Specialist training in Fiji: Why do graduates migrate, and why do they remain? A qualitative study

<p>Abstract</p> <p>Background</p> <p>Specialist training was established in the late 1990s at the Fiji School of Medicine. Losses of graduates to overseas migration and to the local private sector prompted us to explore the reasons for these losses from the Fiji public workforce.</p> <p>Methods</p> <p>Data were collected on the whereabouts and highest educational attainments of the 66 Fiji doctors who had undertaken specialist training to at least the diploma level between 1997 and 2004. Semistructured interviews focusing on career decisions were carried out with 36 of these doctors, who were purposively sampled to include overseas migrants, temporary overseas trainees, local private practitioners and public sector doctors.</p> <p>Results</p> <p>120 doctors undertook specialist training to at least the diploma level between 1997 and 2004; 66 of the graduates were Fiji citizens or permanent residents; 54 originated from other countries in the region. Among Fiji graduates, 42 completed a diploma and 24 had either completed (21) or were enrolled (3) in a master's programme. Thirty-two (48.5%) were working in the public sectors, four (6.0%) were temporarily training overseas, 30.3% had migrated overseas and the remainder were mostly in local private practice. Indo-Fijian ethnicity and non-completion of full specialist training were associated with lower retention in the public sectors, while gender had little impact. Decisions to leave the public sectors were complex, with concerns about political instability and family welfare predominating for overseas migrants, while working conditions not conducive to family life or frustrations with career progression predominated for local private practitioners. Doctors remaining in the public sectors reported many satisfying aspects to their work despite frustrations, though 40% had seriously considered resigning from the public service and 60% were unhappy with their career progression.</p> <p>Conclusion</p> <p>Overall, this study provides some support for the view that local or regional postgraduate training may increase retention of doctors. Attention to career pathways and other sources of frustration, in addition to encouragement to complete training, should increase the likelihood of such programmes' reaching their full potentials.</p

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

Background: In 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.\ud \ud Case description: A 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.\ud \ud Discussion and evaluation: Over 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.\ud \ud Conclusions: Despite 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

B¯okin-b¯obai

Bone scintigraphy has a long and useful track record in the early detection of trauma, both acute and chronic, since its introduction in the 1970s as a new imaging modality. It has been widely used in the early detection of occult bone injury that is not evident on plain x-ray, with a significant increase in sensitivity with the adoption of SPECT. Adoption of scintigraphy into the investigation of sporting injuries was a more successful enterprise in the last 1970s and 1980s and, in many instances of stress fracture and the medial tibial stress syndrome, became the reference standard. MRI has diminished the role of scintigraphy with its exquisite contrast resolution and excellent spatial resolution, especially for soft-tissue injury. It reflects the cyclical nature of technological advances in imaging. We are now at another exciting crossroad, where SPECT has been combined with CT, allowing the marriage of the superb contrast resolution of SPECT with the high spatial resolution of CT. Early experience suggests that there is an incremental value of 25-30 % over SPECT or CT alone, opening up exciting possibilities for imaging trauma. Evidence for its utility in sporting and non-sporting trauma will be evaluated