International migration of surgeons, anaesthesiologists, and obstetricians

Lantz, Adam; Holmer, Hampus; Finlayson, Samuel R.G.; Ricketts, Thomas C.; Watters, David; Gruen, Russell L.; Hagander, Lars

doi:10.1016/s2214-109x(15)70084-7

Cited by 28 publications

(19 citation statements)

References 4 publications

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“…However, there is little knowledge on how to optimally provide effective and efficient surgical training. Especially in LICs, where trainer resources are limited, monitoring the progress during the training in these programmes is, therefore, of great importance to assure that the trainees gain the required skills and experience [5].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a surgical task sharing training programme’s logbook system in Sierra Leone

et al. 2019

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Background Personal logbooks are universally applied for monitoring and evaluation of surgical trainees; however, the quality and accuracy of such logbooks in low income countries (LICs) are poorly examined. Logbooks are kept by the individual trainee and detail every surgical procedure they perform and their role during the procedure. The aim of this study was to evaluate the quality of such a logbook system in Sierra Leone and to identify areas of improvement. Methods The last 100 logbook entries for students and graduates participating in a surgical task sharing training programme were compared with hospital records (HRs). The logbook entries were categorized as matching , close matching or over-reported . Moreover, HRs were checked for under-reported procedures. Semi-structured interviews were conducted with the study participants on logbook recording routines. The results were analysed using mixed effects logistic regression models. Results Three thousand one hundred sixty-nine database entries from 35 participants were analysed. Of that amount, 62.2% of the entries matched the HRs, 10.4% were close matches and 26.9% were over-reported. 20.7% of the investigated HRs were under-reported. Conclusions Information gathered from surgical logbook systems must be applied with care, and great efforts must be made to ensure that the logbook systems used provide reliable data. Based on analysis of the logbook data and interviews, focus areas are suggested to ensure reliable logbook data in LICs. Clear instructions and proper training should be provided when introducing the logbook system to the users. The importance of logging all procedures, including minor ones, should be emphasized. The logbook system should be user friendly and only as extensive as necessary. Lastly, keeping the logbooks exclusively digital is recommended, combined with sufficient IT equipment and training. Electronic supplementary material The online version of this article (10.1186/s12909-019-1647-2) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Evaluation of a surgical task sharing training programme’s logbook system in Sierra Leone

et al. 2019

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“…However, according to a 2015 estimation, at least 4.8 billion of the world's population do not have access to surgery services, and most of this inaccessibility occurs in low-to middle-income countries (4). The current shortage of surgery specialists will be exacerbated in the near future due to changes in world demography in aging and noncommunicable diseases, the prevalence of chronic disease and workforce flow, especially in mid-dle-to high-income countries (5,6). One of the workforce flows which affects specialist supply is the phenomenon of dual practice (DP), defined as working simultaneously in the public and the private sector (7,8).…”

Section: Introductionmentioning

confidence: 99%

Effect of dual practice on service delivery time by surgeons in the Islamic Republic of Iran: multi-level analysis of a national survey, 2016

Bayat

Shokri

Khalilnezhad

et al. 2018

East Mediterr Health J

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Background: One of the work patterns which affects the supply of specialists is the phenomenon of dual practice (DP), i.e., working simultaneously in the public and private sectors. Uncontrolled DP in the surgery health workforce can have adverse effects on access to surgeons, efficiency, effectiveness and quality of surgery services. Aims: The aim of this article is to examine the impact of DP on service delivery time by surgeons. Methods: We used a prestructured form to collect data on surgery specialists in all 925 Iranian hospitals. National medical ID codes, council ID codes, first name, surname and father's name were used for data matching. Multilevel linear regression was used to assess the association between DP and study variables, which were recruitment type, faculty status, experience, sex and age. Results: The 4642 surgery specialists in this study, representing 31.08% of the total number of surgeons identified, spent mean 1.09 (standard deviation 0.33) hours full-time equivalent (FTE) on health care service delivery. Specialists with DP had long service delivery time (β = 0.427). Female specialists (β =-0.049) and full-time specialists (β =-0.082) spent less time on health care service delivery. Permanent specialists had higher FTE (P < 0.001) and as the population increases, FTE increases (P < 0.05). Conclusions: Although DP had a direct impact on surgeons' working hours, it seems that a greater share of the difference in working time was used in the private sector services, leading to poor access to surgery services in the public sector. Therefore, it is necessary to develop a systems approach to regulate DP.

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“…In Sierra Leone, the role of task sharing is increasing, as an increasing proportion of all caesarean sections are carried out by SACHOs50 54—a cadre of associate physicians trained in surgery for 3 years after basic training as a community health officer and an obligatory period of clinical practice. Only about 40 physicians graduate from Sierra Leone’s only medical school each year,55 and many of these physicians leave the country to pursue other opportunities including postgraduate specialist training 56. There is only one postgraduate training programme in the country, in general surgery,55 and none yet in obstetrics, so task sharing for caesarean sections will likely continue to play an important role in expanding access to surgical obstetric care for many years to come.…”

Section: Discussionmentioning

confidence: 99%

The rate and perioperative mortality of caesarean section in Sierra Leone

et al. 2019

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IntroductionSierra Leone has the world’s highest maternal mortality, partly due to low access to caesarean section. Limited data are available to guide improvement. In this study, we aimed to analyse the rate and mortality of caesarean sections in the country.MethodsWe conducted a retrospective study of all caesarean sections and all reported in-facility maternal deaths in Sierra Leone in 2016. All facilities performing caesarean sections were visited. Data on in-facility maternal deaths were retrieved from the Maternal Death Surveillance and Response database. Caesarean section mortality was defined as in-facility perioperative mortality.ResultsIn 2016, there were 7357 caesarean sections in Sierra Leone. This yields a population rate of 2.9% of all live births, a 35% increase from 2012, with district rates ranging from 0.4% to 5.2%. The most common indications for surgery were obstructed labour (42%), hypertensive disorders (25%) and haemorrhage (22%). Ninety-nine deaths occurred during or after caesarean section, and the in-facility perioperative caesarean section mortality rate was 1.5% (median 0.7%, IQR 0–2.2). Haemorrhage was the leading cause of death (73%), and of those who died during or after surgery, 80% had general anaesthesia, 75% received blood transfusion and 22% had a uterine rupture diagnosed.ConclusionsThe caesarean section rate has increased rapidly in Sierra Leone, but the distribution remains uneven. Caesarean section mortality is high, but there is wide variation. More access to caesarean sections for maternal and neonatal complications is needed in underserved areas, and expansion should be coupled with efforts to limit late presentation, to offer assisted vaginal delivery when indicated and to ensure optimal perioperative care.

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International migration of surgeons, anaesthesiologists, and obstetricians

Cited by 28 publications

References 4 publications

Evaluation of a surgical task sharing training programme’s logbook system in Sierra Leone

Evaluation of a surgical task sharing training programme’s logbook system in Sierra Leone

Effect of dual practice on service delivery time by surgeons in the Islamic Republic of Iran: multi-level analysis of a national survey, 2016

The rate and perioperative mortality of caesarean section in Sierra Leone

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