Qualification programmes for immigrant health professionals: A systematic review


Autoři: Sidra Khan-Gökkaya aff001;  Sanna Higgen aff001;  Mike Mösko aff001
Působiště autorů: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Research Group on Migration and Psychosocial Health, Hamburg, Germany aff001
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224933

Souhrn

Background

Immigrant health professionals are a particularly vulnerable group in a host country’s labour market, as they face several barriers when re-entering their occupations. International studies indicate that early interventions can increase the employability of immigrants. Qualification programmes are one of these early interventions that can support the re-integration of these health professionals into the labour market. The purpose of this review is to identify international qualification programmes for immigrant health professionals, analyse their content and evaluate their effectiveness.

Methods

Six international databases (PubMed, Web of Science, CINAHL, PsychInfo, EBSCO and ProQuest Social Sciences) were systematically searched. The search terms were identified using the PICOS-framework. The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were screened independently by two authors and discussed. Studies included in the final synthesis were assessed with the Mixed Methods Appraisal Tool (MMAT) and Kirkpatrick’s Training Evaluation Model.

Results

Out of 10,371 findings, 31 articles were included in the final synthesis. The majority of them were addressed to international health care professionals and doctors. Two of them were addressed to refugee doctors. Three types of programme elements were identified: teaching, clinical practise and social support. The programmes’ length ranged from 2 days to up to 2.5 years. Despite recommendations in its favour, pre- and post-programme support was scarce. Results also indicate a lack of transparency and quality in terms of evaluation. Effectiveness was mostly observed in the area of language improvement and an increase in self-confidence.

Conclusion

This review points out the lack of systematically evaluated qualification programmes for immigrant health professionals. Programme providers should focus on implementing programmes for all health professionals as well as for underrepresented groups, such as refugees. In order to generate best practises it is necessary to evaluate these programmes. This requires the development of appropriate instruments when working with immigrant population in the context of educational programmes.

Klíčová slova:

Global health – Health care policy – Labor markets – Language – Medical doctors – Nurses – Professions – Non-randomized controlled trials


Zdroje

1. International Organization for Migration. World Migration Report 2018. Geneva: Switzerland: International Organization for Migration, 2018. https://publications.iom.int/system/files/pdf/wmr_2018_en.pdf.

2. United Nations. Department of Economic and Social Affairs. Population Division. International Migration Report 2017. Highlights. New York: United Nations, 2017. https://www.un.org/en/development/desa/population/migration/publications/migrationreport/docs/MigrationReport2017_Highlights.pdf.

3. Aluttis C, Bishaw T, Frank MW. The workforce for health in a globalized context: global shortages and international migration. Global health action. 2014;7:23611. Epub 2014/02/25. doi: 10.3402/gha.v7.23611 24560265

4. Knapp B, Bähr H, Dietz M, Dony E, Fausel G, Müller M, et al. Beratung und Vermittlung von Flüchtlingen: IAB-Forschungsbericht. Nürnberg: Institut für Arbeitsmarkt- und Berufsforschung (IAB), 2017. http://doku.iab.de/forschungsbericht/2017/fb0517.pdf.

5. Klingler C, Marckmann G. Difficulties experienced by migrant physicians working in German hospitals: a qualitative interview study. Human Resources for Health. 2016;14(1):57. Epub 2016/09/25. doi: 10.1186/s12960-016-0153-4 27662831

6. Ong YL, Bannon M, Paice E. Getting refugee doctors back to work: challenges, obstacles and solutions. In: Jackson N, Carter Y, editors. Refugee Doctors: Support, Development and Integration in the NHS: Radcliffe Publishing; 2004. p. 31–7.

7. Bloch A. Refugees in the UK labour market: The conflict between economic integration and policy-led labour market restriction. Journal of Social Policy. 2008;37(1):21–36.

8. Lai DW, Janki S, Ernest K. Unspoken skills and tactics: Essentials for immigrant professionals in integration to workplace culture. Journal of International Migration and Integration. 2017;18(3):937–59. http://dx.doi.org/10.1007/s12134-017-0513-5.

9. Humphries N, Tyrrell E, McAleese S, Bidwell P, Thomas S, Normand C, et al. A cycle of brain gain, waste and drain: a qualitative study of non-EU migrant doctors in Ireland. Human Resources for Health. 2013;11(63). doi: 10.1186/1478-4491-11-63 24321432

10. Jirovsky E, Hoffmann K, Maier M, Kutalek R. "Why should I have come here?": A qualitative investigation of migration reasons and experiences of health workers from sub-Saharan Africa in Austria. BMC Health Services Research. 2015;15:74. Epub 2015/04/18. doi: 10.1186/s12913-015-0737-z 25885693

11. Mozetic K. Being highly skilled and a refugee: Self-perceptions of non-european physicians in Sweden. Refugee Survey Quarterly. 2018;37(2):231–51. doi: 10.1093/rsq/hdy001

12. Konle-Seidl R, Bolits, G. Labour Market Integration of Refugees: strategies and good practices. Brussels: European Parliament. Policy Department A: Economic and Scientific Policy, 2016.

13. Desiderio MV. Integrating refugees into host country labor markets: challenges and policy options. Washington D.C.: Migration Policy Institute, 2016.

14. Harris A, Delany C. International medical graduates in transition. The clinical teacher. 2013;10(5):328–32. Epub 2013/09/11. doi: 10.1111/tct.12021 24015740

15. Ong YL, Paice E. A successful initiative for getting refugee doctors back into medical employment: the PRIME project. British Journal of Hospital Medicine. 2006;67(5):264–6. Epub 2006/05/30. doi: 10.12968/hmed.2006.67.5.21067 16729638

16. United Nations High Commissioner for Refugees (UNHCR). Global Trends. Forced Displacement in 2016. Geneva: United Nations High Commissioner for Refugees (UNHCR), 2017.

17. World Health Organization. Out of conflict, a new life for Syrian health workers in Turkey 2018 [06.12.2018]. http://www.euro.who.int/en/countries/turkey/news/news/2018/3/out-of-conflict,-a-new-life-for-syrian-health-workers-in-turkey.

18. Andrew RF. How do IMGs compare with Canadian medical school graduates in a family practice residency program? Canadian Family Physician. 2010;56(9):e318–22. 20841570

19. Peters V, Braeseke G. Pflegekrafte aus Vietnam. Pflege. 2016;29(6):315–21. Epub 2016/11/17.

20. Atack L, Cruz EV, Maher J, Murphy S. Internationally educated nurses’ experiences with an integrated bridge program. Journal of continuing education in nursing. 2012;43(8):370–8. Epub 2012/06/22. doi: 10.3928/00220124-20120615-62 22715875

21. Hawken S. Overseas-trained doctors’ evaluation of a New Zealand course in professional development. The New Zealand medical journal. 2005;118(1219):U1584. Epub 2005/08/02. 16059405

22. Elis A, Notzer N, Lewinski U, Rapoport MJ. A training course for the Israeli phase I written board examination in internal medicine increases the success rate of foreign graduate physicians. European Journal of Internal Medicine. 2005;16(3):165–9. doi: 10.1016/j.ejim.2004.12.002 15967330

23. Greig A, Dawes D, Murphy S, Parker G, Loveridge B. Program evaluation of a model to integrate internationally educated health professionals into clinical practice. BMC medical education. 2013;13:140. Epub 2013/10/15. doi: 10.1186/1472-6920-13-140 24119470

24. Higgins NS, Taraporewalla K, Edirippulige S, Ware RS, Steyn M, Watson MO. Educational support for specialist international medical graduates in anaesthesia. Medical Journal of Australia. 2013;199(4):272–4. doi: 10.5694/mja12.11639 23984785

25. Lujan J, Little K. Preparing underemployed Latino U.S. nurses through the Mexico NCLEX-RN Success Program. The Journal of nursing education. 2010;49(12):704–7. Epub 2010/10/20. doi: 10.3928/01484834-20100930-03 20954572

26. Parrone J, Sredl D, Miller M, Phillips M, Donaubauer C. An evidence-based teaching/learning strategy for foreign nurses involving the health education systems incorporated examination as a predictor for national council licensure examination for registered nurses success. Teaching & Learning in Nursing. 2008;3(1):35–40.

27. Romem Y, Benor DE. Training immigrant doctors: issues and responses. Medical Education. 1993;27(1):74–82. doi: 10.1111/j.1365-2923.1993.tb00232.x 8433665

28. Kehoe A, McLachlan J, Metcalf J, Forrest S, Carter M, Illing J. Supporting international medical graduates’ transition to their host-country: realist synthesis. Medical Education. 2016;50(10):1015–32. doi: 10.1111/medu.13071 27628719

29. Lineberry M, Osta A, Barnes M, Tas V, Atchon K, Schwartz A. Educational interventions for international medical graduates: a review and agenda. Medical Education. 2015;49(9):863–79. Epub 2015/08/25. doi: 10.1111/medu.12766 26296403

30. Covell CL, Neiterman E, Bourgeault IL. Scoping review about the professional integration of internationally educated health professionals. Human Resources for Health. 2016;14(1):38. doi: 10.1186/s12960-016-0135-6 27316536

31. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS medicine. 2009;6(7):e1000097. Epub 2009/07/22. doi: 10.1371/journal.pmed.1000097 19621072

32. Sackett DL, Straus S, Richardson W, Rosenberg S, Haynes RB. Evidence Based Medicine: How to practice and teach EBM: Churchill Livingstone; 2000.

33. Peters M, Godfrey C, Khalil H, McInerney P, Soares C, Parker D. The Joanna Briggs Institute Reviewers’ Manual 2015: Methodology for JBI scoping reviews. University of Adelaide: The Joanna Briggs Institute, 2017.

34. International Labour Office. International Standard Classification of Occupations (ISCO-08), Geneva: ILO, 2012.

35. Pluye P, Robert E, Cargo M, Bartlett G, O’Cathain A, Griffiths F, et al. Proposal: A mixed methods appraisal tool for systematic mixed studies reviews. 2011. http://mixedmethodsappraisaltoolpublic.pbworks.com.

36. Kirkpatrick DL. Evaluating training programs: The four levels. San Francisco: Berrett-Koehler; 1994.

37. Daniel SL, Annemarie L, Switzer-McIntyre S, Evans C. An innovative program to support internationally educated health professionals and their instructors: role of the clinical practice facilitator. Journal of Continuing Education in the Health Professions. 2016;36(4):269–77. doi: 10.1097/CEH.0000000000000115 28350308

38. Fernández-Peña J. Integrating immigrant health professionals into the US health care workforce: A report from the field. Journal of Immigrant & Minority Health. 2012;14(3):441–8. doi: 10.1007/s10903-011-9496-z 21769614

39. Majumdar B, Keystone JS, Cuttress LA. Cultural sensitivity training among foreign medical graduates. Medical Education. 1999;33(3):177–84. doi: 10.1046/j.1365-2923.1999.00291.x 10211237

40. McGrath P, Henderson D. The observer program: insights from international medical graduates. Education for Health: Change in Learning & Practice (Medknow Publications & Media Pvt Ltd). 2009;22(3):1–10.

41. Sullivan EA, Willcock S, Ardzejewska K, Slaytor EK. A pre-employment programme for overseas-trained doctors entering the Australian workforce, 1997–99. Medical Education. 2002;36(7):614–21. doi: 10.1046/j.1365-2923.2002.01196.x 12109980

42. Wright A, Ryan M, Haigh C, Sunderji I, Vijayakumar P, Smith C, et al. Supporting international medical graduates in rural Australia: a mixed methods evaluation. Rural and Remote Health. 2011;11(4):1–18.

43. Baker D, Robson J. Communication training for international graduates. The clinical teacher. 2012;9(5):325–9. Epub 2012/09/22. doi: 10.1111/j.1743-498X.2012.00555.x 22994473

44. Bruce DL, Brunner EA, Breihan JM, Menges RL. A public speaking course for foreign medical graduates. Anesthesiology. 1974;41(4):480–8.

45. Cheung CR. NHS induction and support programme for overseas-trained doctors. Medical Education. 2011;45(5):531–2. doi: 10.1111/j.1365-2923.2011.03960.x 21486356

46. Gerrish K, Griffith V. Integration of overseas Registered Nurses: evaluation of an adaptation programme. Journal of advanced nursing. 2004;45(6):579–87. Epub 2004/03/12. doi: 10.1046/j.1365-2648.2003.02949.x 15012635

47. Goldszmidt M, Kortas C, Meehan S. Advanced medical communications: support for international residents. Medical Education. 2007;41(5):522. Epub 2007/05/02. doi: 10.1111/j.1365-2929.2007.02751.x

48. Horner M. A review of a supervised practice programme for overseas nurses. Nursing Times. 2004;100(27):38–41. Epub 2004/08/20. 15317262

49. Lax LR, Russell ML, Nelles LJ, Smith CM. Scaffolding knowledge building in a web-based communication and cultural competence program for international medical graduates. Academic Medicine. 2009;84(10 Suppl):S5–8. Epub 2010/01/27. doi: 10.1097/ACM.0b013e3181b37b4d 19907385

50. Ong YL, McFadden G, Gayen A. Induction for overseas qualified doctors. Hospital medicine. 2002;63(9):558–60. Epub 2002/10/03. doi: 10.12968/hosp.2002.63.9.1955 12357862

51. Ong YL, Gayen A. Helping refugee doctors get their first jobs: the pan-London clinical attachment scheme. Hospital medicine. 2003/09/10 ed 2003. p. 488–90. doi: 10.12968/hosp.2003.64.8.2265 12958762

52. Porter JL, Townley T, Huggett K, Warrier R. An acculturization curriculum: orienting international medical graduates to an internal medicine residency program. Teaching and learning in medicine. 2008;20(1):37–43. Epub 2008/04/30. doi: 10.1080/10401330701542644 18444184

53. Stenerson H, Davis PM, Labash AM, Procyshyn M. Orientation of international medical graduates to Canadian medical practice. The Journal of Continuing Higher Education. 2009;57(1):29–34. doi: 10.1080/07377360902804051

54. Watt D, Violato C, Lake D, Baig L. Effectiveness of a clinically relevant educational program for improving medical communication and clinical skills of international medical graduates. Canadian medical education journal. 2010;1(2):11. Epub 2010-07-07.

55. Christie J, Pryor E, Paull AM. Presenting under pressure: communication and international medical graduates. Medical Education. 2011;45(5):532. Epub 2011/04/14. doi: 10.1111/j.1365-2923.2011.03955.x 21486357

56. Butschek S, Walter T. What active labour market programmes work for immigrants in Europe? A meta-analysis of the evaluation literature. IZA Journal of Migration. 2014;3(1):48. doi: 10.1186/s40176-014-0023-6

57. Yu X. Transitioning international nurses: an outlined evidence-based program for acute care settings. Policy, politics & nursing practice. 2010;11(3):202–13. Epub 2010/12/17. doi: 10.1177/1527154410384879 21159717

58. Garcia-Ramirez M, Martinez MF, Balcazar FE, Suarez-Balcazar Y, Albar MJ, Domínguez E, et al. Psychosocial empowerment and social support factors associated with the employment status of immigrant welfare recipients. Journal of Community Psychology. 2005;33(6):673–90. doi: 10.1002/jcop.20072

59. Kalra G, Bhugra DK, Shah N. Identifying and addressing stresses in international medical graduates. Academic Psychiatry. 2012;36(4):323–9. doi: 10.1176/appi.ap.11040085 22851031

60. Hollifield M, Warner TD, Lian N, Krakow B, Jenkins JH, Kesler J, et al. Measuring trauma and health status in refugees: a critical review. Journal of the American Medical Association. 2002;288(5):611–21. Epub 2002/08/02. doi: 10.1001/jama.288.5.611 12150673

61. Eva KW. Assessing Tutorial-Based Assessment. Advances in Health Sciences Education. 2001;6(3):243–57. doi: 10.1023/a:1012743830638 11709638

62. Eurofound. Approaches to the labour market integration of refugees and asylum seekers. Luxembourg: Publications Office of the European Union, 2016. https://www.eurofound.europa.eu/sites/default/files/ef_publication/field_ef_document/ef1646en.pdf.

63. Bertelsmann-Stiftung. From refugees to workers: Mapping labour-market integration support measures for asylum seekers and refugees in EU member states. Gütersloh: 2016. https://www.bertelsmannstiftung.de/fileadmin/files/user_upload/Studie_NW_From_Refugees_to_Workers_Vol1.pdf.


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2019 Číslo 11