Does tutor subject-matter expertise influence student achievement in the problem based learning curriculum at UNITRA medical school?

Objective. To establish whether or not tutor subject-matter expertise influences student achievement in content-based examinations in the problem-based learning (PBL) curriculum at the University of Transkei (UNITRA) Medical School.Design. A retrospective study of MB ChB III student achievement in end-of-block modified essay questions (MEQ) examinations in microbiology, pathology and pharmacology for the years 1994 - 1999, inclusive. Pooled scores from the expert-tutored groups were compared with those from the groups tutored by non-experts using analysis of variance (ANOVA) or t-test. Subject expert tutors were those with postgraduate specialisation in the given discipline.Setting. The Medical School, Faculty of Health Sciences, UNITRA, Umtata.Outcome measures. Whether pooled mean MEQ scores in end-of-block examinations for microbiology, pathology or pharmacology differ according to the subject-matter expertise of the tutor.Results. There were no significant differences in mean scores obtained for pharmacology (51.1 ± 0.6 versus 52.6 ± 0.7, P = 0.109) and pathology (49.8 ± 0.6 versus 49.9 ± 0.8, P = 0.919). The difference between the scores in microbiology was small (3 percentage points) but statistically significant, with the groups tutored by microbiologists scoring higher than those tutored by pathologists or pharmacologists (54.1 ± 1.0 versus 51.2 ± 0.8, P = 0.032).Conclusions. These data demonstrate that in the UNITRA Medical School PBL curriculum tutor subject-matter expertise has little or no influence on student achievement in the discrete areas of tutor expertise

Foreign advertisements for doctors in the SAMJ 2006 - 2010

Background. There is much concern about the migration of health professionals from developing countries, and the contribution of active recruitment to the phenomenon. One active recruitment strategy is advertisements in professional journals and other media. Objective. To establish the trends in foreign advertisements for doctors placed in the South African Medical Journal (SAMJ) from January 2006 to December 2010. Methods. A retrospective review was conducted of 60 issues of the SAMJ published in the preview years. Printed journals were scanned for foreign advertisements. The findings were compared with a review of 2000 - 2004 in the same journal. Results. There were 1 176 foreign advertisements placed in the SAMJ in the review period, reducing from 355 in 2006 to 121 in 2010. The countries placing the most advertisements were Australia (n=428, 36.4%), Canada (n=286, 24.3%), New Zealand (n=191, 16.2%) and the UK (n=108, 9.2%). Compared with the earlier findings, there was a reduction in advertisements for the top countries, excepting Australia. The top 4 countries remained the same for the 2 review periods, but the order changed, with Australia superseding the UK. Conclusion. The number of foreign advertisements placed in the SAMJ declined over the period under review, and there was a change in ranking of the top 4 advertising countries. These findings are discussed from the perspective of global human resources for health initiatives

Der Einsatz von Missing Data Techniken in der Arbeitsmarktforschung des IAB

"Der Beitrag gibt einen Überblick über aktuelle Forschungsprojekte des Instituts für Arbeitsmarkt- und Berufsforschung (IAB), die sich alle auf unterschiedliche Weise mit der Behebung von Problemen mit Missing Data befassen. Hierzu gehören einerseits Projekte, die Stichproben verwenden wie das IAB-Betriebspanel, die IAB-Beschäftigtenstichprobe oder die Erhebung der offenen Stellen, die entweder wie alle Stichprobenerhebungen durch Antwortausfälle beeinträchtigt sind oder aber zensierte Beobachtungen aufweisen. Auf der anderen Seite zählen hierzu Forschungsprojekte, die versuchen, unterschiedliche Datengrundlagen vereinbar zu machen, die auf verschiedenen regionalen oder klassifikatorischen Abgrenzungen beruhen. Außerdem wird das Projekt TrEffeR des IAB und der Bundesagentur für Arbeit (BA) vorgestellt, das der oft ausgesprochenen Forderung gerecht wird, die Maßnahmen der aktiven Arbeitsmarktpolitik auf breiter Basis zu evaluieren und diese Erkenntnisse für das operative Geschäft der BA nutzbar macht." (Autorenreferat

Health worker migration from South Africa: causes, consequences and policy responses

BackgroundThis paper arises from a four-country study that sought to better understand the drivers of skilled health worker migration, its consequences, and the strategies countries have employed to mitigate negative impacts. The four countries—Jamaica, India, the Philippines, and South Africa—have historically been “sources” of skilled health workers (SHWs) migrating to other countries. This paper presents the findings from South Africa.MethodsThe study began with a scoping review of the literature on health worker migration from South Africa, followed by empirical data collected from skilled health workers and stakeholders. Surveys were conducted with physicians, nurses, pharmacists, and dentists. Interviews were conducted with key informants representing educators, regulators, national and local governments, private and public sector health facilities, recruitment agencies, and professional associations and councils. Survey data were analyzed using descriptive statistics and regression models. Interview data were analyzed thematically.ResultsThere has been an overall decrease in out-migration of skilled health workers from South Africa since the early 2000s largely attributed to a reduced need for foreign-trained skilled health workers in destination countries, limitations on recruitment, and tighter migration rules. Low levels of worker satisfaction persist, although the Occupation Specific Dispensation (OSD) policy (2007), which increased wages for health workers, has been described as critical in retaining South African nurses. Return migration was reportedly a common occurrence. The consequences attributed to SHW migration are mixed, but shortages appear to have declined. Most promising initiatives are those designed to reinforce the South African health system and undertaken within South Africa itself.ConclusionsIn the near past, South Africa’s health worker shortages as a result of emigration were viewed as significant and harmful. Currently, domestic policies to improve health care and the health workforce including innovations such as new skilled health worker cadres and OSD policies appear to have served to decrease SHW shortages to some extent. Decreased global demand for health workers and indications that South African SHWs primarily use migratory routes for professional development suggest that health worker shortages as a result of permanent migration no longer pertains to South Africa

Policy and programmatic implications of task shifting in Uganda: a case study

Abstract Background Uganda has a severe health worker shortage and a high demand for health care services. This study aimed to assess the policy and programmatic implications of task shifting in Uganda. Methods This was a qualitative, descriptive study through 34 key informant interviews and eight (8) focus group discussions, with participants from various levels of the health system. Results Policy makers understood task shifting, but front-line health workers had misconceptions on the meaning and intention(s) of task shifting. Examples were cited of task shifting within the Ugandan health system, some formalized (e.g. psychiatric clinical officers), and some informal ones (e.g. nurses inserting IV lines and initiating treatment). There was apparently high acceptance of task shifting in HIV/AIDS service delivery, with involvement of community health workers (CHW) and PLWHA in care and support of AIDS patients. There was no written policy or guidelines on task shifting, but the policy environment was reportedly conducive with plans to develop a policy and guidelines on task shifting. Factors favouring task shifting included successful examples of task shifting, proper referral channels, the need for services, scarcity of skills and focused initiatives such as home based management of fever. Barriers to task shifting included reluctance to change, protection of professional turf, professional boundaries and regulations, heavy workload and high disease burden, poor planning, lack of a task shifting champion, lack of guidelines, the name task shifting itself, and unemployed health professionals. There were both positive and negative views on task shifting: the positive ones cast task shifting as one of the solutions to the dual problem of lack of skills and high demand for service, and as something that is already happening; while negative ones saw it as a quick fix intended for the poor, a threat to quality care and likely to compromise the health system. Conclusion There were widespread examples of task in Uganda, and task shifting was mainly attributed to HRH shortages coupled with the high demand for healthcare services. There is need for clear policy and guidelines to regulate task shifting and protect those who undertake delegated tasks.</p

Factors influencing treatment outcomes in tuberculosis patients in Limpopo Province, South Africa, from 2006 to 2010: A retrospective study

Background: South Africa has a high burden of tuberculosis (TB), with high human immunodeficiency virus (HIV)-TB co-infection rates and the emergence of multidrugresistant TB. Objectives: To describe treatment outcomes and factors influencing outcomes amongst pulmonary TB (PTB) patients in the Limpopo Province. Method: A retrospective review was conducted of data on the provincial electronic TB register (ETR.net) for the years 2006 to 2010 (inclusive), and a random sample of 1200 records was selected for further analysis. The Chi square test was used to examine the influence of age, gender, health facility level, diagnostic category and treatment regimen on treatment outcomes. Results: Overall 90 617 (54.6% male) PTB patients were registered between 2006 and 2010. Of the sampled 1200 TB cases, 72.6% were in persons aged 22 to 55 years and 86.2% were new cases. The TB mortality rate was 13.6% (much higher than the World Health Organization target of 3%), whilst the default rate was 9.8%. There was a strong association between age (P < 0.001), diagnostic category (P < 0.001), treatment regimen (P < 0.001), and health facility level (P < 0.001) and treatment outcome. Those aged 22–55, and 56–74 years were more likely to die (P < 0.05). Poor treatment outcomes were also associated with initial treatment failure, receiving treatment at hospital and treatment regimen II. Conclusion: The poor TB treatment outcomes in Limpopo, characterised by a high mortality and default rates, call for strengthening of the TB control programme, which should include integration of HIV and/or AIDS and TB services