Job satisfaction of graduates of rural oriented medical students training project in Jiangsu Province, China: a cross-sectional study

Background The Chinese government has worked out the “Rural Oriented Medical Students Training Project” to address physician maldistribution, which attempted to train physicians for rural areas. The present study attempted to evaluate the job satisfaction of the graduates of this project in Jiangsu Province, China. Methods Online questionnaires were sent to the graduates of the “Rural Oriented Medical Students Training Project” (group A) and their colleagues, who were rural physicians recruited from different sources (group B). The study was approved by the Ethics Committee of Xuzhou Medical University, and the approval number was 2,018,057. Information on demographic characteristics, work conditions, and self-reported satisfaction was collected to compare the satisfaction differences between the two recruited rural physicians using the Chi-square test and Mann–Whitney U test. Additionally, factors correlated to the satisfaction of group A were assessed using multivariate linear regression. Statistical analysis was performed using SPSS 23.0 (SPSS Inc., Chicago, IL, USA). P < 0.05 was considered statistically significant. Results Group A exhibited moderate satisfaction (2.81 ± 0.687). The satisfaction score from the highest to the lowest was for occupational ecology, life satisfaction, stress, competency, and internal environment. Positive factors related to the satisfaction of group A were area, monthly income, working hours per week, professional title, and post. Conclusion The satisfaction of the graduates of the “Rural Oriented Medical Students Training Project” was moderate. Factors related to satisfaction included economic incentives, workload, and professional confidence. Possible solutions for increasing satisfaction should consist of economic support and possible ways to improve the professional identification of these graduates.

“Through their eyes, I can work” – rural physicians' perceptions about mobile phone use among community health workers – a qualitative analysis

PurposePhysicians who are primary care providers in rural communities form an essential stakeholder group in rural mobile health (mHealth) delivery. This study was exploratory in nature and was conducted in Udupi district of Karnataka, India. The purpose of this study is to examine the perceptions of rural medical officers (MOs) (rural physicians) regarding the benefits and challenges of mobile phone use by community health workers (CHWs).Design/methodology/approachIn-depth interviews were conducted among 15 MOs belonging to different primary health centers of the district. Only MOs with a minimum five years of experience were recruited in the study using purposive and snowball sampling. This was followed by thematic analysis of the data collected.FindingsThe perceptions of MOs regarding the CHWs' use of mobile phones were largely positive. However, they reported the existence of some challenges that limits the potential of its full use. The findings were categorized under four themes namely, benefits of mobile phone use to CHWs, benefits of mobile phone-equipped CHWs, current mobile phone use by CHWs and barriers to CHWs' mobile phone use. The significant barriers reported in the CHWs' mobile phone use were poor mobile network coverage, technical illiteracy, lack of consistent technical training and call and data expense of the CHWs. The participants recommend an increased number of mobile towers, frequent training in mobile phone use and basic English language for the CHWs as possible solutions to the barriers.Originality/valueStudies examining the perceptions of doctors who are a primary stakeholder group in mHealth as well as in the public health system scenario are limited. To the authors’ knowledge, this is one of the first studies to examine the perception of rural doctors regarding CHWs' mobile phone use for work in India.

Education policies to increase rural physicians in Japan: a nationwide cohort study

Background Japan has established comprehensive education-scholarship programs to supply physicians in rural areas. Their entrants now comprise 16% of all medical students, and graduates must work in rural areas for a designated number of years. These programs are now being adopted outside Japan, but their medium-term outcomes and inter-program differences are unknown. Methods A nationwide prospective cohort study of newly licensed physicians 2014–2018 (n = 2454) of the four major types of the programs—Jichi Medical University (Jichi); regional quota with scholarship; non-quota with scholarship (scholarship alone); and quota without scholarship (quota alone)—and all Japanese physicians in the same postgraduate year (n = 40,293) was conducted with follow-up workplace information from the Physician Census 2018, Ministry of Health, Labour and Welfare. In addition, annual cross-sectional survey for prefectural governments and medical schools 2014–2019 was conducted to obtain information on the results of National Physician License Examination and retention status for contractual workforce. Results Passing rate of the National Physician License Examination was highest in Jichi, followed in descending order by quota with scholarship, the other two programs, and all medical graduates. The retention rate for contractual rural service of Jichi graduates 5 years after graduation (n = 683; 98%) was higher than that of quota with scholarship (2868; 90%; P < 0.001) and scholarship alone (2220; 81% < 0.001). Relative risks of working in municipalities with the least population density quintile in Jichi, quota with scholarship, scholarship alone, and quota alone in postgraduate year 5 were 4.0 (95% CI 3.7–4.4; P < 0.001), 3.1 (2.6–3.7; < 0.001), 2.5 (2.1–3.0; < 0.001), and 2.5 (1.9–3.3; < 0.001) as compared with all Japanese physicians. There was no significant difference between each program and all physicians in the proportion of those who specialized in internal medicine or general practice in postgraduate years 3 to 5 Conclusions Japan’s education policies to produce rural physicians are effective but the degree of effectiveness varies among the programs. Policymakers and medical educators should plan their future rural workforce policies with reference to the effectiveness and variations of these programs.

The impact of urban-based family medicine postgraduate rotations on rural preceptors/teachers

Background: The use of rural rotations within urban-based postgraduate programs is the predominant response of medical education to the health needs of underserved rural populations. The broader impact on rural physicians who teach has not been reported. Methods: This study examined the personal, professional, and financial impact of a rural rotations for urban-based family medicine (UBFM) residents on Canadian rural teaching physicians. A survey was created and reviewed by community and academic rural physicians and a cohort of Canadian rural family physicians teaching UBFM residents was sampled. Survey data and free-text responses were assessed using quantitative and qualitative analyses. Results: Participants with rural residency backgrounds perceived a negative impact of teaching UBFM (p = 0.02 personal and professional) and those in a primary rural environment (as defined below) perceived impact as positive (p < 0.001). Rural preceptors often held contrasting attitudes towards learners with negative judgements counter-balanced by positive thoughts. Duration in practice and of teaching experience did not have a significant impact on ratings. Conclusion: Being a rural preceptor of UBFM residents is rewarding but also stressful. The preceptor location of training and scope of practice appears to influence the impact of UBFM residents.

Rural family physician perspectives on communication with urban specialists: a qualitative study

ObjectiveCommunication is a key competency for medical education and comprehensive patient care. In rural environments, communication between rural family physicians and urban specialists is an essential pathway for clinical decision making. The aim of this study was to explore rural physicians’ perspectives on communication with urban specialists during consultations and referrals.SettingNewfoundland and Labrador, Canada.ParticipantsThis qualitative study involved semistructured, one-on-one interviews with rural family physicians (n=11) with varied career stages, geographical regions, and community sizes.ResultsFour themes specific to communication in rural practice were identified. The themes included: (1) understanding the contexts of rural care; (2) geographical isolation and patient transfer; and (3) respectful discourse; and (4) overcoming communication challenges in referrals and consultations.ConclusionsCommunication between rural family physicians and urban specialists is a critical task in providing care for rural patients. Rural physicians see value in conveying unique aspects of rural clinical practice during communication with urban specialists, including context and the complexities of patient transfers.

Care coordination challenges between a high-volume center and rural physicians treating patients with pancreatic cancer.

58 Background: Pancreatic cancer (PC) patients treated at high-volume centers (HVCs) benefit from specialty services that may not be accessible to rural patients: complex treatment planning, advanced surgical and chemo-radiation options, and multidisciplinary team-based care. As a result, rural PC patients often seek treatment at multiple locations for different episodes of care (i.e., chemotherapy and surgery). The facilitators and barriers to coordinating care between rural physicians and HVCs for rural PC patients treated by both types of providers are not well-understood. Methods: We conducted semi-structured interviews with PC specialists (medical, surgical, and radiation oncologists, n = 9) at a HVC (The Ohio State University) actively treating and co-managing rural PC patients with rural physicians. Using rigorous qualitative methods, two co-authors independently coded the interview transcripts to develop a thematic account of HVC-rural physician care coordination barriers and facilitators. Results: Initial interactions between PC specialists and rural PC patients often require duplication of diagnostic testing (i.e., imaging) due to inadequate transfer of medical records at the time of consultation. This is partly due to inefficient phone communication between HVCs and rural physicians. Such inefficiencies often discourage two-way communication between HVCs and rural physicians, and this can hinder development of a shared understanding of patients’ treatment plans. Specialists suggested a dual-approach may help to improve care coordination in this context: (a) developing better personal relationships with rural physicians to facilitate information-sharing and “closing-the-loop” on patients’ treatment plans; and (b) implementing data systems that permit physicians to share patients’ records across organizations. Several specialists acknowledged the benefit of having a dedicated care coordinator who could help patients connect with specialists, navigate the different healthcare systems, and relay information between providers. Conclusions: Given the challenges that can complicate the PC treatment process for rural patients, it is important to consider opportunities to address these issues. Taking steps to improve efficiency in communication may help facilitate the development of cohesive treatment plans and promote team-based care. Further studies are needed to examine the effects of care coordination interventions, like the use of care coordinators, on improving care for rural PC patients.