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Specialist training aspirations of junior doctors in Sierra Leone: a qualitative follow-up study.

ABSTRACT: Sierra Leone is pursuing multiple initiatives to establish in-country postgraduate medical education (PGME), as part of national efforts to strengthen the health workforce. This paper explored the career preferences of junior doctors in Sierra Leone; and the potential benefits and challenges with regards to the development of PGME locally.Junior doctors (n?=?15) who had graduated from the only medical school in Sierra Leone were purposively sampled based on maximum variation (e.g. men/women, years of graduation). In-depth interviews were conducted in October 2013, and digital diaries and two follow-up interviews were used to explore their evolving career aspirations until November 2016. Additionally, 16 semi-structured interviews with key informants were held to gather perspectives on the development of PGME locally. Results were thematically analysed.All junior doctors interviewed intended to pursue PGME with the majority wanting primarily a clinical career. Half were interested in also gaining a public health qualification. Major factors influencing career preferences included: prior exposure, practical (anticipated job content), personal considerations (individual interests), financial provision, and contextual (aspirations to help address certain health needs). Majority of doctors considered West Africa but East and South Africa were also location options for clinical PGME. Several preferred to leave the African continent to pursue PGME. Factors influencing decision-making on location were: financial (scholarships), practical (availability of preferred specialty), reputation (positive and negative), and social (children). Key informants viewed the potential benefits of expanding PGME in Sierra Leone as: cost-effectiveness (compared to overseas specialist training), maintaining service delivery during training years, decreasing loss of doctors (some decide not to return after gaining their specialist degree abroad), and enhancing quality control and academic culture of the local medical school. Major perceived challenges were capacity constraints, especially the dearth of specialists required to achieve training programme accreditation.This study has provided an insight into the career preferences of junior doctors in Sierra Leone. It is timely as there is increasing political and professional momentum to expand PGME locally. Findings may guide those involved in this PGME expansion in terms of how possibly to influence junior doctors in their career decision-making.

SUBMITTER: Woodward A

PROVIDER: S-EPMC6094461 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Specialist training aspirations of junior doctors in Sierra Leone: a qualitative follow-up study.

Woodward Aniek A Lake Euphemia Gooding EG Rajaraman Natarajan N Leather Andrew A

BMC medical education 20180815 1

<h4>Background</h4>Sierra Leone is pursuing multiple initiatives to establish in-country postgraduate medical education (PGME), as part of national efforts to strengthen the health workforce. This paper explored the career preferences of junior doctors in Sierra Leone; and the potential benefits and challenges with regards to the development of PGME locally.<h4>Methods</h4>Junior doctors (n = 15) who had graduated from the only medical school in Sierra Leone were purposively sampled based on max ...[more]

PMID: 30111330

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Project description:Strong leadership capabilities are essential for effective health services, yet definitions of leadership remain contested. Despite the acknowledged contextual specificity of leadership styles, most leadership theories draw heavily from Western conceptualizations. This cultural bias may attenuate the effectiveness of programmes intended to transform healthcare practice in Sub-Saharan Africa, where few empirical studies on health leadership have been conducted. This paper examines how effective leadership by doctors was perceived by stakeholders in one particular context, Sierra Leone. Drawing together extensive experience of in-country healthcare provision with a series of in-depth interviews with 27 Sierra Leonean doctors, we extended a grounded-theory approach to come to grips with the reach and relevance of contemporary leadership models in capturing the local experiences and relevance of leadership. We found that participants conceptualized leadership according to established leadership models, such as transformational and relational theories. However, participants also pointed to distinctive challenges attendant to healthcare provision in Sierra Leone that required specific leadership capabilities. Context-specific factors included health system breakdown, politicization in the health sector and lack of accountability, placing importance on skills such as persistence, role modelling and taking initiative. Participants also described pressure to behave in ways they deemed antithetical to their personal and professional values and also necessary in order to continue a career in the public sector. The challenge of navigating such ethical dilemmas was a defining feature of leadership in Sierra Leone. Our research demonstrates that while international leadership models were relevant in this context, there is strong emphasis on contingent or situational leadership theories. We further contribute to policy and practice by informing design of leadership development programmes and the establishment of a more enabling environment for medical leadership by governments and international donors.

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Specialist training aspirations of junior doctors in Sierra Leone: a qualitative follow-up study.

Publications

Specialist training aspirations of junior doctors in Sierra Leone: a qualitative follow-up study.

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