Sarcomatous tumor of the right ovary, removed by laparotomy in the gynecological department at the Mogilev obstetric institution

Unfortunately, we do not yet have accurate statistics of malignant neoplasms of the ovaries. Virkhov, for example, of the opinion that they are quite rare. In Schroeder's 600 cases of neoplasms of the ovaries, there are only 10 cases of malignant, consequently somewhat more than 1%. Wert in relation to ovarian cysts determines the frequency of dense neoplasms in 5%. Spencer Wells initially rose 1.72%, followed by even less 1.2%. Leopold), from a more distant time, there are only 8 cases of malignant neoplasms of the ovaries: 4 cases of Spencer Wlls, of which two were fatal, two cases of Spiegelberg, both were fatal, one case of Buren and one recovered a rural doctor whose patient died of a collapse shortly after the operation. Even if we assume that cases of malignant neoplasms of the ovaries are quite rare, then all the same, judging by the latest reports, it cannot be argued that this rarity would be in such a scale as the authors just cited for a longer time estimate it.

Retention of physicians and surgeons in rural areas—what works?

Background Causes for health inequity among rural populations globally are multifactorial, and include poorer access to healthcare professionals. This study summarizes the recent literature identifying factors that influence rural doctor retention and analyses strategies implemented to increase retention. Uniquely, this study addresses the importance of context in the planning, implementation and success of these strategies, drawing on literature from high-, middle- and low-income countries. Methods A systematic review of the English literature was conducted in two parts. The first identified factors contributing to rural doctor retention, yielding 28 studies (2015–2019). The second identified 19 studies up to 2019 that assessed the outcomes of implemented rural retention strategies. Results Universal retention factors for health professionals in a rural environment include rural background, positive rural exposure in training or in the early postgraduate years and personal and professional support. Financial incentives were less influential on retention, but results were inconsistent between studies and differed between high-, middle- and low-income nations. Successful strategies included student selection from rural backgrounds into medical school and undergraduate education programs and early postgraduate training in a rural environment. Bundled or multifaceted interventions may be more effective than single factor interventions. Conclusion Rural health workforce retention strategies need to be multifaceted and context specific, and cannot be effective without considering the practitioner’s social context and the influence of their family in their decision making. Adequate rural health facilities, living conditions, work-life balance and family, community and professional support systems will maximize the success of implemented strategies and ensure sustainability and continuity of healthcare workforce in rural environments.

Training Pathways to Working as a General Practitioner in China

Background and Objectives: To achieve the goal of 300,000 general practitioners by 2020—an increase of 215,200 in a decade—China is utilizing multiple training pathways. To comprehensively illustrate general practitioner training strategies in China, this article introduces and describes these pathways. Methods: We used descriptive policy analysis. This involved taking an inventory of existing literature and source documents and developing a model to illustrate pathways for training general practice physicians. Results: The rural doctor pathway represents rural clinicians who had only basic training and practiced multiple years prior to training reforms. The 3+2 pathway to assistant general practitioners requires 3 years of junior college and 2 years of clinical training. The transfer pathway for current physicians requires 1-2 years of training. The 5+3 pathway comprises 5 years of bachelor of science degree training in clinical medicine and 3 years of standardized residency training. Despite the development of advanced degree programs, their use remains limited. Conclusions: These pathways illustrate significant heterogeneity in training of general practitioners. Training ranges from a 2-year technical degree to a doctorate with research. Emphasis on the 5+3 track shows promise for China’s goals of improved quality and new goal of 500,000 additional general practitioners by 2030.

Memorias de un médico en el Protectorado español de Marruecos a mediados del siglo XX

En este trabajo el doctor Pere Miret Cuadras narra sus vivencias como médico rural en varias cabilas del Protectorado Español en Marruecos, casi todas en el ámbito rural. Su experiencia personal permite abordar el estado de la sanidad y la medicina entre los años 1954 y 1958 en los destinos de Beni Ahamed, el Telata de Ketama, Jemis de Anyera y Tetuán. La vocación profesional del profesional médico tenía que hacer frente a múltiples dificultades de toda índole, caso de la lucha contra enfermedades endémicas como la sífilis, el paludismo, la lepra, y otras dolencias contra las que la Administración luchaba con medios reducidos y muchas veces contra hábitos sociales y culturales que no ayudaban a la erradicación de las enfermedades.In this work, doctor Pere Miret Cuadras narrates his experiences as a rural doctor in several kabyle of the Spanish Protectorate in Morocco, almost entirely within the rural area. His personal experience allow us to understand the condition of health and medicine between the years 1954 and 1958 in the destinations of Beni Ahamed el Telata de Ketama, Jemis de Anyera and Tetuan. The professional vocation of the medical professional had to face multiple difficulties of any nature, For example; the fight against endemic diseases such as syphilis, malaria, leprosy, and many other diseases, which the administration had to deal with limited resources, and more often than not against social and cultural habits that did not help to the eradication of diseases.

Student perspectives on the value of rural electives

Background: Medical students in the Faculty of Health Sciences at the University of the Witwatersrand (Wits) in Johannesburg have the opportunity to do electives at the end of the first and third years of a four-year graduate-entry medical programme. Upon their return they are required to write a short portfolio report. Over the period 2005 to 2011, 402 students chose to do rural electives.Aim and setting: To understand the value of rural electives from the perspective of medical students in the Faculty of Health Sciences at Wits, as derived from their assessment reports.Methods: A review was conducted of 402 elective reports. Common themes were identified through repeated reading of the reports, and then content analysis was undertaken using these themes.Results: Major themes identified were the reasons for choosing a rural facility for the elective, including going to a home community; benefits of the elective, especially in terms of clinical skills and personal growth; relationship issues; the multiple roles of the rural doctor, who is often a role model working in difficult conditions; and the challenges of rural electives.Conclusion: The electives were overwhelmingly positive and affirming experiences for students, who developed clinical skills and also learnt about both themselves and their chosen career.

Pedagogy Rules: Open Mindset in Adopting Fit-for-Purpose Educational Tools in Teaching Dispersed Medical Students

Students in the Rural Clinical School of Western Australia (RCSWA) spend one year of clinical study learning in small groups while embedded in rural or remote communities. This aims to increase the locally trained rural medical workforce. Their learning environment, the clinical context of their learning, and their rural doctor-teachers all contrast with the more traditional learning setting in city hospitals. The RCSWA has succeeded in its outcomes for students and in rural medical workforce impact; it has grown from 4 pilot sites to 14 in 12 years. This reflective piece assimilates observations of the formation of the RCSWA pedagogy and of the strategic alignment of education technologies with learning environment and pedagogy over a seven-year period. Internal and external influences, driving change in the RCSWA, were considered from three observer perspectives in a naturalistic setting. Flexibility in both education technologies and organizational governance enabled education management to actively follow pedagogy. Peter Senge's learning organization (LO) theory was overlaid on the strategies for change response in the RCSWA; these aligned with those of known LOs as well with LO disciplines and the archetypal systems thinking. We contend that the successful RCSWA paradigm is that of an LO.