Educational Predictors for the Retention of Physicians in Remote and Unassisted Areas: a Narrative Review

Abstract

This is an international narrative review study, which had the objectives of identifying and understanding the determining educational aspects for the retention of physicians in remote and unassisted areas. Through search on databases, we selected ten articles about medical education institutions and programs that increased the recruitment and retention levels for their alumni in areas where there was shortage of professionals, which clarified the educational aspects associated to such results, and which were considered as predictors for the retention of physicians. The main predictors found were: selection processes that prioritized the admission of students who were previously linked to places where there was a shortage of physicians; the creation of curricular frameworks based on problem-based methodologies focused on local health issues, with an emphasis in primary care and Family and Community Medicine approaches; and the quality of the educational experiences, especially in the primary care environment in rural or remote areas, which, in turn, involve the educational trajectory and experience of professors, as well as the infrastructure and localization of the medical schools in strategic areas. The placement of school is such areas allow close proximity between the professors to the reality of the vulnerable communities. The results of the review still point out that the retention of physicians in unassisted areas demands the confrontation of social, cultural, economic and political factors, which frequently transcend the governability of educational institutions. They also reiterate the need for a wider conceptual uniformity among research studies in order to ensure more solid scientific evidence about the subject, and the importance of conducting studies that contemplate the Latin-American context, specifically Brazil, where the literature on the topic is still scarce.

Preditores Educacionais para Fixação de Médicos em Áreas Remotas e Desassistidas: uma Revisão Narrativa

“…It is also noteworthy in the Brazilian context, that the adoption of the Family Health Strategy (FHS) prior to the PMM, strengthened PHC with positive impacts on access to services and health indicators [19][20][21] , but the great difficulty in attracting and settling doctors in remote, rural areas and/or those with difficult access has been related to the slow expansion of coverage (about 1.5% per year) 16,22,23 . Moreover, the small number of medical students who contemplates working in small municipalities or specializing in areas linked to PHC or Public Health can aggravate this scenario 8,22,24 .…”