Nancy Maroun

Post-graduation migration intentions of students of Lebanese medical schools: a survey study

BackgroundThe international migration of physicians is a global public health problem. Lebanon is a source country with the highest emigration factor in the Middle East and North Africa and the 7th highest in the World. Given that residency training abroad is a critical step in the migration of physicians, the objective of this study was to survey students of Lebanese medical schools about their intentions to train abroad and their post training plans.MethodsOur target population consisted of all students of Lebanese medical schools in the pre-final and final years of medical school. We developed the survey questionnaire based on the results of a qualitative study assessing the intentions and motives for students of Lebanese medical schools to train abroad. The questionnaire inquired about students demographic and educational characteristics, intention to train abroad, the chosen country of abroad training, and post-training intention of returning to Lebanon.ResultsOf 576 eligible students, 425 participated (73.8% response rate). 406 (95.5%) respondents intended to travel abroad either for specialty training (330 (77.6%)) or subspecialty training (76 (17.9%)). Intention to train abroad was associated with being single compared with being married. The top 4 destination countries were the US (301(74.1%)), France (49 (12.1%)), the United Kingdom (31 (7.6%)) and Canada (17 (4.2%)). One hundred and two (25.1%) respondents intended to return to Lebanon directly after finishing training abroad; 259 (63.8%) intended to return to Lebanon after working abroad temporarily for a varying number or years; 43 (10.6%) intended to never return to Lebanon. The intention to stay indefinitely abroad was associated male sex and having a 2nd citizenship. It was inversely associated with being a student of one of the French affiliated medical schools and a plan to train in a surgical specialty.ConclusionAn alarming percentage of students of Lebanese medical schools intend to migrate for post graduate training, mainly to the US. A minority intends to return directly to Lebanon after finishing training abroad.

EBM user and practitioner models for graduate medical education: what do residents prefer?

The objective of the study reported in this article was to assess and explain medical residents’ preferences for the evidence based medicine (EBM) practitioner versus the EBM user models. A self-administered survey and focus group of residents attending a core curriculum EBM master session were undertaken. Most residents, particularly those earlier in their training, preferred the practitioner model. Residents perceived that model as an opportunity to gain advanced EBM skills during residency, as providing the ability to choose practicing under both models, and as offering the gain of independent thinking and greater self-confidence in their critical appraisal skills. The user model had the advantage of reduced time requirements. In sum, the majority of residents preferred a curriculum that focuses on the practitioner over the user model.

A survey of internal medicine residents and faculty about the duration of attendings’ inpatient rotations

AbstractOBJECTIVE: Some training programs are shortening the duration of attendings’ rotations from 4 weeks to 2 weeks. Our objective was to determine the effect of 2-week inpatient rotation on self-reported impact on medical education, patient care practices, and faculty performance by internal medicine residents and teaching faculty. DESIGN: Cross-sectional study using an anonymous mailed and emailed survey. SETTING: University-based internal medicine residency program in Buffalo, New York that recently introduced 2-week rotations. PARTICIPANTS: One hundred nineteen residents (99 responded, 83%) and 83 teaching faculty (76 responded, 92%). MEASUREMENTS: Perceived impact on medical education, patient care, and attending performance on 7-point Likert scales ranging from negative (−3) across neutral (0) to positive (+3) ratings. RESULTS: In general, residents and attendings felt that the short rotation negatively affects the attending’s ability to evaluate residents and some aspects of patient care, but that it has no negative impact on residents’ or medical students’ learning. Attendings thought the 2-week rotation positively affects their private life and overall productivity. Subgroup analysis indicated that residents who graduated from U.S. medical schools were more pessimistic about the 2-week rotation compared to their international counterparts. Attendings who had completed at least one short rotation had consistently higher ratings of the 2-week rotation. CONCLUSION: Residents and attendings’ perceptions suggest that the shorter attending inpatient rotation might have negative impact on medical education and patient care but positive effects on the attending’s work productivity and private life. This tradeoff requires further evaluation including objective medical education and patient care outcomes.

Willingness of Lebanese physicians in the United States to relocate to Lebanon

BackgroundWe recently proposed that Lebanon could become a regional ‘academic hub’ through the repatriation of emigrated Lebanese physicians who would then provide clinical services in the Arab Gulf region on a locum tenens basis. The objectives of this study were to assess the willingness of Lebanese medical graduates practicing in the United States of America to relocate to Lebanon and the Arab Gulf region and to explore the factors associated with this willingness.MethodsIn 2009 we surveyed Lebanese medical graduates practicing medicine in the United States. The questionnaire included questions about their willingness to relocate to Lebanon and to the Arab Gulf region and the associated timeframes. The questionnaire also included questions about family factors. We linked responders’ answers to their personal, educational, and practice characteristics provided by the American Medical Association Physicians’ Dataset. We conducted both descriptive and regression analyses.ResultsA total of 286 physicians participated in the survey (57% response rate). A majority (61%) was willing to relocate to Lebanon (51% possibly, 10% definitely). A third (33%) were willing to relocate to the Arab Gulf region (31% possibly, 2% definitely). About half (54%) were willing to relocate to Lebanon as a base for clinical missions to the Arab Gulf region (49% possibly, 5% definitely). Willingness to relocate to Lebanon was independently associated with Lebanese citizenship and the birthplace of the spouse being Lebanon, and inversely associated with US citizenship. Willingness to relocate to the Arab Gulf region was independently associated with being board certified, and inversely associated with being married, the age of the oldest child, and practicing in direct patient care. Willingness to relocate to Lebanon as a base was not independently associated with any factor.ConclusionsThe findings of this study support the feasibility of the proposal of Lebanon becoming a regional ‘academic hub’. Future research should explore other factors important for the feasibility of the proposal as well as actual relocation.

An emigration versus a globalization perspective of the Lebanese physician workforce: a qualitative study

BackgroundLebanon is witnessing an increased emigration of physicians. The objective of this study was to understand the perceptions of Lebanese policymakers of this emigration, and elicit their proposals for future policies and strategies to deal with this emigration.MethodsWe conducted semi-structured individual interviews with the deans of Lebanon’s seven medical schools, the presidents of the two physicians professional associations, and governmental officials. We analyzed the results qualitatively.ResultsParticipants differed in the assessment of the extent and gravity of emigration. Lebanon has a surplus of physicians, driven largely by the over-production of graduates by a growing number of medical schools. Participants cited advantages and disadvantages of the emigration on the personal, financial, medical education system, healthcare system, and national levels. Proposed strategies included limiting the number of students entering medical schools, creating job opportunities for graduating students, and implementing quality standards. Most participants acknowledged the globalization of the Lebanese physician workforce, including exchanges with the Gulf region, exchanges with developed countries, and the involvement of North American medical education institutions in the region.ConclusionMany Lebanese policy makers, particularly deans of medical schools, perceive the emigration of the physician workforce as an opportunity in the context of the globalization of the profession.

Factors Influencing Lebanese Medical Students' Decisions to Train Abroad: Evaluation of a Conceptual Framework

Objective: To evaluate a conceptual framework portraying the factors underlying the intentions of medical stu- dents to train abroad. Methods: Eligible subjects were students in the pre-final and final years of medical studies in Lebanon. A survey ques- tionnaire based on the conceptual framework inquired about demographic and educational characteristics, influencing fac- tors, and intentions to train abroad. We assessed each of the factors for its frequency, distribution, and association with the intention to train abroad. Results: Of 576 eligible students, 425 (74%) participated. The frequency of the framework factors varied from 16% to 94% and was the highest for factors related to training and professional career. The factors independently associated with the intention to train abroad related to residency training, concern with professional career and political conditions. The intention to train abroad was also associated with thinking that the general public considers doctors trained abroad as more qualified (OR=6.3; 95% CI=1.2-33.2); receiving information about abroad training from doctors trained or training abroad (OR= 9.7; 95% CI=1.7-56.6); having relatives or friends living abroad (OR=6.9; 95% CI=1.4-35.7); and witnessing resi- dents traveling to retrain abroad (OR=22.2; 95% CI=4.5-111.1).