Immigrants in Health Care: Keeping Americans Healthy Through Care and Innovation

Immigrants play an outsized and imperative role in the U.S. health care industry. Combining existing data and profiles of immigrants across the health care spectrum, Immigrants in Health Care: Keeping Americans Healthy Through Care and Innovation, published by The Immigrant Learning Center, Inc. (ILC) and the Institute for Immigration Research, a joint venture between George Mason University and The ILC, outlines the impact of the foreign-born in health care as a whole and particularly in three subfields: medicine and medical science, long-term care and nursing. Comprising only 13% of the general population, immigrants are 22% of nursing, psychiatric and home health aides, 28% of physicians and surgeons and 40% of medical scientists in manufacturing research and development. Foreign-born health care workers are critical in meeting the demands of the current health care market, which includes shortages of physicians in rural and inner-city areas, a need for cutting-edge medical technology and an aging and longer-lived population rapidly diversifying in race and ethnicity. Given the necessary innovation and cultural and linguistic skills immigrants bring to health care, the authors recommend creating provisional visas for home care workers, supporting the Professional Access to Health Workforce Integration Act, and investing in and further developing workforce development programs that support and help integrate immigrant health care professionals. (Crystal Ye for The ILC Public Education Institute

The clinical skills of general practitioners in Nairobi, Kenya: a cross-sectional study

Background Quality service delivery in primary care requires motivated and competent health professionals. In the Kenyan private sector, general practitioners (GP), with no post-graduate training in family medicine, offer primary care. There is a paucity of evidence on the ability of primary care providers to deliver comprehensive care and no such evidence is available for GPs practising in the private sector in Kenya. Aim To evaluate GPs’ training and experience in the skills required for comprehensive primary care. Design and setting A cross-sectional descriptive survey in 13 primary care clinics in the private sector of Nairobi, Kenya Method A questionnaire, originally designed for a national survey of primary care doctors in South Africa, was adapted. The study collected self-reported data on performance of clinical skills by 25 GPs. Data were analysed in the Statistical Package for Social Sciences. Results GPs were mostly under 40 years, with less than 10 years of experience and an equal gender distribution. GPs reported moderate performance with adult health, communication and consultation, and clinical administration; and weak performance with emergencies, child health, surgery, ear-nose-and-throat, eyes, women’s health and orthopaedics. The GPs lacked training in specific skills such as proctoscopy, contraceptive devices, skin procedures, intra-articular injections, red reflex test and use of a genogram. Conclusion General practitioners lacked training and performed poorly in some of the essential skills required in primary care. Continuing professional development, training in Family Medicine and deployment of family physicians to the clinics could improve the comprehensiveness of care

A TD-MD: Transdisciplinary Double-Doctor, a journey to post-traumatic growth

The context in which my public works were created has been and continues to be complex environments that include diversity, conflict, trauma, deprivation, colonialism and, more recently, while writing this thesis—a global pandemic and the war in Ukraine. I have chosen an autoethnographic lens to this critique. I open with a critical reflection of the shaping of my agency in the world through the formative years of childhood in Canada that account for some of the ways that I have, in turn, shaped my environments and how they have shaped me to have the positionality I have today. This leads onto my professional accomplishments and personal growth as I engage myself and the reader in narrative discourse. I chose autoethnography as a lens for its capacity to embrace both the evocative nature of personal and professional practice and analytic autoethnography which guides the evocative and the experiential towards contributions beyond self and one’s profession that have something to say about the human condition and how humans have interacted with the world both constructively and destructively. Both these dimensions are intrinsic to understanding the dichotomous skills and understanding that I possess and the diverse works I have both created and conducted, which are manifestations of my agency in and on the world. At this transition point in my life, I felt the need to subject them to a critical gaze. Three themes had arisen in my own works which I wanted to look at more closely through this opportunity to engage more critically in my own outputs. First: Global Health; my work as executive Director and founder of Global Familymed Foundation as well as an article written with colleagues from Nepal and Myanmar and a podcast series I have run with global partners. I question whether the work conducted was through a colonial paradigm. Second: Social Innovation, where I use the Adaptive Cycle metaphor to analyse different facets of my career representing each phase. Artefacts in this chapter include the two non-profits, the Cooperative, and the corporation I founded as well as programming I conducted in other organizations. Third: Trauma, both the intense study I conducted to become an integrated traumatologist as well as the demonstration of my critical questioning through TikTok-style self-psychoanalysis around my motivations to create my social media channel and write my book The Modern Trauma Toolkit. The insights which have emerged for me are profound; offering future directions related to social justice, education, innovation, and post-traumatic growth

A Fragmented Profession within the System of Professions: The Experience of the Audiology Professional in the United Kingdom

The main purpose of this study was to explore the lived experience of audiology professionals in the United Kingdom. For the purposes of this study an audiology professional is defined as someone who completed a United Kingdom or International course/training pathway in audiology and who is working in the UK. The definition can include audiologists, hear(ing) care assistants, hearing aid dispensers, hearing therapists and clinical scientists. Audiology professionals working in Higher Education were also included. Working in two different contexts with similar and dissimilar aspects of role descriptions, as well as boundaries of practice led to the research question: What is the experience of audiology professionals in becoming and being an audiology professional in the United Kingdom? The following strands narrowed the focus of the study and helped to identify the appropriate methodological approach: 1. The experience of becoming an audiology professional 2. The experience of being an audiology professional 3. The impact of change in education pathways and service delivery on the audiology professional The research question was explored through an Exploratory Sequential Mixed Methods approach starting with interviews of eight participants followed by a survey circulated to the wider profession with 329 respondents. Data analysis consists of interpretive phenomenological analysis of the interviews and descriptive statistics for the surveys. The results from both stages will be discussed in relation to the sociology of professions, specifically Abbott’s (1988) system of professions with elements of Bourdieu’s social world theory (1985). The results sketch a fragmented profession divided by titles, professional organisations, and regulatory bodies as well as many education pathways across the private sector and the NHS

Fostering Sustainable Biomedical Research Training in Mozambique: A Spin-Off of the Medical Education Partnership Initiative.

BACKGROUND: The further development of research capacity in low- and middle-income countries is critical to the delivery of evidence-based healthcare, the design of sound health policy and effective resource allocation. Research capacity is also critical for the retention of highly skilled faculty and staff and for institutional internationalization. OBJECTIVES: We summarize the accomplishments, challenges and legacy of a five-year program to train biomedical researchers entitled Enhanced Advanced Biomedical Research Training for Mozambique (EABRTM). METHODS: A program conducted from 2015-2021 built upon the Medical Education Partnership Initiative to develop research capacity at Eduardo Mondlane University (UEM) and allied institutions. The project included design and implementation of postgraduate training programs and bolstered physical and human research infrastructure. FINDINGS: The program supported development and implementation of UEMs first doctoral (Bioscience and Public Health) and master (Biosciences) programs with 31 and 23 students enrolled to date, respectively. Three master programs were established at Lúrio University from which 176/202 (87.1%) and 107/202 (53.0%) students obtained a Postgraduate Diploma or masters degree, respectively. Scholarships were awarded to 39 biomedical researchers; 13 completed master degrees, one completed a PhD and five remain in doctoral studies. Thirteen administrative staff and four biomedical researchers were trained in research administration and in biostatistics, respectively. A total of 119 courses and seminars benefited 2,142 participants. Thirty-five manuscripts have been published to date in peer-reviewed international journals of which 77% are first-authored by Mozambicans and 44% last-authored by Africans. Sustainability was achieved through 59 research projects awarded by international agencies, totaling $16,363,656.42 and funds ($ 7,319,366.11) secured through 2025. CONCLUSIONS: The EABRTM program substantially increased research and mentorship capacity and trained a new generation of biostatisticians and research administrators. These programmatic outcomes significantly increased the confidence of early stage Mozambican researchers in their ability to successfully pursue their career goals

Examining medical doctors’ internship training experience and labour market transition in Kenya

Kenya has a severe shortage of doctors. Despite medical schools increasing the numbers of medical officers (MO) in training, less than half of newly qualified/registered MOs were absorbed by the public sector between 2015 and 2018. It seems timely to understand the labour market for this profession in system terms and in personal terms for doctors, especially during their labour market entry. I used a multiple-method approach including literature reviews, quantitative survey and qualitative interviews to examine doctors’ internship training experiences and labour market transition in Kenya. I found that the resources available in hospitals overall was often inadequate to support medical internship training in Kenya, especially for Level 4/district or smaller hospitals. Over half reported that their hospitals did not have enough consultants, physical resources and supplies of diagnostics, equipment and medications required for their study and work. Over half of the interns experienced burnout and anxiety, some did not have good supervision at all times and had to perform inappropriate tasks, especially in smaller hospitals. Such poor internship experiences influenced MOs’ career intentions. Some preferred to leave the public sector, however the majority still preferred to work in the public sector or continue with specialist training immediately after internship. Nonetheless, as decentralisation in 2013 led to county governments being responsible for local workforce recruitment, they are not absorbing these MOs into the public sector. This is for reasons including limited health system financing, a willingness to rely on interns to provide hospital care, and preference for recruiting other cheaper health worker cadres. These findings suggest that Kenya needs to take a strategic approach to match the demand and supply of physicians, especially at labour market entry (i.e. internship) as well as improve the internship training resources and capacity. Poor planning and management not only wastes resources and undermines healthcare delivery, but can also be detrimental to individual physicians

Medicine and Parenting: Significance of stress and burnout. A study on the impact of parenting on stress and burnout amongst General Practice registrars

Background Balancing a career and a family is challenging due to the significant physical, mental, and emotional demands. This balance can be particularly troublesome when juggling simultaneous training towards a medical specialty fellowship and a young family. The timing for these training years often coincides with the years typically associated with reproductive and early family life. Burnout and stress have been shown to be rising within the medical workforce, especially among junior doctors and registrars. There is limited evidence on the impact of parenting to alleviate or exacerbate stress and burnout amongst these trainees, and how balancing challenging work demands with life events impacts on their experiences of stress and burnout. Aim The thesis aimed to understand the experiences of stress and burnout in General Practice registrars, with a focus on the impact of parenting. The thesis was conceptualised with the aid of Abendroth and den Dulk’s (2011) work-life balance framework. The framework facilitated investigation at multiple levels of potential impacts on stress and burnout, starting at a national policy/systems-based level, and moving sequentially to examine individual experiences at the workplace and personal level. Methods This thesis used mixed methods research with an explanatory sequential design approach. An initial systematic review was conducted to determine what was already known in the literature regarding the topic area. This review was repeated prior to the thesis compilation in 2023 to encompass recent updates to the literature. This was followed by a policy review of maternity leave policies in Australian medical speciality training programs, across both hospital and community-based speciality training programs. A quantitative study was undertaken employing a cross sectional online survey design. The survey instrument utilised the Maslach Burnout Inventory and data was analysed using bivariate and multivariate regression models. Finally, a qualitative analysis was completed to explore the experience of stress and burnout in General Practice registrars and the factors that may exacerbate or protect the registrars from stress and burnout, with a focus on the experiences of two groups of registrars, those that have children, and those that do not. Results It was identified that there is a paucity of Australian literature looking at the impact of stress and burnout on training doctors, and notable gaps in evidence around the impact of parenting on the experiences of stress and burnout. Current maternity and paternity leave policies across specialty training programs in Australia do not allow parents to undertake a variety of flexible work options around pregnancy, paternity leave and return to work. Specifically, in General Practice training there is an inequity in comparison to other speciality training programs as there is no paid leave entitlements. Additionally, stress and burnout were found to be very common across General Practice training with over 75% of registrars in the quantitative component of this thesis experiencing moderate to high levels of burnout, with all the interviewed registrars in the qualitative arm experiencing episodes of stress and burnout in their General Practice registrar training terms. Factors that contribute to stress and burnout included time pressures, financial pressures, isolation, lack of support from both the workplace and personal networks, and worry and guilt across both professional and personal roles. Protective mechanisms for stress and burnout included supportive national policies that encourage work life balance, support from within the workplace, at a policy and local level, support at an individual level within the home, balance across work and life commitments, and access to localised supports, including other avenues such as having a personal psychologist or a General Practitioner (GP). Conclusion This study contributed to the existing literature, and to the best of the candidate’s knowledge, it is the first comprehensive investigation in the context of community-based medicine, focussing on burnout and the impact of parenting. This research confirmed the high rates of burnout in this population and explored themes across those participants’ experiences that contributed to, and alleviated, their stress and burnout. This thesis has highlighted the following key and practical opportunities that can be made to reduce the occurrence of stress and burnout in the General Practice registrar population. At a national level, specific policy recommendations have been identified. The first recommendation pertains to designing and implementing a program of flexible and paid maternity and paternity leave for all registrars. The second recommendation is to encourage all medical professionals to have their own GP and formal or informal debriefing networks. The third recommendation is a targeted approach to attract and retain registrars into the General Practice registrar training program. Based on these findings, the following research directions have been recommended to improve relevant policies. These include further research into equitable funding of leave entitlements including maternity and paternity leave. Additional, research to further investigate the effects of different support systems, for example, family, peers, and professional counselling, in mitigating burnout. There is also a need to undertake research to enable a greater understanding on the limitations around the recruitment and retention of General Practice registrars, and further investigations into burnout mitigation, specifically surrounding workplace flexibility and job satisfaction

Bridging The Gap Between Ancillary Health Professions And Rural Community Health Needs

Introduction Rural communities are home to nearly one-fifth of the American population, and they face unique challenges when working to access healthcare (Health Resources & Services Administration, 2021; Slagle et al., 2012). Ancillary health professionals (AHPs) are healthcare professionals, excluding physicians, nurses, and dentists (Ancillary Care Services, 2015). The scholarly project aimed to find what evidence existed in regard to bridging the gap between the healthcare needs of rural communities, and the availability of AHPs. Methods The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines (Tricco et al., 2018). Based on the findings of the scoping review, additional products were developed and disseminated. Projects were developed following Dunn et al.’s (1994) framework, Ecology of Human Performance, in an attempt to understand the person, context, and task interactions to increase the overall performance range of rural AHPs. Results At the completion of the scholarly project, the researcher had developed several products including: (a) a rural health lecture, (b) a newsletter discussing the resources available through the Rural Health Information Hub, (c) an advocacy letter to a state licensure board discussing increased data collection, (d) a poster presentation on the benefits of more licensure data collection, (e) a poster on the findings of the scoping review, and (f) a scoping review produced for journal publication consideration. Discussion There continues to be a need for increased rural healthcare access and greater AHP workforce development. Education, recruitment, and retention are all valuable components in expanding the AHP performance range to ensure that the needs of rural communities can be appropriately addressed. By preparing students for future rural practice, and ensuring that practitioners have the appropriate supports, the AHP workforce can be enhanced and bolstered to meet and exceed the healthcare needs of rural communities

Interventions for and experiences of shared decision-making underpinning reproductive health, family planning options and pregnancy for women with or at high risk of kidney disease:a systematic review and qualitative framework synthesis

OBJECTIVE: To determine intervention effects and synthesise qualitative research that explored women with or at high risk of kidney disease experiences of shared decision-making in relation to their reproductive health, family planning options and pregnancy. DESIGN: A systematic review of interventions and a qualitative evidence synthesis. DATA SOURCES: We searched Cochrane, CINAHL, MEDLINE, Scopus, ProQuest, Elsevier, PubMed, ScienceDirect and Web of Science. ELIGIBILITY CRITERIA: Shared decision-making interventions and qualitative studies related to reproductive health involving women with or at high risk of kidney disease published from 1980 until January 2021 in English (clinical settings, global perspective). DATA EXTRACTION AND SYNTHESIS: Titles were screened against the inclusion criteria and full-text articles were reviewed by the whole team. Framework synthesis was undertaken. RESULTS: We screened 1898 studies. No evidence-based interventions were identified. 18 qualitative studies were included, 11 kidney disease-specific studies and 7 where kidney disease was a common comorbidity. Women frequently felt unprepared and uninformed about their reproductive options. Conversations with healthcare professionals were commonly described as frustrating and unhelpful, often due to a perceived loss of autonomy and a mismatch in preferences and life goals. Examples of shared decision-making were rare. Kidney disease exacerbated societal expectations of traditional gender roles (eg, wife, mother, carer) including capability to have children and associated factors, for example, parenting, (sexual) relationships, body image and independent living (including financial barriers to starting a family). Local interventions were limited to types of counselling. A new health system model was developed to support new interventions. CONCLUSION: There is a clear need to establish new interventions, test those already in development and develop new clinical guidance for the management of women with or at high risk of kidney disease in relation to their reproductive health, including options to preserve fertility earlier. Other health conditions with established personalised reproductive care packages, for example, cancer, could be used to benchmark kidney practice alongside the new model developed here