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

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ABSTRACT 20

Postgraduate specialist training at the Fiji School of Medicine: what do the students think?

Introduction: Postgraduate specialist training was established at the Fiji School of Medicine in 1998. Since then, most students who have earned a one-year specialist Diploma have not completed a Masters, and many have since migrated overseas, or entered local private practice. Because the retention of Masters graduates is much higher, it is important to understand the reasons why so many students have dropped out, and whether interventions could be put in place to improve Masters completion rates.\ud \ud Methods: Semi-structured interviews were carried out between 2004 and 2006 for 36 out of 66 Fiji doctors who had\ud trained to the Diploma level or higher by 2004. Nine senior consultants were also interviewed. All were asked to describe their experiences and impressions about postgraduate training in Fiji.\ud \ud Results: Feelings about the postgraduate programs were mixed. On a positive note, many felt they had learned a great deal and developed further as doctors because of the programs. Others expressed disappointments about under-resourcing of teaching, unsatisfactory clinical supervision, and distressing levels of conflict between their duties as a clinician in a public hospital and academic expectations. Many dropped out because of a combination of heavy clinical and academic workloads alongside disappointments about various aspects of the course.\ud \ud Discussion: The postgraduate programs at the Fiji School of Medicine hold considerable promise in helping to meet the specialist workforce needs for Fiji, but more attention needs to be paid to how to retain more enrollees through to Masters graduation. Attention to improved clinical supervision in the hospitals, ensuring manageable clinical workloads, and trying to avoid conflicts between academic and clinical expectations may help more students to continue through to graduation

Professional satisfaction and dissatisfaction among Fiji specialist trainees: what are the implications for preventing migration?

The migration of doctors from developing countries threatens the health status of the populations left behind. This\ud qualitative study was conducted to explore why an unexpected number of Fiji specialist trainees left the public sector,\ud often to migrate, using a lens of professional satisfaction. Forty seven Fiji doctors, including 36 of 66 who undertook\ud specialist training in Fiji, were interviewed about the factors that led to their own professional satisfaction and\ud dissatisfaction. Three major components of professional satisfaction emerged: professional growth, service, and\ud recognition, with considerable overlap between categories. The aspects of professional dissatisfaction were more\ud varied but could be categorized as the absence or blocking of the elements of professional satisfaction. From the\ud interviews, a professional satisfaction model was developed featuring the three overlapping central elements of\ud satisfaction on a background of an enabling health system. This model might have implications for health systems\ud seeking to retain their workers

Lack of coordination between health policy and medical education: a contributing factor to the resignation of specialist trainees in Fiji?

Aim: Specialist training was established in Fiji in 1998. This study explored whether health policy, and in particular mismatches between existing policy and the new realities of local specialist training, contributed to decisions by many trainees to ultimately leave the public sectors, often to migrate. Method: Data was collected on the whereabouts of all specialist trainees. Semi-structured interviews were carried out with 36 of 66 Fiji trainees in order to explore reasons for continuing or not completing training, as well as the reasons behind subsequent career choices. Results: Overall, 54.5% of doctors remained in the public sectors or were temporarily overseas. Completion of specialist training was particularly associated with improved retention. Policies that contributed to frustration and sometimes resignations included a lack of transparency in the selection of doctors to enter training pathways, and unreliable career progression following completion of training. Doctors who left training before completion mentioned family stresses, which were exacerbated by delayed age at entry into training and a lack of certainty in regards to the timing of improved working conditions through career advancement. Conclusion: Policy adjustments to expedite entry into training, as well as to establish predictable career progression as a reward for training may increase training completions and overall retention

Professional Satisfaction and Dissatisfaction Among Fiji Specialist Trainees: What Are the Implications for Preventing Migration?

The migration of doctors from developing countries threatens the health status of the populations left behind. This qualitative study was conducted to explore why an unexpected number of Fiji specialist trainees left the public sector, often to migrate, using a lens of professional satisfaction. Forty seven Fiji doctors, including 36 of 66 who undertook specialist training in Fiji, were interviewed about the factors that led to their own professional satisfaction and dissatisfaction. Three major components of professional satisfaction emerged: professional growth, service, and recognition, with considerable overlap between categories. The aspects of professional dissatisfaction were more varied but could be categorized as the absence or blocking of the elements of professional satisfaction. From the interviews, a professional satisfaction model was developed featuring the three overlapping central elements of satisfaction on a background of an enabling health system. This model might have implications for health systems seeking to retain their workers

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

Background: 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. Methods: 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. Results: 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. Conclusion: 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

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

Abstract 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. 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 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 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. 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.</p