Reforming medical education admission and training in low- and middle-income countries: who gets admitted and why it matters

Abstract

Recent studies reveal public-sector healthcare providers in low- and middle-income countries (LMICs) are frequently absent from work, solicit informal payments for service delivery, and engage in disrespectful or abusive treatment of patients. While extrinsic factors may foster and facilitate these negative practices, it is not often feasible to alter the external environment in low-resource settings. In contrast, healthcare professionals with strong intrinsic motivation and a desire to serve the needs of their community are less likely to engage in these negative behaviors and may draw upon internal incentives to deliver a high quality of care. Reforming medical education admission and training practices in LMICs is one promising strategy for increasing the prevalence of medical professionals with strong intrinsic motivation.

Association of off-the-job training with work performance and work–family conflict among physicians: a cross-sectional study in China

“…In response to the rapid development of medical science and the need for hospitals to maintain work efficiency to save human resources, the main type of continuing medical education is currently in-service training, which includes online learning. 29 30 In-service training and online training may save time and money because they are less likely to negatively affect physicians’ workload than onsite DT or OS. Therefore, it is important to determine the extent to which off-the-job training can improve physicians’ work performance.…”

<p>Medical Students at the School of Medicine and Health Sciences, University of Papua New Guinea: Predictors of Performance and Student Backgrounds</p>

“…Studies in other countries, including lower and middleincome countries, strongly suggest that students' social background and geographical origins are important predictors of career choice and that students from rural areas are more likely than those from urban areas to work in rural environments after initial training. 10 The Training for Health Equity Graduate Outcome Study reported that "rural and low income background and regional location of medical school were the most important predictors of intent to practice in a rural location". 11 Whether or not this applies to the PNG situation is unknown.…”

Barriers to implementation of evidence into clinical practice in low-resource settings

“…Barriers at the health-care provider level include inadequate quantity and quality of health-care workers to provide surveillance, research, prevention, acute care and rehabilitation services. In LRSs, health-care systems depend heavily on individual performance of the few available health workers, who are often overstretched by high disease burdens and workforce shortages 7 . Poor motivation can lead to negative provider behaviour, such as absenteeism, poor communication and discourteous treatment of patients, which in turn leads to distrust and reduced use of the service 7 .…”

“…In LRSs, health-care systems depend heavily on individual performance of the few available health workers, who are often overstretched by high disease burdens and workforce shortages 7 . Poor motivation can lead to negative provider behaviour, such as absenteeism, poor communication and discourteous treatment of patients, which in turn leads to distrust and reduced use of the service 7 . The negative effects of these actions are frequently overlooked by policy makers and administrators owing to low levels of accountability.…”

“…The negative effects of these actions are frequently overlooked by policy makers and administrators owing to low levels of accountability. Skills gaps in LRSs are often traceable to inadequate training curricula, lack of training facilities and resources, and dysfunctional health systems 7 . These skills gaps not only hinder effective service delivery but also result in an inability to identify evidence gaps and conduct research aimed at generating and implementing evidence-based solutions.…”