example for developing review protocol · 4/33 geographically skewed distributions of healthcare...

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REVIEW PROTOCOL

Recommendation 7

The effect of targeted admissions policies in increasing the socio-economic, ethnic and geographical diversity of students

A systematic review

Review protocol

Organization, City, Country: The University of Tokyo, Tokyo, Japan Prepared by: Date:

Rachel Marie Amiya, Tamy Yamamoto August 2011

Senior supervisor: Masamine Jimba Research team members: Rachel Marie Amiya, Tamy Yamamoto, Laura Shiao,

Bruno Sunguya, Kayoko Yoshikawa, Saw Yu Mon

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Table of Contents

1.0 Background .......................................................................................................... 3

2.0 Objective .............................................................................................................. 5

3.0 Review Question .................................................................................................. 5

4.0 Evidence gathering and study selection ............................................................... 6

5.0 Assessment of risk of bias and data extraction .................................................... 9

6.0 Data synthesis ..................................................................................................... 10

7.0 Dissemination ..................................................................................................... 10

8.0 Resource implications ........................................................................................ 10

9.0 References .......................................................................................................... 10

Appendix A: Search strategy for PICO B2, sub-item (a) ............................................. 12

Appendix B: Search strategy for PICO B2, sub-item (b) ............................................. 19

Appendix C: Search strategy for PICO B2, sub-item (c).............................................. 26

Appendix D: Data extraction forms (See attached excel workbook) . Error! Bookmark

not defined.

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1.0 Background

a. Definition of key terms:

Recruitment (of students): The process of searching for potential students or of undertaking to favorably influence a potential student’s decision to enter a programme of health professional education.1

Admission (of students): The process, based on defined criteria, by which a student is allowed to enter the initial programme of health professional education.2

Retention (of students): A programme outcome involving the maintenance of a student’s satisfactory progress toward his or her pedagogical objective until it is attained.3

Underserved population (medically): Interpreted in the broadest sense, a relatively poorer population inhabiting an area with limited access to qualified health care providers and health services of adequate quality. May include, for example, populations occupying the following types of settings: remote rural areas; small or remote islands; urban slum areas; areas that are in conflict or post-conflict; refugee camps; and areas inhabited by minority or indigenous groups.4

Underrepresented population (medically): A racial or ethnic population that is underrepresented in healthcare professions relative to their numbers in the general population.5

Rural population: A population of an area that is not urban in nature, where ‘urban’ delineates the contours of a contiguous territory inhabited at urban density levels without regard to administrative boundaries (Source: WHO, 2010). Recognizing the absence of a universal or standardized definition of ‘rural’ meaningful in an international context, the diversity of definitions commonly utilized in the literature may also be accepted, based on factors including distance from nearest urban centre, population density, common nature of employment, government structures, degree of isolation, and distance from nearest ‘major hospital’ or high-level health care institution.6

b. Importance to transforming and scaling up health professional education and training:

The distribution of health manpower in underserved areas has been the subject of broad attention and concern in recent years. Both developed and developing countries report

1 World Bank. “Health Systems: Glossary”. Retrieved from http://go.worldbank.org/D3O1CJZU20; Dolence, M. G. (1991). Setting the context for evaluation of recruitment and retention programs. New Directions for Institutional Research, 70: 5-19. 2 WHO (2009). Global Standards for the Initial Education of Professional Nurses and Midwives. Geneva: World Health Organization. Retrieved from http://www.who.int/hrh/nursing_midwifery/hrh_global_standards_education.pdf. 3 Dolence, op cit. 4 Alliance for Health Policy and Systems Research (Alliance HPSR)/World Health Organization (WHO) (2008). Call for Research Proposals: Incentives to attract and retain qualified health workers to under-served areas within low and middle income countries. Retrieved from http://www.who.int/alliance-hpsr/callsforproposals/Alliance%20HPSR_IncentivesAttractAndRetainHealthWorkers.pdf. 5 Association of American Medical Colleges, “Underrepresented in Medicine Definition”. Retrieved from https://www.aamc.org/initiatives/urm/. 6 Wilson et al. (2009). A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas. Rural Remote Health, 9(1060) (online). Retrieved from http://www.rrh.org.au/publishedarticles/article_print_1060.pdf.

http://go.worldbank.org/D3O1CJZU20

http://www.who.int/hrh/nursing_midwifery/hrh_global_standards_education.pdf

http://www.who.int/alliance-hpsr/callsforproposals/Alliance%20HPSR_IncentivesAttractAndRetainHealthWorkers.pdf

https://www.aamc.org/initiatives/urm/

http://www.rrh.org.au/publishedarticles/article_print_1060.pdf

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geographically skewed distributions of healthcare professionals, favoring urban and wealthy areas,7 despite the fact that rural communities experience more health-related problems.8 In fact, the maldistribution of health professionals seems to be worsening in many developing countries.9

The resulting shortage of healthcare professionals in rural communities is a global problem that poses a serious challenge to equitable healthcare delivery.10

Many of the policies to address geographical imbalances have tended to have only a short-term impact. Increasingly, there is a need for countries to adopt measures to improve medium- and long-term retention in underserved, underrepresented, and rural areas through innovative regulatory mechanisms in undergraduate and postgraduate health professional education and training.

Recruitment/admission mechanisms: Recruiting and admitting more students from rural areas to medical schools is a policy with potentially positive medium and long-term impacts on the geographical distribution of doctors as such students are more likely to take up practice in rural areas. 11 There is also limited evidence that being from a minority (or underrepresented) ethnic group or an underserved population increases the likelihood of practicing in a rural or underserved area.12

Retention mechanisms: Underrepresented/minority students and those from economically and educationally disadvantaged backgrounds often lack many of the basic resources and preparation needed to successfully progress from high school to undergraduate training and then on to professional education.

Specifically, underrepresented students are more likely to lack:

Adequate preparation between secondary school and health professional school; Support from parents and peers to pursue higher education goals; Financial resources to cover educational expenses; Health professional role models from underrepresented backgrounds.

Few studies have documented the efficacy of interventions involving scholarships or

7 Lehmann et al. (2008). Staffing remote rural areas in middle- and low-income countries: a literature review of attraction and retention. BMC Health Serv Res. 8: 19; Vanasse et al. (2007). Long term regional migration patterns of physicians over the course of their active practice careers. Rural Remote Health 7: 812. (Online). Retrieved from http://www.hrhresourcecenter.org/node/1821; Dussault and Franceschini (2006). Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Human Res Health 4: 1; Priester and Elliot (1995). Forecasting physician workforce requirements in Minnesota. Minn Med 78(10): 21-28; Wright and Jablosnowski (1987). The rural-urban distribution of health professionals in Georgia. J Rural Health 3(1): 53-70. 8 Hart (1971). The inverse care law. Lancet 1(7696): 405-412. 9 Lehmann, op cit.; Health Systems Trust (2005). HST publishes its 10th SAHR: The Importance of the Health Worker. (Online). Retrieved from http:/www.hst.org.za/news/20040927. 10 WHO (2003). World Health Report 2003 – shaping the future. (Online). Retrieved from http://www.who.int/whr/2003/en/index.html. 11 OECD (2008). The Looming Crisis In the Health Workforce: How can OECD countries repond? (Online). Retrieved from http://www.oecd.org/dataoecd/25/14/41509461.pdf; Playford et al. (2006). Going country: rural student placement factors associated with future rural employment in nursing and allied health. Aust J Rural Health 14(1): 14-19; De Vries and Reid (2003). Do South African medical students of rural origin return to rural practice? S Afr Med J 93: 789-793; Laven and Wilkinson (2003). Rural doctors and rural backgrounds: how strong is the evidence? A systematic review. Aust J Rural Health 11: 277-284; Easterbrook et al. (1999). Rural background and clinical rural rotations during medical training: effect on practice location. Can Med Assoc J 160(8): 1159-1163; Rabinowitz (1993). Recruitment, retention, and follow-up of graduates of a program to increase the number of family physicians in rural and underserved areas. New Engl J Med 328(13): 934-939. 12 Fryer et al. (2001). Hispanic versus white, non-Hispanic physician medical practices in Colorado. J Health Care Poor Underserved 12(3): 342-351.

http://www.hrhresourcecenter.org/node/1821

http://www.who.int/whr/2003/en/index.html

http://www.oecd.org/dataoecd/25/14/41509461.pdf

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bursaries with rural return of service agreements, and the reported outcomes are highly variable. For example, many service-linked scholarships, loans, and loan repayment programs have been described, but effects on the rural/remote workforce are not clear.

There is a recognized dire need to evaluate in a scientifically rigorous fashion the impact of interventions and policies that aim to redress the inequitable distribution of healthcare professionals in underserved, underrepresented, and rural areas. It is only with the availability of more rigorous evidence and sufficient political commitment in this area that we will be able to address the pressing issue of equitable healthcare delivery and to identify effective strategies to guide future practice and policy toward transforming and scaling up health professional education and training.

2.0 Objective

To assess the effect of active recruitment, admission and retention of students from underserved, underrepresented or rural populations in health professional schools, supported by regulatory mechanisms, for both undergraduate and postgraduate programs, on the quantity, quality and relevance of health professionals.

A separate search strategy is presented for each sub-question in Appendices A-C.

3.0 Review Question

For the purposes of this literature review, the population, intervention, comparators and outcomes (PICO) framework to inform the review objectives are presented below:

Sub-item

Population Intervention Comparison Outcome

(a) Students from underserved, underrepresented or rural populations in health professional schools

Active recruitment and targeted admission policies

No active recruitment or targeted admission policies

Quantity, quality and relevance of health professionals

(b) Students from underserved, underrepresented or rural populations in health professional schools

Support structures and systems to retain students

No support structures and systems to retain students


(c) Students from underserved, underrepresented or rural populations in health professional schools

Community-based support programs by which communities support their own members for return of services

No community-based support


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4.0 Evidence gathering and study selection

4.1 Evidence gathering

The evidence gathering approach will have four components:

4.1.1 Searching databases

The databases in the table below will be searched with a pre-determined strategy as detailed in Appendices A-C. In cases where the search results are small in number, search terms will be reduced to maximize the search sensitivity.

Databases

Databases for biomedicine and health sciences:

PubMed/MEDLINE

Cumulative Index to Nursing and Allied Health Literature (CINAHL)

Cochrane Library (CDSR)

Excerpta Medica Database (EMBASE)

Health Systems Evidence (PPD/CCNC)

NHS Evidence

Databases for social sciences:

Campbell Library

ISI Web of Knowledge

Social Science Research Network (SSRN)

Databases for education:

BEME database

Educational Resources Information Center (ERIC)

Regional databases for biomedicine and health science:

African Index Medicus

Australasian Medical Index

Index Medicus for Eastern Mediterranean Region

Index Medicus for South-East Asia Region (IMSEAR)

IndMED

Japan Science and Technology Information Aggregator, Electronic (J-STAGE)

KoreaMed

LILACS

Panteleimon

Western Pacific Region Index Medicus (WPRIM)

General databases:

Google

Google Scholar OpenGrey

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4.1.2 Hand searching

The following journals and websites will be hand-searched for relevant articles:

Resources to be searched by hand

Academic Medicine

American Academy of Family Physicians (AAFP)

American College of Physicians (ACP)

American Journal of Health Studies

Assessment & Evaluation in Higher Education

Association of American Medical Colleges (AAMC)

Association for Medical Education in Europe (AMEE)

Best Evidence Medical Education (BEME) database

BioMed Central

Council on Graduate Medical Education (COGME)

FADE: The North West Grey Literature Service

Grey Literature Network Services

Health Education Journal

Health Management Information Consortium (HMIC)

Health Services Research (HSR)

Health & Social Care in the Community

HRH Global Resource Center

International Medical Association (IMA)

International Council of Nurses (ICN)

International Journal of Academic Development (IJAD)

International Journal of Nursing Education Scholarship (IJNES)

International Pharmaceutical Federation (FIP)

Intute

Japan International Cooperation Agency (JICA) project reports

Joint Community Journal on Quality Improvement

Journal of Allied Health

Journal of Dental Education (JDE)

Journal of Interprofessional Care

Medical Teacher

New York Academy of Medicine Grey Literature Report

OpenGrey

SAMSS

Teaching and Teacher Education

UNESCO

World Bank

World Federation of Medical Education (WFME)

WHO’s Library Database (WHOLIS)

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4.1.3 Expert network consultations

A network of health professional education experts will be consulted by email to identify additional grey literature or research that has not been found through the above processes.

The following experts and networks will be contacted regarding additional such materials:

Experts and networks to be contacted

UNESCO

Global Health Workforce Economics Network

Health Professions Education Research Network (HPERN) of B.C.

Centre for Educational Development in Health Arusha (Republic of Tanzania)

Selected members of the WHO expert group on Increasing access to health workers in remote and rural areas through improved retention

One or more of the following researchers: Dr. Eugene Boostrom (Meio University, Japan), Dr. Pattapong Kessomboon & Dr. Sauwanan Bumrerraj (Khon Kaen University, Thailand), Dr. James Rourke (Memorial University, Canada), Dr. Roger Rosenblatt (University of Washington, USA), Dr. Vanessa C. Burch (University of Cape Town, South Africa), Dr. Andrew Hayward (University College London, UK), Dr. John M. Watson (Health Protection Agency, UK), Dr. Arnold S. Monto (University of Michigan, USA)

4.1.4 Reference searches

Bibliographies of those papers that match the eligibility criteria below will be searched by hand to identify any further, relevant references, which will be subject to the same screening and selection process.

4.2 Eligibility criteria

After gathering the evidence, the following eligibility criteria will be applied to the results and all identified references screened independently by two reviewers (RA, TY) using a three-stage approach to reviewing the title, abstract and full text.

4.2.1 Types of studies

All types of evaluative study designs are eligible for inclusion, including grey literature. Studies will not be selected on methodological quality.

4.2.2 Types of participants

Students from underserved, underrepresented or rural populations in health professional schools (undergraduate and postgraduate programmes), encompassing the following types of health professionals:

Medical Doctors, both Generalist and Specialist Practitioners, including Public Health Doctors (ISCO-08 minor group 221)

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Nursing Professionals, both Generalist and Advanced nursing professionals, including Public Health Nurses (ISCO-08 minor group 222, unit 2221)

Midwifery Professionals (ISCO-08 minor group 222, unit 2222)

Dentists (ISCO-08 minor group 226, unit 2261)

Pharmacists (ISCO-08 minor group 226, unit 2262)

Paramedical Practitioners (ISCO-08 minor group 226, unit 2240)

4.2.3 Types of intervention:

Active recruitment and targeted admission policies , support structures and systems to retain students, community-based support programs for return of services

4.2.4 Types of outcome measures

The primary outcomes of interest are the quantity, quality and relevance of practicing health professionals. These are defined by a number of measurable outcomes found in the Outcomes Framework document. Other important outcomes include values and preferences, resource use/costs, benefits and harms, as well as all other unintended effects of the intervention. Studies that include other outcomes should not be excluded at this stage in the evidence retrieval. Other secondary outcomes can also be defined, as needed.

4.3 Exclusion criteria

Editorials, newspaper articles and other forms of popular media will be excluded. Failure to meet any one of the above eligibility criteria (section 3.2) will result in exclusion from the review and any apparent discrepancies during the selection process will be resolved by a third, independent reviewer. The number of excluded studies (including reasons for exclusion for those excluded following review of the full text) will be recorded at each stage.

5.0 Assessment of risk of bias and data extraction

Following the initial selection of literature, the reviewers should consult with the WHO Secretariat regarding the process to be followed for summarizing the studies. Data will be extracted from relevant papers using predefined evidence summary templates, attached in Appendix D. Data will be collected regarding the reasons for exclusion, characteristics of included studies, participants, interventions (including comparators) and outcomes. The final decision for inclusion or exclusion will be made by a team consisting of the WHO Secretariat, methodologist and researchers conducting the review. Any potential disagreement will be recorded and resolved by further discussion.

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Risk of bias across studies will be assessed using the approach outlined by the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group. Any disagreements will be recorded and resolved by involvement of an additional reviewer.

6.0 Data synthesis

The availability of appropriate data and resources to conduct a meta-analysis will be considered, where feasible.

7.0 Dissemination

A final set of tables including a GRADE Evidence Table and Descriptive Evidence Table will be produced and submitted to the WHO Secretariat as stipulated in the Procedures for the Retrieval of Evidence and Summary of Evidence. In addition, a manuscript will be prepared for submission to a peer-reviewed journal.

8.0 Resource implications

The project lead will work closely with the WHO Secretariat to define the scope and methods of the review and facilitate access to unpublished literature, supporting translation of foreign language literature where necessary.

Proposed milestones and timescales are outlined below:

Milestones

Identification and retrieval of the evidence

Conduct literature review, hand searching, and contacts with experts and networks

Summarizing evidence in Descriptive

Evidence Tables (Table 1. Summary of systematic literature reviews, Table 2. Summary of relevant literature)

Development of GRADE Evidence Tables in collaboration with WHO, Geneva, and the GRADE network methodologist

9.0 References

When citing articles, please use the WHO standard citation format, called the Vancouver style. Some examples:

Article in a Journal Burt BA, Pai S. Sugar consumption and caries risk: a systematic review. Journal of Dental Education, 2001, 65:1017–1023.

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Chapter in a book Melton L J III. Epidemiology of fractures. In: Riggs BL, Melton L J III, eds. Osteoporo¬sis: etiology, diagnosis, and management, 2nd ed. Philadelphia, PA, Lippincott-Raven, 1995:225–247.

Corporate author Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of antioxidant vitamin supplementation in 20 536 high-risk individuals: a randomised placebo-controlled trial. Lancet, 2002, 360:23–33.

WHO Publication with no named author The international pharmacopoeia, 3rd ed. Vol. 5. Tests and general requirements for dosage forms; quality specifications for pharmaceutical substances and tablets. Geneva, World Health Organization, 2003.

More on the WHO-style can be found here: http://www.nlm.nih.gov/bsd/uniform_requirements.html

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Appendix A: Search strategy, sub-item (a)

The effect of active recruitment and targeted admission policies, supported by regulatory

mechanisms to enroll students from underserved, underrepresented, or rural populations

in health professional schools on quantity, quality and relevance.

Population: Students from underserved, underrepresented or rural populations

in health professional schools

Intervention: Active recruitment and targeted admission policies

Comparison: No active recruitment or targeted admission policies

Outcomes: Quantity, Quality and Relevance of health professionals

Search terms

Search Concept MeSH headings Keywords/Text words

Population-I (Health Professional Students/ Schools/ Education)

Students, Health Occupations

Students, Premedical

Students, Medical

Students, Nursing

Students, Public Health

Schools, Health Occupations

Schools, Medical

Schools, Nursing

Schools, Dental

Schools, Pharmacy

Schools, Public Health

Education, Premedical

Education, Medical

Education, Dental

Education, Pharmacy

Education, Medical, Undergraduate

Education, Nursing

Education, Nursing, Baccalaureate

Education, Nursing, Associate

Education, Nursing, Diploma Programs

Health Personnel/education

Family Practice/education

Internal Medicine/education

Clinical Competence/education

Internship and Residency

health student*

health care student*

healthcare student*

medical student*

nursing student*

premedical student*

midwifery student*

public health student*

medical residen*

medical intern*

medical school*

nursing school*

midwifery school*

dental school*

dentistry school*

pharmacy school*

health professional school*

school* of medicine

school* of nursing

school* of midwifery

school* of dentistry

school* of dental medicine

school* of pharmacy

school* of pharmaceutical science*

school* of health science*

school* of public health

facult* of medicine

facult* of nursing

facult* of midwifery

facult* of dentistry

facult* of dental medicine

facult* of pharmacy

facult* of pharmaceutical science*

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Search Concept MeSH headings Keywords/Text words facult* of health science*

department* of medicine

department* of nursing

department* of midwifery

department* of dentistry

department* of dental medicine

department* of pharmacy

department* of pharmaceutical science*

department* of health science*

medical education

medical training

nursing education

nursing training

midwifery education

midwifery training

dental education

dental training

dentistry education

dentistry training

pharmacy education

pharmacy training

pre service education

preservice education

pre licensure education

prelicensure education

pre licensure training

prelicensure training

clerkship*

clinical rotation*

clinical placement*

Population-II (Underserved, underrepresented or rural populations)

Rural Population

Rural Health

Rural Health Services

Hospitals, Rural

Medically Underserved Area

under served

underserved

underrepresented

under represented

rural

remote

nonmetropolitan

deprived

shortage area*

inequitabl* distribut*

maldistribut*

Intervention School Admission Criteria

recruit*

admission*

enrol*

student selection

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Search Concept MeSH headings Keywords/Text words selection of students

affirmative action

The above MeSH thesaurus headings, keywords and free text terms will be amended as required in accordance with each different database used to maximize sensitivity. The scope of each free text search should include the study title and abstract where possible. Individual MESH and free text terms will be combined with the Boolean operator OR, unless otherwise specified. Each search concept should then be combined with the Boolean operator AND as follows: population AND intervention. An example search outlining the appropriate combination of terms is detailed below, executed using PubMed.

Search limits

Limit category Specified limit

Languages English, Japanese

Publication type None

Date of publication 1995-2011

Study design None

Electronic search sources

Category Sources Healthcare databases

PubMed/MEDLINE EMBASE CINAHL ISI Web of Knowledge ERIC SSRN J-STAGE African Index Medicus Australasian Medical Index Index Medicus for Eastern Mediterranean Region IndMED KoreaMed LILACS Index Medicus for the South-East Asia Region (IMSEAR) Panteleimon Western Pacific Region Index Medicus (WPRIM) WHO’s Library Database (WHOLIS)

Evidence-based reviews

Cochrane library (CDSR) BEME database Health Systems Evidence (PPD/CCNC)

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Campbell Library Guidelines NHS Clinical Knowledge Summaries

National Library of Guidelines Grey literature NHS Evidence

OpenGrey Association of African Universities Database of African Theses and Doctorates (DATAD)

Internet searching Google Google Scholar

Example search output – PubMed

No. Search terms Hits

1 “Students, Health Occupations” [MeSH] 38,500

2 “Students, Premedical” [MeSH] 143

3 “Students, Medical” [MeSH] 17,442

4 “Students, Nursing” [MeSH] 15,033

5 “Students, Public Health” [MeSH] 36

6 “Schools, Health Occupations” [MeSH] 32,614

7 “Schools, Medical” [MeSH] 18,897

8 “Schools, Nursing” [MeSH] 4,997

9 “Schools, Dental” [MeSH] 5,156

10 “Schools, Pharmacy” [MeSH] 677

11 “Schools, Public Health” [MeSH] 770

12 “Education, Premedical” [MeSH] 647

13 “Education, Medical” [MeSH] 115,049

14 “Education, Dental” [MeSH] 15,662

15 “Education, Pharmacy” [MeSH] 4,401

16 “Education, Medical, Undergraduate” [MeSH] 17,804

17 “Education, Nursing” [MeSH] 65,453

18 “Education, Nursing, Baccalaureate” [MeSH] 12,723

19 “Education, Nursing, Associate” [MeSH] 1,629

20 “Education, Nursing, Diploma Programs” [MeSH] 3,438

21 “Health Personnel/education” [MeSH] 42,427

22 “Family Practice/education” [MeSH] 9,441

23 “Internal Medicine/education” [MeSH] 8,969

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24 “Clinical Competence/education” [MeSH] 1

25 “Internship and Residency” [MeSH] 29,700

26

“health student” [tw] OR “health students” [tw] OR “health

care student” [tw] OR “health care students” [tw] OR

“healthcare student” [tw] OR “healthcare students” [tw] OR

“medical student” [tw] OR “medical students” [tw]

28,456

27 “nursing student” [tw] OR “nursing students” [tw] 17,560

28 “premedical student” [tw] OR “premedical students” [tw] 207

29 “midwifery student” [tw] OR “midwifery students” [tw] 160

30 “public health student” [tw] OR “public health students” [tw] 99

31 “medical resident” [tw] OR “medical residents” [tw] OR

“medical residence” [tw] OR “medical residency” [tw] 869

32 “medical intern” [tw] OR “medical interns” [tw] OR “medical

internship” [tw] 162

33

“medical school” [tw] OR “medical schools” [tw] OR “school

of medicine” [tw] OR “schools of medicine” [tw] OR “health

professional school” [tw] OR “health professional schools”

[tw] OR “school of health science” [tw] OR “schools of

health science” [tw] OR “school of health sciences” [tw] OR

“schools of health sciences” [tw] OR “faculty of medicine”

[tw] OR “faculties of medicine” [tw] OR “faculty of health

science” [tw] OR “faculties of health science” [tw] OR

“faculty of health sciences” [tw] OR “faculties of health

sciences” [tw] OR “department of medicine” [tw] OR

“departments of medicine” [tw] OR “department of health

science” [tw] OR “departments of health science” [tw] OR

“department of health sciences” OR “departments of health

sciences” [tw] OR “medical education” [tw] OR “medical

training” [tw]

123,915

34

“nursing school” [tw] OR “nursing schools” [tw] OR “school

of nursing” [tw] OR “schools of nursing” [tw] OR “faculty of

nursing” [tw] OR “faculties of nursing” [tw] OR “department

of nursing” [tw] OR “departments of nursing” [tw] OR

“nursing education” [tw] OR “nursing training” [tw]

69,711

35

“midwifery school” [tw] OR “midwifery schools” [tw] OR

“school of midwifery” [tw] OR “schools of midwifery” [tw]

OR “faculty of midwifery” [tw] OR “faculties of midwifery”

[tw] OR “department of midwifery” [tw] OR “departments of

midwifery” [tw] OR “midwifery education” [tw] OR

“midwifery training” [tw]

595

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36

“dental school” [tw] OR “dental schools” [tw] OR “dentistry

school” [tw] OR “dentistry schools” [tw] OR “school of

dentistry” [tw] OR “schools of dentistry” [tw] OR “school of

dental medicine” [tw] OR “schools of dental medicine” [tw]

OR “faculty of dentistry” [tw] OR “faculties of dentistry” [tw]

OR “faculty of dental medicine” [tw] OR “faculties of dental

medicine” [tw] OR “dental education” [tw] OR “dental

training” [tw] OR “dentistry education” [tw] OR “dentistry

training” [tw]

20,301

37

“pharmacy school” [tw] OR “pharmacy schools” [tw] OR

“school of pharmacy” [tw] OR “schools of pharmacy” [tw]

OR “school of pharmaceutical science” [tw] OR “schools of

pharmaceutical science” [tw] OR “school of pharmaceutical

sciences” [tw] OR “schools of pharmaceutical sciences” [tw]

OR “faculty of pharmacy” [tw] OR “faculties of pharmacy”

[tw] OR “faculty of pharmaceutical science” [tw] OR

“faculties of pharmaceutical science” [tw] OR “faculty of

pharmaceutical sciences” [tw] OR “faculties of

pharmaceutical sciences” [tw]

821

38 “school of public health” [tw] OR “schools of public health”

[tw] 314

39

“pre service education” [tw] OR “preservice education” [tw]

OR “pre service training” [tw] OR “preservice training” [tw]

OR “pre licensure education” [tw] OR “prelicensure

education” [tw] OR “pre licensure training” [tw] OR

“prelicensure training” [tw]

81

40 “clerkship” [tw] OR “clerkships” [tw] 4,239

41 “clinical rotation” [tw] OR “clinical rotations” [tw] 540

42 “clinical placement” [tw] OR “clinical placements” [tw] 633

43 OR/1-42 290,752

44 “Rural Population” [MeSH] 32,433

45 “Rural Health” [MeSH] 19,870

46 “Rural Health Services” [MeSH] 7,207

47 “Hospitals, Rural” [MeSH] 3,573

48 “Medically Underserved Area” [MeSH] 4,843

49 “under served” [tw] OR “underserved” [tw] 7,628

50 “under represented” [tw] OR “underrepresented” [tw] 3,636

51 “rural” [tw] 95,324

52 “remote” [tw] 36,368

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53 “nonmetropolitan” [tw] 460

54 “deprived” [tw] 19,696

55 “shortage area” [tw] OR “shortage areas” [tw] 213

56 “inequitable distribution” [tw] OR “inequitably distributed”

[tw] 108

57 “maldistribution” [tw] OR “maldistributed” [tw] 807

58 OR/44-57 157,236

59 43 AND 58 7,325

60 “School Admission Criteria” [MeSH] 3,653

61 “recruit” [tw] OR “recruits” [tw] OR “recruiting” [tw] OR

“recruited” [tw] OR “recruitment” [tw] 154,004

62 “admission” [tw] OR “admissions” [tw] 121,497

63 “enroll” [tw] OR “enrolment” [tw] OR “enrolling” [tw] 6,429

64 “student selection” [tw] OR “selection of students” [tw] 217

65 “affirmative action” [tw] 311

66 OR/60-65 279,147

67 59 AND 66 911

68 67 [Limit to: (Date of Publication 1995-2011, Languages

English or Japanese)] 727

19/33

Appendix B: Search strategy, sub-item (b)

The effect of support structures and systems to retain students from underserved,

underrepresented or rural populations, such as special courses or programs designed to

bridge the gap between secondary school and health professional schools, on quantity,

quality and relevance



Intervention: Support structures and systems to retain students

Comparison: No support structures or systems


Search terms





Students, Medical

Students, Nursing



Schools, Medical

Schools, Nursing

Schools, Dental

Schools, Pharmacy



Education, Medical

Education, Dental

Education, Pharmacy


Education, Nursing









health student*


healthcare student*

medical student*

nursing student*

premedical student*

midwifery student*


medical residen*

medical intern*

medical school*

nursing school*

midwifery school*

dental school*

dentistry school*

pharmacy school*


school* of medicine

school* of nursing




school* of pharmacy




facult* of medicine

facult* of nursing




facult* of pharmacy

20/33

Search Concept MeSH headings Keywords/Text words facult* of pharmaceutical science*

facult* of health science*









medical education

medical training

nursing education

nursing training

midwifery education

midwifery training

dental education

dental training

dentistry education

dentistry training

pharmacy education

pharmacy training







clerkship*

clinical rotation*

clinical placement*


Rural Population

Rural Health


Hospitals, Rural


under served

underserved

underrepresented

under represented

rural

remote

nonmetropolitan

deprived

shortage area*


maldistribut*

Intervention Student Dropouts


student dropout*

school dropout*

retain*

student retention

21/33

Search Concept MeSH headings Keywords/Text words support structure*

support system*

support program*

student support

student assistance

professional support*

pre medical

premedical

student assistance


Search limits





Study design None



PubMed/MEDLINE EMBASE CINAHL ISI Web of Knowledge ERIC SSRN J-STAGE African Index Medicus Australasian Medical Index Index Medicus for Eastern Mediterranean Region IndMED KoreaMed LILACS Index Medicus for the South-East Asia Region (IMSEAR)

22/33

Panteleimon Western Pacific Region Index Medicus (WPRIM) WHO’s Library Database (WHOLIS)


Cochrane library (CDSR) BEME database Health Systems Evidence (PPD/CCNC) Campbell Library

Guidelines NHS Clinical Knowledge Summaries National Library of Guidelines

Grey literature NHS Evidence OpenGrey Association of African Universities Database of African Theses and Doctorates (DATAD)


Example search output – PubMed (2nd August 2011)





















23/33








26





28,456







32 “medical intern” [tw] OR “medical interns” [tw] OR

“medical internship” [tw] 162

33

“medical school” [tw] OR “medical schools” [tw] OR

“school of medicine” [tw] OR “schools of medicine” [tw] OR

“health professional school” [tw] OR “health professional

schools” [tw] OR “school of health science” [tw] OR

“schools of health science” [tw] OR “school of health

sciences” [tw] OR “schools of health sciences” [tw] OR

“faculty of medicine” [tw] OR “faculties of medicine” [tw]

OR “faculty of health science” [tw] OR “faculties of health

science” [tw] OR “faculty of health sciences” [tw] OR

“faculties of health sciences” [tw] OR “department of

medicine” [tw] OR “departments of medicine” [tw] OR

“department of health science” [tw] OR “departments of

health science” [tw] OR “department of health sciences” OR

“departments of health sciences” [tw] OR “medical

education” [tw] OR “medical training” [tw]

123,915

34

“nursing school” [tw] OR “nursing schools” [tw] OR “school





69,711

35 “midwifery school” [tw] OR “midwifery schools” [tw] OR 595

24/33







36





OR “faculty of dentistry” [tw] OR “faculties of dentistry”

[tw] OR “faculty of dental medicine” [tw] OR “faculties of

dental medicine” [tw] OR “dental education” [tw] OR “dental


training” [tw]

20,301

37











821


[tw] 314

39






81




43 OR/1-42 290,752






25/33




51 “rural” [tw] 95,324

52 “remote” [tw] 36,368





[tw] 108


58 OR/44-57 157,236

59 43 AND 58 7,325

60 “Student Dropouts” [MeSH] 1,405


62 “student dropout” [tw] OR “student dropouts” [tw] 1,410

63 "school dropout" [tw] OR "school dropouts" [tw] 349

64 “student retention” [tw] 80

65

"support structure" [tw] OR "support structures" [tw] OR

"support system" [tw] OR "support systems" [tw] OR

"support program" [tw] OR "support programs" [tw] OR

"support programme" [tw] OR "support programmes" [tw]

13,593

66 "student assistance" [tw] OR "student support" [tw] 140

67 "professional support" [tw] 675

68 "premedical" [tw] OR "pre medical" [tw] 1,028

69 OR/60-68 17,020

70 59 AND 69 169



26/33

Appendix C: Search strategy, sub-item (c)

The effect of community-based support programmes, involving both financial and in-kind

assistance, by which communities identify and/or support their own members for return

of services, on quantity, quality and relevance.



Intervention: Community-based support programs by which communities

support their own members for return of service

Comparison: No community-based support


Search terms





Students, Medical

Students, Nursing



Schools, Medical

Schools, Nursing

Schools, Dental

Schools, Pharmacy



Education, Medical

Education, Dental

Education, Pharmacy


Education, Nursing









health student*


healthcare student*

medical student*

nursing student*

premedical student*

midwifery student*


medical residen*

medical intern*

medical school*

nursing school*

midwifery school*

dental school*

dentistry school*

pharmacy school*


school* of medicine

school* of nursing




school* of pharmacy




facult* of medicine

facult* of nursing




facult* of pharmacy

27/33

Search Concept MeSH headings Keywords/Text words facult* of pharmaceutical science*

facult* of health science*









medical education

medical training

nursing education

nursing training

midwifery education

midwifery training

dental education

dental training

dentistry education

dentistry training

pharmacy education

pharmacy training







clerkship*

clinical rotation*

clinical placement*


Rural Population

Rural Health


Hospitals, Rural


under served

underserved

underrepresented

under represented

rural

remote

nonmetropolitan

deprived

shortage area*


maldistribut*

Intervention Fellowships and Scholarships

Financial Support

Training Support

Physician Incentive Plans

stipend*

grant*

loan*

fellowship*

28/33

Search Concept MeSH headings Keywords/Text words Employee Incentive Plans

Reimbursement, Incentive

scholarship*

subsidy

subsidies

financial support*

financial assistance

financial incentive*

monetary incentive*

monetary support*

in-kind support*

in-kind assistance*

non-financial incentive*

return of service*

community-based


Search limits





Study design None



PubMed/MEDLINE EMBASE CINAHL ISI Web of Knowledge ERIC SSRN J-STAGE African Index Medicus Australasian Medical Index Index Medicus for Eastern Mediterranean Region

29/33

IndMED KoreaMed LILACS Index Medicus for the South-East Asia Region (IMSEAR) Panteleimon Western Pacific Region Index Medicus (WPRIM) WHO’s Library Database (WHOLIS)


Cochrane library (CDSR) BEME database Health Systems Evidence (PPD/CCNC) Campbell Library

Guidelines NHS Clinical Knowledge Summaries National Library of Guidelines

Grey literature NHS Evidence OpenGrey Association of African Universities Database of African Theses and Doctorates (DATAD)


Example search output – PubMed (2nd August 2011)

















30/33












26





28,456







32 “medical intern” [tw] OR “medical interns” [tw] OR

“medical internship” [tw] 162

33

“medical school” [tw] OR “medical schools” [tw] OR

“school of medicine” [tw] OR “schools of medicine” [tw] OR

“health professional school” [tw] OR “health professional

schools” [tw] OR “school of health science” [tw] OR

“schools of health science” [tw] OR “school of health

sciences” [tw] OR “schools of health sciences” [tw] OR

“faculty of medicine” [tw] OR “faculties of medicine” [tw]

OR “faculty of health science” [tw] OR “faculties of health

science” [tw] OR “faculty of health sciences” [tw] OR

“faculties of health sciences” [tw] OR “department of

medicine” [tw] OR “departments of medicine” [tw] OR

“department of health science” [tw] OR “departments of

health science” [tw] OR “department of health sciences” OR

“departments of health sciences” [tw] OR “medical

education” [tw] OR “medical training” [tw]

123,915

34 “nursing school” [tw] OR “nursing schools” [tw] OR “school 69,711

31/33






35

“midwifery school” [tw] OR “midwifery schools” [tw] OR






595

36





OR “faculty of dentistry” [tw] OR “faculties of dentistry”

[tw] OR “faculty of dental medicine” [tw] OR “faculties of

dental medicine” [tw] OR “dental education” [tw] OR “dental


training” [tw]

20,301

37











821


[tw] 314

39






81




43 OR/1-42 290,752


32/33








51 “rural” [tw] 95,324

52 “remote” [tw] 36,368





[tw] 108


58 OR/44-57 157,236

59 43 AND 58 7,325

60 “Fellowships and Scholarships” [MeSH] 3,799

61 “Financial Support” [MeSH] 32,872

62 “Training Support” [MeSH] 8,805

63 “Physician Incentive Plans” [MeSH] 1,856

64 “Employee Incentive Plans” [MeSH] 1,443

65 “Reimbursement, Incentive” [MeSH] 2,201

66

"stipend" [tw] OR "stipends" [tw] OR "grant" [tw] OR

"grants" [tw] OR "loan" [tw] OR "loans" [tw] OR

"fellowship" [tw] OR "fellowships" [tw] OR "scholarship"

[tw] OR "scholarships" [tw] OR "subsidy" [tw] OR

"subsidies" [tw]

20,442

67

"financial support" [tw] OR “financial supports” [tw] OR

"financial assistance" [tw] OR "financial incentive" [tw] OR

"financial incentives" [tw] OR "monetary incentive" [tw] OR

"monetary incentives" OR "monetary support" [tw] OR

“monetary supports” [tw]

7,650

68

"in-kind support" [tw] OR “in-kind supports” [tw] OR "in-

kind assistance" [tw] OR “non-financial incentive” [tw] OR

"non-financial incentives" [tw]

50

69 "return of service" [tw] OR “return of services” [tw] 7

33/33


70 "community-based" [tw] 27,870

71 OR/60-70 83,700

72 59 AND 71 921



example for developing review protocol · 4/33 geographically skewed distributions of healthcare...

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