In many countries there is a shortage of health workers. The high financial and resource investments needed to train health workers make it important to find ways to increase the number of students entering initial health professional training (sometimes referred to as pre-licensure training) and reduce the number of pre-graduation drop-outs. Ways to achieve this include interventions to increase the capacity of health professional training institutions; reduce the loss of students (and increase the likelihood that students will graduate); or increase the recruitment of students from other countries into health professional training institutions. Minority academic advisory programmes that include academic, personal, financial and vocational advising, skills building, mentorships, supplementary training, and annual evaluations are an approach to achieving this amongst students from minority groups.
-Increase the number of minority students enrolled in health sciences.
-Slightly increase retention through to graduation.
-Decrease differences in retention levels through to graduation between minority and non-minority students in the health sciences.
There is a considerable shortage of health workers globally and this shortfall is greatest in sub-Saharan Africa. Health worker education is costly in terms of the financial, temporal and other resources required, but vital in terms of providing universal good-quality healthcare services and attaining health-related objectives. Strategies to increase the number of health professional students and to promote their retention to graduation are therefore essential.
Review objectives: To assess the effect of changes in the pre-licensure education of health professionals on health-worker supply.
|What the review authors searched for
|What the review authors found
Study designs & interventions
Randomised trials, controlled before-after studies and interrupted time series studies of interventions that could increase the capacity of health professional training institutions; reduce the loss of students (and increase the likelihood that students will graduate); or increase the recruitment of students from other countries into health professional training institutions.
2 controlled before-after studies of minority academic advising programmes consisting of academic, personal, financial and vocational advice, skills building, mentorships, supplementary training and annual evaluations.
Health professional students prior to licensure.
2 studies among minority groups and general health professional students.
2 studies from the USA.
Increased numbers of health workers ultimately available for recruitment into the health workforce, improved population-to-health professional ratios.
2 studies of the numbers of health workers ultimately available for recruitment into the health workforce.
|Date of most recent search: February 2008.
|Limitations: This is a well-conducted systematic review with only minor limitations.
Pariyo GW, Kiwanuka SN, Rutebemberwa E, et al. Effects of changes in the pre-licensure education of health workers on health-worker supply. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD007018.
Two studies conducted among students at health professional training institutions in the USA were identified. An academic advising program for minority groups was implemented in two institutions, and changes in the levels of enrolment for the minority group and retention to graduation rates were measured.
Academic advising programmes for minority groups may:
The effects of other pre-licensure measures to increase health worker supply in low-income countries are uncertain. No studies were found that evaluated pre-licensure measures in low-income countries.
Minority academic advising programs
People: Students (minority groups and general) in health professional training institutions.
|Certainty of the evidence
Increased numbers of health workers ultimately available for recruitment into the health workforce
One study found a 45% (Male: 48%, Female: 43%) relative increase in the total number of minority group allied health sciences students enrolled. Retention to graduation of minority group students increased from 72% to 83% (p=0.051)
The relative difference in retention to graduation between minority and non-minority groups was reduced from 14% to 2.5% (p<0.0002). Another study found that the percentage of minority students retained to graduation increased by 5.2% (p>0.05), and the fraction of minority group students increased by 11%.
|p: p-value; GRADE: GRADE Working Group grades of evidence (see above and last page).
All included studies were conducted in high-income countries. No relevant evidence from low-income countries was identified.
The included studies focused on equity between racial groups in a high-income country.
The review did not provide information on costs or cost-effectiveness.
|MONITORING & EVALUATION
The currently available evidence is very limited and restricted to one high-income country.
|*Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low-income countries. For additional details about how these judgements were made see: http://www.supportsummaries.org/methods
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This summary was prepared by
Peter Steinmann, Swiss Tropical and Public Health Institute, Switzerland.
Conflict of interest
None declared. For details, see: www.supportsummaries.org/coi
This summary has been peer reviewed by: Ben Marais, George Pariyo, and Hanna Bergman.
This review should be cited as
Pariyo GW, Kiwanuka SN, Rutebemberwa E, et al. Effects of changes in the pre-licensure education of health workers on health-worker supply. Cochrane Data-base of Systematic Reviews 2009, Issue 2. Art. No.: CD007018.
The summary should be cited as
Steinmann P. Do changes in the pre-licensure education of health workers impact on the supply of health workers? A SUPPORT Summary of a systematic review. August 2016. www.supportsummaries.org
evidence-informed health policy, evidence-based, systematic review, health systems research, health care, low and middle-income countries, developing countries, primary health care, education, retention, enrolment, health worker, minority, mentoring.