional hazards regression. Comparing 2009-2013 with 2004-2008, there was an improvement of 10 percentage points in retention of new rural doctors at 2 years (58% versus 48% ) and 7 percentage points at 5 years (38% versus 31%). The retention failure rate ratio was 0.68 (95% CI, 0.58-0.83). The improvement at 5 years was largely attributable to gains in retention of those who began as GP registrars (37% versus 14%). Failure of doctor retention was lower in those who possessed procedural skills (RR 0.61, 95% CI, 0.47-0.78) and lower in international medical graduates than in those trained in Australia (RR 0.75, 95% CI, 0.59-0.95). New rural GP retention in WA has improved substantially, an observation at least consistent with government initiatives delivering a positive return. However, it remains the case that the majority of new doctors have left rural practice within 5 years of commencing their tour of service.

Attracting, equipping and retaining young medical doctors in HIV vaccine science in South Africa.

BackgroundHIV remains a significant health problem in South Africa (SA). The development of a preventive vaccine offers promise as a means of addressing the epidemic, yet development of the human resource capacity to facilitate such research in SA is not being sustained. The HIV Vaccine Trials Network (HVTN) has responded by establishing South African/HVTN AIDS Early Stage Investigator Programme (SHAPe), a programme to identify, train and retain clinician scientists in HIV vaccine research in SA.ObjectivesThe present study sought to identify factors influencing the attraction and retention of South African medical doctors in HIV vaccine research; to understand the support needed to ensure their success; and to inform further development of clinician research programmes, including SHAPe.MethodsIndividual interviews and focus groups were held and audio-recorded with 18 senior and junior research investigators, and medical doctors not involved in research. Recordings were transcribed, and data were coded and analysed.ResultsFindings highlighted the need for: (1) medical training programmes to include a greater focus on fostering interest and developing research skills, (2) a more clearly defined career pathway for individuals interested in clinical research, (3) an increase in programmes that coordinate and fund research, training and mentorship opportunities and (4) access to academic resources such as courses and libraries. Unstable funding sources and inadequate local funding support were identified as barriers to promoting HIV research careers.ConclusionExpanding programmes that provide young investigators with funded research opportunities, mentoring, targeted training and professional development may help to build and sustain SA's next generation of HIV vaccine and prevention scientists.

Why and how do general practitioners teach? An exploration of the motivations and experiences of rural Australian general practitioner supervisors.

BackgroundIn medical education, a learner-centred approach is recommended. There is also a trend towards workplace-based learning outside of the hospital setting. In Australia, this has resulted in an increased need for General Practitioner (GP) supervisors who are receptive to using adult learning principles in their teaching. Little is known about what motivates Australian GP supervisors and how they currently teach.MethodsA qualitative study involving semi-structured interviews with 20 rural GP supervisors who work within one Regional Training Provider region in Australia explored their reasons for being a supervisor and how they performed their role. Data was analysed using a thematic analysis approach.ResultsGP supervisors identified both personal and professional benefits in being a supervisor, as well as some benefits for their practice. Supervision fulfilled a perceived broader responsibility to the profession and community, though they felt it had little impact on rural retention of doctors. While financial issues did not provide significant motivation to teach, the increasing financial inequity compared with providing direct patient care might impact negatively on the decision to be or to remain a supervisor in the future.The principal challenge for supervisors was finding time for teaching. Despite this, there was little evidence of supervisors adopting strategies to reduce teaching load. Teaching methods were reported in the majority to be case-based with styles extending from didactic to coach/facilitator. The two-way collegiate relationship with a registrar was valued, with supervisors taking an interest in the registrars beyond their development as a clinician.ConclusionSupervisors report positively on their teaching and mentoring roles. Recruitment strategies that highlight the personal and professional benefits that supervision offers are needed. Practices need assistance to adopt models of supervision and teaching that will help supervisors productively manage the increasing number of learners in their practices. Educational institutions should facilitate the development and maintenance of supportive supervision and a learning culture within teaching practices. Given the variety of teaching approaches, evaluation of in-practice teaching is recommended.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-015-0474-3) contains supplementary material, which is available to authorized users.

Distribution of GPs in Scotland by age, gender and deprivation.

General practice in the UK is widely reported to be in crisis, with particular concerns about recruitment and retention of family doctors. This study assessed the distribution of GPs in Scotland by age, gender and deprivation, using routinely available data. We found that there are more GPs (and fewer patients per GP) in the least deprived deciles than there are in the most deprived deciles. Furthermore, there are a higher proportion of older GPs in the most deprived deciles. There are also important gender differences in the distribution of GPs. We discuss the implications of these findings for policymakers and practitioners.

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.

A qualitative study of factors influencing retention of doctors and nurses at rural healthcare facilities in Bangladesh.

BackgroundBangladesh is a highly populous country with three-quarters rural population. Pressing national shortages in health professionals has resulted in high vacancy rates in rural areas. These are compounded by excessive absenteeism and low retention among nurses and doctors posted to rural locations. This study attempts to ascertain reasons for providers’ reluctance to work in rural and remote areas and to identify ways in which these barriers to appropriate staffing might be resolved.MethodsThis is a qualitative study based on in-depth interviews with healthcare providers (n = 15) and facility managers (n = 4) posted in rural areas, and key informant interviews with health policymakers at the national level (n = 2). Interview guides were written in English and translated and administered in Bengali. The collected data were re-translated and analyzed in English. Braun and Clarke’s thematic analysis approach (data familiarization, coding, identifying and reviewing themes, and producing a final report) was used.ResultsParticipants reported poor living conditions in rural areas (e.g., poor housing facilities and unsafe drinking water); overwhelming workloads with poor safety and insufficient equipment; and a lack of opportunities for career development, and skill enhancement. They reported insufficient wages and inadequate opportunities for private practice in rural areas. Managers described their lack of sufficient authority to undertake disciplinary measures for absenteeism. They also pointed at the lack of fairness in promotion practices of the providers. Policymakers acknowledged unavailability or insufficient allowances for rural postings. There is also a lack of national policy on rural retention.ConclusionsThe findings revealed a complex interplay of factors influencing doctors’ and nurses’ availability in rural and remote public health facilities from the perspective of different players in the healthcare delivery system of Bangladesh. In addition, the study generated several possibilities for improvement, including increased allowances and incentives for rural posting; a transparent and fair promotion system for serving in rural areas; enhanced authority of the local managers for reducing worker absenteeism; and improved national policies on rural retention.

Diabetic patients' perspectives on the challenges of glycaemic control.

IntroductionThe factors affecting the control of diabetes are complex and varied. However, little is documented in the literature on the overall knowledge of diabetic patients about glycaemic control. This study explored the patients’ perspectives on the challenges of glycaemic control.MethodsIn this qualitative study, semi-structured interviews were conducted with seventeen purposively selected diabetic patients with HBA1c ≥ 9% at Mthatha General Hospital, South Africa. The interviews were conducted in the isiXhosa language and were audiotaped. Two experienced qualitative researchers independently transcribed and translated the interviews. Thematic content analysis was conducted.ResultsThree main themes emerged: overall knowledge of diabetes and treatment targets, factors affecting the control of diabetes and how glycaemic control could be improved.The majority of the participants demonstrated poor knowledge of treatment targets for diabetes. The majority of the participants reported that lack of money affected their control of diabetes. Some of the participants reported that the nearest clinics do not have doctors; hence, they are compelled to travel long distances to see doctors.ConclusionPoverty, lack of knowledge and access to doctors affect the control of diabetes in the rural communities of Mthatha, South Africa. The government should address recruitment and retention of doctors in primary health care.

General practice: a better way forward?

This article is a contribution to the current debate about the future of general practice. Present rhetoric emphasising under-resourcing is disappointingly one-dimensional and is hindering exploration of alternative solutions. Workload is a major problem. Demand and expectations have risen substantially and an ageing population has brought increasing comorbidity. Early discharge and the devolution of more follow-up care to the community have also added to the responsibilities carried by primary care teams. GPs are reporting high levels of stress; morale and job satisfaction are lower than they should be. Retention of doctors is suboptimal and recruitment worryingly low. The administrative burden associated with the Quality and Outcomes Framework (QOF) is burdensome and often to no good purpose. Many patients report outstanding care from individual GPs and from practices generally. However, not all care is good, and there is noticeable public disenchantment on a number of fronts. Patients report real difficulty accessing GPs …

Attracting, equipping and retaining young medical doctors in HIV vaccine science in South Africa

Background: HIV remains a significant health problem in South Africa (SA). The development of a preventive vaccine offers promise as a means of addressing the epidemic, yet development of the human resource capacity to facilitate such research in SA is not being sustained. The HIV Vaccine Trials Network (HVTN) has responded by establishing South African/HVTN AIDS Early Stage Investigator Programme (SHAPe), a programme to identify, train and retain clinician scientists in HIV vaccine research in SA. Objectives: The present study sought to identify factors influencing the attraction and retention of South African medical doctors in HIV vaccine research; to understand the support needed to ensure their success; and to inform further development of clinician research programmes, including SHAPe. Methods: Individual interviews and focus groups were held and audio-recorded with 18 senior and junior research investigators, and medical doctors not involved in research. Recordings were transcribed, and data were coded and analysed. Results: Findings highlighted the need for: (1) medical training programmes to include a greater focus on fostering interest and developing research skills, (2) a more clearly defined career pathway for individuals interested in clinical research, (3) an increase in programmes that coordinate and fund research, training and mentorship opportunities and (4) access to academic resources such as courses and libraries. Unstable funding sources and inadequate local funding support were identified as barriers to promoting HIV research careers. Conclusion: Expanding programmes that provide young investigators with funded research opportunities, mentoring, targeted training and professional development may help to build and sustain SA’s next generation of HIV vaccine and prevention scientists.

Supervisor continuity or co-location: which matters in residency education? Findings from a qualitative study of remote supervisor family physicians in Australia and Canada.

Changes to health care systems and working hours have fragmented residents' clinical experiences with potentially negative effects on their development as professionals. Investigation of off-site supervision, which has been implemented in isolated rural practice, could reveal important but less overt components of residency education. Insights from sociocultural learning theory and work-based learning provided a theoretical framework. In 2011-2012, 16 family physicians in Australia and Canada were asked in-depth how they remotely supervised residents' work and learning, and for their reflections on this experience. The verbatim interview transcripts and researchers' memos formed the data set. Template analysis produced a description and interpretation of remote supervision. Thirteen Australian family physicians from five states and one territory, and three Canadians from one province, participated. The main themes were how remoteness changed the dynamics of care and supervision; the importance of ongoing, holistic, nonhierarchical, supportive supervisory relationships; and that residents learned "clinical courage" through responsibility for patients' care over time. Distance required supervisors to articulate and pass on their expertise to residents but made monitoring difficult. Supervisory continuity encouraged residents to build on past experiences and confront deficiencies. Remote supervision enabled residents to develop as clinicians and professionals. This questions the supremacy of co-location as an organizing principle for residency education. Future specialists may benefit from programs that give them ongoing and increasing responsibility for a group of patients and supportive continuity of supervision as residents.

Measuring Job Satisfaction Patterns in Saudi Arabia’s Southern Regions Hospitals: Implications for Hospital Staff Retention

Saudi Arabia Southern Region hospitals have shortage of health professionals especially doctors. Retention of quality doctors and minimizing staff turnover has, therefore, become a major priority for hospitals. Job satisfaction is recognized as key factor influencing retention of doctors. In our paper special emphasis is put on doctors working is Southern Region hospitals of Saudi Arabia. By conducting correlation analysis we determine the most important factors conducive to job satisfaction. Results of the study indicate that opportunities for promotion have a strong link with job satisfaction, whereas relations with co-workers and attitude toward supervisor exhibited a moderately strong relationship with job satisfaction. The factors of nature of the work, compensations and benefits lack a significant link to overall job satisfaction. The findings imply that the health care service managers need to pay closer attention to the needs of their human resources, especially doctors, in order to not only minimize the doctors turnover but also to improve the organizations’ performance. Additionally, introducing turnover risk programs as well as employee satisfaction programs within the hospital’s management schemes have become a must. Saudi Arabian hospitals, especially those in the Southern Region, can make use of retention strategies to annihilate the unbalance caused by the doctors’ high turnover.