Pre-service medical education course completion and drop-out rates - Human Resources for Health - Human Resources for Health

Introduction

The “Global strategy connected quality resources for health: Workforce 2030” was adopted by the 69th World Health Assembly. Among its objectives is the strengthening of information connected quality resources for health, to pass evidence-based argumentation decisions. These information see the people completion and drop-out rates, to pass mechanisms that enactment recruitment and retention.

Objective

This insubstantial sought to measure trends successful people completion and drop-out rates of wellness workforce students. However, archetypal information were lone obtained for pre-service aesculapian students, but nary different wellness idiosyncratic occupational groups.

Methods

A mixed method attack was employed to get information presented successful this paper. A structured questionnaire was sent retired to targeted aesculapian grooming institutions, regulatory bodies, and National Medical Associations, supplemented by a web and lit hunt for existing studies oregon information reports. Data were analyzed utilizing IBM SPSS Statistics mentation 21.0 (Chicago, IL, USA) and Microsoft Excel 2010.

Results

Eight antecedently published studies were identified originating from six countries, with people completion rates ranging from 84% successful Pakistan to 98.6% successful the United States of America, portion the drop-out rates ranged from 1.4% successful the United States of America to 16% successful Pakistan. An investigation of pre-service aesculapian students successful Australia and New Zealand, revealed mean people completion rates of 93.3% and 96.9%, respectively, and mean drop-out rates of 6.7% and 3.1%, respectively. An investigation of pre-service aesculapian students from Nigeria, revealed an mean people completion complaint of 88.3%, and an mean drop-out complaint of 11.7%. Data were not readily disposable for astir countries targeted during the research, either due to the fact that of deficiency of existing mechanisms for collation of required information oregon restrictions making specified information publically unavailable and inaccessible.

Conclusions

Drop-out complaint for pre-service aesculapian students varies crossed countries with immoderate countries signaling higher drop-out rates, which rise important concerns astir the capableness of specified countries to standard up accumulation of quality resources for health. Data that show some people completion and drop-out rates, and question to supply penetration into reasons for observed numbers, tin pass mechanisms to code the causes of people drop-out and enactment pupil retention.

A wellness strategy consists of each the organizations, institutions, resources and radical whose superior intent is to amended wellness [1]. Among these components of a wellness system, Human Resources for Health (HRH) is captious towards the attainment of effective, equitable, accessible, affordable and prime wellness work coverage.

Despite the captious value of HRH, the disposable HRH successful astir countries is incapable to lucifer colonisation wellness needs. Estimates by the World Health Organization successful 2016 projected a planetary shortage of 18 cardinal wellness workers needed by 2030 to execute the Universal Health Coverage (UHC) targets of the Sustainable Development Goals (SDG) 2030 docket [2]. This shortage successful HRH cuts crossed assorted countries of the world, with countries astatine each levels of improvement contending with varying levels and forms of HRH challenges, specified arsenic education/production, deployment, maldistribution and inefficient usage of HRH, and mediocre moving conditions [2]. This is worsened by the unceasing emigration of wellness workers, peculiarly from low- and middle-income (LMIC) countries wherever the situation of HRH shortage is adjacent much captious [3, 4]. The situation is besides compounded by the wide dearth of wellness workforce information for planning, decision-making and tracking of advancement successful HRH successful assorted countries.

It was successful realization of the request to code this spread successful HRH, done stimulation of greater governmental committedness to wellness financing and concern successful the education, recruitment, training, improvement and retention of the wellness workforce, peculiarly successful processing countries, that the “Global Strategy connected Human Resources for Health: Workforce 2030” was adopted by the 69th World Health Assembly [2]. The strategy has arsenic its imaginativeness the acceleration of advancement towards Universal Health Coverage and the United Nations Sustainable Development Goals done equitable entree to wellness workers wrong strengthened wellness systems. Among its 4 halfway objectives is the strengthening of information connected quality resources for health, for monitoring and ensuring accountability for the implementation of national, regional, and planetary strategies.

The foregoing underscores the ground for this insubstantial which seeks to appraise information connected graduation/course completion rates and drop-out rates of aesculapian students from aesculapian acquisition and grooming institutions, with the anticipation of providing insights to pass readying and decision-making connected aesculapian workforce production, recruitment and retention.

For the intent of this paper, drop-out complaint is defined arsenic the complaint of students from a cohort of students exiting a wellness workforce acquisition and grooming programme without completion [5], portion graduation/ people completion complaint is defined arsenic the ratio of the fig of students graduating from a wellness workforce acquisition and grooming programme to the fig of students enrolled successful the archetypal twelvemonth of the aforesaid acquisition and grooming programme [5].

A mixed method attack was employed to get information presented successful this paper.

A structured questionnaire was sent to targeted aesculapian grooming institutions and regulatory bodies, arsenic good arsenic National Medical Associations that are members of the Commonwealth Medical Association. This was done done nonstop interaction with the aesculapian grooming institutions and regulatory bodies, arsenic good arsenic done nonstop contacts with National Medical Associations successful 15 (15) countries, distributed crossed Africa, Asia, the Caribbean, Europe and America. The structured questionnaire consisted of a conception which highlighted the intent of the study, the explanation of presumption to beryllium studied, arsenic good arsenic assurance of confidentiality of the information to beryllium obtained from the respondents. It besides had a conception which sought to elicit information connected the fig of aesculapian students admitted and the fig of aesculapian students that graduated implicit a 12-year play (between the twelvemonth 2009 and 2020). The websites of immoderate aesculapian schools and nationalist aesculapian regulatory bodies and associations, were besides accessed for applicable accusation and data. This included publically disposable secondary information sourced from the website of Medical Deans successful New Zealand and Australia [6]. Additionally, a superior hunt and reappraisal of peer-reviewed lit and studies connected the taxable was conducted, utilizing PubMed and Google student databases. Search presumption utilized for the lit hunt included: Medical, School attainment, Medical Student progression, Medical Student retention, Course completion rate, Attrition rate, Drop-out rate, Failure rate.

Obtained information were analyzed utilizing IBM SPSS Statistics mentation 21.0 (Chicago, IL, USA) and Microsoft Excel 2010. Descriptive statistic were deployed and results were presented arsenic percentages, rates, and graphs.

Eight antecedently published studies were identified from the lit search, originating from six countries arsenic shown successful Table 1: United States of America (n = 2), United Kingdom (n = 2), Netherlands (n = 1), Pakistan (n = 1), Saudi Arabia (n = 1), and Germany (n = 1). The people completion rates successful the published studies ranged from 84% successful Pakistan to 98.6% successful the United States of America, portion the drop-out rates ranged from 1.4% successful the United States of America to 16% successful Pakistan (Table 1).

From the website of Medical Deans successful New Zealand and Australia [6], immoderate publically disposable secondary information were sourced and analyzed. From an investigation of 7 sets of pre-service aesculapian students successful New Zealand, this insubstantial recovered that whereas the people completion rates ranged from 89.8 to 97.4% with an mean course-completion complaint of 93.3%, the drop-out rates ranged from 2.6 to 10.2% with an mean drop-out complaint of 6.7% (Fig. 1).

Fig. 1

Course completion and drop-out rates for pre-service aesculapian students successful New Zealand (2014–2020)

Similarly, from an investigation of 7 sets of pre-service aesculapian students successful Australia, this survey recovered that the people completion rates ranged from 94.1 to 98.4% with an mean course-completion complaint of 96.9%, portion the drop-out rates ranged from 1.6 to 5.9% with an mean drop-out complaint of 3.1% (Fig. 2).

Fig. 2

Course completion and drop-out rates for pre-service aesculapian students successful Australia (2014–2020)

Three further datasets were identified but not publically accessible. The United Kingdom Medical Education Database (UKMED) [7] offers a biannual rhythm of information merchandise for datasets matched wrong confidentiality ineligible requirements, but the dates were not substantially wrong the survey play (October–December, 2021); the Association of American Medical Colleges (AAMC) Student Records System (SRS) [8] is simply a confidential, password-protected, secure, Internet-based records strategy developed for usage by aesculapian schoolhouse registrars and their designated authorized users; and the database of the Organization for Economic Co-operation and Development (OECD) developed for usage by authorized users [9].

Only superior information from the Medical and Dental Council of Nigeria were received successful effect to the questionnaire. The information collected successful Nigeria were for the play 2015–2020, upon completion/graduation by the aesculapian students. The information collected were to beryllium compared with schools worldwide crossed the aforesaid period. An investigation of the information revealed a people completion complaint that ranged from 79.2% successful the twelvemonth 2019 to 96.5% successful the twelvemonth 2015, with an mean people completion complaint of 88.3%, portion the drop-out complaint ranged from 3.5% successful the twelvemonth 2015 to 20.8% successful the twelvemonth 2019, with an mean drop-out complaint of 11.7%. Drop-out complaint was observed to beryllium highest successful 2019 (Fig. 3).

Fig. 3

Course completion and drop-out rates of pre-service aesculapian students successful Nigeria (2015–2020)

The “Global strategy connected quality resources for health: Workforce 2030” was adopted by the 69th World Health Assembly. Amongst its objectives is the strengthening of information connected quality resources for health. These information see the people completion and drop-out rates which are important indices that should beryllium of interest to aesculapian acquisition and grooming institutions, and to WHO Member States, to pass mechanisms that enactment recruitment and retention.

Aside from the wellness workforce shortages seen successful astir countries, worsened by the improvement of emigration, people completion and drop-out rates among aesculapian students and students successful allied wellness professions, person important economical impact. A precocious drop-out complaint tin pb to important economical losses to a country, arsenic the nationalist investments made connected the acquisition and grooming of students earlier they dropped out, are wasted. Apart from the information that precocious drop-out rates whitethorn negatively impact the representation of the affected institutions, the affected students and their families whitethorn endure psychosocial problems of rejection and reduced self-worth, arsenic good arsenic the accidental outgo and fiscal investments made successful their ain studies.

Whereas the acquisition of assorted cadres of wellness professionals done existing wellness acquisition and grooming institutions remains a cardinal origin successful the improvement of HRH, determination beryllium constricted information connected the people completion and drop-out rates of aesculapian students and students successful professions allied to medicine. Though this survey sought information crossed wellness nonrecreational and wellness workforce groups, lone information for aesculapian education/ pre-service aesculapian students were obtained. Unlike what was recovered successful the lawsuit of New Zealand, Australia, United States of America (USA), and the United Kingdom (UK), with platforms for information collation and tracking of the show of aesculapian students, this survey recovered a important deficiency of effectual and businesslike platforms and mechanisms for specified information collation successful astir institutions and countries from which information were sought. Whereas small oregon nary trouble was experienced successful accessing secondary information from New Zealand and Australia [6], the constricted play for this survey coupled with the information that information were not publically accessible successful immoderate countries owed to immoderate restrictions and requirements for exertion for information (sometimes wrong a constrictive model play for application) made it hard to entree secondary information from the United Kingdom Medical Education Database (UKMED) [7], the database of the Association of American Medical Colleges (AAMC) Student Records System (SRS) [8], and the database of the Organization for Economic Co-operation and Development (OECD) [9].

It is evident from disposable lit and analyzed information that the people completion and drop-out rates of aesculapian students alteration crossed countries. Data are unavailable to find whether determination is further saltation wrong countries, oregon wrong oregon crossed occupations. An investigation of publically disposable information connected pre-service aesculapian students sourced from Medical Deans successful New Zealand [6], betwixt the twelvemonth 2014 and the twelvemonth 2020, revealed comparatively unchangeable precocious people completion and debased drop-out rates. Similarly, a survey of publically disposable information connected pre-service aesculapian students sourced from Medical Deans successful Australia [6] betwixt the twelvemonth 2014 and the twelvemonth 2020 besides revealed comparatively unchangeable precocious people completion and debased drop-out rates, adjacent though the rates for Australia were comparatively much unchangeable than those for aesculapian students successful New Zealand. Some drop-out rates are to beryllium expected; this could beryllium owed to idiosyncratic beingness choices, wellness reasons, insufficient world progression oregon fittingness to signifier reasons. The reasons for the variations recovered successful the course-completion and drop-out rates among pre-service aesculapian students successful New Zealand and Australia are not instantly known. In the United States of America, a survey conducted among 3 (3) cohorts of matriculating classes of aesculapian students and followed up for 10 years each, revealed a comparatively precocious graduation/course completion complaint and a debased drop-out rate. Among each the aesculapian students crossed the 3 cohorts, it was reported that lone 1.4% of the aesculapian students near aesculapian schoolhouse [10]. This survey uncovering is akin to the findings successful different survey connected people completion and drop-out rates of US aesculapian students, sourced from the website of the Association of American Medical Colleges (AAMC) Student Records System (SRS) [8]. The AAMC survey recovered that the aesculapian schoolhouse graduation rates for students undergoing the Doctor of Medicine (MD) aesculapian grade programme remained unchangeable from 1993–1994 done 2012–2013, with a 4-year graduation complaint that ranged from 81.6 to 83.4% and with a full nationalist attrition complaint of 3.3%. It besides recovered that 6 years aft matriculation, the mean graduation complaint was 95.9% for MD students not participating successful combined grade programs. This amounts to a drop-out complaint of 4.1%. These findings are akin to findings from a 2004 cross-sectional survey of students admitted into the College of Medicine, King Saud University, Saudi Arabia. A survey of 5 world years (1994–1998) revealed a debased drop-out complaint of 3.8% [11]. Similarly, a retrospective descriptive survey of aesculapian schoolhouse attrition implicit a 10-year play (2001–2011) carried retired astatine the University College Cork, revealed an wide drop-out complaint of 5.7% [12], portion different survey conducted by Heublein et al. [13] connected drop-out complaint among aesculapian students successful Germany recovered a drop-out complaint of 10%. Unlike the drop-out complaint of astir 10.0% and a precocious people completion complaint (about 90.0%) that were recovered successful a comparative survey conducted among 5-year undergraduate and 4-year postgraduate introduction aesculapian students who graduated successful the twelvemonth 2007 and 2008 from the University of Nottingham, United Kingdom [14], a drop-out complaint of 14% was recovered from the effect of a retrospective survey of records of aesculapian students betwixt 1983 and 1992 astatine Leeds School of Medicine, United Kingdom [15]. The saltation successful the UK studies whitethorn beryllium owed to the varied fig of cohorts, categories, and fig of aesculapian students that were studied, and antithetic interventions introduced implicit the clip period. A erstwhile survey of 396 aesculapian students successful Pakistan conducted implicit a 6-year play (1996–2001), revealed a drop-out complaint of 16%. [16]

While it was hard to root superior and secondary information from low- and middle-income countries (LMIC) mostly owed to non-existing organization platforms for regular collation of specified important data, information connected aesculapian students from aesculapian schools successful Nigeria were sourced done the level of the Medical and Dental Council of Nigeria (MDCN) which regulates the aesculapian and dental professions successful Nigeria [17]. The obtained information revealed a opposition from the information obtained from New Zealand and Australia with an mean people completion complaint of 88.3%, and an mean drop-out complaint of 11.7%. When the findings from New Zealand and Australia are compared with the findings from Nigeria, we admit the variations successful people completion and drop-out rates betwixt countries. In examination with the rates obtained for New Zealand and Australia, the observed higher drop-out and little course-completion rates among aesculapian students successful Nigeria, peculiarly successful the respective years of 2019 (drop-out complaint of 20.8%) and 2020 (drop-out complaint of 15.8%) is worthy of further interrogation. The recorded higher drop-out rates whitethorn nevertheless beryllium attributed to periods of stagnation successful immoderate aesculapian schools successful Nigeria owed to suspension of the accreditation presumption of immoderate aesculapian schools, disruptions successful the world calendar caused by predominant concern actions by world unit of universities, concern actions by aesculapian doctors and different wellness workers, arsenic good arsenic disruptions owed to the COVID-19 pandemic (particularly during the archetypal question of COVID-19 successful Nigeria successful the twelvemonth 2020) [18,19,20,21,22,23]. The quality successful admittance policies, duration of study, curriculum, and adopted teaching and grooming methods whitethorn besides relationship for the quality successful drop-out rates betwixt the countries [24] arsenic the accepted benignant of program is utilized successful Nigeria. Furthermore, arsenic was observed successful the lit reappraisal done by Arulsamy Anand [25] connected reasons for drop-out successful aesculapian schools, different probable reasons for the precocious drop-out complaint whitethorn beryllium the deficiency of information and anemic world abilities of immoderate aesculapian students, wellness challenges, and fiscal constraints experienced by immoderate aesculapian students (especially those with mediocre socio-economic backgrounds) worsened by lack of pupil loans and bursaries. Another origin whitethorn beryllium the availability of pupil payment services including world advising and counselling services, arsenic good arsenic the expanding emigration of families from Nigeria to different developed countries, with aesculapian students withdrawing from schoolhouse to alteration them emigrate with their families. [26, 27]

Limitations

There was large trouble successful accessing information connected people completion and drop-out rates from aesculapian acquisition grooming institutions/medical schools, fundamentally owed to the virtual non-existence of organization platforms and mechanisms for specified information collation, and successful immoderate cases, the restrictions imposed connected nationalist entree to specified data. These importantly constricted the information that could beryllium sourced straight successful the people of this study. Another regulation was the information that bulk of disposable lit connected people completion and drop-out rates progressive studies conducted successful precocious income and developed countries, a information that made comparative investigation difficult. The non-uniform fig and cohort of aesculapian students studied successful this insubstantial and successful astir of the lit recovered connected people completion and drop-out rates, arsenic good arsenic the constricted fig of countries studied, is simply a regulation connected the generalizability of the survey findings. Another regulation was the non-segregation into nationalist and backstage aesculapian schools successful astir of the publically disposable data. A segregation of the information would person helped to measure if determination were immoderate variations successful the people completion and drop-out rates betwixt nationalist and backstage aesculapian schools.

To date, the bulk of published studies astir drop-out rates of aesculapian students are focused connected precocious income, unchangeable countries; to our knowledge, this is the archetypal availability of broad nationalist information connected drop-out rates from Nigeria. In the discourse of efforts to standard up and prolong a beardown wellness workforce to execute Universal Health Coverage, it is concerning to find drop-out rates of much than 10%, arsenic was reported successful immoderate of the studied countries. The value of close signaling of students' matriculation and graduation by institutions providing aesculapian acquisition to pass workforce readying cannot beryllium overemphasized.

Therefore, it is recommended that countries and aesculapian acquisition grooming institutions make mechanisms for seamless and regular information collection/collation and archiving connected attrition/drop-out and completion rates. Accrediting bodies for aesculapian schools should see work of attrition/drop-out and completion rates arsenic request for accreditation. Secondly, entree indispensable beryllium ensured to alteration mentation from this data; this whitethorn see securing mechanisms to lucifer oregon collate datasets earlier releasing for probe analysis, arsenic is the signifier with UKMED. Access to these information volition facilitate readying and informed argumentation decision-making connected strategies for improving HRH. Efforts should besides beryllium made to marque information connected aesculapian acquisition easy accessible without violating confidentiality. Further studies connected wellness workforce acquisition people completion and drop-out rates should beryllium undertaken to supply further insights and to code observed limitations of this study.

Association of American Medical Colleges

Human Resource for Health

Low- and middle-income country

Doctor of Medicine

Medical and Dental Council of Nigeria

Sustainable Development Goal

Student Records System (SRS)

Universal Health Coverage

United Kingdom

United Kingdom Medical Education Database

United States of America

World Health Organization

References

Authors and Affiliations

1. Department of Family Medicine, University of Benin Teaching Hospital, Ugbowo, P.O. Box 10427, Benin City, Edo, Nigeria

   Osahon Enabulele

2. Department of Family Medicine, University of Benin, Benin City, Edo, Nigeria

   Osahon Enabulele

3. Department of Restorative Dentistry, University of Benin, P.M.B. 1154, Benin City, Edo, Nigeria

   Joan Emien Enabulele

Contributions

OE did the design, explanation of intelligence content, lit search, information evaluation, manuscript drafting, review, editing, and preparation. JE did lit search, information evaluation, and manuscript drafting. All the authors person work and approved the last manuscript.

Corresponding author

Correspondence to Osahon Enabulele.

Ethics support and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

We, the authors, state none.

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