Browse > Article
http://dx.doi.org/10.3961/jpmph.16.062

A Qualitative Inquiry Into the Challenges of Medical Education for Retention of General Practitioners in Rural and Underserved Areas of Iran  

Delavari, Sajad (Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences)
Arab, Mohammad (Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences)
Rashidian, Arash (Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences)
Nedjat, Saharnaz (Department of Epidemiology and Biostatistics, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences)
Souteh, Rahmatollah Gholipour (Department of Public Policy, Faculty of Management, University of Tehran)
Publication Information
Journal of Preventive Medicine and Public Health / v.49, no.6, 2016 , pp. 386-393 More about this Journal
Abstract
Objectives: General practitioners (GPs) retention in rural and underserved areas highly effects on accessibility of healthcare facilities across the country. Education seems to be a critical factor that affects GPs retention. Thus, the present study aimed at inquiry into medical education challenges that limit their retention in rural and underserved areas. Methods: A qualitative approach was applied for the aim of this study. Data were gathered via 28 semi-structured interviews with experts at different levels of Iran's health system as well as GPs who retained and refused to retain working in rural settings. Interviews mainly were performed face-to-face and in some cases via telephone during 2015 and then coded and analyzed using content analysis approach. Results: Iran's medical education is faced with several challenges that were categorized in four main themes including student selection, medical students' perception about their field of study, education setting and approach, curriculum of medical education. According to experts this challenges could results in making GP graduates disinterested for practicing in rural and underserved areas. Conclusions: Challenges that were found could have negative effects on retention. Modification in student's perception about rural practice could be done via changing education setting and approach and curriculum. These modifications could improve GPs retention in rural and underserved areas.
Keywords
Medical education; General practitioners; Rural health;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Xiang YX, Xiong JY, Tian MM, Yuan F, Feng ZC. Factors influencing the utilization of postpartum visits among rural women in China. J Huazhong Univ Sci Technolog Med Sci 2014;34(6): 869-874.   DOI
2 Shen Y, Yan H, Reija K, Li Q, Xiao S, Gao J, et al. Equity in use of maternal health services in Western Rural China: a survey from Shaanxi province. BMC Health Serv Res 2014;14:155.   DOI
3 Ganle JK. Ethnic disparities in utilisation of maternal health care services in Ghana: evidence from the 2007 Ghana Maternal Health Survey. Ethn Health 2016;21(1):85-101.   DOI
4 Ganle JK, Parker M, Fitzpatrick R, Otupiri E. A qualitative study of health system barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition. BMC Pregnancy Childbirth 2014;14:425.   DOI
5 Su D, Pratt W, Salinas J, Wong R, Pagan JA. Rural-urban differences in health services utilization in the US-Mexico border region. J Rural Health 2013;29(2):215-223.   DOI
6 Earle-Richardson G, Scribani M, Scott E, May J, Jenkins P. A comparison of health, health behavior, and access between farm and nonfarm populations in rural New York state. J Rural Health 2015;31(2):157-164.   DOI
7 Kulig JC, Kilpatrick K, Moffitt P, Zimmer L. Recruitment and retention in rural nursing: it's still an issue! Nurs Leadersh (Tor Ont) 2015;28(2):40-50.   DOI
8 Rahman FR, Maharaj V, Yates R, Beeley C, Moore I, Rose A, et al. Addressing the inverse care law: the role of community paediatric services. Perspect Public Health 2014;134(2):85-92.   DOI
9 Moosa S, Wojczewski S, Hoffmann K, Poppe A, Nkomazana O, Peersman W, et al. The inverse primary care law in sub-Saharan Africa: a qualitative study of the views of migrant health workers. Br J Gen Pract 2014;64(623):e321-e328.   DOI
10 McLean G, Guthrie B, Mercer SW, Watt GC. General practice funding underpins the persistence of the inverse care law: cross-sectional study in Scotland. Br J Gen Pract 2015;65(641): e799-e805.   DOI
11 Unwin J, Peters D. Gatekeepers and the Gateway--a mixed-methods inquiry into practitioners' referral behaviour to the Gateway Clinic. Acupunct Med 2009;27(1):21-25.   DOI
12 Takian A, Doshmangir L, Rashidian A. Implementing family physician programme in rural Iran: exploring the role of an existing primary health care network. Fam Pract 2013;30(5): 551-559.   DOI
13 Khayatzadeh-Mahani A, Takian A. Family physician program in Iran: considerations for adapting the policy in urban settings. Arch Iran Med 2014;17(11):776-778.
14 Qing Y, Hu G, Chen Q, Peng H, Li K, Wei J, et al. Factors that influence the choice to work in rural township health centers among 4,669 clinical medical students from five medical universities in Guangxi, China. J Educ Eval Health Prof 2015;12:40.   DOI
15 Kawamoto R, Uemoto A, Ninomiya D, Hasegawa Y, Ohtsuka N, Kusunoki T, et al. Characteristics of Japanese medical students associated with their intention for rural practice. Rural Remote Health 2015;15(2):3112.
16 Landy DC, Gorin MA, Egusquiza JD, Weiss J, O’Connell MT. Medical student attitudes before and after participation in rural health fairs. J Res Med Sci 2012;17(3):298-303.
17 Wurie HR, Samai M, Witter S. Retention of health workers in rural Sierra Leone: findings from life histories. Hum Resour Health 2016;14:3.   DOI
18 Jones MP, Humphreys JS, Nicholson T. Is personality the missing link in understanding recruitment and retention of rural general practitioners? Aust J Rural Health 2012;20(2):74-79.   DOI
19 Walker JH, Dewitt DE, Pallant JF, Cunningham CE. Rural origin plus a rural clinical school placement is a significant predictor of medical students’ intentions to practice rurally: a multi-university study. Rural Remote Health 2012;12:1908.
20 Wasko K, Jenkins J, Meili R. Medical practice in rural Saskatchewan: factors in physician recruitment and retention. Can J Rural Med 2014;19(3):93-98.
21 Sapkota BP, Amatya A. What factors influence the choice of urban or rural location for future practice of Nepalese medical students? A cross-sectional descriptive study. Hum Resour Health 2015;13:84.   DOI
22 Zambrano LI, Pereyra-Elías R, Reyes-García SZ, Fuentes I, Mayta-Tristan P. Influence of parental education on Honduran medical students' labour perspectives: rural work and emigration. Can J Rural Med 2015;20(4):121-128.
23 Laurence CO, Eley DS, Walters L, Elliott T, Cloninger CR. Personality characteristics and attributes of international medical graduates in general practice training: Implications for supporting this valued Australian workforce. Aust J Rural Health 2016;24(5):333-339.   DOI
24 Myroniuk L, Adamiak P, Bajaj S, Myhre DL. Recruitment and retention of physicians in rural Alberta: the spousal perspective. Rural Remote Health 2016;16(1):3620.
25 Stearns JA, Stearns MA. Graduate medical education for rural physicians: curriculum and retention. J Rural Health 2000;16 (3):273-277.   DOI
26 Dossajee H, Obonyo N, Ahmed SM. Career preferences of final year medical students at a medical school in Kenya: a cross sectional study. BMC Med Educ 2016;16:5.   DOI
27 Amiresmaili M, Khosravi S, Feyzabadi VY. Factors affecting leave out of general practitioners from rural family physician program: a case of Kerman, Iran. Int J Prev Med 2014;5(10): 1314-1323.
28 Wood ME, Mansoor GF, Hashemy P, Namey E, Gohar F, Ayoubi SF, et al. Factors influencing the retention of midwives in the public sector in Afghanistan: a qualitative assessment of midwives in eight provinces. Midwifery 2013;29(10):1137-1144.   DOI
29 Kruger E, Tennant M. Short-stay rural and remote placements in dental education, an effective model for rural exposure: a review of eight-year experience in Western Australia. Aust J Rural Health 2010;18(4):148-152.   DOI
30 Eley D, Baker P. Does recruitment lead to retention? Rural clinical school training experiences and subsequent intern choices. Rural Remote Health 2006;6(1):511.
31 Lee J, Walus A, Billing R, Hillier LM. The role of distributed education in recruitment and retention of family physicians. Postgrad Med J 2016;92(1090):436-440.   DOI
32 Boehm J, Cordier R, Thomas Y, Tanner B, Salata K. The first year experience of occupational therapy students at an Australian regional university: promoting student retention and developing a regional and remote workforce. Aust J Rural Health 2015. doi: https://doi.org/10.1111/ajr.12252.   DOI
33 Allen SM, Ballweg RA, Cosgrove EM, Engle KA, Robinson LR, Rosenblatt RA, et al. Challenges and opportunities in building a sustainable rural primary care workforce in alignment with the Affordable Care Act: the WWAMI program as a case study. Acad Med 2013;88(12):1862-1869.   DOI
34 Khosravan S, Karimi Moonaghi H, Yazdani S, Ahmadi S, Mansoorian MR. Leadership and management curriculum planning for Iranian general practitioners. J Adv Med Educ Prof 2015;3(4):159-165.
35 Talib ZM, Baingana RK, Sagay AS, Van Schalkwyk SC, Mehtsun S, Kiguli-Malwadde E. Investing in community-based education to improve the quality, quantity, and retention of physicians in three African countries. Educ Health (Abingdon) 2013; 26(2):109-114.   DOI
36 Hartley S, Macfarlane F, Gantley M, Murray E. Influence on general practitioners of teaching undergraduates: qualitative study of London general practitioner teachers. BMJ 1999;319 (7218):1168-1171.   DOI
37 Sturman N, Rego P, Dick ML. Rewards, costs and challenges: the general practitioner's experience of teaching medical students. Med Educ 2011;45(7):722-730.   DOI
38 Wilkinson D, Birks J, Davies L, Margolis S, Baker P. Preliminary evidence from Queensland that rural clinical schools have a positive impact on rural intern choices. Rural Remote Health 2004;4(4):340.
39 Pagaiya N, Kongkam L, Sriratana S. Rural retention of doctors graduating from the rural medical education project to increase rural doctors in Thailand: a cohort study. Hum Resour Health 2015;13:10.   DOI
40 Winn CS, Chisholm BA, Hummelbrunner JA, Tryssenaar J, Kandler LS. Impact of the Northern Studies Stream and Rehabilitation Studies programs on recruitment and retention to rural and remote practice: 2002-2010. Rural Remote Health 2015; 15(2):3126.