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REVIEW PROTOCOL TEMPLATE

Recommendation 6

Does the direct entry of graduates from relevant undergraduate, postgraduate, or other educational programmes into higher levels of

health professional studies affect the quantity, quality and relevance of health professionals?

A systematic review

Review protocol

Organization, City, Country: Mahidol University

Department of Public Health Nursing, Faculty of Nursing Bangkok, Thailand

Prepared by: Nantiya Watthayu, Hiroki Matsui Document date: September 2011 Senior supervisor Francesca Celletti Research team members Rebecca Bailey, Erica Lynette Wheeler, Dolea Carmen

Mihaela, Annette Mwansa Nkowane, Rodrigo Rodriguez Fernandez, Rachel Marie Amiya, Fongcum Tilokskulchai, Krongdai Unhasuta

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Table of Contents

[ DOES THE DIRECT ENTRY OF GRADUATES FROM RELEVANT UNDERGRADUATE, POSTGRADUATE, OR OTHER EDUCATIONAL PROGRAMMES INTO HIGHER LEVELS OF HEALTH PROFESSIONAL STUDIES AFFECT THE QUANTITY, QUALITY AND RELEVANCE OF HEALTH PROFESSIONALS? ] .............................................. 1

A SYSTEMATIC REVIEW .......................................................................................................................... 1

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

2.0 Objective ............................................................................................................. 3

3.0 Review Question ................................................................................................. 3

4.0 Evidence gathering and study selection .............................................................. 3

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 ........................................................................................................... 8

Appendix A: database search strategy ............................................................................ 9

Appendix B: data extraction forms (see attached excel workbook) ............................. 14

Appendix C: Example of databases, websites and journals which could be searched . 14

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1.0 Background

Include definitions, answers to background questions, description of the intervention and how it might work to help better understand the question.

In response to HRH shortage, healthcare professional education is exploring creative strategies to increase capacity and reach new student populations. Direct entry/admission/accelerated second degree are an Innovative approach gaining interest to health professional education. Direct admission or accelerated second degree build on previous learning experience and provide a way for individuals from relevant undergraduate, postgraduate, or other educational programs to transition into higher levels of health professional studies.

2.0 Objective

To assess the effect of direct entry/admission of graduates from relevant undergraduate, postgraduate, or other educational programmes into higher levels of health professional studies affect 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

Graduates from relevant undergraduate, postgraduate, or other educational programmes

Direct entry/admission into higher levels of health professional schools

No direct entry/admission into higher levels of health professional schools

Quantity, quality and relevance of health professionals

4.0 Evidence gathering and study selection

See Appendix C for examples of databases, websites and journals which may be searched.

4.1 Evidence gathering

The evidence gathering approach will have four components:

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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 Database

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

WHO Global Index Medicus

WHO portal of clinical trials

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/cgi-bin/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)

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J-STAGE (Japanese)

ICHUSHI (Japanese),

General databases

Google Scholar

Google

4.1.2 Hand searching

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

Resources that will be searched by hand

Journal of Interprofessional Care, 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, opensigle.inist.fr, HMIC database, IMA, FIP, (AMEE), UNESCO

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

WHO Technical Group for Health Professional Education, Dean consortium, Thai Nursing council

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 (Fongcum Tilokskulchai, Krongdai Unhasuta, Rachel Amiya) 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.

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4.2.2 Types of participants: This is a succinct description of the types of participants that you will include. For example, you might copy the health professionals definition here.

Health professional schools graduating: Medical Doctors - both Generalist and Specialist Practitioners, including Public

Health Doctors Nursing Professionals, including Public Health Nurses, Midwifery Professionals,

including Public Health Midwives Dentists Pharmacists

4.2.3 Types of intervention: This is a succinct description of the types of intervention you will include.

The outcomes focus on the effectiveness of direct admitted graduates into higher levels of health professional schools.

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 will 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 B. Data will be collected regarding the reasons for exclusion,

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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. 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 (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

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

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9.0 References

When citing articles, please use the WHO standard citation format, called the Harvard system. The Harvard citation system shows the author and date in the body of the text. This may be done in one of two ways: Ballance, Ewart & Fitzsimmons (2001) have reported ... It has been reported (Ballance, Ewart & Fitzsimmons, 2001) that ... Some examples of formatting reference lists: Article in a Journal Burt BA, Pai S (2001). Sugar consumption and caries risk: a systematic review. Journal of Dental Education, 65:1017–1023.

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

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

WHO Publication with no named author World Health Organization (2003). 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.

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

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Appendix A: database search strategy

Search terms

Search Concept

MeSH headings Keywords

Population Students, Health, Occupations [MeSH]

Education, Graduate [MeSH]

Education, Medical, Undergraduate[MeSH]

School, Medical [MeSH]

School, Nursing [MeSh]

School, Dental[MeSH]

School, Pharmacy[MeSH]

School, Public Health[MeSH]

Educaction, Medical [MeSH]

Education, Medical,

Graduate[MeSH]

Education, Dental,

Graduate[MeSH]

Education,Pharmacy,

Graduate[MeSH]

Education,Nursing,

Graduate[MeSH]

Education, Dental, [MeSH]

Education, Nursing, [MeSH]

Education, Pharmacy,

[MeSH]

Education, Public Health

Professional [MeSH]

Education, Nursing, Diploma Programs [Mesh]

Education, Nursing, Baccalaureate [MeSH]

Family Practice/education [MeSH]

Education, Nursing,

Health student*

Health care student*

Healthcare student*

Clinical Competence

Medical student*

Nursing student*

Premedical student*

Pharmacy student*

Dentistry student*

Midwifery student*

Public health student*

Medical Education

Nursing Education

Midwifery Education

Dentistry Education

Pharmacy Education

Health Professional Education

Medical Internship

Medical Residency

Internship

Resident*

Residency

Clinical Competence

Graduate education

Graduate program

Graduate school*

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Graduate [MeSH]

Internal Medicine/education [MeSH]

Internship and Residency [MeSH]

Postgraduate education

Postgraduate program

Postgraduate school

Post-graduate education

Post-graduate school*

Medical school*

Nursing school*

Dental school*

Pharmacy school*

Public Health school*

School of Public Health*

Health professional education

Internship and residency

Postgraduate school*

Intervention Direct admission*

Direct school admission*

DSA

Direct entry

Direct entree

Direct enrollment

Direct entrance

Direct admitted

Directly admitted

Immediate entry

Direct transfer

Direct incorporation

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

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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

Other limits Human data

Databases (same as section 3.1.1 above)

Topic/Field

Database

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/cgi-bin/wxislind.exe/iah/online/?IsisScript=iah/iah.xis&base=LILACS&lang=i)

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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)

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Example search output – PubMed (DATE)

Cut and paste from PubMed here, for example:

No. Search term Hits

1

POPULATION CONCEPT Mesh Students, Health, Occupations[MeSH] OR Education, Graduate[MeSH] OR Education, Medical, Undergraduate[MeSH] OR School, Medical[MeSH] OR School, Nursing[MeSh] OR School, Dental[MeSH] OR School, Pharmacy[MeSH] OR School, Public Health[MeSH] OR Educaction, Medical[MeSH] OR Education, Medical, Graduate[MeSH] OR Education, Dental, Graduate[MeSH] OR Education, Pharmacy, Graduate[MeSH] OR Education, Nursing, Graduate[MeSH] OR Education, Dental[MeSH] OR Education, Nursing[MeSH] OR Education, Pharmacy[MeSH] OR Education, Public Health Professional[MeSH] OR Education, Nursing, Diploma Programs[Mesh] OR Education, Nursing, Baccalaureate[MeSH] OR Family Practice/education[MeSH] OR Education, Nursing, Graduate[MeSH] OR Internal Medicine/education[MeSH] OR Internship and Residency[MeSH]

224338

2

POPULATION CONCEPT Keywords Health student* [tw] OR Health care student* [tw] OR Healthcare student* [tw] OR Clinical Competence [tw] OR Medical student* [tw] OR Nursing student* [tw] OR Premedical student* [tw] OR Pharmacy student* [tw] OR Dentistry student* [tw] OR Midwifery student* [tw] OR Public health student* [tw] OR Medical Education [tw] OR Nursing Education [tw] OR Midwifery Education [tw] OR Dentistry Education [tw] OR Pharmacy Education [tw] OR Health Professional Education [tw] OR Medical Internship [tw] OR Medical Residency [tw] OR Internship [tw] OR Resident* [tw] OR Residency [tw] OR Clinical Competence [tw] OR Graduate education [tw] OR Graduate program [tw] OR Graduate school* [tw] OR Postgraduate education [tw] OR Postgraduate program [tw] OR Postgraduate school [tw] OR Post-graduate education [tw] OR Post-graduate school* [tw] OR Medical school* [tw] OR Nursing school* [tw] OR Dental school* [tw] OR Pharmacy school* [tw] OR Public Health school* [tw] OR School of Public Health* [tw] OR Health professional education [tw] OR Internship and residency [tw] OR Postgraduate school*

380851

3 1 OR 2 396723

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No. Search term Hits

4

INTERVENTION CONCEPT Keywords Direct admission* [tw] OR Direct school admission* [tw] OR DSA [tw] OR Direct entry [tw] OR Direct entrée [tw] OR Direct enrollment [tw] OR Direct entrance [tw] OR Direct admitted [tw] OR Directly admitted [tw] OR Immediate entry [tw] OR

Direct incorporation [tw] OR Direct transfer [tw]

21821

5 3 AND 4 246

6 7 [Limit to: Humans and Languages (English, Japanese) and Publication Date from 1995/01/01 to Present ]

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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 British Education Index

http://www.leeds.ac.uk/bei/COLN/COLN_default.html

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UNESCO Publications Database http://www.unesco.org/new/en/unesco/resources/online-materials/publications/unesdoc-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/cgi-bin/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)

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

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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/