Mental health services in Luxembourg: an overview

We describe mental health services in Luxembourg and how they have evolved over the past 50 years. Health services in Luxembourg are provided through a social health insurance-based system and mental health services are no exception. Additional services are offered through mixed-funding avenues drawing on social care budgets in the main. Luxembourg is closely connected with neighbouring countries, where a large proportion of its workforce live. No run-through medical training exists and the entire medical workforce, including psychiatrists, have trained in other countries. This is reflected in a rich but often non-uniform approach to the provision of psychiatric care.

The Physician Assistant/associate Medical Workforce: 2020-2035

Background: Physician assistant/associates (PAs) are health care professionals whose roles expand universal access to a broad range of people across many nations. In the US, there is a growing shortage of physicians. PAs and advanced practice registered nurses (APRNs) were developed to help span medical providers' supply and demand gap. A forecasting project was undertaken to predict the likely census of PAs in the medical workforce spanning 2020 to 2035. Methods: Microsimulation modeling of the American PA workforce was performed using standard stock and flow format. The number of clinically active PAs employed in 2020 formed the baseline. Graduation rates and PA program expansion were factored as critical parameters to predict annual growth; attrition estimates balanced the equation. Two models, one based on data from the Bureau of Labor Statistics (BLS) and another based on data from the National Commission on Certification of Physician Assistants (NCCPA), were analyzed to estimate future annual PA numbers. Results: As of 2020, the BLS estimated 125,280 PAs were employed in the medical workforce; the NCCPA estimate was 148,560 PA in active practice. The mean age was 40, and 76% were female. The Accreditation Review Commission accredited 277 PA education programs for the Physician Assistant (ARC-PA), and 99% had a graduating class. The mean annual graduation cohort was 45. The BLS model predicted approximately 204,243 clinically active PAs by 2035; the NCCPA-based model predicted 211,537 PAs in clinical practice. Conclusions: A physician assistant/associate predictive model based on two data sources projects the supply of PAs by 2035 between 204,000 and 212,000: a growth rate of ± 35% (3.5% model differences). If the most likely scenario is realized, the 15-year growth of the PA will help improve the gap in the supply and demand of American medical service.

Strategies to Facilitate Improved Recruitment, Development, and Retention of the Rural and Remote Medical Workforce: A Scoping Review

Background: Medical workforce shortages in rural and remote areas are a global issue. High-income countries (HICs) and low- and middle-income countries (LMICs) seek to implement strategies to address this problem, regardless of local challenges and contexts. This study distilled strategies with positive outcomes and success from international peer-reviewed literature regarding recruitment, retention, and rural and remote medical workforce development in HICs and LMICs. Methods: The Arksey and O’Malley scoping review framework was utilised. Articles were retrieved from electronic databases Medline, Embase, Global Health, CINAHL Plus, and PubMed from 2010-2020. PRISMA-P guideline was used to ensure rigour in reporting the methodology in the interim, and PRISMA extension for scoping review (PRISMA-ScR) was used as a guide to report the findings. The success of strategies was examined against the following outcomes: for recruitment - rural and remote practice location; for development -personal and professional development; and for retention - continuity in rural and remote practice and low turnover rates. Results: Sixty-one studies were included according to the restriction criteria. Most studies (n=53; 87%) were undertaken in high-income countries, with only eight studies from low and middle-income countries. This scoping review found implementation strategies classified as Educational, Financial, and Multidimensional were successful for recruitment, retention, and development of the rural and remote medical workforce. Conclusion: This scoping review shows that effective strategies to recruit and retain rural and remote medical workforce are feasible worldwide despite differences in socio-economic factors. While adjustment and adaptation to match the strategies to the local context are required, the country's commitment to act to improve the rural medical workforce shortage is most critical.

Vulnerable Medical Student Ecosystems: Transdisciplinary Learning Sciences Interventions, Maximizing Student Learning and Promoting Mental Health

Medical students (MS), as a focus of investigation, are usually the last group that would be considered as suffering from mental health issues. However, the literature shows otherwise; MS suffer debilitating anxiety and depression which worsen with the progression of their studies. The literature also highlights the medical school curriculum as a significant cause of the elevated stress, anxiety, and depression levels within the MS population. This article explores the vulnerable nature of MS by focusing on the nature of the medical school’s hidden curriculum and culture, highlighting its impact on the entire medical education ecosystem and the MS. This article, then, investigates the three dominant epistemological belief frames in medical school which impact the vulnerable nature of MS. Finally, this article presents potential interventions, targeting the need for cultural change that may contribute to the creation of a more compassionate learning ecosystem to build the MS’ mental resilience in medical school and create a stronger medical workforce.

A qualitative exploration of medical students’ placement experiences with telehealth during COVID-19 and recommendations to prepare our future medical workforce

Background Clinical practice is increasingly being digitalised. Little is known about how medical students learn and were exposed to telehealth during COVID-19. This is particularly important if we wish to further improve healthcare access and equity in rural areas and vulnerable populations. This formative study sought to explore the exposure and attitudes of medical students on telehealth and COVID-19 during their rural clinical placement in 2020 and provide recommendations. Methods Focus groups were held in August 2020 after completion of a 12-month rural placement. Questions centred around students’ exposure and experiences with telehealth during COVID-19. Data was analysed using thematic analysis. Results There has been a clear shift in students now acknowledging the importance of telehealth and, more importantly, expressing a clear wish for telehealth to be embedded in the curriculum starting in their first year. In tandem with this, students expressed the need for their clinical supervisors or hospital teams to have the capability to practice telehealth efficiently as this will improve the telehealth experience and lead to better engagement for both staff and students. Furthermore, it was felt that rural clinicians should play a lead role in telehealth implementation given it is integral to rural practice. Conclusions Medical students are more exposed to and more interested to learn about telehealth since COVID-19 and wish to see telehealth training built into their curriculum from the outset of medical school. Themes that emerged from this formative study can potentially assist in planning for telehealth education during and post COVID-19 and inform further telehealth research. Embedding telehealth skills training and guidelines into the medical program, and particularly rural medicine training programs, is essential to prepare the future medical workforce to ensure access and quality patient care during pandemics and also to improve access for rural Australians.

Gender-Based Analysis of the Psychological Impact of the COVID-19 Pandemic on Healthcare Workers in Spain

Purpose: This study aims to analyze from a gender perspective the psychological distress experienced by the medical workforce during the peak of the pandemic in Spain.Methods: This is a single-center, observational analytic study. The study population comprised all associated health workers of the Cruces University Hospital, invited by email to participate in the survey. It consisted of a form covering demographic data, the general health questionnaire-28 (GHQ-28), and the perceived stress scale (PSS-14). We used multivariant regression analysis to check the effect of gender on the scores. We used gender analysis in both design and interpretation of data following SAGER guidelines.Results: Females made 74.6% of our sample, but their proportion was higher in lower-paid positions such as nursery (89.9%) than in higher-paid ones. The percentage of women categorized as cases with the GHQ-28 was 78.4%, a proportion significantly higher than in the male population (61.3%, p < 0.001). The multivariant regression analysis showed that being women, working as orderly hospital porters, and having a past psychiatric history were risk factors for higher scores in both the GHQ-28 and PSS-14.Conclusion: Women and those with lower-paid positions were at risk of higher psychological distress and worse quality of life within the medical workforce during the first wave of the pandemic. Gender analysis must be incorporated to analyze this fact better.