Dissertation (Ph.D.)--University of South Florida, 2009. / Title from PDF of title page. Document formatted into pages; contains 305 pages. Includes vita. Includes bibliographical references.

Quais os impactos de curto prazo ocorridos a partir dos ciclos iniciais de implantação do “Programa Mais Médicos” (PMM) em municípios do Rio Grande do Sul? Essa dissertação versa um sobre subtipo de ensaio comunitário acerca da problemática em questão, com estudo agregado com múltiplos grupos, longitudinal em série temporal retrospectiva, a partir de dados de fontes secundárias, com análise descritiva de propósito exploratório. Trata-se de 10 grupos conformados por agregados de municípios do Rio Grande do Sul, selecionados e estratificados em 5 faixas populacionais, estando pareados pela condição de implantação e não implantação do PMM. Realizou-se análise comparativa e descritiva de um conjunto selecionado de indicadores correlatos aos serviços de Atenção Primária à Saúde (APS). De um modo geral, observou-se o incremento de indicadores de estrutura nos agregados de municípios com implantação do PMM, notadamente nos agregados com faixas de menores populações. Em termos de indicadores de resultados observou-se discreto incremento na produção de serviços nos agregados com implantação do PMM, contudo, não foram identificadas diferenças significativas de internações por causas sensíveis e de outros indicadores de impacto próprios da APS. As hipóteses mais plausíveis para explicar os achados estão referidas ao exíguo tempo decorrido entre a implantação do PMM e a realização do estudo, além da constatação de que nos ciclos iniciais de implantação do programa houve predominância de caráter substitutivo de trabalho profissional médico nos municípios selecionados para o estudo. / What are the short-term impacts occurred in the early cycles implementation of the "More Doctors Program" (PMM) in municipalities of Rio Grande do Sul? This research focuses on one community trial subtype, added to multiple groups, in longitudinal retrospective time series, based on data from secondary sources, with descriptive analysis of exploratory purpose. It is conformed by 10 groups clusters of municipalities of Rio Grande do Sul, selected and stratified into five population groups, being matched by the deployment condition and not implementation of PMM. We carried out comparative and descriptive analysis of a selected set of indicators related to the services of Primary Health Care (PHC). In general, there was the structure of indicators of growth in clusters of municipalities with implementation of PMM, especially in conglomerates with smaller populations tracks. In terms of outcome indicators showed a slight increase in the production of services in conglomerates with implementation of PMM, however, significant differences in hospital admissions were identified by sensitive causes and other APS's own impact indicators. The most plausible hypotheses to explain the findings are referred to the narrow time between the implementation of the PMM and the study, besides the fact that in the early cycles of program implementation was substitute character predominance of medical professional working in selected municipalities to the study.

Quais os impactos de curto prazo ocorridos a partir dos ciclos iniciais de implantação do “Programa Mais Médicos” (PMM) em municípios do Rio Grande do Sul? Essa dissertação versa um sobre subtipo de ensaio comunitário acerca da problemática em questão, com estudo agregado com múltiplos grupos, longitudinal em série temporal retrospectiva, a partir de dados de fontes secundárias, com análise descritiva de propósito exploratório. Trata-se de 10 grupos conformados por agregados de municípios do Rio Grande do Sul, selecionados e estratificados em 5 faixas populacionais, estando pareados pela condição de implantação e não implantação do PMM. Realizou-se análise comparativa e descritiva de um conjunto selecionado de indicadores correlatos aos serviços de Atenção Primária à Saúde (APS). De um modo geral, observou-se o incremento de indicadores de estrutura nos agregados de municípios com implantação do PMM, notadamente nos agregados com faixas de menores populações. Em termos de indicadores de resultados observou-se discreto incremento na produção de serviços nos agregados com implantação do PMM, contudo, não foram identificadas diferenças significativas de internações por causas sensíveis e de outros indicadores de impacto próprios da APS. As hipóteses mais plausíveis para explicar os achados estão referidas ao exíguo tempo decorrido entre a implantação do PMM e a realização do estudo, além da constatação de que nos ciclos iniciais de implantação do programa houve predominância de caráter substitutivo de trabalho profissional médico nos municípios selecionados para o estudo. / What are the short-term impacts occurred in the early cycles implementation of the "More Doctors Program" (PMM) in municipalities of Rio Grande do Sul? This research focuses on one community trial subtype, added to multiple groups, in longitudinal retrospective time series, based on data from secondary sources, with descriptive analysis of exploratory purpose. It is conformed by 10 groups clusters of municipalities of Rio Grande do Sul, selected and stratified into five population groups, being matched by the deployment condition and not implementation of PMM. We carried out comparative and descriptive analysis of a selected set of indicators related to the services of Primary Health Care (PHC). In general, there was the structure of indicators of growth in clusters of municipalities with implementation of PMM, especially in conglomerates with smaller populations tracks. In terms of outcome indicators showed a slight increase in the production of services in conglomerates with implementation of PMM, however, significant differences in hospital admissions were identified by sensitive causes and other APS's own impact indicators. The most plausible hypotheses to explain the findings are referred to the narrow time between the implementation of the PMM and the study, besides the fact that in the early cycles of program implementation was substitute character predominance of medical professional working in selected municipalities to the study.

Quais os impactos de curto prazo ocorridos a partir dos ciclos iniciais de implantação do “Programa Mais Médicos” (PMM) em municípios do Rio Grande do Sul? Essa dissertação versa um sobre subtipo de ensaio comunitário acerca da problemática em questão, com estudo agregado com múltiplos grupos, longitudinal em série temporal retrospectiva, a partir de dados de fontes secundárias, com análise descritiva de propósito exploratório. Trata-se de 10 grupos conformados por agregados de municípios do Rio Grande do Sul, selecionados e estratificados em 5 faixas populacionais, estando pareados pela condição de implantação e não implantação do PMM. Realizou-se análise comparativa e descritiva de um conjunto selecionado de indicadores correlatos aos serviços de Atenção Primária à Saúde (APS). De um modo geral, observou-se o incremento de indicadores de estrutura nos agregados de municípios com implantação do PMM, notadamente nos agregados com faixas de menores populações. Em termos de indicadores de resultados observou-se discreto incremento na produção de serviços nos agregados com implantação do PMM, contudo, não foram identificadas diferenças significativas de internações por causas sensíveis e de outros indicadores de impacto próprios da APS. As hipóteses mais plausíveis para explicar os achados estão referidas ao exíguo tempo decorrido entre a implantação do PMM e a realização do estudo, além da constatação de que nos ciclos iniciais de implantação do programa houve predominância de caráter substitutivo de trabalho profissional médico nos municípios selecionados para o estudo. / What are the short-term impacts occurred in the early cycles implementation of the "More Doctors Program" (PMM) in municipalities of Rio Grande do Sul? This research focuses on one community trial subtype, added to multiple groups, in longitudinal retrospective time series, based on data from secondary sources, with descriptive analysis of exploratory purpose. It is conformed by 10 groups clusters of municipalities of Rio Grande do Sul, selected and stratified into five population groups, being matched by the deployment condition and not implementation of PMM. We carried out comparative and descriptive analysis of a selected set of indicators related to the services of Primary Health Care (PHC). In general, there was the structure of indicators of growth in clusters of municipalities with implementation of PMM, especially in conglomerates with smaller populations tracks. In terms of outcome indicators showed a slight increase in the production of services in conglomerates with implementation of PMM, however, significant differences in hospital admissions were identified by sensitive causes and other APS's own impact indicators. The most plausible hypotheses to explain the findings are referred to the narrow time between the implementation of the PMM and the study, besides the fact that in the early cycles of program implementation was substitute character predominance of medical professional working in selected municipalities to the study.

The widely acknowledged doctor shortage in Canada has recently motivated a more critical look at the licensure rates of International Medical Doctors (IMDs), also known as International Medical Graduates (IMGs). However, very little research has been conducted on the experiences of IMDs before they enter the Canadian medical system. This qualitative study collected interview data from 15 diverse IMDs seeking licensure in Ontario, Canada. The participants varied with respect to age, country of origin, English language proficiency on arrival, and time in Canada. In addition, two bridging support programs were observed, and interviews were conducted with three educators from the programs. The interviews were analysed using thematic content analysis (Boyatzis, 1998; Miles & Huberman, 1994). An analysis of metaphors used by the IMDs to describe their experiences during the licensing process supported the use of poetic representation for key findings, resulting in three poems that are interspersed in the body of the thesis (Ellingson, 2011; Glesne, 1997; Richardson, 2002; Richardson & Adams St. Pierre, 2005). The theoretical framework of the research was informed by Vygotskian Sociocultural Theory, which views learning as inseparable from social interaction and context (Vygotsky, 1987). Third-generation Activity Theory (AT), which has descended from Vygotsky’s work, was applied to highlight the higher-level systemic issues related to medical licensing. Results of this study indicate that IMDs with lower English proficiency face substantial difficulties on arrival, with limited access to the type of medically-relevant language instruction needed to support them. In fact, all pre-licensure IMDs struggle to access the interactional learning opportunities (i.e., Vygotskian “mediational means”) to support their entry into the system. Licensing challenges include limited exam preparation resources that support acquisition of Canadian cultural content; unequal access to clinical observerships; and a selection process which lacks transparency and emphasizes a screening tool unfamiliar to IMDs, the residency interview. Implications of this study include the revisiting of immigration policy; increasing the transparency and effectiveness of the selection process/residency interview; reviewing the role of clinical observerships in the selection process and exploring the potential of observerships to function as a licensure portfolio assessment.

The widely acknowledged doctor shortage in Canada has recently motivated a more critical look at the licensure rates of International Medical Doctors (IMDs), also known as International Medical Graduates (IMGs). However, very little research has been conducted on the experiences of IMDs before they enter the Canadian medical system. This qualitative study collected interview data from 15 diverse IMDs seeking licensure in Ontario, Canada. The participants varied with respect to age, country of origin, English language proficiency on arrival, and time in Canada. In addition, two bridging support programs were observed, and interviews were conducted with three educators from the programs. The interviews were analysed using thematic content analysis (Boyatzis, 1998; Miles & Huberman, 1994). An analysis of metaphors used by the IMDs to describe their experiences during the licensing process supported the use of poetic representation for key findings, resulting in three poems that are interspersed in the body of the thesis (Ellingson, 2011; Glesne, 1997; Richardson, 2002; Richardson & Adams St. Pierre, 2005). The theoretical framework of the research was informed by Vygotskian Sociocultural Theory, which views learning as inseparable from social interaction and context (Vygotsky, 1987). Third-generation Activity Theory (AT), which has descended from Vygotsky’s work, was applied to highlight the higher-level systemic issues related to medical licensing. Results of this study indicate that IMDs with lower English proficiency face substantial difficulties on arrival, with limited access to the type of medically-relevant language instruction needed to support them. In fact, all pre-licensure IMDs struggle to access the interactional learning opportunities (i.e., Vygotskian “mediational means”) to support their entry into the system. Licensing challenges include limited exam preparation resources that support acquisition of Canadian cultural content; unequal access to clinical observerships; and a selection process which lacks transparency and emphasizes a screening tool unfamiliar to IMDs, the residency interview. Implications of this study include the revisiting of immigration policy; increasing the transparency and effectiveness of the selection process/residency interview; reviewing the role of clinical observerships in the selection process and exploring the potential of observerships to function as a licensure portfolio assessment.