Scaling up specialist training in developing countries: lessons learned from the first 12 years of regional postgraduate training in Fiji – a case study

Abstract

BackgroundIn 1997, regional specialist training was established in Fiji, consisting of one-year Postgraduate Diplomas followed by three-year master’s degree programs in anesthesia, internal medicine, obstetrics/gynecology, pediatrics and surgery. The evolution of these programs during the first 12 years is presented.Case descriptionA case study utilizing mixed methods was carried out, including a prospective collection of enrolment and employment data, supplemented by semi-structured interviews. Between 1997 and 2009, 207 doctors (113 from Fiji and 94 from 13 other countries or territories in the Pacific) trained to at least the Postgraduate Diploma level. For Fiji graduates, 29.2% migrated permanently to developed countries, compared to only 8.5% for regional graduates (P <0.001). Early years of the program were characterized by large intakes and enthusiasm, but also uncertainty. Many resignations took place following a coup d’etat in 2000. By 2005, interviews suggested a dynamic of political instability initially leading to resignations, leading to even heavier workloads, compounded by academic studies that seemed unlikely to lead to career benefit. This was associated with loss of hope and downward spirals of further resignations. After 2006, however, Master’s graduates generally returned from overseas placements, had variable success in career progression, and were able to engage in limited private practice. Enrolments and retention stabilized and increased.Discussion and evaluationOver time, all specialties have had years when the viability and future of the programs were in question, but all have recovered to varying degrees, and the programs continue to evolve and strengthen. Prospective clarification of expected career outcomes for graduates, establishment of career pathways for diploma-only graduates, and balancing desires for academic excellence with workloads that trainees were able to bear may have lessened ongoing losses of trainees and graduates.ConclusionsDespite early losses of trainees, the establishment of regional postgraduate training in Fiji is having an increasingly positive impact on the specialist workforce in the Pacific. With forethought, many of the difficulties we encountered may have been avoidable. Our experiences may help others who are establishing or expanding postgraduate training in developing countries to optimize the benefit of postgraduate training on their national and regional workforces.

Utilising a scholarship program as a workforce strategy for the community-managed mental health sector

“…These challenges are consistent with other postgraduate literature (Andrews and Harris, 2009;O'Donnell et al, 2009;Gibbons and Shannon, 2013;Shandler and Steenekamp, 2014). Oman et al (2012) concluded that students struggle "to cope with the demands" of their study alongside work, family and financial commitments. O'Donnell et al (2009) suggested that this is largely because the majority of postgraduate students are adults who have returned to study after several years in the workforce.…”

“…One challenge that appeared to diminish over the research timeframe was the scholarship participants' concern that they could not use or adapt to studying via an online platform. Lewis (2009) explains that the "paradigm shift" from face-to-face to online learning can be challenging, but if the learner is committed they can master this mode; a sentiment echoed by others (Kahu et al, 2014;Posey and Pintz, 2014;Oman et al, 2012). Universities are encouraged to support a student's transition to online learning by providing access to orientation modules prior to study commencement, creating relationships with course convenors, peer mentors and other students, and responding to the diverse needs of students (Moore and Fetzner, 2010;Milman, 2013;Posey and Pintz, 2014).…”

Higher Education Scholarships: A review of their impact on workplace retention and career progression

“…There were mixed results in terms of outcome; of the 12 students completing the degree, only three were working in a health science library, and four were working in other academic libraries. Similar to Lyon et al (2011), several studies described scholarship initiatives as a means to attract people into the workforce at a career entry-level, as opposed to maintaining the current workforce (Duffourc, 2006;Oman, Rodgers, Usher, & Moulds, 2012;Pathman et al, 2004).…”

Building worldly insights

“…This degree program was set up to meet the needs of isolated island communities in the Pacific through an on-line/distant learning medical curriculum. 37,38 Newfoundland has a retention issue with medical graduates, with about two-thirds leaving the province to practice. From that basis alone, Newfoundland is funding the production of a medical workforce from which it does not derive full benefit; this is to the advantage of other parts of Canada that are in effect free riders on the Memorial University of Newfoundland.…”

“…This degree program was set up to meet the needs of isolated island communities in the Pacific through an on-line/distant learning medical curriculum. 37,38…”