REVIEW PROTOCOL Recommendation 3 Does the innovative expansion of faculty affect the quantity, quality and relevance of health professionals? A systematic review Review protocol Organization, City, Country: Prepared by: Date: Senior supervisor Research team members University of the Philippines Manila, Manila, Philippines Venice Celis September 2011 Marilyn Lorenzo Jenny dela Rosa, Grace Fernandez, Venice Celis, Janet Clemente 1/13
Table of Contents A SYSTEMATIC REVIEW... 1 1.0 Background... 3 2.0 Objective... 3 3.0 Review Question... 3 4.0 Evidence gathering and study selection... 4 5.0 Assessment of risk of bias and data extraction... 6 6.0 Data synthesis... 7 7.0 Dissemination... 7 8.0 Resource implications... 7 9.0 References... 7 Appendix A: search strategy... Error! Bookmark not defined. Appendix B: data extraction forms (see attached excel workbook)... 12 Appendix C: Example of databases, websites and journals which could be searched. 12 2/13
1.0 Background Include definitions, answers to background questions, description of the intervention and how it might work to help better understand the question. This section is optional. 2.0 Objective To assess the effect of streamlined educational pathways, or ladder programmes, for the advancement of practicing health professionals, in both undergraduate and postgraduate programmes, on the improvement of the quantity, quality, and relevance of health professionals. 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: Population Intervention Comparison Outcome Health Science Educational Programs for: o Medical Doctors including PH doctors o Nursing Professionals including PH nurses o Midwifery Professionals including PH midwives o Dentists o Pharmacists Health Science Students including: o Medical students o Nursing students o Premedical students o Midwifery students o Residents Health Professionals o Doctors/physicians o Nurses/nursing staff o Midwives o Dentists/dental staff Innovative expansion of faculty No Innovative expansion of faculty Quantity, quality and relevance of health professionals 3/13
o Pharmacists Paramedical practitioners 4.0 Evidence gathering and study selection 3.1 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 Appendix A. In cases where the search results are small in number, search terms will be reduced to maximize the search sensitivity. Topic/Field Medicine and Health Sciences Education Social Sciences Regional databases Grey Literature databases Local databases Database PubMed, Campbell Library, Cochrane Library, Health Systems Evidence ERIC Social Science databases SSRN African Index Medicus, Australasian Medical Index, Index Medicus for Eastern Mediterranean Region, IndMED, KoreaMed, LILACS, IMSEAR, Panteleimon, WPRIM, British Education Index, Research and Development Resource Base (RDRB) OPENSIGLE, NewYork Academy of Medicine Grey Lit site, FADE Library, HMIC, Biomed, INTUTE, MedicalTeacher database, DATAD, International Journal of Pharmacy Education HERDIN, UP Integrated Library System, UST Miguel de Bienvenides Library, De La Salle University Library, Ateneo de Manila Library, Siliman University Library, Ateneo de Zamboanga Library, Xavier University Library, San Carlos University Library, 4.1.2 Hand searching The following journals and websites will be hand-searched for relevant articles: Resources that will be searched by hand WHO's Library Database (WHOLIS) HRH Global Resource Center World Federation of Medical Education World Bank Resources regarding the UP Manila School of Health Sciences 4/13
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. Experts and networks will be contacted regarding additional articles Consultation with relevant members of the Core Guidelines Development Group 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. 4.3.2 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 (ML, VC) 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: Participants in this study are: Health Science Educational Programs for: o Medical Doctors including PH doctors o Nursing Professionals including PH nurses o Midwifery Professionals including PH midwives o Dentists o Pharmacists Health Science Students including: o Medical students o Nursing students o Premedical students o Midwifery students o Residents Health Professionals o Medical Doctors - both Generalist and Specialist Practitioners, and Public Health Doctors o Nursing Professionals- both Generalist and specialist practitioners, including nurse practitioners and Public Health Nurses o Midwifery Professionals, including Public Health Midwives o Dentists o Pharmacists Paramedical practitioners as defined in the ISCO-08 minor group 224 and Mullan and 5/13
Frehywot, 2007; WHO, 2010. Will also include The Mid-level Cadres like Assistant medical officers, Clinical officers, Health Assistants, Health Officers, Medical Assistants, Nurse Clinicians, Physician Assistants. 4.2.3 Types of intervention: - Does the Does the innovative expansion of faculty affect the quantity, quality and relevance of health professionals? 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. Secondary outcomes include values and preferences, costs and benefits, harms and all unintended effects of the intervention are also of critical importance and will be eligible. 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 inclusion criteria 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 final selection, reviewers will extract required data from each paper, using the predefined evidence summary templates attached in Appendix B. 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. Risk of bias across studies will be assessed using the approach outlined by the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group. 6/13
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 submitted to peer-reviewed journals for publication (a more specific dissemination proposal can go here as well). 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 Evidence retrieval protocol developed Identifying and retrieving the evidence and conduct of literature review Conduct of hand searching and contacts with experts and networks. Summarize the evidence Develop Descriptive Evidence Table Develop GRADE Evidence Table Submit Descriptive Evidence Table and GRADE Evidence Table to the WHO Secretariat Upload PDFs of articles to FTP site 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. Chapter in a book 7/13
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 8/13
Search Concept MeSH headings Population Faculty[Mesh] Nurse Clinicians[Mesh] Textwords Faculty[tw] teachers[tw] teacher[tw] mentors[tw] mentor[tw] preceptor[tw] preceptors[tw] educator[tw] educators[tw] teaching staff[tw] tutor[tw] tutors[tw] faculty of pharmacy[tw] clinicians[tw] clinical instructors[tw] clinical teachers[tw] clinical staff[tw] Intervention 1 adjunct faculty[tw] part-time faculty[tw] temporary faculty[tw] guest lecturers[tw] visiting lecturers[tw] visiting professor[tw] visiting academic[tw] visiting scholar[tw] School expansion[tw] Intervention 2 joint appointment of faculty[tw] shared appointment of faculty[tw] dual appointment of faculty[tw] appointment in health services and educational institutions[tw] Intervention 3 Research Support as Topic[Mesh] improve research facility[tw] improve research facilities[tw] improve research infrastructure[tw] improve research infrastructures[tw] 9/13
increase research funding[tw] increase research resources[tw] expand research network[tw] expand research networks[tw] expand research linkage[tw] expand research linkages[tw] training of faculty in research[tw] PubMed Search Output Search Most Recent Queries Time Result #12 Search Faculty[Mesh] OR Nurse Clinicians[Mesh] OR Faculty[tw] OR teachers[tw] OR teacher[tw] OR mentors[tw] OR mentor[tw] OR preceptor[tw] OR preceptors[tw] OR educator[tw] OR educators[tw] OR teaching staff[tw] OR tutor[tw] OR tutors[tw] OR faculty of pharmacy[tw] OR clinicians[tw] OR clinical instructors[tw] OR clinical teachers[tw] OR clinical staff[tw] 20:21:14 157,223 #13 Search adjunct faculty[tw] OR part-time faculty[tw] OR temporary faculty[tw] OR guest lecturers[tw] OR visiting lecturers[tw] OR visiting professor[tw] OR visiting academic[tw] OR visiting scholar[tw] OR school expansion[tw] #14 Search joint appointment of faculty[tw] OR shared appointment of faculty[tw] OR dual appointment of faculty[tw] OR appointment in health services and educational institutions[tw] #15 Search Research Support as Topic[Mesh] OR improve research facility[tw] OR improve research facilities[tw] OR improve research infrastructure[tw] OR improve research infrastructures[tw] OR increase research funding[tw] OR increase research resources[tw] OR expand research network[tw] OR expand research networks[tw] OR expand research linkage[tw] OR expand research linkages[tw] OR training of faculty in research[tw] 20:22:16 224 20:22:56 0 20:26:47 18,792 10/13
#16 Search (#12) AND #13 20:29:39 152 #17 Search (#12) AND #14 20:31:56 0 #18 Search (#12) AND #15 20:32:18 954 #19 Search ((#16) OR #17) OR #18 20:32:51 1,104 #20 Search #19 Limits: English 20:33:29 1,068 #21 Search #19 Limits: English, Publication Date from 1995 to 2011 20:34:18 757 11/13
Appendix B: data extraction forms (see attached excel workbook) 1) GRADE Evidence Table Template.xls 2) Descriptive Evidence Table.xls Appendix C: Example of databases, websites and journals which could be searched Databases Databases for biomedicine and health sciences: Pubmed/MEDLINE CINAHL Cochrane Library (CDSR) Health Systems Evidence (PPD/CCNC) UK Pubmed Central Global Health Library (Global Index Medicus) UK Pubmed Central Databases for social sciences: ISI Web of knowledge Campbell Library Social Science Research Network Databases for education: ERIC BEME database Regional databases for biomedicine and health sciences: African Index Medicus (www.indexmedicus.afro.who.int) Australasian Medical Index (www.nla.gov.au/ami) Index Medicus for Eastern Mediterranean Region (www.emro.who.int/his/vhsl) Chinese Biomedical Literature Database (CBM) (www.imicams.ac.cn/cbm/index.asp) IndMED (www.indmed.nic.in) KoreaMed (www.koreamed.org/searchbasic.php) LILACS (www.bases.bireme.br/cgibin/wxislind.exe/iah/online/?isisscript=iah/iah.xis&base=lilacs&lang=i) Index Medicus for the South-East Asia Region (IMSEAR) (www.library.searo.who.int/modules.php?op=modload&name=websis&file=imsear) Panteleimon for Russia and Ukraine (www.panteleimon.org/maine.php3) Western Pacific Region Index Medicus (WPRIM) (wprim.wpro.who.int/searchbasic.php) PASCAL (www.international.inist.fr/article21.html) 12/13
General databases: Google Scholar 4.1.2 Hand searching The following journals and websites will be hand-searched for relevant articles: Resources that will be searched by hand, for peer-reviewed articles and grey literature Assessment & Evaluation in Higher Education American Journal of Health Studies Teaching and Teacher Education Academic Medicine Journal of Interprofessional Care Academic Medicine Medical Teacher International Journal for Academic Development WHO's Library Database (WHOLIS) SAMMS HRH Global Resource Center World Federation of Medical Education International Council of Nurses Association of American Medical Colleges Council on Graduate Medical Education American Academy of Family Physicians American College of Physicians World Bank HMIC database Grey Literature Network Service http://www.greynet.org OPENSIGLE System for Information on Grey Literature in Europe http://opensigle.inist.fr/ NewYork Academy of Medicine Grey Literature site http://www.nyam.org/library/online-resources/grey-literature-report/ FADE Library http://www.fade.nhs.uk/ HMIC: Health Management Information Consortium http://library.nhs.uk/help/resource/hmic Biomed http://www.biomedcentral.com/ INTUTE http://www.intute.ac.uk/ 13/13