The Fiji School of Medicine postgraduate training project

Clunie, G. J. A.; McCaig, Eddie; Baravilala, Wame

doi:10.5694/j.1326-5377.2003.tb05724.x

Cited by 14 publications

(16 citation statements)

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“…This was done in order to address the failure of most overseas-trained Pacific Island specialists to return to or remain in the Pacific, along with an ongoing dependence on expatriates for specialist services in the region [4-7]. The early years after the establishment of these programs, however, coincided with an era of increasing openness of developed countries, including nearby Australia and New Zealand, to the migration of doctors from developing countries.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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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.

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Section: Introductionmentioning

confidence: 99%

“…The programs were established through an $AUD 5.5 million dollar (approximately $US 5.5 million dollars) five-year grant funded by AusAID [4], and contracted through the Royal Australasian College of Surgeons. The programs were approved by the Ministry of Health and accredited by the University of the South Pacific.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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“…Australian Aid supported the FSM to provide specialist training in surgery, medicine, paediatrics, obstetrics and gynaecology and anaesthesia, and appointed the RACS to manage the inaugural programme that involved a 1‐year diploma and further 3 years to graduate with Master of Medicine (MMed). Only the best students were selected to proceed to a further 3 years of study, progressing from the diploma to the MMed. For the past 20 years, surgical training has taken place in Fiji, usually at the Colonial War Memorial Hospital.…”

Section: Resultsmentioning

confidence: 99%

Surgical training programmes in the South Pacific, Papua New Guinea and Timor Leste

Watters

McCaig

Nagra

et al. 2019

British Journal of Surgery

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Background There is a surgical workforce shortage in Papua New Guinea (PNG), the Pacific and Timor Leste. Previously, Pacific Island specialists who trained overseas tended to migrate. Methods A narrative review was undertaken of the training programmes delivered through the University of Papua New Guinea and Fiji National University's Fiji School of Medicine, and support provided through Australian Aid and the Royal Australasian College of Surgeons (RACS), including scholarships and visiting medical teams. Results The Fiji School of Medicine MMed programme, which commenced in 1998, has 39 surgical graduates. Sixteen of 22 Fijians, nine of ten Solomon Islanders and four of five in Vanuatu currently reside and/or work in‐country. Surgical training in PNG began in 1975, and now has 104 general surgical graduates, 11 of whom originate from the Pacific Islands or Timor Leste. The PNG retention rate of local graduates is 97 per cent, with 80 per cent working in the public sector. Twenty‐two surgeons have also undertaken subspecialty training. Timor Leste has trained eight surgical specialists in PNG, Fiji, Indonesia or Malaysia. All have returned to work in‐country. The RACS has managed Australian Aid programmes, providing pro bono visiting medical teams to support service delivery and, increasingly, capacity building in the region. The RACS has funded scholarships and international travel grants to further train or sustain the surgical specialists. Conclusion The local MMed programmes have been highly successful in retaining specialists in the region. Partnerships with Australian Aid and RACS have been effective in ensuring localization of the faculty and ongoing professional development.

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“…The training should be the same standard as that in the West, but with the knowledge, skills and attitudes acquired appropriate to the culture, resources and pathology. Obtaining the FRACS was not a viable option as it would have required the trainees to spend long periods in Australia, their services lost to PNG – with a high risk of being seduced into staying as has been the case with many Fijians 10,11 …”

Section: A Short History Of Medical and Surgical Training In Papua Nementioning

confidence: 99%

“…Obtaining the FRACS was not a viable option as it would have required the trainees to spend long periods in Australia, their services lost to PNG -with a high risk of being seduced into staying as has been the case with many Fijians. 10,11 It was important that the programme did not present a risk to general surgical training. There were concerns that creating a class of specialists would result in those surgeons being unwilling or unable to provide the general surgical service, so needed in the country.…”

Section: Specialist Surgeonsmentioning

confidence: 99%

Specialist Surgical Training in Papua New Guinea: The Outcomes After 10 Years

Kevau

Watters²

2006

ANZ Journal of Surgery

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Surgical training commenced in 1975, the year that Papua New Guinea (PNG) gained independence. The training involves a 4-year programme leading to a Master of Medicine (MMed), awarded by the University of Papua New Guinea. In the past 30 years just over 50 general surgeons have graduated. There have also been 9 graduates in the area of ear nose and throat, 10 in ophthalmology and 2 in oral surgery. The subspecialization of general surgeons began in 1994 with four trainees, two orthopaedic, one head and neck and one urological. The model used was to develop specialist skills over 2-3 years only qualified (MMed) general surgeons so that their ability to carry out general surgical procedures and work in a remote hospital was not lost. The different specialties required different balances of in-country and out-of-country training depending on the local ability to provide training in PNG. An important sponsor has been the PNG National Department of Health, which has funded the training posts by using existing general surgical positions and covering the loss of manpower while surgeons are training overseas, sometimes for up to 2 years. Medical education and tertiary health service projects, funded by Aus-Aid, have also contributed significantly to the teaching and training. These projects have provided visiting specialists to teach and hospital attachments for national surgeons to train in Australasia. Various individual surgeons and their specialist societies in Australasia have also provided invaluable support. Three surgeons have been recipients of the Rowan Nicks scholarship. Twelve surgeons have been awarded a specialist diploma and a further five are in training. The posting of national specialist surgeons to Port Moresby has resulted in all modules of the General surgery MMed programme being taught by Papua New Guineans, which would have been hard to imagine back in 1993. The MMed is now a sustainable programme and can be provided without external support. National surgeons carry out a wide range of specialist procedures, formerly carried out only by visiting teams. They are also able to make outreach visits within PNG and specialist visits to neighbouring Pacific Island countries.

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The Fiji School of Medicine postgraduate training project

Cited by 14 publications

References 0 publications

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

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

Surgical training programmes in the South Pacific, Papua New Guinea and Timor Leste

Specialist Surgical Training in Papua New Guinea: The Outcomes After 10 Years

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