A Methodology for Using Workforce Data to Decide Which Specialties and States to Target for Graduate Medical Education Expansion

OBJECTIVE: To outline a methodology for allocating graduate medical education (GME) training positions based on data from a workforce projection model. DATA SOURCES: Demand for visits is derived from the Medical Expenditure Panel Survey and Census data. Physician supply, retirements, and geographic mobility are estimated using concatenated AMA Masterfiles and ABMS certification data. The number and specialization behaviors of residents are derived from the AAMC's GMETrack survey. DESIGN: We show how the methodology could be used to allocate 3,000 new GME slots over 5 years-15,000 total positions-by state and specialty to address workforce shortages in 2026. EXTRACTION METHODS: We use the model to identify shortages for 19 types of health care services provided by 35 specialties in 50 states. PRINCIPAL FINDINGS: The new GME slots are allocated to nearly all specialties, but nine states and the District of Columbia do not receive any new positions. CONCLUSIONS: This analysis illustrates an objective, evidence-based methodology for allocating GME positions that could be used as the starting point for discussions about GME expansion or redistribution

Drivers and barriers of international migration of doctors to and from the United Kingdom: a scoping review.

BACKGROUND: Many high-income countries are heavily dependent on internationally trained doctors to staff their healthcare workforce. Over one-third of doctors practising in the UK received their primary medical qualification abroad. Simultaneously, an average of around 2.1% of doctors leave the UK medical workforce annually to go overseas. The aim of this study was to identify the drivers and barriers of international migration of doctors to and from the UK. METHODS: A scoping review was conducted. We searched EMBASE, MEDLINE, CINAHL, ERIC and BEI in January 2020 (updated October 2021). Grey literature and citation searching were also carried out. Empirical studies reporting on the drivers and barriers to the international migration of doctors to and from the UK published in the English language from 2009 to present were included. The drivers and barriers were coded in NVivo 12 building on an existing framework. RESULTS: 40 studies were included. 62% were quantitative, 18% were qualitative, 15% were mixed-methods and 5% were literature reviews. Migration into and out of the UK is determined by a variety of macro- (global and national factors), meso- (profession led factors) and micro-level (personal factors). Interestingly, many of the key drivers of migration to the UK were also factors driving migration from the UK, including: poor working conditions, employment opportunities, better training and development opportunities, better quality of life, desire for a life change and financial reasons. The barriers included stricter immigration policies, the registration process and short-term job contracts. CONCLUSIONS: Our research contributes to the literature by providing a comprehensive up-to-date review of the drivers and barriers of migration to and from the UK. The decision for a doctor to migrate is multi-layered and is a complex balance between push/pull at macro-/meso-/micro-levels. To sustain the UK's supply of overseas doctors, it is vital that migration policies take account of the drivers of migration particularly working conditions and active recruitment while addressing any potential barriers. Immigration policies to address the impact of Brexit and the COVID-19 pandemic on the migration of doctors to and from the UK will be particularly important in the immediate future. Trial registration PROSPERO CRD42020165748

Gravel pits support waterbird diversity in an urban landscape

We assessed the benefit of 11 gravel pits for the settlement of waterbird communities in an urbanized area lacking natural wetlands. Gravel pits captured 57% of the regional species pool of aquatic birds. We identified 39 species, among which five were regionally rare. We used the Self Organizing Map algorithm to calculate the probabilities of presence of species, and to bring out habitat conditions that predict assemblage patterns. The age of the pits did not correlate with assemblage composition and species richness. There was a positive influence of macrophyte cover on waterbird species richness. Larger pits did not support more species, but species richness increased with connectivity. As alternative wetland habitats, gravel pits are attractive to waterbirds, when they act as stepping stones that ensure connectivity between larger natural and/or artificial wetlands separated in space

Demographics, distribution and experiences of UK clinical academic trainees using GMC NTS Survey data

Involvement in research plays an integral role in the delivery of high-quality patient care, benefitting doctors, patients and employers. It is important that access to clinical academic training opportunities are inclusive and equitable. To better understand the academic trainee population, distribution of academic posts and their reported experience of clinical training, we analysed 53 477 anonymous responses from General Medical Council databases and the 2019 National Training Survey. Academic trainees are more likely to be men, and the gender divide begins prior to graduation. There are very low numbers of international medical graduates and less than full-time academic trainees. A small number of UK universities produce a greater prevalence of doctors successfully appointed to academic posts; subsequent academic training also clusters around these institutions. At more senior levels, academic trainees are significantly more likely to be of white ethnicity, although among UK graduates, no ethnicity differences were seen. Foundation academic trainees report a poorer experience of some aspects of their clinical training placements, with high workloads reported by all academic trainees. Our work highlights important disparities in the demographics of the UK clinical academic trainee population and raises concerns that certain groups of doctors face barriers accessing and progressing in UK academic training pathways

Chromogenic detection of nerve agent mimics

A new chromogenic protocol for the selective detection of nerve agent mimics is reported.Costero Nieto, Ana Maria, [email protected] ; Gil Grau, Salvador, [email protected] ; Parra Alvarez, Margarita, [email protected]

International Consortium for Health Outcomes Measurement (ICHOM): Standardized Patient-Centered Outcomes Measurement Set for Heart Failure Patients

Whereas multiple national, international, and trial registries for heart failure have been created, international standards for clinical assessment and outcome measurement do not currently exist. The working group's objective was to facilitate international comparison in heart failure care, using standardized parameters and meaningful patient-centered outcomes for research and quality of care assessments. The International Consortium for Health Outcomes Measurement recruited an international working group of clinical heart failure experts, researchers, and patient representatives to define a standard set of outcomes and risk-adjustment variables. This was designed to document, compare, and ultimately improve patient care outcomes in the heart failure population, with a focus on global feasibility and relevance. The working group employed a Delphi process, patient focus groups, online patient surveys, and multiple systematic publications searches. The process occurred over 10 months, employing 7 international teleconferences. A 17-item set has been established, addressing selected functional, psychosocial, burden of care, and survival outcome domains. These measures were designed to include all patients with heart failure, whether entered at first presentation or subsequent decompensation, excluding cardiogenic shock. Sources include clinician report, administrative data, and validated patient-reported outcome measurement tools: the Kansas City Cardiomyopathy Questionnaire; the Patient Health Questionnaire-2; and the Patient-Reported Outcomes Measurement Information System. Recommended data included those to support risk adjustment and benchmarking across providers and regions. The International Consortium for Health Outcomes Measurement developed a dataset designed to capture, compare, and improve care for heart failure, with feasibility and relevance for patients and clinicians worldwide

Neutron-proton pairing in the N=Z radioactive fp-shell nuclei 56Ni and 52Fe probed by pair transfer

The isovector and isoscalar components of neutron-proton pairing are investigated in the N=Z unstable nuclei of the \textit{fp}-shell through the two-nucleon transfer reaction (p,$^3$He) in inverse kinematics. The combination of particle and gamma-ray detection with radioactive beams of $^{56}$Ni and $^{52}$Fe, produced by fragmentation at the GANIL/LISE facility, made it possible to carry out this study for the first time in a closed and an open-shell nucleus in the \textit{fp}-shell. The transfer cross-sections for ground-state to ground-state (J=0$^+$,T=1) and to the first (J=1$^+$,T=0) state were extracted for both cases together with the transfer cross-section ratios $\sigma$(0$^+$,T=1) /$\sigma$(1$^+$,T=0). They are compared with second-order distorted-wave born approximation (DWBA) calculations. The enhancement of the ground-state to ground-state pair transfer cross-section close to mid-shell, in $^{52}$Fe, points towards a superfluid phase in the isovector channel. For the "deuteron-like" transfer, very low cross-sections to the first (J=1$^+$,T=0) state were observed both for \Ni\phe\, and \Fe\phe\, and are related to a strong hindrance of this channel due to spin-orbit effect. No evidence for an isoscalar deuteron-like condensate is observed.Comment: 7 pages, 4 figure