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Introduction: Effective primary healthcare services have been identified by the World Health Organization as the most equitable approach to enhancing universal healthcare. Robust models of mentoring for registered nurses (RNs) transitioning to primary healthcare roles have yet to be described in the Australian context. A robust mentoring model can support RNs to fulfill their potential, bridging the gap between theory and practice. In 2015, the peak body for nurses in primary health care (PHC) began developing a transition to practice program, including embedded mentoring to support newly graduated and more experienced registered and enrolled nurses. This quality improvement study reports the experiences and perspectives of nurses participating as mentors in two separate offerings of the program delivered between 2019 and 2021. Method: A two-phase concurrent mixed methods evaluation utilized data from pre- and post online surveys and post program meetings. Quantitative items underwent descriptive analyses. Thematic analysis of free-text responses and comments was conducted independently by two researchers. Mentors voluntarily provided self-report data and were informed that data is routinely collected to support continuous quality improvement processes for all programs. An Information Sheet informed mentors of data usage, confidentiality, and options to withdraw without penalty from the program at any time. Results: Seventy-nine mentors were recruited to support two groups of nurses (N = 111). Mentor self-rated overall satisfaction with program participation was 86.67% (very or extremely satisfied). Mentors described being "witness to mentee growth," "having facilitated access to learning" and receiving "unexpected benefits" including personal and professional growth and enhanced enthusiasm for their role in PHC. Conclusion: The embedded mentoring reported in this article combined a focus on skills acquisition and professional identity with the provision of a range of resources and support activities. Sustainable mentoring programs will be an important mechanism for supporting the expanding roles required of nurses working in primary health. [ABSTRACT FROM AUTHOR]

Recruitment and retention of medical practitioners to rural practice is an ongoing global issue. Rural longitudinal integrated clerkships (LIC) are an innovative solution to this problem, which are known to increase rural workforce. Crucially this association increases with time on rural placement. This study examines factors that promote retention in a Rural LIC. A two-phased, sequential design qualitative study in a cohort of students enrolled in a rural LIC at Griffith University, Queensland, Australia. Phase I consisted of an open-ended questionnaire and phase II follow-up focus groups from the same cohort. Data was transcribed and analysed using an iterative, six-step thematic analysis process to identify salient themes. Twenty-four students were invited to participate, of which eight respond in phase I and thirteen participated in phase II. Participants described retention being driven by connectivity within three broad themes: current practice, future practice (immediate internship and career intention), and social networks. Participant proposals to increase connectivity were also suggested including peer-led solutions and short rotations in metropolitan hospitals. Connectivity is key to retention on rural longitudinal integrated clerkships. Programs which enhance connectivity with current practice, future practice, and social networks will increase retention on rural medical programs. [ABSTRACT FROM AUTHOR]

Background: Globally, robotic surgery (RS) has witnessed remarkable growth, yet Australia and New Zealand (ANZ) lack dedicated RS training programs, creating a workforce gap. This narrative review synthesises international research to explore trends and challenges in robotic education. Methods: We conducted a comprehensive literature review, searching PubMed, Google Scholar, and MEDLINE using keywords like 'robotic surgery', 'surgical education', 'robotic surgery training', and 'robotic surgery curriculum'. We selected studies contributing to understanding current curricula, training tools, and issues in robotic education, utilising the international experience and how it might apply to the ANZ context. Results: RS in ANZ has grown significantly over two decades, but formal curricula for trainees are absent. North America and Europe employ diverse training tools and curricula. Barriers include cost, access, time constraints, equipment complexity, changing training environments, and competition from emerging robotic surgical systems. Balancing the curriculum's demands with trainees' existing requirements is essential. Conclusion: Developing a tailored RS curriculum within ANZ's surgical training is crucial for RS to become the primary surgical approach in the future. By working towards a national curriculum we can prepare skilled trainees in robotics to meet the rising demand. The most significant barrier is the lack of robotics in public hospital where trainees are based. This curriculum should encompass online teaching modules, bedside assistance, surgical simulation, dual console mentoring, and primary operator experience. [ABSTRACT FROM AUTHOR]

Objective: To determine the distinct influences of rural background and rural residency training on rural practice choice among family physicians. Data Sources and Study Setting: We used a subset of The RTT Collaborative rural residency list and longitudinal data on family physicians from the American Board of Family Medicine National Graduate Survey (NGS; three cohorts, 2016–2018) and American Medical College Application Service (AMCAS). Study Design: We conducted a logistic regression, computing predictive marginals to assess associations of background and residency location with physician practice location 3 years post‐residency. Data Collection/Extraction Methods: We merged NGS data with residency type—rural or urban—and practice location with AMCAS data on rural background. Principal Findings: Family physicians from a rural background were more likely to choose rural practice (39.2%, 95% CI = 35.8, 42.5) than those from an urban background (13.8%, 95% CI = 12.5, 15.0); 50.9% (95% CI = 43.0, 58.8) of trainees in rural residencies chose rural practice, compared with 18.0% (95% CI = 16.8, 19.2) of urban trainees. Conclusions: Increasing rural programs for training residents from both rural and urban backgrounds, as well as recruiting more rural students to medical education, could increase the number of rural family physicians. [ABSTRACT FROM AUTHOR]

Objective: To inform policy supporting the retention of family physicians (FPs) in the perinatal care workforce by identifying physician characteristics that are associated with retention. Data Sources and Study Setting: We surveyed FPs who had been in practice for at least 11 years and reported attending deliveries as part of their practice. Study Design: We compared the characteristics of FPs who continue to provide perinatal care to those who have ceased and explored their reasons for no longer attending deliveries. Data Collection/Extraction Methods: We estimated a probit regression with the dependent variable: whether the physician currently delivers babies. Open‐ended survey responses were analyzed and close‐coded using a conceptual content analysis approach. Principle Findings: Of the FPs who received a survey, 1505 (37%) responded. Those who continue attending deliveries were more likely to receive a stipend or be paid per hour/shift in addition to their salary versus those paid a salary (percentage point difference = 13), and less likely to work part‐time versus full‐time (percentage point difference = −20). Those who ceased attending deliveries cite lifestyle (n = 208), call structure (n = 113), and delivery volume (n = 89) among the reasons for doing so. Conclusions: Evidence‐based policies aimed at preventing attrition from the perinatal care workforce, which might include targeting compensation models and work–life balance. [ABSTRACT FROM AUTHOR]

To scope and synthesise literature around the job satisfaction of early career midwives – those in their first five years of post-qualification practice – including the effect on their career aspirations and intention to leave the profession. Scoping review. Relevant databases were searched for published research studies and grey literature. Literature were selected through adherence to pre-set inclusion and exclusion criteria to ensure relevance. Literature was included that was published from 2012. Selected literature were tabled and common themes were mapped to look for similarities and differences in findings. Ten papers were included – seven original research studies, a fact sheet, a non peer-reviewed article, and a conference paper. Negative themes – lack of support, workload stress, and job dissatisfaction, and positive themes – passion for midwifery, collegial relationships, and autonomy – were found across many of the included papers. Many midwives are considering leaving their profession due to the stress of their work, role dissatisfaction, and a lack of support. This is more common amongst early career midwives. There were some protective factors such as having pride in the midwifery profession. More research is needed to identify and address the needs specific to early career midwives. [ABSTRACT FROM AUTHOR]

The Indian Health Service (IHS) faces severe workforce shortages due to underfunding and underdevelopment of clinical training programs. Unlike other direct federal health care systems that have implemented clinical training paradigms as central parts of their success, the IHS has no formalized process for developing such programs internally or in partnership with academic institutions. While the Indian Health Care Improvement Act (IHCIA) authorizes mechanisms by which the IHS can support overall workforce development, a critical portion of the act (U.S. Code 1616p) intended for developing clinical training programs within the agency remains unfunded. Here, we review the funding challenges of the IHCIA, as well as its authorized and funded workforce development programs that have only partially addressed workforce shortages. We propose that through additional funding to 1616p, the IHS could implement clinical training programs needed to prepare a larger workforce more capable of meeting the needs of American Indian/Alaska Native communities. [ABSTRACT FROM AUTHOR]

Context: There is growing evidence supporting a shift towards 'grow your own' approaches to recruiting, training and retaining health professionals from and for rural communities. To achieve this, there is a need for sound methodologies by which universities can describe their area of geographic focus in a precise way that can be utilised to recruit students from their region and evaluate workforce outcomes for partner communities. In Australia, Deakin University operates a Rural Health Multidisciplinary Training (RHMT) program funded Rural Clinical School and University Department of Rural Health, with the purpose of producing a graduate health workforce through the provision of rural clinical placements in western and south-western Victoria. The desire to establish a dedicated Rural Training Stream within Deakin's Doctor of Medicine course acted as a catalyst for us to describe our 'rural footprint' in a way that could be used to prioritise local student recruitment as well as evaluate graduate workforce outcomes specifically for this region. Issue: In Australia, selection of rural students has relied on the Australian Statistical Geography Standard Remoteness Areas (ASGS-RA) or Modified Monash Model (MMM) to assign rural background status to medical course applicants, based on a standard definition provided by the RHMT program. Applicants meeting rural background criteria may be preferentially admitted to any medical school according to admission quotas or dedicated rural streams across the country. Until recently, evaluations of graduate workforce outcomes have also used these rurality classifications, but often without reference to particular geographic areas. Growing international evidence supports the importance of place-based connection and training, with medical graduates more likely to work in a region that they are from or in which they have trained. For universities to align rural student recruitment more strategically with training in specific geographic areas, there is a need to develop precise geographical definitions of areas of rural focus that can be applied during admissions processes. Lessons learned: As we strived to describe our rural activity area precisely, we modelled the application of several geographical and other frameworks, including the MMM, ASGS-RA, Primary Healthcare Networks (PHN), Local Government Areas (LGAs), postcodes and Statistical Areas. It became evident that there was no single geographical or rural framework that (1) accurately described our area of activity, (2) accurately described our desired workforce focus, (3) was practical to apply during the admissions process. We ultimately settled on a bespoke approach using a combination of the PHN and MMM to achieve the specificity required. This report provides an example of how a rural activity footprint can be accurately described and successfully employed to prioritise students from a geographical area for course admission. Lessons learned about the strengths and limitations of available geographical measures are shared. Applications of a precise footprint definition are described including student recruitment, evaluation of workforce outcomes for a geographic region, benefits to stakeholder relationships and an opportunity for more nuanced RHMT reporting.

There are well-documented shortages of healthcare providers in rural and remote communities worldwide, and these shortages correlate with inequitable health outcomes for rural peoples. Despite a wide array of efforts to remedy the issue, these shortages persist to this day. The Healthcare Traveling Roadshow (HCTRS) is a grassroots initiative that began in 2010 to help address the shortage of healthcare providers in rural communities throughout British Columbia. Since its inception, the HCTRS has been predicated on three evidence-based guiding principles which have been shown to markedly increase the rate at which healthcare students choose to practice rurally. These principles are: (1) to showcase healthcare careers as viable and realistic options for rural youth (high school students) using interactive stations and near-peer teaching; (2) to expose healthcare students to rural communities and showcase them as a potential opportunity for their future practice; and (3) to provide a unique interprofessional experience to healthcare students from diverse healthcare careers and backgrounds. Through the synergy of these three principles the HCTRS aims to increase the longitudinal recruitment and retention of healthcare workers in underserved rural communities. This paper will share our experience from 15 years of running this initiative, for those hoping to implement similar programs in other areas of the world.

Abstract Introduction The rapid development of artificial intelligence (AI) in healthcare has exposed the unmet need for growing a multidisciplinary workforce that can collaborate effectively in the learning health systems. Maximizing the synergy among multiple teams is critical for Collaborative AI in Healthcare. Methods We have developed a series of data, tools, and educational resources for cultivating the next generation of multidisciplinary workforce for Collaborative AI in Healthcare. We built bulk‐natural language processing pipelines to extract structured information from clinical notes and stored them in common data models. We developed multimodal AI/machine learning (ML) tools and tutorials to enrich the toolbox of the multidisciplinary workforce to analyze multimodal healthcare data. We have created a fertile ground to cross‐pollinate clinicians and AI scientists and train the next generation of AI health workforce to collaborate effectively. Results Our work has democratized access to unstructured health information, AI/ML tools and resources for healthcare, and collaborative education resources. From 2017 to 2022, this has enabled studies in multiple clinical specialties resulting in 68 peer‐reviewed publications. In 2022, our cross‐discipline efforts converged and institutionalized into the Center for Collaborative AI in Healthcare. Conclusions Our Collaborative AI in Healthcare initiatives has created valuable educational and practical resources. They have enabled more clinicians, scientists, and hospital administrators to successfully apply AI methods in their daily research and practice, develop closer collaborations, and advanced the institution‐level learning health system.

Abstract Visual impairment and blindness pose a significant and growing public health threat in Nigeria. Over 1.6 million Nigerians are visually impaired or blind, with more than 80% of these cases being preventable and treatable. The risk for ocular morbidities is expected to increase due to rapid population growth, an aging population, and the rising burden of noncommunicable diseases. Despite efforts to improve eye health services, universal eye health remains elusive, with 35% of Nigerians unable to access eye care in primary healthcare (PHC) facilities. Many Nigerians instead turn to traditional and alternative medicine for primary eye care (PEC), which can worsen their outcomes. This article highlights the potential of the country's PHC system to address these challenges, emphasizing the importance of PEC as an integral part of PHC. The article discusses the various challenges faced by PHC workers in delivering eye care services in Nigeria, focusing on financing, training, leadership, and policies for eye care. It also provides a set of comprehensive recommendations aimed at overcoming these challenges, including improved leadership and policy implementation, optimized financing, strengthened collaborations and partnerships, enhanced education and training, and effective human resource management systems. We emphasize the importance of holistic and strategic efforts to bolster the PHC workforce's capacity to provide universal eye healthcare in Nigeria, ultimately improving access to high‐quality eye care services for all.

The rapidly expanding older population across Low- and Middle-Income Countries (LMICs) underscores the urgent need to strengthen the health systems. However, the extent of service coverage and healthcare workforce allocation strategies for geriatric and palliative care in LMICs remains inadequately explored. To address this, we conducted this systematic review, following the standard guidelines, to synthesize available data from four databases spanning 2011 to 2022. Utilizing the Risk of Bias Assessment tool for non-randomized studies (ROBANS) for quantitative studies and the JBI (formerly known as Joanna Briggs Institute) checklist for qualitative research, we assessed the risk of bias and the quality in the included studies. Despite a comprehensive search, only three eligible studies were found, revealing a scarcity of research. The identified challenges include deficiencies in leadership, governance, financing, and essential resources, leading to compromised service coverage. The health workforce, often limited and lacking inadequate training, exacerbates the situation. Our evidence synthesis proposes some potential solutions such as telemedicine and cross-country collaboration through distance learning mechanisms to address these issues. The findings and recommendations from this review offer valuable insights applicable across various healthcare service contexts within LMICs and advocate for more health systems research in this topic area.

Introduction: The purpose of this study was to understand what literature exists to comprehend demographics and predicted trends of rural allied health professionals (AHPs), person factors of rural AHPs, and recruitment and retention of rural AHPs. Methods: A scoping review was completed and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Articles were analyzed using three a priori categories of recruitment and retention, person factors, and demographics and trends. Results: Eighty articles met inclusion criteria for the review. Most of the literature came from Australia. Most research studies were qualitative or descriptive. A priori coding of the articles revealed overlap of the a priori codes across articles; however, the majority of articles related to recruitment and retention followed by demographics and trends and person factors. Recruitment and retention articles focused on strategies prior to education, during education, and recruitment and retention, with the highest number of articles focused on retention. Overall, there were no specific best strategies. Demographic data most commonly gathered were age, practice location, profession, sex, gender, previous rural placement and number of years in practice. While person factors were not as commonly written about, psychosocial factors of rural AHPs were most commonly discussed, including desire to care for others, appreciation of feeling needed, connectedness to team and community and enjoyment of the rural lifestyle. Conclusion: The evidence available provides an understanding of what research exists to understand recruitment and retention of AHPs from a recruitment and retention approach, person factor approach, and demographics and trends approach. Based on this scoping review, there is not a clear road map for predicting or maintaining AHPs in a rural workforce. Further research is needed to support increased recruitment and retention of AHPs in rural areas.

Abstract Background General practice in the UK is under substantial pressure and practices are increasingly including paramedics as part of their workforce. Little is known about how different models of paramedic working may affect successful implementation of the role, as viewed from patient, clinician and system perspectives. This realist synthesis developed theories about ‘models of paramedic working in general practice’ in different UK contexts to understand their impact. Methods The rapid realist synthesis comprised data from: (1) empirical and grey literature searches; (2) semi-structured realist interviews with system leaders involved with the implementation of the role; and (3) a stakeholder event with healthcare professionals and the public, to develop initial programme theories that can be tested in future work. Sources were analysed using a realist approach that explored the data for novel or causal insights to generate initial programme theories. Results Empirical sources (n = 32), grey sources (n = 95), transcripts from system leader interviews (n = 7) and audio summaries from the stakeholder event (n = 22 participants) were synthesised into a single narrative document. The findings confirmed the presence of a wide variety of models of paramedic working in UK general practice. The perceived success of models was influenced by the extent to which the paramedic service was mature and embedded in practice, and according to four theory areas: (1) Primary care staff understanding and acceptance of the paramedic role; (2) Paramedic induction process, including access to training, supervision and development opportunities; (3) Patient understanding and acceptance of the role; (4) Variations in paramedic employment models. Conclusions Variability in how the paramedic role is operating and embedding into general practice across the UK affects the success of the role. These findings provide a theoretical foundation for future research to investigate various ‘models of paramedic working’ in different contexts.

The World Health Organization (WHO) recommends the requirement of human resource for health (HRH) stands at 44.5 skilled health workers per 10,000 population. WHO recognizes India as one of the countries which has HRH crisis. Karnataka, a southern state in India, has the highest number of medical colleges yet faces the shortage of specialists in the public hospitals. We conducted desk review to understand the HRH crisis, particularly the medical specialists in India. Simultaneously, we conducted secondary research to explore the initiatives taken by the Government of Karnataka (GoK) to mitigate the shortage of medical specialists in the rural areas. GoK scaled up the National Board of Examination in Medical Sciences (NBEMS) postgraduate and super-speciality courses such as Diplomate of National Board (DNB), Diploma, and Doctorate of National Board (DrNB) in district hospitals (minimum 250–500 bedded) and taluk hospitals (minimum 100 bedded) by utilizing the existing resources. Karnataka is the first state in India to expand the NBEMS (DNB and Diploma) courses in taluk hospitals and to begin DrNB courses in district hospitals. The paper documents the process of implementation of the NBEMS courses at district and taluk hospitals of Karnataka, which has supported in strengthening these hospitals in the state.

Background Medical deserts are considered a problematic issue for many Western countries which try to employ multitude of policies and initiatives to achieve a better distribution of their health workforce (HWF). The aim of this study was to systematically map research and provide an overview of definitions, characteristics, contributing factors and approaches to mitigate medical deserts within the European Union (EU)-funded project “ROUTE-HWF” (a Roadmap OUT of mEdical deserts into supportive Health WorkForce initiatives and policies).Methods We performed a scoping review to identify knowledge clusters/research gaps in the field of medical deserts focusing on HWF issues. Six databases were searched till June 2021. Studies reporting primary research from Western countries on definitions, characteristics, contributing factors, and approaches were included. Two independent reviewers assessed studies for eligibility, extracted data and clustered studies according to the four defined outcomes.Results Two-hundred and forty studies were included (n = 116, 48% Australia/New Zealand; n = 105, 44% North America; n = 20, 8% Europe). All used observational designs except for five quasi-experimental studies. Studies provided definitions (n = 171, 71%), characteristics (n = 95, 40%), contributing factors (n = 112, 47%), and approaches to mitigate medical deserts (n = 87, 36%). Most medical deserts were defined by the density of the population in an area. Contributing factors to HWF issues in medical deserts consisted in work-related (n = 55, 23%) and lifestyle-related factors (n = 33, 14%) of the HWF as well as sociodemographic characteristics (n = 79, 33%). Approaches to mitigate them focused on training adapted to the scope of rural practice (n = 67, 28%), HWF distribution (n = 3, 1%), support/infrastructure (n = 8, 3%) and innovative models of care (n = 7, 3%).Conclusion Our study provides the first scoping review that presents and categorizes definitions, characteristics, contributing factors, and approaches to mitigate HWF issues in medical deserts. We identified gaps such as the scarcity of longitudinal studies to investigate the impact of factors contributing to medical deserts, and interventional studies to evaluate the effectiveness of approaches to mitigate HWF issues.

Background Conflict has devastating effects on health systems, especially on healthcare workers (HCWs) working in under-resourced and hostile environments. However, little evidence is available on how policy-makers, often together with development partners, can optimize the organization of the health workforce and support HCWs to deliver accessible and trustworthy health services in conflict-affected settings (CAS).Methods A scoping review was conducted to review recent evidence (2016-2022) on human resources for health (HRH) in CAS, and critically discuss HRH challenges in these settings. Thirty-six studies were included in the review and results were presented using an adapted version of the health labour market (HLM) framework.Results Evidence from CAS highlights that conflict causes specific constraints in both the education sector and in the HLM, and deepens any existing disconnect between those sectors. Parallel and inadequate education and performance management systems, attacks on health facilities, and increased workload and stress, amongst other factors, affect HCW motivation, performance, distribution, and attrition. Short-term, narrowly focused policy-making undermines the long-term sustainability and resilience of the health workforce in CAS, and also contributes to the limited and narrow available research base.Conclusion While HRH and workforce issues in CAS include those found in many other low- and middle-income countries (LMICs), an additional set of challenges for HCWs, governance dynamics and institutional constraints in CAS ‘multiply’ negative effects on the health workforce. HRH policies, programmes and interventions must be aligned with the political and broader societal context, including the stage, severity and other dynamics of conflict. During conflict, it is important to try to monitor in- and outflow of HCWs and provide HCWs the support they need at local level or through remote measures. The post-conflict situation may present opportunities for improvement in HRH, but a clear understanding of political economy dynamics is required to better act on any such a window of opportunity.

Background This descriptive study reports the early career outcomes of postdoctoral fellows who completed a novel embedded fellowship training program, the Canadian Institutes of Health Research (CIHR) Health System Impact (HSI) Fellowship. The program was designed to support impact-oriented career paths of doctoral graduates, build research capacity within health system organizations (HSOs), and help to advance learning health systems (LHSs) in Canada.Methods Employment of fellowship alumni upon completion of the program was tracked using internet searches of publicly accessible online sources and complemented with program survey data.Results Descriptive analyses show that all 87 eligible alumni included in the study are currently employed (100% of 87), with 92% employed in Canada. Their employment spans several sectors, including in academic (37%), public (29%), healthcare delivery (17%), and private (14%) sectors. Altogether, 32% of alumni hold hybrid roles with an affiliation in academia and another sector. The most common position types are senior scientist (42%), professorships (18%), and director, manager or administrator roles (12%). Program reporting data indicate that these employment outcomes are generally consistent with the group’s career aspirations reported at the start of the fellowship program, and that the program receives high ratings from fellows in the extent it is believed to support their career preparedness and readiness (4.49 out of 5).Conclusion This study finds that HSI Fellow alumni are employed mostly in research-related roles in a range of sectors including, but not limited to, academia, and that they positively perceive the program’s success in elevating their career readiness and potential to make an impact – suggesting that the program may help equip fellows with the skills, readiness and networks for contribution in a broad array of employment sectors and roles. The findings are a promising signal of the demand for research talent and the growing capacity for LHSs in Canada.

Background Nurse practitioners (NPs)—nurses with advanced training who can provide and prescribe care—are increasingly prevalent internationally. The growth of NPs can be attributed to physician shortages, growing demand for health services, and the professionalization of nursing. Ensuring efficacious integration of NPs into the health system is critical for maximizing their impact on patient and system outcomes. Nonetheless, there is a dearth of information on practical policy interventions facilitating the successful integration of NPs. Effective policy interventions should capture the perspectives of actors at all levels of the health system—ie, national and organizational levels. This study aimed to delineate a taxonomy of policy interventions for integrating NPs into health systems. This paper presents a taxonomy developed among gerontology NPs in Israel. Methods This qualitative descriptive study used multiple perspective, one-to-one interviews with four professional groups—national policy-makers, organizational administrators, NPs, and physicians. Data were analyzed using deductive content analysis. Analysis accounted for diverging and converging patterns between professional groups. Results: There were 58 participants across the four professional groups. The national-level domain interventions include marketing, workforce development, professional licensure and regulation, financial incentives, stakeholder cooperation, education and training programs, and national-level research. Organizational domain interventions included organizational guidelines, infrastructure development and resource allocation, interprofessional leadership engagement, and organizational messaging. Unit- and care-team domain interventions included interprofessional experience and exposure, team communication, and mentorship. Conclusion The taxonomy’s trichotomy of three health system level domains describes the relationship between national and organizational policy interventions. Adopting these interventions may result in an improved response to provider shortages. Policies insufficiently addressing role clarity and workforce retention resulted in poor integration and a failure to efficaciously combat workforce shortages. Future work will expand the focus of this preliminary taxonomy by further development and testing with international participants.

Abstract Background This review paper offers a policy-tracing trend analysis of national experiences among low- and middle-income countries in strengthening human resources for health information systems (HRHIS). This paper draws on evidence from the last two decades and applies a modified Bardach’s policy analysis framework. A timely review of the evidence on HRHIS and underlying data systems is needed now more than ever, given the halfway mark of the Global Strategy on Human Resources for Health: Workforce 2030 and the protracted COVID-19 pandemic and other global health emergencies, over and above the increasing need for health and care workers to provide essential health services. Main text Considering World Health Assembly resolutions and HRH-related global developments between 2000 and 2022, we targeted peer-reviewed and gray literature covering the inception, impact, bottlenecks, and gaps of HRHIS. We also considered results from a Bill and Melinda Gates Foundation-funded project that assessed HRH data systems in 21 countries and the use of HRH data and information for policy, planning, and management. Aligned with the National Health Workforce Accounts (NHWA), we identify priority themes related to digital priorities for HRHIS and governance/leadership and present case studies of five countries that pursued different pathways to successfully develop their HRHIS. Summary conclusion Over the last two decades, considerable progress has been achieved through a scaled-up implementation of HRHIS combined with the skills needed to analyze and use data, sustain systems functionality, and make systematic improvements over time. Global health development aid investments and technical innovations have led to advancements in HRHIS, district health information software (DHIS2), and partner collaborations during the HIV/AIDS, Ebola, and COVID-19 crises. Although the progressive implementation of NHWA continues to steer country-level efforts through standardized indicators and regular reporting, traditional challenges remain, such as data systems fragmentation, lack of interoperability between systems, and underutilization of reported data. Encouragingly, some countries demonstrate strong governance and leadership capacities and others strong HRHIS digital capacities. Both HRH and health service data are needed to inform on-demand decisions during times of emergencies and pandemics as well as during routine essential health services delivery. Evidence-based examples from distinctive countries demonstrate that reliable HRHIS is achievable for better planning and management of the health and care workforce.

Abstract Background Despite the implementation of various government policies to retain Thai dentists in public sector, a high turnover rate among early career dentists has persisted for decades. This study aims to explore factors relating to early career dentists’ choice of the public sector as their preferred workplace and decisions relating to staying, resigning, or relocating from the workplace after one-year employment. Methods A one-year cross-sectional survey was conducted among Thai early career dentists who began working in 2020 using two sets of online questionnaires. The first survey assessed factors influencing dentists’ decision to choose the public sector as their preferred workplace at the beginning of the year. The second survey investigated factors influencing dentists’ decision to stay, resign, or relocate from the same workplace at one-year after employment. Descriptive statistics and multivariable binary logistic regression were used for data analysis. Results A total of 198 early career dentists completed the online survey questionnaire at the starting point (December 2020–January 2021), and 186 dentists completed the one-year employment questionnaire. The living environment and provided amenities and facilities were the most influential factors in their decision to choose and remain in the public sector. Conversely, their attitude toward unrelated job descriptions and an increased opportunity to pursue postgraduate studies were the most relevant factors when deciding to relocate to a new workplace. Factors such as delayed authority in bureaucracy, hometown location, and being in relationship status were the most significant contributors to resignation from the public sector. Conclusions The major factors influencing dentists’ choice and retention in the public sector include the living environment, supportive supervisors and colleagues, and the availability of opportunities for further postgraduate education. Meanwhile, factors impacting retention after one year of work are related to hometown location and the bureaucracy system. Collaborations among ministries, tailored to each local community’s specific requirements, may enhance dentists’ retention in public sectors.

Abstract Background A 15 million health workforce shortage is still experienced globally leading to a sub-optimal healthcare worker-to-population ratio in most countries. The use of low-skilled care assistants has been suggested as a cost-saving human resource for health strategy that can significantly reduce the risks of rationed, delayed, or missed care. However, the characterisation, role assignment, regulation, and clinical governance mechanisms for unlicensed assistive workforce remain unclear or inconsistent. The purpose of this study was to map and collate evidence of how care assistants are labelled, utilised, regulated, and managed in formal hospital settings as well as their impact on patient care. Methods We conducted a scoping review of literature from PUBMED, CINAHL, PsychINFO, EMBASE, Web of Science, Scopus, and Google Scholar. Searches and eligibility screening were conducted using the Participants–Context–Concepts framework. Thematic content analysis guided the synthesis of the findings. Results 73 records from a total of 15 countries were included in the final full-text review and synthesis. A majority (78%) of these sources were from high-income countries. Many titles are used to describe care assistants, and these vary within and across countries. On ascribed roles, care assistants perform direct patient care, housekeeping, clerical and documentation, portering, patient flow management, ordering of laboratory tests, emergency response and first aid duties. Additional extended roles that require higher competency levels exist in the United States, Australia, and Canada. There is a mixture of both positive and negative sentiments on their impact on patient care or nurses’ perception and experiences. Clinical and organisational governance mechanisms vary substantially across the 15 countries. Licensure, regulatory mechanisms, and task-shifting policies are largely absent or not reported in these countries. Conclusions The nomenclature used to describe care assistants and the tasks they perform vary substantially within countries and across healthcare systems. There is, therefore, a need to review and update the international and national classification of occupations for clarity and more meaningful nomenclature for care assistants. In addition, the association between care assistants and care outcomes or nurses’ experience remains unclear. Furthermore, there is a dearth of empirical evidence on this topic from low- and middle-income countries.

Stressors from everyday life, along with those from work and academic environment, may compromise the mental health and well-being of allied health professionals. With this study, we tried to estimate the prevalence and factors associated with burnout and depression among students of Bachelor of Physical Therapy and Occupational Therapy in Delhi NCR region. This cross-sectional study was carried out among 197 students pursuing a Bachelor of Physiotherapy (BPT) and Occupational Therapy (BOT) in Delhi, NCR region. Data collection was online, using Oldenburg Burnout Inventory (OLBI) and Patient Health Questionnaire (PHQ-9) to assess burnout and depression, respectively, along with basic socio-demographic information. Data analysis was carried out on Stata 15.1. Prevalence was estimated, and factors associated with Burnout and depression were explored using Linear and logistic regression models, respectively. Among 197 participants, the majority were females and the mean age was 22 years. The prevalence of burnout and depression was 79.7% (95% CI: 73.4, 84.7) and 66.5% (95% CI: 59.6, 72.7), respectively. Some factors, like experiencing symptoms of physical exhaustion and satisfaction with academic support from faculty at college, were associated with both burnout and depression separately. The prevalence of burnout and depression among BPT/BOT students in Delhi, NCR, was alarming yet comparable to other health professionals in India and globally. The study provides a narrative of these issues along with associated factors identified among the study population. A need for a longitudinal study to establish a causal association of factors with burnout and depression among this study population is iterated.

Abstract Objectives Comparison of national midwife workforce data from the National Provider Identifier file determined it undercounted midwives compared to national data available from the American Midwifery Certification Board. This undercount may be due to the existence of three taxonomy categories for midwives when registering for the National Provider Identifier. The objective of this study was to obtain an accurate count of advanced practice midwives using the National Provider Identifier Data. Methods A recode strategy was created using the NPPES Data Dissemination File for November 7, 2021. The strategy identified advanced practice midwives using education and certification information provided in the “credentials” field. The strategy was validated using the NPPES Data Dissemination File for August 7, 2022 and the gold standard was the American Midwifery Certification Board count of midwives by state for August, 2022. Validation compared the accuracy and precision of the recode to the accuracy and precision of using the advanced practice midwife taxonomy category. Results The recode strategy improved the accuracy and precision of the count of advanced practice midwives compared to the identification of advanced practice midwives using the advanced practice midwife taxonomy category. Conclusions for practice Recoding the NPPES Data Dissemination File provides a more accurate and precise count of advanced practice midwives than relying on the existing advanced practice midwife taxonomy classification. Researchers can use the NPPES Data Dissemination File when studying the midwifery workforce.

Background: This study provides an update to a landmark 2004 report describing demographics, training, and trends in adherence to thoracic surgery practice standards in Canada. Methods: An updated questionnaire was administered to all members of the Canadian Association of Thoracic Surgeons via email (n=142, compared to n=68 in 2004). Our report incorporates internal data from Ontario Health and the Canadian Partnership Against Cancer. Results: Forty-eight surgeons completed the survey (male, 70.8%; mean±standard deviation age, 50.3±9.3 years). This represents a 33.8% response rate, compared to 64.7% in 2004. Most surgeons (69%) served a patient population of over 1 million per center; 32%–34% reported an on-call ratio of 1:4–1:5 days, and the average weekly hours worked was 56.4±11.9. Greater access to dedicated geographic units per center (73% in 2021 vs. 53% in 2004) has improved thoracic-associated services and house staff, notably endoscopy units (100% vs. 91%), with 73% of respondents having access to both endobronchial and endoscopic ultrasound. Access to thoracic radiology has also improved, particularly regarding positron emission tomography scanners per center (76.9% vs. 13%). Annual case volumes for lung (255 vs. 128), esophageal (41 vs. 19), and mediastinal resections (30 vs. 13), along with hiatal hernia repair (45 vs. 20), have increased substantially despite reports of operating room availability and radiology as rate-limiting steps. Conclusion: This survey characterizes compliance with current practice standards, addressing the needs of thoracic surgeons across Canada. Over 85% of respondents were aware of the 2004 compliance paper, and 35% had applied for resources and equipment in response.

ObjectivesTo understand the facilitators and barriers to hospice staff engagement of patients and surrogates in advance care planning (ACP) conversations.DesignQualitative study conducted with purposive sampling and semistructured interviews using ATLAS.ti software to assist with template analysis.Settings and participantsParticipants included 51 hospice professionals (31 clinicians, 13 leaders, and 7 quality improvement administrators) from 4 geographically distinct nonprofit US hospices serving more than 2700 people.MeasuresInterview domains were derived from the implementation science framework of Capability, Opportunity, Motivation, and Behavior (COM-B), with additional questions soliciting recommendations for behavior change. Differences in themes were reconciled by consensus. The facilitator, barrier, and recommendation themes were organized within the COM-B framework.ResultsCapability was facilitated by interdisciplinary teamwork and specified clinical staff roles and inhibited by lack of self-perceived skill in engaging in ACP conversations. Opportunities for ACP occurred during admission to hospice, acute changes, or deterioration in patient condition. Opportunity-related environmental barriers included time constraints such as short patient stay in hospice and workload expectations that prevented clinicians from spending more time with patients and families. Motivation to discuss ACP was facilitated by the employee's goal of providing personalized, patient-centered care. Implicit assumptions about patients' and families' preferences reduced staff's motivation to engage in ACP. Hospice staff made recommendations to improve ACP discussions, including training and modeling practice sessions, earlier introduction of ACP concepts by clinicians in prehospice settings, and increasing workforce diversity to reflect the patient populations the organizations want to reach and cultural competency.Conclusions and implicationsEven hospice staff can be uncomfortable discussing death and dying. Yet staff were able to identify what worked well. Solutions to increase behavior of ACP engagement included staff training and modeling practice sessions, introducing ACP prior to hospice, and increasing workforce diversity to improve cultural competency.

Background: General practice in the UK is under substantial pressure and practices are increasingly including paramedics as part of their workforce. Little is known about how different models of paramedic working may affect successful implementation of the role, as viewed from patient, clinician and system perspectives. This realist synthesis developed theories about 'models of paramedic working in general practice' in different UK contexts to understand their impact. Methods: The rapid realist synthesis comprised data from: (1) empirical and grey literature searches; (2) semi-structured realist interviews with system leaders involved with the implementation of the role; and (3) a stakeholder event with healthcare professionals and the public, to develop initial programme theories that can be tested in future work. Sources were analysed using a realist approach that explored the data for novel or causal insights to generate initial programme theories. Results: Empirical sources (n = 32), grey sources (n = 95), transcripts from system leader interviews (n = 7) and audio summaries from the stakeholder event (n = 22 participants) were synthesised into a single narrative document. The findings confirmed the presence of a wide variety of models of paramedic working in UK general practice. The perceived success of models was influenced by the extent to which the paramedic service was mature and embedded in practice, and according to four theory areas: (1) Primary care staff understanding and acceptance of the paramedic role; (2) Paramedic induction process, including access to training, supervision and development opportunities; (3) Patient understanding and acceptance of the role; (4) Variations in paramedic employment models. Conclusions: Variability in how the paramedic role is operating and embedding into general practice across the UK affects the success of the role. These findings provide a theoretical foundation for future research to investigate various 'models of paramedic working' in different contexts. [ABSTRACT FROM AUTHOR]

Background: Prosthetists and orthotists (POs) are the smallest of the 14 allied health profession (AHP) workforces within NHS England. Obtaining data on the workforce has always been challenging due to this information being held across different organisations. An understanding of the prosthetic and orthotic (P&O) workforce is essential to ensure that it is adequately equipped to meet the evolving needs of users of P&O services. The study aims to estimate the size and composition, for the first time, of the UK P&O workforce and P&O service provision. Methods: To gather the required information, two surveys (one for the UK P&O workforce and one for UK P&O private company) and two freedom of information (FOI) requests [one for all NHS Trusts and Health Boards (HB) in the UK and one for the higher education institutes in the UK offering programmes leading to registration as a PO were developed and distributed from September to December 2022. Results: The P&O workforce survey received a 74% response rate (863 POs) and 25 private companies reported employing one or more P&O staffing groups. From the FOI requests, 181 of a potential 194 Trusts/Health Boards and all four higher education institutions responded. The study indicated a total of 1766 people in the UK P&O workforce, with orthotists and orthotic technicians representing the largest percentage of the workforce at 32% and 30%, respectively. A greater percentage of prosthetists (65%) and orthotists (57%) were employed by private companies compared to the NHS. Only 34% of POs stated that they "definitely" planned to remain in the workforce for the next 5 years. The current UK PO employment levels are 142 to 477 short of the World Health Organisation's (WHO) recommendation. Conclusions: The low job satisfaction amongst many POs and the projected increase in the number of people who will require prosthetic and/or orthotic care in the UK are challenges for future UK P&O services. Strategies are required to create a sustainable and resilient workforce that can meet the needs of a changing healthcare landscape. [ABSTRACT FROM AUTHOR]

This paper aims to provide knowledge on medical trainees' considerations about specialisation as they move from undergraduate to postgraduate medical education; especially their interest in general practice compared to other specialities. We developed and content-validated a questionnaire to examine medical trainees' speciality considerations and conducted a descriptive, cross-sectional study. All medical trainees initiating their internship in Denmark in 2022 (N = 1,188) were invited to participate in the study. Medical specialities were categorised as hospital service specialities, internal medicine specialities, primary care, psychiatry specialities and surgery and emergency specialities. Descriptive statistics were used to describe the cohort and examine the participants' speciality considerations by assigning them to one of the following three orientations: committed, undecided or non-committed to a speciality. The response rate was 38.8% (n = 461), and participants' mean age was 27.4 years with a majority of females (68.1%). Nearly 25% of the participants had general practice as speciality preference, and only 13.9% had excluded general practice for future specialisation. Overall, around half of the participants had general practice as a first, second or third preference for specialisation. Danish medical trainees show considerable interest in general practice at the time of their transition from undergraduate to postgraduate education. However, to meet future demands on the primary care, further recruitment of general practitioners is still needed. This knowledge of the specialities' recruitment potential will likely be of interest to medical educators and healthcare planners alike. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) recommends the requirement of human resource for health (HRH) stands at 44.5 skilled health workers per 10,000 population. WHO recognizes India as one of the countries which has HRH crisis. Karnataka, a southern state in India, has the highest number of medical colleges yet faces the shortage of specialists in the public hospitals. We conducted desk review to understand the HRH crisis, particularly the medical specialists in India. Simultaneously, we conducted secondary research to explore the initiatives taken by the Government of Karnataka (GoK) to mitigate the shortage of medical specialists in the rural areas. GoK scaled up the National Board of Examination in Medical Sciences (NBEMS) postgraduate and super-speciality courses such as Diplomate of National Board (DNB), Diploma, and Doctorate of National Board (DrNB) in district hospitals (minimum 250--500 bedded) and taluk hospitals (minimum 100 bedded) by utilizing the existing resources. Karnataka is the first state in India to expand the NBEMS (DNB and Diploma) courses in taluk hospitals and to begin DrNB courses in district hospitals. The paper documents the process of implementation of the NBEMS courses at district and taluk hospitals of Karnataka, which has supported in strengthening these hospitals in the state. [ABSTRACT FROM AUTHOR]

Delivering specialised care for major burns requires a multidisciplinary health workforce. While health systems ‘hardware’ issues, such as shortages of the healthcare workforce and training gaps in burn care are widely acknowledged, there is limited evidence around the systems ‘software’ aspects, such as interest, power dynamics, and relationships that impact the healthcare workforce performance. This study explored challenges faced by the health workforce in burn care to identify issues affecting their performance. Qualitative in-depth interviews were conducted with a purposively selected sample (n = 31, 18 women and 13 men) of various cadres of the burn care health workforce in Uttar Pradesh, India. Inductive coding and thematic analysis identified three major themes. First, the dynamics within the multidisciplinary team where complex relations, power and normative hierarchy hampered performance. Second, the dynamics between health workers and patients due to the clinical and emotional challenges of dealing with burn injuries and multitasking. Third, dynamics between specialised burn units and broader health systems are narrated in challenges due to inadequate first response and delayed referral from primary care facilities. These findings indicate that burn care health workers in India face multiple challenges that need systemic intervention with a multipronged human resource for health framework. [ABSTRACT FROM AUTHOR]

Aim: To understand the experience of critical care nurses during the COVID‐19 pandemic, through the application of the Job‐Demand‐Resource model of occupational stress. Design: Qualitative interview study. Methods: Twenty‐eight critical care nurses (CCN) working in ICU in the UK NHS during the COVID‐19 pandemic took part in semi‐structured interviews between May 2021 and May 2022. Interviews were guided by the constructs of the Job‐Demand Resource model. Data were analysed using framework analysis. Results: The most difficult job demands were the pace and amount, complexity, physical and emotional effort of their work. Prolonged high demands led to CCN experiencing emotional and physical exhaustion, burnout, post‐traumatic stress symptoms and impaired sleep. Support from colleagues and supervisors was a core job resource. Sustained demands and impaired physical and psychological well‐being had negative organizational consequences with CCN expressing increased intention to leave their role. Conclusions: The combination of high demands and reduced resources had negative impacts on the psychological well‐being of nurses which is translating into increased consideration of leaving their profession. Implications for the Profession and/or Patient Care: The full impacts of the pandemic on the mental health of CCN are unlikely to resolve without appropriate interventions. Impact: Managers of healthcare systems should use these findings to inform: (i) the structure and organization of critical care workplaces so that they support staff to be well, and (ii) supportive interventions for staff who are carrying significant psychological distress as a result of working during and after the pandemic. These changes are required to improve staff recruitment and retention. Reporting Method: We used the COREQ guidelines for reporting qualitative studies. Patient and Public Contribution: Six CCN provided input to survey content and interview schedule. Two authors and members of the study team (T.S. and S.C.) worked in critical care during the pandemic. [ABSTRACT FROM AUTHOR]

Refugees and immigrants have experienced heightened health inequities related to COVID-19. As community-embedded frontline health personnel, refugee and immigrant community health workers (riCHWs) played essential roles in the provision of informational, instrumental, and emotional support during the unprecedented first year of the pandemic. Despite the importance of this workforce, riCHWs are at high risk for burnout due to low recognition and demanding workloads. This was exacerbated as riCHWs navigated a new and uncertain health delivery landscape. We sought to glean insight into riCHWs' stressors, coping strategies and resources, and self-efficacy to identify ways to support their work and wellbeing. Using a narrative inquiry approach, we conducted semi-structured, in-depth interviews with 11 riCHWs working in a midsized city in the midwestern United States. We generated three distinct yet interrelated themes: (1) Rapid and trustworthy information is key, (2) Creativity and perseverance are good ... structural support is better, and (3) Integrating riCHW expertise into health promotion programming and decision-making. Although riCHWs were deeply committed to enhancing community wellbeing, quickly shifting responsibilities in tandem with structural-level health inequities diminished their self-efficacy and mental health. riCHWs relied on work-based friends/colleagues for informational and emotional support to enhance their capacity to deliver services. Findings suggest increasing opportunities for peer support and idea-exchange, professional development, and integration of riCHW expertise in health promotion decision-making are effective strategies to enhance riCHWs' professional self-efficacy and personal wellbeing. [ABSTRACT FROM AUTHOR]

Introduction: There is now strong evidence to support the positive impact of place-based medical education on the recruitment and retention of the rural health workforce in Australia. Much of this work, however, has been undertaken in the context of 'extended rural clinical placement' - students undertaking part of their medical degree in a rural location. Until recently, there were only a few places in Australia in which students could undertake the entirety of their medical degree in a rural area. With the introduction of the Murray-Darling Medical Schools Network (MDMSN) initiative, this dynamic is changing. The MDMSN is part of the Stronger Rural Health Strategy and builds on the Australian Government's existing Rural Health Multidisciplinary Training Program to establish a network of rurally based medical programs in the Murray-Darling region. The MDMSN offers a unique opportunity to explore the effect of complete rural immersion during medical school on subsequent rural practice. This article describes the establishment of a research collaboration intended to ensure the harmonisation of research data collection from the outset of the MDMSN program. Methods: The MDMSN research collaboration is a longitudinal, multi-university program of work to explore the effect of rurally based medical school programs in the Murray-Darling region. Initially it has been agreed that administrative student data will be collected from existing university datasets to help characterise this novel student cohort. Each university will then distribute an entry survey to all first-year MDMSN students. The survey will collect demographic information as well as information regarding rural background, preferences and future practice intention. Questions have been aligned with and adapted from the Medical Schools Outcomes Database survey, the Australian Bureau of Statistics, and from the literature. This information will be combined with graduate information from the Australian Health Practitioner Regulation Agency. Results: The MDMSN research collaboration will work toward the co-design of research projects, to facilitate and progress multi-site research addressing nationally relevant research questions. Early research efforts are focused on our ability to better understand the new cohort of students embarking on rurally based medical education, their practice intentions and realisation. Subsequent work of the collaboration may lead to deeper understanding of the rural student experience, any effect of 'place', changes in student professional identity over time, and their relationship to subsequent rural practice. Conclusion: The MDMSN research collaboration is a proactive initiative that brings together data and experience from five new rurally based medical programs, and answers calls for multi-institution and longitudinal studies. It is uniquely placed to capture the impact of the MDMSN program, including the effect of complete rural immersion on the future practice location of these graduates. Ultimately, the combined research efforts of the MDMSN research collaboration will add knowledge to address the known rural workforce maldistribution, particularly how to attract and retain medical workforce. [ABSTRACT FROM AUTHOR]

Introduction: Rural areas worldwide face a general surgeon shortage, limiting rural populations' access to surgical care. While individual and practice-related factors have been well-studied in the US, we need a better understanding of the role of community characteristics in surgeons' location choices. This study aimed to understand the deeper meanings surgeons associated with community characteristics in order to inform efforts spanning the rural surgeon workforce pathway, from early educational exposures, and undergraduate and graduate medical education, to recruitment and retention. Methods: We conducted a qualitative, descriptive interview study with general surgeons in the Midwestern US about the role and meaning of community characteristics, exploring their backgrounds, education, practice location choices, and future plans. We focused on rural surgeons and used an urban comparison group. We used convenience and snowball sampling, then conducted interviews in-person and via phone, and digitally recorded and professionally transcribed them. We coded inductively and continued collecting data until reaching code saturation. We used thematic network analysis to organize codes and draw conclusions. Results: A total of 37 general surgeons (22 rural and 15 urban) participated. Interviews totaled over 52 hours. Three global themes described how rural surgeons associated different, often deeper, meanings with certain community characteristics compared to their urban colleagues: physical environment symbolism, health resources' relationship to scope of practice, and implications of intense role overlap (professional and personal roles). All interviewees spoke to all three themes, but the meanings they found differed importantly between urban and rural surgeons. Physical landscapes and community infrastructure were representative of autonomy and freedom for rural surgeons. They also shared how facilities, equipment, staff, staff education, and surgical partners combined to create different scopes of practice than their urban counterparts experienced. Often, rural surgeons found these resources dictated when they needed to transfer patients to higher-acuity facilities. Rural surgeons experienced role overlap intensely, as they cared for patients who were also friends and neighbors. Conclusion: Rural surgeons associated different meanings with certain community characteristics than their urban counterparts. As they work with prospective rural surgeons, educators and rural communities should highlight how health resources can translate into desired scopes of practice. They also should share with trainees the realities of role overlap, both how intense and stressful it can be but also how gratifying. Educators should include the rural social context in medical and surgical education, looking for even more opportunities to collaborate with rural communities to provide learners with firsthand experiences of rural environments, resources, and role overlap. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to identify associations between state policies and access to midwifery care. Identifying policies that facilitate increased access to midwives will help policymakers determine the best methods for increasing access to midwives in their states. Methods: This cross‐sectional study was conducted at the county level as a secondary analysis of National Vital Statistics data from the Natality online database. The unit of analysis was counties with populations of at least 100,000, and the outcome was the proportion of births attended by midwives in 2019. The potential predictors of increased access to midwifery care were independent midwife licensure, independent midwife prescribing, midwife access to hospital medical staff membership, and midwife Medicaid parity. Medicaid provider resources and state statutes verified Medicaid reimbursement rates and eligibility for hospital medical staff privileges. Each state was categorized as an independent or restricted licensure state according to data from the American College of Nurse‐Midwives. Data for the control variable, the presence of a midwifery education program, were gathered from the Accreditation Commission for Midwifery Education. The analysis was conducted as a Poisson regression. Results: There was no association between independent licensing and increased access among all states. Stratifying the analysis by independent licensing law revealed that all but one policy was related to higher rates of midwife attendance at birth. Maximum Medicaid reimbursement correlated with greater access regardless of licensing status. The rate of midwife‐attended births in independent licensing states grew as the number of potential predictors in a county increased. Discussion: Regulatory policies beyond independent licensing are associated with women's access to midwifery services. In independent licensing states, adopting additional policies favorable to midwives may strengthen access to midwifery. Policymakers and regulators can use these findings to identify strategies for accelerating the expansion of midwifery access in their states. [ABSTRACT FROM AUTHOR]

Australian osteopaths engage in multidisciplinary care and referrals with other health professionals, including general practitioners (GPs), for musculoskeletal care. This secondary analysis compared characteristics of Australian osteopaths who refer to, and receive referrals from, GPs with osteopaths who do not refer. The analysis was undertaken to identify pertinent characteristics that could contribute to greater engagement between Australian osteopaths and GPs. Data were from the Australian osteopathy practice-based research network comprising responses from 992 osteopaths (48.1% response rate). Osteopaths completed a practice-based survey exploring their demographic, practice, and clinical management characteristics. Backward logistic regression identified significant characteristics associated with referrals. Osteopaths who reported sending referrals (n = 878, 88.5%) to GPs were more likely than their non-referring colleagues to receive referrals from GPs (aOR = 4.80, 95% CI [2.62–8.82]), send referrals to a podiatrist (aOR = 3.09, 95% CI [1.80–5.28]) and/or treat patients experiencing degenerative spinal complaints (aOR = 1.71, 95% CI [1.01–2.91]). Osteopaths reporting receiving referrals (n = 886, 89.3%) from GPs were more likely than their non-referring colleagues to send referrals to GPs (aOR = 4.62, 95% CI [2.48–8.63]) and use the Medicare EasyClaim system (aOR = 4.66, 95% CI [2.34–9.27]). Most Australian osteopaths who report engaging in referrals with GPs for patient care also refer to other health professionals. Referrals from GPs are likely through the Chronic Disease Management scheme. The clinical conditions resulting in referrals are unknown. Further research could explore the GP–osteopath referral network to strengthen collaborative musculoskeletal care. The outcomes of this study have the potential to inform Australian osteopaths participating in advocacy, public policy and engagement with Australian GPs. [ABSTRACT FROM AUTHOR]

Background: Despite the implementation of various government policies to retain Thai dentists in public sector, a high turnover rate among early career dentists has persisted for decades. This study aims to explore factors relating to early career dentists' choice of the public sector as their preferred workplace and decisions relating to staying, resigning, or relocating from the workplace after one-year employment. Methods: A one-year cross-sectional survey was conducted among Thai early career dentists who began working in 2020 using two sets of online questionnaires. The first survey assessed factors influencing dentists' decision to choose the public sector as their preferred workplace at the beginning of the year. The second survey investigated factors influencing dentists' decision to stay, resign, or relocate from the same workplace at one-year after employment. Descriptive statistics and multivariable binary logistic regression were used for data analysis. Results: A total of 198 early career dentists completed the online survey questionnaire at the starting point (December 2020–January 2021), and 186 dentists completed the one-year employment questionnaire. The living environment and provided amenities and facilities were the most influential factors in their decision to choose and remain in the public sector. Conversely, their attitude toward unrelated job descriptions and an increased opportunity to pursue postgraduate studies were the most relevant factors when deciding to relocate to a new workplace. Factors such as delayed authority in bureaucracy, hometown location, and being in relationship status were the most significant contributors to resignation from the public sector. Conclusions: The major factors influencing dentists' choice and retention in the public sector include the living environment, supportive supervisors and colleagues, and the availability of opportunities for further postgraduate education. Meanwhile, factors impacting retention after one year of work are related to hometown location and the bureaucracy system. Collaborations among ministries, tailored to each local community's specific requirements, may enhance dentists' retention in public sectors. [ABSTRACT FROM AUTHOR]

Background: Inequities of health outcomes persist in rural populations globally. This is strongly associated with there being less health coverage in rural and underserviced areas. Increasing health care coverage in rural area requires rural health system strengthening, which subsequently necessitates having tools to guide action. Objective: This mapping review aimed to describe the range of tools, frameworks and resources (hereafter called tools) available globally for rural health system capacity building. Methods: This study collected peer-reviewed materials published in 15-year period (2005–2020). A systematic mapping review process identified 149 articles for inclusion, related to 144 tools that had been developed, implemented, and/or evaluated (some tools reported over multiple articles) which were mapped against the World Health Organization's (WHO's) six health system building blocks (agreed as the elements that need to be addressed to strengthen health systems). Results: The majority of tools were from high- and middle-income countries (n = 85, 59% and n = 43, 29%, respectively), and only 17 tools (12%) from low-income countries. Most tools related to the health service building block (n = 57, 39%), or workforce (n = 33, 23%). There were a few tools related to information and leadership and governance (n = 8, 5% each). Very few tools related to infrastructure (n = 3, 2%) and financing (n = 4, 3%). This mapping review also provided broad quality appraisal, showing that the majority of the tools had been evaluated or validated, or both (n = 106, 74%). Conclusion: This mapping review provides evidence that there is a breadth of tools available for health system strengthening globally along with some gaps where no tools were identified for specific health system building blocks. Furthermore, most tools were developed and applied in HIC/MIC and it is important to consider factors that influence their utility in LMIC settings. It may be important to develop new tools related to infrastructure and financing. Tools that have been positively evaluated should be made available to all rural communities, to ensure comprehensive global action on rural health system strengthening. [ABSTRACT FROM AUTHOR]

Objectives. Industry reports suggest that routine and essential care in Australian residential aged care (RAC), including allied health (AH) services, were disrupted during the coronavirus diseas 2019 (COVID-19) pandemic. This study aimed to explore whether AH services in RAC were paused during the pandemic, factors associated with a pause in care delivery, and qualitative details on how COVID-19 impacted AH service delivery. Methods. A 26-question survey was distributed via social media, health service providers, and AH networks between February and April 2022. Participation was restricted to AH professionals and assistants with experience in RAC during the pandemic. A mix of closed and open-ended response questions was used to collect demographic data and experiences of delivering care during the pandemic. Quantitative responses were analysed with descriptive statistics and a probit model. Content analysis was performed on open-ended questions. Results. One hundred and four AH professionals and assistants responded to the survey. Fifty-five percent of participants (n = 51) were contractually or casually employed. AH services were negatively impacted by the pandemic with 52% of respondents experiencing a pause in service delivery and 78% reporting poorer AH care quality. In a probit model, contracted/casually employed respondents were more likely to experience a pause in care delivery (1.03, P < 0.05) compared to permanently employed AH professionals. Conclusion. Insecure work arrangements may have exacerbated inconsistent care during the pandemic (impacting residents) and may have negative implications on the RAC AH workforce. In the future, an AH inclusive workforce policy including data collection and research is required to monitor and plan the RAC workforce. [ABSTRACT FROM AUTHOR]

Internationally educated immigrant healthcare workers face skill underutilization working in lower-skilled healthcare jobs or outside healthcare. This study explored barriers to and solutions for integrating immigrant health professionals. Content analysis identifying key themes from semi-structured qualitative interviews with representatives from Welcome Back Centers (WBCs) and partner organizations. 18 participants completed interviews. Barriers facing immigrant health professionals included lack of access to resources, financial constraints, language difficulties, credentialing challenges, prejudice, and investment in current occupations. Barriers facing programs that assist immigrant health professionals included eligibility restrictions, funding challenges, program workforce instability, recruitment difficulties, difficulty maintaining connection, and pandemic challenges. Long-term program success depended on partner networks, advocacy, addressing prejudice, a client-centered approach, diverse resources and services, and conducting research. Initiatives to integrate immigrant health professionals require multi-level responses to diverse needs and collaborations among organizations that support immigrant health professionals, healthcare systems, labor, and other stakeholders. [ABSTRACT FROM AUTHOR]

Background: This review paper offers a policy-tracing trend analysis of national experiences among low- and middle-income countries in strengthening human resources for health information systems (HRHIS). This paper draws on evidence from the last two decades and applies a modified Bardach's policy analysis framework. A timely review of the evidence on HRHIS and underlying data systems is needed now more than ever, given the halfway mark of the Global Strategy on Human Resources for Health: Workforce 2030 and the protracted COVID-19 pandemic and other global health emergencies, over and above the increasing need for health and care workers to provide essential health services. Main text: Considering World Health Assembly resolutions and HRH-related global developments between 2000 and 2022, we targeted peer-reviewed and gray literature covering the inception, impact, bottlenecks, and gaps of HRHIS. We also considered results from a Bill and Melinda Gates Foundation-funded project that assessed HRH data systems in 21 countries and the use of HRH data and information for policy, planning, and management. Aligned with the National Health Workforce Accounts (NHWA), we identify priority themes related to digital priorities for HRHIS and governance/leadership and present case studies of five countries that pursued different pathways to successfully develop their HRHIS. Summary conclusion: Over the last two decades, considerable progress has been achieved through a scaled-up implementation of HRHIS combined with the skills needed to analyze and use data, sustain systems functionality, and make systematic improvements over time. Global health development aid investments and technical innovations have led to advancements in HRHIS, district health information software (DHIS2), and partner collaborations during the HIV/AIDS, Ebola, and COVID-19 crises. Although the progressive implementation of NHWA continues to steer country-level efforts through standardized indicators and regular reporting, traditional challenges remain, such as data systems fragmentation, lack of interoperability between systems, and underutilization of reported data. Encouragingly, some countries demonstrate strong governance and leadership capacities and others strong HRHIS digital capacities. Both HRH and health service data are needed to inform on-demand decisions during times of emergencies and pandemics as well as during routine essential health services delivery. Evidence-based examples from distinctive countries demonstrate that reliable HRHIS is achievable for better planning and management of the health and care workforce. [ABSTRACT FROM AUTHOR]

International migration of healthcare workers is well established and has become a means of maintaining service quality in many high income countries. In recent years, there has been a dramatic increase in recruitment of health personnel who have been trained abroad, including from the poorest countries in the world. In this article, using General Medical Council (GMC) data, we chart the growth in numbers of international staff working in the United Kingdom, where since 2018, over half of all new GMC registrations have been of doctors trained abroad. There is evidence that this migration of health staff results in poorer health service provision in low and middle income countries, as well as substantial economic impacts in these countries that have invested in training their health workforce. Recruiting governments have argued that remittances compensate for the loss of personnel, and that training opportunities can enable skills transfer to countries with weaker health systems. However, we found that the costs to the source countries dwarfed remittances, and that only a tiny fraction of people who move to take up posts in wealthier countries ever return to their countries of origin to work. We conclude that in addition to the investment in health systems (and workforce development) in low and middle income countries as part of Official Development Assistance for Health, there is an urgent need to increase training of nurses and doctors so that damaging migration is no longer relied upon to fill gaps in healthcare personnel. [ABSTRACT FROM AUTHOR]

As the first anniversary of the inaugural Sherman A. James Diverse and Inclusive Epidemiology Award from the Society of Epidemiologic Research approaches, I present a transcript of that session. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background: Geriatric nurse practitioners (NPs) are introduced into health systems to alleviate provider shortages and improve care for older adults. To achieve these goals, geriatric NPs must be integrated into the health system such that they can efficaciously practice. Internationally, little is known about factors affecting the integration of NPs. Such evidence would improve policymaking and the impact of geriatric NPs on care. In Israel, geriatric NPs were recently introduced. Their ongoing integration is an exemplar for other countries. Purpose: To identify factors affecting the integration of geriatric NPs in Israel and discuss application of these factors in international policy and research. Methodology: The Consolidated Framework for Implementation Research guided this qualitative descriptive study. A semistructured interview guide was used to collect data from four professional groups (geriatric NPs, physicians, administrators, and policymakers), which, together, provide a system-level perspective. Factors were identified using deductive content analysis and designated as facilitators, barriers, neutral, or mixed effects. Results: There were 58 participants across the four professional groups. Twenty-eight factors were identified, including patient needs and leadership engagement (facilitators), available information (barrier), culture (mixed), and evidence strength (neutral). Perspectives on several factors differed by the professional group's role in integrating NPs (e.g., costs). Conclusions: The barriers highlight lacking interprofessional support from a priori policymaking and communication breakdowns. Policies should reflect priorities of administrators, clinicians, and policymakers. Implications: These factors may inform policymaking in other countries but would be most effective if based on country-specific research. This implementation science approach may inform future studies. [ABSTRACT FROM AUTHOR]

Emerging technological advances hold potential to assist the long-term care (LTC) workforce in caring for an aging population in the home and LTC settings. Technology may alter workforce needs and mitigate rising workforce demand. This study identified and assessed emerging technologies that may assist, replace, and/or support recruitment and retention of the LTC workforce and identified barriers and facilitators to their implementation. We identified a variety of technologies with applications for LTC, created a taxonomy of technology types and functions across LTC settings, and conducted semi-structured interviews with a sample of company leaders to assess perceived impact of their products and services on the LTC workforce. Thematic analysis of those interviews found that technology is not currently positioned to replace the LTC workforce but may facilitate work and support worker recruitment and retention. More rigorous evaluation of technologies in LTC and financing mechanisms are needed to support widespread adoption. [ABSTRACT FROM AUTHOR]

Rationale: Primary care access challenges are experienced by many communities. In several jurisdictions, including Canada, family physicians (FP) have the professional autonomy to organize their practice in alignment with professional and personal interests. Although system‐level interventions are tremendously important, investment in upstream interventions associated with the medical education of graduating FPs is a promising strategy for ameliorating primary healthcare access challenges. Aims and Objectives: This study investigates the medical education experiences that influence FP's decisions about practice locations in Canada. Methods: We conducted semistructured interviews with FPs who completed undergraduate and postgraduate medical training in Canada and now have a practice in Ontario, Canada. Interview data were coded and analysed using an unconstrained descriptive approach. Results: FPs preferred practice locations are intimately tied to their desired practice scope. Practice preferences were shaped through training experiences with patient populations, heightened clinical responsibilities, practice models and locations, professional mentorships and networks. Proximity to family, partner and lifestyle preferences, cultural connections and the available practice opportunities also shaped practice location decisions. Conclusion: Medical education influences the identification and refinement of professional family practice preferences. Health workforce policies and interventions should leverage medical education to promote more equitable primary healthcare access. [ABSTRACT FROM AUTHOR]

Posting and Transfer (PT) refers to deployment of the health workforce in ways that ensure appropriate numbers and distribution. Although PT is a crucial aspect of health workforce governance, it remains under-researched from the viewpoint of implementation, health workforce and governance. The aim of this paper is to examine public sector doctors' experience of their initial postings, in the context of local policy from two Indian states. We carried out a review search for policy documentation. A total 61 in-depth interviews were conducted in both states with 33 doctors, as subjects of the study. There were 28 key informant (KI) interviews of health administrators and other policy actors to understand their perspectives of PT policies and implementation. Thematic analysis was used to analyse data. Job histories were constructed from the doctors' interviews to track their experience with the PT system, and analysed using location, duration and postings. Despite search for state policy for PT, we were unable to identify any policy documentation. However, participants referred to PT practices that suggested expectations of what the poliy meant to them. These expectations were corroborated by KI, and the job histories and interview data enabled the authors to construct a series of norms, interpreted as evidence of implied policy. The main norms identified relate to service need, native place, request, gender and posting duration. The norm related to state need had strong face validity, while other norms based on request, gender and duration were less consistent in application. In the absence of documented policies, the construction of norms from the qualitative data proved useful to examine the dynamics of health workers' interactions with the initial PT systems This construction of norms provides a methodological innovation allowing health policy and systems researchers to compensate for the absence of documented policy in exploring PT functions. [ABSTRACT FROM AUTHOR]