Jane Runnacles, Nicola Davey, Emelia Shead, Emma Parish, Alice Roueché
Since 2018, the NHS London Specialty School of Paediatrics has collaborated with QIClearn (an independent organisation) to design and deliver a structured Quality Improvement (QI) education programme for postgraduate resident doctors in the region to build QI capacity. The programme (QI Change Champions) has been designed not only to equip resident doctors with core improvement skills but, uniquely, to secure its own future through a novel, scalable approach to faculty and mentor development. This paper outlines the experience and learning from this programme, discusses transferable lessons and the potential contribution to the wider field of QI education. We believe we have developed an innovative and sustainable model for embedding essential QI capability into postgraduate training for resident doctors in a region. We have observed QI in practice by constantly reflecting, learning and adapting our approach. Although this is not a formal programme evaluation, we have described our work in practice and the themes captured from mentor and learner feedback used to continually improve the programme. The analysis was designed to mitigate bias, in view of the fact that QIClearn was receiving payment as a company, and the faculty who co-designed the programme were educators for the London Specialty School of Paediatrics and not employed by QIClearn. We have enrolled 254 resident doctors across 16 iterations (2 per year) to equip them with the skills to deliver meaningful change in the NHS. We recognised early on that sustainable QI education depends on development of a faculty development pipeline. We have trained 14 mentors selected from those who completed the programme who demonstrate particular skill in motivating others and understanding of QI methodology. Our novel Mentor in Training model has enabled us to both expand our regional QI capacity and develop the next generation of clinical leaders and educators. We have built on the growing field of evidence for near-peer mentors in medical education and developed a real community of practice to support our learners. We suggest that there are long term benefits to building this community but this is an area that needs to be explored further in future research..
P. Broman, S. Vaughan, P. Andersen, M. J. Cannings, M. B. P. Haggie, K. O’Connor, K. Kovanur Sampath, S. Tan, O. Webster, J.-R. Yap, S. Brownie
Student-assisted, -run or -led health clinics (SLCs) are increasingly common worldwide, but student outcomes remain under-evaluated, with existing work focused narrowly on clinical and/or academic outcomes. This study presents the findings of an evaluation of the impact of a student-assisted clinic in New Zealand, on participating students subjective wellbeing, assessed using the Satisfaction with Life Scale (SWLS), as well as on a range of programme-related intermediate outcomes theorised to support wellbeing, including leadership, communication, and clinical capability. Students undertaking placements at the clinic were surveyed at three time points: at the start, the end, and at six months post-placement. Participating students maintained levels of self-reported wellbeing over placement periods while significantly improving leadership, purpose, cultural connection, and clinical capability. Income and sleep were shown to be key factors related to SWLS scores. Student-related outcomes from SLCs may extend beyond clinical care and academic performance, highlighting the value of a more holistic approach to SLC evaluation.
This study conducted a systematic literature review with narrative synthesis to examine the effectiveness of health insurance in improving access to care and reducing out-of-pocket (OOP) health spending among beneficiaries. Using PRISMA guidelines, a systematic search was conducted across three databases (Web of Science, PubMed, and Google Scholar). Results were limited to human studies published in English between 2015 and 2024. Studies reporting on the effectiveness of health insurance were included and critically appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross-Sectional Studies. The findings were synthesised using a thematic narrative synthesis approach. The database search identified 495 studies. After removing duplicates and completing title, abstract, and full-text screening, 12 studies were included in the review. From the results, it is suggestive that health insurance has the potential to increase healthcare uptake and reduce excessive dependence on OOP, and hence can guarantee financial protection. However, enrolment remains low and significant disparities exists in enrolment between rural and urban, northern and southern population and educated and non-educated class. Efforts should be directed towards encouraging enrolment into health insurance, and improve its benefits for enrollees. However, to encourage enrolment, especially among the poor and rural population, Nigerian government should commit itself in full implementation the Vulnerable Group Fund which aims to target over 83 million Nigerians in the informal sector for coverage.
Yuki Julius Ng, Alex J. van Duinen, Håkon A. Bolkan, Anita Gadgil, Priti Patil, Nobhojit Roy
The Lancet Commission on Global Surgery has stated that two-thirds of the world's population does not have adequate access to surgical and anaesthesia care. Surgical, Obstetric and Anaesthetic (SAO) workforce and surgical volume (SV) are two of the six indicators recommended for monitoring and planning. This study aims to examine the correlation between SAO density and SV at the national level. A cross-sectional ecological regression study was conducted with SAO workforce per 100,000 population and SV per 100,000 population, extracted from the World Bank Database. Countries that reported both indicators were included. If SAO was not available for the corresponding SV year, it was adjusted according to the population growth. A logarithmic regression model was used to describe the nonlinear association between SAO workforce density and surgical volume with SPSS. Model fit (R 2) analysis, diagnostics, and a model implied marginal slope analysis were conducted. A total of 57 countries were included, with 37 (64.9%) requiring adjustment. The fitted logarithmic regression model (y = 884 ln(x) + 685) had an R 2 of 0.524. At an SAO density of 10 per 100,000 population, the fitted model predicted approximately 2720 procedures per 100,000 population. At 20 and 40 SAO, 3333.7 (95% CI for fitted mean: 2917.2–3750.2) and 3946.5 (95% CI for fitted mean: 3470.7–4,422.3) procedures are expected, respectively. The marginal slope analysis of our model was progressively smaller at higher SAO densities. This study provides empirical insights into the nonlinear relationship between SAO workforce density and surgical volume. The findings highlight the need to balance workforce expansion with wider health-system capacity and may contribute to the future development of more informative surgical planning and performance indicators.
