Challenges for implementing WFME standards for accreditation in health professions education in low and middle-income countries: a scoping review

2020 ◽  
pp. 1-30
Author(s):  
Aisha Rafi ◽  
Muhammad Idrees Anwar ◽  
Admin
Keyword(s):  
Medical Education ◽  
Scoping Review ◽  
Health Professions ◽  
Health Professions Education ◽  
Evidence Based ◽  
Inclusion Criteria ◽  
Middle Income ◽  
Middle Income Countries ◽  
Accreditation Standards

Abstract The accreditation standards developed by WFME are acknowledged as regulatory mechanism for quality assurance of medical education programs. The scoping review aims to collect all the published and unpublished evidence based on the inclusion criteria, to identify the barriers affecting the implementation of quality curriculum defined by WFME. It summarizes and presents the evidence-based challenges faced by middle and low income countries for accreditation process. The literature was searched using search terms, `challenges of WFME accreditation’, `barriers to accreditation’, `challenges to accreditation in health care system’, `hindrances to WFME accreditation standards’, `barriers to WFME standards’, in PubMed, ERIC, PsycINFO databases and Google scholar (for grey literature) to find the evidence published within last 10 years. This search strategy retrieved 922 publications and only 19 articles fulfill the inclusion criteria. A All those studies, which address the barriers or challenges to implementation of accreditation standards in medical education, were included. The inhibitors to implementation of curriculum in course other than medical education were excluded from the study. The included studies address the barriers to nine areas of WFME standards. The data was charted and QualSyst appraisal tool was used to appraise the quality of studies included in review. The eligibility of selected articles was carried out by using the validated QualSyst checklist to assess the quality of included studies.  The scoping review will inform and lay the foundation for more empirical studies on quality improvement in health professions education particularly in low and middle-income countries. Keywords: Challenges of accreditation,

Abstract P681: Implementation of Stroke Prevention Interventions in Low- and Middle-Income Countries: A Scoping Review

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Nessa Ryan ◽  
Vida Rebello ◽  
Desiree Gutierrez ◽  
Kameko Washburn ◽  
Alvaro Zevallos Barboza ◽  
...  
Keyword(s):  
Scoping Review ◽  
Stroke Prevention ◽  
Health Workers ◽  
Evidence Based ◽  
Community Based Interventions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Implementation Outcomes ◽  
Prevention Interventions ◽  
Low And Middle Income

Background: Stroke is the second leading cause of death globally and an increasing concern in low- and middle-income countries (LMIC) where, due to limited capacity to treat stroke, preventative efforts are critically important. Although some research on evidence-based interventions for stroke prevention in LMIC exists, there remains a significant gap in understanding of their implementation across various contexts in LMIC. Objectives: In this scoping review, our objective was to identify and synthesize the implementation outcomes (using Proctor et al.’s taxonomy, 2011) for stroke prevention interventions, as well as to describe the diverse interventions employed. Methods: Eligible studies were empirical, focused on implementation of stroke prevention programs or policies, and occurred in at least one LMIC. Five databases were searched, including PubMed, PsycINFO, CINAHL, EMBASE, and Web of Science. Two reviewers independently assessed studies for selection and charted data; discrepancies were resolved through discussion with a third reviewer until consensus was reached. Narrative synthesis was used to analyze and interpret the findings. Results: Studies were predominantly focused in Asia, targeting primary or secondary prevention, and facility-based. Interventions were conducted at the level of individual (n=11), system (n=12), or both (n=4). Various implementation outcomes were reported, most commonly cost (n=10), acceptability (n=7), fidelity (n=7), and feasibility (n=6), but also adoption (n=4), penetration (n=3), appropriateness (n=1), and sustainability (n=1). Conclusions: Findings highlight the breadth of evidence-based interventions for stroke prevention available to implement in LMIC settings, including culturally acceptable education interventions, cost-effective medications, and community-based interventions implemented by community health workers. Implementation outcomes remain under-reported, and more rigorous research is needed to better plan and evaluate the implementation of these interventions to prevent stroke.

scholarly journals Reforming medical education admission and training in low- and middle-income countries: who gets admitted and why it matters

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Katherine Tumlinson ◽  
Dilshad Jaff ◽  
Barbara Stilwell ◽  
Dickens Otieno Onyango ◽  
Kenneth L. Leonard
Keyword(s):  
Medical Education ◽  
Intrinsic Motivation ◽  
Healthcare Providers ◽  
Extrinsic Factors ◽  
Middle Income ◽  
Negative Behaviors ◽  
Middle Income Countries ◽  
And Training ◽  
Low And Middle Income

AbstractRecent studies reveal public-sector healthcare providers in low- and middle-income countries (LMICs) are frequently absent from work, solicit informal payments for service delivery, and engage in disrespectful or abusive treatment of patients. While extrinsic factors may foster and facilitate these negative practices, it is not often feasible to alter the external environment in low-resource settings. In contrast, healthcare professionals with strong intrinsic motivation and a desire to serve the needs of their community are less likely to engage in these negative behaviors and may draw upon internal incentives to deliver a high quality of care. Reforming medical education admission and training practices in LMICs is one promising strategy for increasing the prevalence of medical professionals with strong intrinsic motivation.

scholarly journals Scoping review of acute stroke care management and rehabilitation in low and middle-income countries

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
George Lameck Chimatiro ◽  
Anthea J. Rhoda
Keyword(s):  
Developing Countries ◽  
Scoping Review ◽  
Stroke Care ◽  
Middle Income ◽  
Middle Income Countries ◽  
Care Processes ◽  
Care Structure ◽  
Care Outcomes ◽  
Low And Middle Income

Abstract Background Stroke is a major public health concern, affecting millions of people worldwide. Care of the condition however, remain inconsistent in developing countries. The purpose of this scoping review was to document evidence of stroke care and service delivery in low and middle-income countries to better inform development of a context-fit stroke model of care. Methods An interpretative scoping literature review based on Arksey and O’Malley’s five-stage-process was executed. The following databases searched for literature published between 2010 and 2017; Cochrane Library, Credo Reference, Health Source: Nursing/Academic Edition, Science Direct, BioMed Central, Cumulative Index to Nursing and Allied Health Literature (CINNAHL), Academic Search Complete, and Google Scholar. Single combined search terms included acute stroke, stroke care, stroke rehabilitation, developing countries, low and middle-income countries. Results A total of 177 references were identified. Twenty of them, published between 2010 and 2017, were included in the review. Applying the Donebedian Model of quality of care, seven dimensions of stroke-care structure, six dimensions of stroke care processes, and six dimensions of stroke care outcomes were identified. Structure of stroke care included availability of a stroke unit, an accident and emergency department, a multidisciplinary team, stroke specialists, neuroimaging, medication, and health care policies. Stroke care processes that emerged were assessment and diagnosis, referrals, intravenous thrombolysis, rehabilitation, and primary and secondary prevention strategies. Stroke-care outcomes included quality of stroke-care practice, functional independence level, length of stay, mortality, living at home, and institutionalization. Conclusions There is lack of uniformity in the way stroke care is advanced in low and middle-income countries. This is reflected in the unsatisfactory stroke care structure, processes, and outcomes. There is a need for stroke care settings to adopt quality improvement strategies. Health ministry and governments need to decisively face stroke burden by setting policies that advance improved care of patients with stroke. Stroke Units and Recombinant Tissue Plasminogen Activator (rtPA) administration could be considered as both a structural and process necessity towards improvement of outcomes of patients with stroke in the LMICs.

scholarly journals Learning styles and the myths surrounding it: a systematic scoping review of the literature.

2021 ◽  
Author(s):  
Lucas de Mendonça ◽  
Regis Rodrigues Vieira ◽  
Michel Silvio Duailibi
Keyword(s):  
Medical Education ◽  
Learning Style ◽  
Cognitive Processing ◽  
Scoping Review ◽  
Postgraduate Medical Education ◽  
Inclusion Criteria ◽  
Theoretical Assumption ◽  
Cross Sectional ◽  
Searching Strategy

Abstract Background: Learning style (LS) is the theoretical assumption that each individual has a better form for cognitive processing throughout learning. In medical education, LS has been studied as a tool to optimize medical learning. Teaching in the postgraduate medical environment embraces specific methodological aspects for mastering medical abilities and LS inventories have been widely used for enhance learning. However, no review has been done on this subject until this date. Therefore, a scoping review was performed to explore the extent of evidence on LS and postgraduate medical education. Methods: a systematic scoping review was performed according to PRISMA - ScR and JBI guidelines. We searched MEDLINE, ERIC, LILACS and SCIELO virtual library on February 2020. A peer review was performed with blinding of both investigators and any divergence was resolved by consensus. Searching strategy, search terms, exclusion and inclusion criteria and data charting were structured prior to the beginning of the study. Data was summarized and collated. Analysis of the quality of the evidence was also performed using specific tools.Results: 211 studies were obtained with the search engine after duplicates were removed. Of these, 40 were selected after applying exclusion and inclusion criteria. Two other studies were excluded post initial screening. The majority of studies were from United States. General surgery, internal medicine and family medicine were the specialties that had most studies on LS. Kolb LSI was the most used LS inventory. The majority of studies were observational with a cross sectional design (34 out of 38). Only four studies were RCTs with a low quality of evidence and a high risk of bias. It was also seen that LS may change through training, with work-hours and areas of specialty training.Conclusion: There is a lack of high quality studies to provide reliable evidence for the utilization of LS in postgraduate medical education and it is desirable for more Cohort or Randomized Control Trials in this area for a more robust evidence.

scholarly journals Lung cancer awareness and palliative care interventions implemented in low-and middle-income countries: a scoping review

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ugochinyere I. Nwagbara ◽  
Themba G. Ginindza ◽  
Khumbulani W. Hlongwana
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Scoping Review ◽  
Methodological Quality ◽  
Signs And Symptoms ◽  
Warning Signs ◽  
Cancer Awareness ◽  
Middle Income ◽  
Middle Income Countries

Abstract Background Lung cancer is the most diagnosed cancer worldwide. In low- and middle-income countries (LMICs), lung cancer is often diagnosed at a late stage due to poor knowledge and awareness of its signs and symptoms. Increasing lung cancer awareness is likely to reduce the diagnosis and treatment delays. The implementation of early palliative care has also been reported to improve a patient’s quality of life, and even survival. The aim of this scoping review was to map evidence on lung cancer awareness and palliative care interventions implemented in sub-Saharan Africa (SSA) and other LMICs. Methods This scoping review was guided by Arksey and O’Malley’s framework. Databases such as the EBSCOhost, PubMed, Science Direct, Google Scholar, World Health Organization (WHO) library and grey literature were used to perform systematic searches of relevant articles. The methodological quality assessment of included primary studies was assessed using the Mixed Method Appraisal Tool (MMAT). NVivo version 10 software was used to perform the thematic content analysis of the included studies. Results A total number of screened articles was 2886, with 236 meeting the eligibility criteria and 167 further excluded following abstract screening. Sixty-nine (69) articles qualified for full-article screening and 9 were selected for detailed data extraction and methodological quality assessment. Of the included nine studies, eight described at least one lung cancer warning signs and symptoms, while one described the effectiveness of palliative care for lung cancer. Eight articles recognized the level of lung cancer knowledge, risk factors awareness of warning signs and symptoms in LMICs, mostly Africa and Asia. Conclusions Most of the participants were aware of tobacco use as the major risk factor for lung cancer but lacked knowledge on the other pre-disposing risk factors. Evidence on palliative care is scarce, therefore, awareness interventions packaged with evidence on the value of timely access to palliative care services in improving the quality of life of the lung cancer patients and their families, are required.

scholarly journals Virtue and Care Ethics & Humanism in Medical Education: A Scoping Review

2021 ◽  
Author(s):  
David J. Doukas ◽  
David T. Ozar ◽  
Martina Darragh ◽  
Janet M. de Groot ◽  
Brian S. Carter ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Education ◽  
Virtue Ethics ◽  
Scoping Review ◽  
Care Ethics ◽  
Health Professions ◽  
Health Professions Education ◽  
Exclusion Criteria ◽  
Health Ethics ◽  
English Articles

Abstract PURPOSE:This scoping review explores how virtue and care ethics are incorporated into health professions education and how these factors may relate to the development of humanistic patient care.METHOD:Our team identified citations in the literature emphasizing virtue ethics and care ethics (in PubMed, NLM Catalog, WorldCat, EthicsShare, EthxWeb, Globethics.net, Philosopher’s Index, and ProQuest Central) lending themselves to constructs of humanism curricula. Our exclusion criteria consisted of non-English articles, those not addressing virtue and care ethics and humanism in medical pedagogy, and those not addressing aspects of character in health ethics. We examined in a stepwise fashion whether citations: 1) Contained definitions of virtue and care ethics; 2) Implemented virtue and care ethics in health care curricula; and 3) Evidenced patient-directed caregiver humanism.RESULTS: 811 citations were identified, 88 intensively reviewed, and the final 25 analyzed in-depth. We identified multiple key themes with relevant metaphors associated with virtue/care ethics, curricula, and humanism education.CONCLUSIONS:This research sought to better understand how virtue and care ethics can potentially promote humanism and identified themes that facilitate and impede this mission.

A scoping review of oncology medical education interventions in low and middle income countries.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e23004-e23004
Author(s):  
Safiya Karim ◽  
Zahra Sunderji ◽  
Matthew Jalink ◽  
Sahar Mohamed ◽  
Nazik Hammad ◽  
...  
Keyword(s):  
Medical Education ◽  
Scoping Review ◽  
Middle Income ◽  
Middle Income Countries ◽  
Medical Education And Training ◽  
Incidence And Mortality ◽  
E Learning ◽  
Education Interventions ◽  
Low And Middle Income ◽  
Education Initiatives

e23004 Background: A large proportion of the global cancer burden occurs in low and middle income countries (LMICs). One of the significant barriers to adequate cancer control is the lack of an adequately trained oncology workforce. Medical education and training initiatives in oncology are necessary to tackle growing cancer incidence and mortality rates. We performed a scoping review of oncology medical education interventions in LMICs to understand the strategies used to train the global oncology workforce. Methods: We searched OVID MEDLINE and EMBASE databases between January 1, 1995 and March 4, 2020 using a standardized scoping review framework. Articles were eligible if they described an oncology medical education intervention within an LMIC with clear outcomes. Articles were classified based on the target population, the level of medical education, form of collaboration with another institution and if there was an e-learning component to the intervention. Results: Of the 806 articles screened, 25 met criteria and were eligible for analysis. The Middle East/Africa was the most common geographic area of the educational initiative (N=14/25). The majority of interventions were targeted towards physicians (n=15/25) and focused on continuing medical education (n=22/25). Twelve articles described the use of e-learning as part of the intervention. Twenty four articles described some form of collaboration, most commonly with an institution from a high-income country. Language barriers, technology, and lack of physical infrastructure and resources in the LMIC were the most common challenges described. The majority of the initiatives were funded through grants or charitable donations. Conclusions: There is a paucity of published interventions of oncology medical education initiatives in LMICs. Continued medical education initiatives and those targeted towards physicians are most common. There is a lack of collaboration between LMICs in these interventions. Further interventions are needed earlier during medical training and for non-physicians. In addition, increased use of e-learning interventions may overcome certain identified challenges. Encouragement of locally funded initiatives as well as scholarly evaluation and publication of these initiatives are important to improve cancer care in LMICs.

Abstract P723: Adaptation of Stroke Prevention Interventions for Low- and Middle-Income Countries: A Scoping Review

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Nessa Ryan ◽  
Kameko Washburn ◽  
Vida Rebello ◽  
Desiree Gutierrez ◽  
Hector Perez ◽  
...  
Keyword(s):  
Scoping Review ◽  
Stroke Prevention ◽  
Health Workers ◽  
Evidence Based ◽  
Two Phase ◽  
Middle Income ◽  
Risk Factor Modification ◽  
Middle Income Countries ◽  
Prevention Interventions ◽  
Low And Middle Income

Introduction: Stroke is a leading cause of mortality globally, with 85% of stroke death occurring in low- and middle-income countries (LMICs). Translation of evidence-based stroke prevention interventions from their original setting to the novel context in which they will be implemented is often unreported; especially in LMICs where it has been severely understudied. Thus, our objective was to investigate how adaptation has been examined within research on stroke prevention interventions in LMICs through a scoping review of the available literature in order to highlight benefits and best-practices, identify gaps, and develop a greater understanding of these efforts that will ultimately support attempts to address the global burden of stroke. Methods: This review was conducted in accordance with PRISMA-ScR guidelines. Five databases were searched (PubMed, PsycINFO, CINAHL, EMBASE, and Web of Science), for eligible studies using a search strategy developed in consultation with a research librarian. Two reviewers independently assessed the retrieved articles for selection based on the inclusion criteria (peer-reviewed empirical papers or protocols, reported on adaptation of stroke prevention interventions, and occurred in at least one LMIC) through a two phase process consisting of (1) title and abstract screening and (2) full-text screening. Discrepancies were resolved through discussion until consensus was reached. Data were charted and a narrative synthesis, guided by the FRAME framework, was used to analyze and interpret the findings. Results: Of 380 articles retrieved, a total of six articles reporting adaptation of primary (n=4) or secondary (n=2) stroke prevention interventions in LMICs were identified. Types of interventions included use of community health workers (n = 2), use of mHealth tools (n=2), and interventions aimed at risk factor modification (n = 2). Adaptations were proactively planned, with multiple adaptation goals reported. Conclusions: This is the first review of its kind to focus on adaptation of evidence-based stroke prevention interventions in LMICs. Through our systematic investigation, we highlight the need for additional research to assess the processes and outcomes of stroke prevention interventions.

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