Dataset Information

Retention of medical doctors at the district level: a qualitative study of experiences from Tanzania.

ABSTRACT:

Background

Retention of Human Resources for Health (HRH), particularly doctors at district level is a big challenge facing the decentralized health systems in poorly resourced countries. Tanzania, with 75% of its population in rural areas, has only 26% of doctors serving in rural areas. We aimed to analyze the experiences regarding the retention of doctors at district level in Tanzania from doctors' and district health managers' perspectives.

Methods

A qualitative study was carried out in three districts from June to September 2013. We reviewed selected HRH documents and then conducted 15 key informant interviews with members of the District Health Management teams and medical doctors working at the district hospitals. In addition, we conducted three focus group discussions with Council Health Management Team members in the three districts. Incentive package plans, HRH establishment, and health sector development plans from the three districts were reviewed. Data analysis was performed using qualitative content analysis.

Results

None of the districts in this study has the number of doctors recommended. Retention of doctors in the districts faced the following challenges: unfavourable working conditions including poor working environment, lack of assurance of career progression, and a non-uniform financial incentive system across districts; unsupportive environment in the community, characterized by: difficulty in securing houses for rent, lack of opportunities to earn extra income, lack of appreciation from the community and poor social services. Health managers across districts endeavour to retain their doctors through different retention strategies, including: career development plans, minimum financial incentive packages and avenues for private practices in the district hospitals. However, managers face constrained financial resources, with many competing priorities at district level.

Conclusions

Retention of doctors at district level faces numerous challenges. Assurance of career growth, provision of uniform minimum financial incentives and ensuring availability of good social services and economic opportunities within the community are among important retention strategies.

SUBMITTER: Sirili N

PROVIDER: S-EPMC5891935 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:Purpose: A qualitative inquiry was conducted to investigate the qualification requirements of medical doctors in different professional fields and from different perspectives. The inquiry was part of an empirical workplace analysis. Methods: Seventy-four structured interviews were conducted and analyzed to examine critical incidents and behaviors of medical doctors working in different professional fields (clinical theory, clinical practice, practitioner) and disciplines, and from three different perspectives (medical doctors, non-medical staff, and patients). In addition, the National Competency-based Catalogue of Learning Objectives for Medical Education (Nationaler Kompetenzbasierter Lernzielkatalog Medizin / NKLM) was used. Results: The results revealed eleven relevant competencies, which could be categorized into three superordinate competence clusters: interpersonal, work-related, and self-related. The perspectives of medical doctors and non-medical staff included all eleven competencies. However, the perspective of patients did not include one interpersonal and two self-related competencies. Nearly all of the critical behaviors mentioned are included in the NKLM. However, the NKLM also includes behaviors that were not mentioned in the interviews. Conclusions: The behavior-oriented interviews resulted in a requirement profile that is very similar in structure to other competency models in occupational contexts. Comparisons of the different perspectives predominantly revealed similarities. However, the patient perspective also revealed interesting differences compared to the perspectives of medical doctors and non-medical staff. The behavior-related results of the interviews can be directly used for the development of exercises in selection and personnel development contexts and for potential appraisals specific to different medical disciplines. In future steps, the results of this initial qualitative step are to be replicated and extended using quantitative studies and a representative sample. The main overall objective is the definition of relevant competencies both for the selection and development of medical students and for the design of potential appraisals as part of personnel development programs in different medical disciplines.

Project description:BACKGROUND:Evidence-based medicine is the integration of individual clinical expertise, best external evidence and patient values which was introduced more than two decades ago. Yet, primary care physicians in Malaysia face unique barriers in accessing scientific literature and applying it to their clinical practice. AIM:This study aimed to explore the views and experiences of rural doctors' about evidence-based medicine in their daily clinical practice in a rural primary care setting. METHODS:Qualitative methodology was used. The interviews were conducted in June 2013 in two rural health clinics in Malaysia. The participants were recruited using purposive sampling. Four focus group discussions with 15 medical officers and three individual in-depth interviews with family medicine specialists were carried out. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked and analyzed using a thematic approach. RESULTS:Key themes identified were: (1) doctors viewed evidence-based medicine mainly as statistics, research and guidelines, (2) reactions to evidence-based medicine were largely negative, (3) doctors relied on specialists, peers, guidelines and non-evidence based internet sources for information, (4) information sources were accessed using novel methods such as mobile applications and (5) there are several barriers to evidence-based practice, including doctor-, evidence-based medicine-, patient- and system-related factors. These included inadequacies in knowledge, attitude, management support, time and access to evidence-based information sources. Participants recommended the use of online services to support evidence-based practice in the rural settings. CONCLUSION:The level of evidence-based practice is low in the rural setting due to poor awareness, knowledge, attitude and resources. Doctors use non-evidence based sources and access them through new methods such as messaging applications. Further research is recommended to develop and evaluate interventions to overcome the identified barriers.

Project description:IntroductionUncertainty tolerance (UT), a construct explicating individuals' response to perceived uncertainty, is increasingly considered a competency for effective medical practice. Lower UT among physicians is linked with negative outcomes, including less favorable attitudes toward patient-centered care, and increased burnout risk. Despite decades of research, as yet few have engaged methodological approaches aiming to understand the factors that may influence medical students' UT (so-called moderators). Such knowledge, though, could inform teaching practices for fostering learners' skills for managing uncertainties. Accordingly, we asked "What factors do medical students in their clinical years perceive as moderating their perceptions of, and responses to, uncertainty?"MethodsWe conducted a qualitative study with forty-one medical students in clinical years at an Australian medical school, with data collected throughout 2020. Participants described their experiences of uncertainty through both in-semester reflective diary entries (n = 230) and end of semester group or individual semi-structured interviews (n = 40). Data were analyzed using a team-based framework analysis approach.ResultsFour major themes of UT moderators were identified: (1) Individual factors, (2) Sociocultural factors, (3) Academic factors and (4) Reflective learning. Aspects of individual, sociocultural and academic factors were perceived as having either positive or negative influences on students' perceptions of uncertainty. By contrast, reflective learning was described as having a predominantly positive influence on students' perceptions of uncertainty, with students noting learning opportunities and personal growth afforded through uncertain experiences.ConclusionsAs healthcare becomes increasingly complex, a future challenge is equipping our medical students with strategies and skills to manage uncertainties. Our study identified multiple moderators of medical students' UT, key among them being reflective learning. We also identified UT moderators that contemporary and future medical educators may be able to harness in order to develop learner UT as a healthcare graduate attribute, especially through teaching practices such as intellectual candor. Further research is now required to evaluate the impact of proposed educational interventions, and to develop effective assessments of students' skills for managing clinical uncertainties.

Project description:BACKGROUND:Professionalism is amongst the major dimensions determining the competence of medical doctors. Poor professionalism affects the overall outcome of healthcare services. This study explores the perspectives of young medical doctors on professionalism in Pakistan. METHODS:A qualitative study based on in-depth interviews was conducted with 60 young medical doctors, aged less than 40?years, who had studied medicine in Pakistani universities, were Pakistani nationals, and were employed at various hierarchical levels, from house officer to consultant specialist, in public tertiary hospitals in Pakistan. The respondents were identified through a multistage maximum heterogeneity sampling strategy. A semi-structured interview guide was developed based on a previous extensive literature review. Written consent was obtained from the hospitals and study participants. Qualitative thematic analysis was applied to analyse the data. RESULTS:The data analysis revealed that rigidity of opinions, unacceptability of contrasting perspectives, false pride, and perceived superiority over other professions and patients were major components of poor medical professionalism. Most of the young doctors believed that there is no need to include professionalism and humanity course modules in the medical curriculum, because topics related to social sciences are deemed irrelevant to medicine and judged to be common sense. The doctors recognised good professionalism in themselves, while reporting unprofessional behaviour demonstrated by their colleagues and paramedics. Other factors contributing to poor medical professionalism included the use of social media applications during duty hours, ridiculing patients, substance use such as smoking cigarettes in the office, referrals of complicated cases to other hospitals, freeing up beds before holidays, lack of cooperation from paramedical staff, and inadequate role models. CONCLUSIONS:Poor medical professionalism among young doctors needs to be addressed by policymakers. There is a need to revisit the medical curriculum to strengthen professionalism. It is essential to develop the qualities of tolerance, teachability, and acceptance in doctors in order to facilitate interprofessional collaborations and avoid medical errors.