A survey of factors influencing career preference in new-entrant and exiting medical students from four UK medical schools

Our thanks to Professor Gillian Needham and Dr Murray Lough for their encouragement and support, and their comments on an earlier draft of this manuscript. Our thanks also to NHS Education for Scotland [NES] for funding, and the Scottish Medical Deans Education Group [SMDEG] for supporting this project. We are grateful to all the students who gave their time to complete the survey questionnaire and to those who helped organise and carry out data collection.Peer reviewedPublisher PD

Empathy, Religious Affiliation, and the Growth of Osteopathic Medicine

A key distinction of Doctors of Osteopathic Medicine (D.O.s) is their recognition of each patient as a whole person rather than just addressing his ailment. This focus previously highlighted physical manipulation over medications; however, the osteopathic profession has evolved significantly over the years. As this field is no longer identified by its original rejection of pharmaceuticals, other original principles of osteopathic medicine have impacted the growth of the field. The data collected from surveyed patients indicated that many osteopathic patients and physicians have religious backgrounds, and there is a widespread emphasis on psychological integration. The increased number of patients is largely due to the increased prevalence of osteopathic physicians, with growth of the field supplemented by good experiences and recommendations

‘It would not be tolerated in any other profession except medicine’: survey reporting on undergraduates’ exposure to bullying and harassment in their first placement year

OBJECTIVES: To determine the extent to which undergraduate medical students experience (and/or witness) bullying and harassment during their first year on full-time placements and to compare with new General Medical Council (GMC) evidence on bullying and harassment of doctors in training.SETTING: A UK university offering medical and nursing undergraduate programmes.PARTICIPANTS: 309 medical and nursing undergraduate students with 30-33?weeks' placement experience (123 medical students and 186 nursing students); overall response rate: 47%.PRIMARY AND SECONDARY OUTCOME MEASURES: (A) students' experience of bullying and harassment; (B) witnessing bullying and harassment; (C) actions taken by students; (D) comparison of medical and nursing students' data.RESULTS: Within 8?months of starting clinical placements, a fifth of medical and a quarter of nursing students reported experiencing bullying and harassment. Cohorts differ in the type of exposure reported and in their responses. Whereas some nursing students follow incidences with query and challenge, most medical students acquiesce.CONCLUSIONS: Bullying and harassment of medical (and nursing) students-as well as witnessing of such incidents-occurs as soon as students enter the clinical environment. This augments evidence published by the GMC in its first report on undermining of doctors in training (December 2013). The data suggest differences between nursing and medical students in how they respond to such incidents.<br/

For public service or money : understanding geographical imbalances in the health workforce

Geographical imbalances in the health workforce have been a consistent feature of nearly all health systems, especially in developing countries. The authors investigate the willingness to work in a rural area among final year nursing and medical students in Ethiopia. Analyzing data obtained from contingent valuation questions, they find that household consumption and the student's motivation to help the poor, which is their proxy for intrinsic motivation, are the main determinants of willingness to work in a rural area. The authors investigate who are willing to help the poor and find that women are significantly more likely to help than men. Other variables, including a rich set of psycho-social characteristics, are not significant. Finally, the authors carry out some simulations on how much it would cost to make the entire cohort of starting nurses and doctors choose to take up a rural post.Health Monitoring&Evaluation,Health Systems Development&Reform,Educational Sciences,Economic Theory&Research,Housing&Human Habitats

For public service or money: Understanding geographical imbalances in the health workforce in Ethiopia

Geographical imbalances in the health workforce have been a consistent feature of nearly all health systems, and especially in developing countries. In this paper we investigate the willingness to work in a rural area among final year nursing and medical students in Ethiopia. Analyzing data obtained from contingent valuation questions, we find that household consumption and the student’s motivation to help the poor, which is our proxy for intrinsic motivation, are the main determinants of willingness to work in a rural area. We investigate whoe is willing to help the poor and find that women are significantly more likely than men. Other variables, including a rich set of psychosocial characteristics, are not significant. Finally, we carry out some simulation on how much it would cost to make the entire cohort of starting nurses and doctors chooseto take up a rural post.Health care delivery, health workers, labour supply, public service

Allopathic Medicine’s Influence on Indigenous Peoples in the Kumaon Region of India

This paper focuses on the use of western medicine in the Kumaon region of Uttarakhand, India. The goal of this research is to understand which healing practices are preferable in rural villages. Semi-structured interviews were conducted with 53 participants, including two spiritual healers, two doctors, and one pharmacist. Results indicate that allopathic medicine, otherwise known as modern medicine or western medicine, has become the go-to remedy for even the most remote people in India. Nearly all participants use allopathic medicine, but less than half of the participants experiment with other forms of healing, such as Ayurveda, homeopathy, meditation, and yoga. This study explores the problems that result from becoming too dependent on western medicine; these issues stem from a lack of knowledge patients have about the dosage and intensity of the drugs they take. It is important to educate rural villagers about the dangers that various medicines can cause, as well as establish more medical facilities that promote alternative treatments alongside modern medicine

Health care professionals' perceptions towards lifelong learning in palliative care for general practitioners: a focus group study

Background: There is a growing need for palliative care. The majority of palliative patients prefer their general practitioner (GP) to organize their palliative home care. General practitioners need a range of competences to perform this task. However, there has been no general description so far of how GPs keep these competences up-to-date. The present study explores current experiences, views and preferences towards training and education in palliative care among GPs, palliative home-care professionals and professionals from organizations who provide training and education. Methods: Five focus groups were brought together in Belgium, with a total of 29 participants, including members of the three categories mentioned above. They were analysed using a constant comparison method. Results: The analysis revealed that undergraduate education and continuing medical education (CME) while in practice, is insufficient to prepare GPs for their palliative work. Workplace learning (WPL) through collaboration with specialized palliative home-care nurses seems to be a valuable alternative. Conclusions: The effectiveness of undergraduate education might be enhanced by adding practical experience. Providers of continuing medical education should look to organize interactive, practice-based and interprofessional sessions. Therefore, teachers need to be trained to run small group discussions. In order to optimize workplace learning, health care professionals should be trained to monitor each other’s practice and to provide effective feedback. Further research is needed to clarify which aspects of interprofessional teamwork (e.g. professional hierarchy, agreements on tasks and responsibilities) influence the effectiveness of workplace learning

Pro-social preferences and self-selection into the public health sector: evidence from economic experiments

There is growing interest in the role of pro-social motivation in public service delivery. In general, economists no longer question whether people have social preferences, but ask how and when such preferences will influence their economic and social decisions. Apart from revealing that individuals on average share and cooperate even when such actions lower their own material pay-off, economic experiments have documented substantial individual heterogeneity in the strength and structure of social preferences. In this paper we study the extent to which these differences are related to career choices, by testing whether preferences vary systematically between Tanzanian health worker students who prefer to work in the private health sector and those who prefer to work in the public health sector. Despite its important policy implications, this issue has received hardly any attention to date. By combining data from a questionnaire and two economic experiments, we find that students who prefer to work in the public health sector have stronger pro-social preferences than those who prefer to work in the private sector. We also show that the extent to which these students care about others can be conditional and linked to inequality aversion. A systematic selfselection of pro-socially motivated health workers into the public sector suggests that it is a good idea to have two sectors providing health services: this can ensure efficient matching of individuals and sectors by allowing employers in the two sectors to use different payment mechanisms tailored to attract and promote good performance from different types of health workers.pro-social preferences; career choice; economic experiments; health workers