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REVIEW PROTOCOL TEMPLATE

Recommendation 11

Effectiveness of transformative continuous professional development and

in-service training through active participation of education and training

A systematic review

Review protocol

Senior supervisor Prof. Masamine Jimba

Research team members Tamy Yamamoto, Rachel Amiya, Yumon Saw, Laura

Shiao, and Bruno Sunguya

Organization, City, Country: The University of Tokyo, Japan

Prepared by:

Date:

Laura Shiao, Bruno Sunguya

July 2011

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Table of Contents

WORKING TITLE: ...................................................... ERROR! BOOKMARK NOT DEFINED.

A SYSTEMATIC REVIEW (PICO XX) ................................................................................ 1

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 ................................................ 11

6.0 Data synthesis ................................................................................................... 11

7.0 Dissemination ................................................................................................... 11

8.0 esource implications ......................................................................................... 12

9.0 References ........................................................................................................ 12

Appendix A: search strategy ......................................................................................... 14

Appendix B: data extraction forms (see attached excel workbook) ............................ 25

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1.0 Background

I. Definition of terms;

Continuing professional development (CPD)

Continuing professional development which was known as Continuous medical education

is the training beyond clinical update. It includes wide-ranging competencies like research

and scientific writing, multidisciplinary context of patient care, professionalism and ethical

practice, communication, leadership, management and behavioural skills, team building,

information technology, audit, and appropriate attitudinal change to ensure improved

patient service and research outcomes and attainment of the highest degree of

satisfaction by stakeholders. The CPD includes education methods beyond the didactic,

embodies concepts of self-directed learning and personal development and considers

organizational and systemic factors. (1)

In-service training (life-long training)

Training received while one is fully employed in the health sector. The aim is to equip

health workers or the trainers of health workers with the skills to deliver specific

interventions. (2,3)

II. Rationale of transformative CPD and in-service training

Health inequalities within and between countries, together with new health challenges

such as new infectious, environmental, behavioral risks, at a time of rapid demographic

and epidemiological transitions, are threatening the health of all. Health workers, as part

of the health system, are demanded to keep up with the evolving health needs, policies,

technologies, and knowledge. (4)

Continuing professional development (CPD) provides health professionals learning

opportunities by which health professionals keep up to date with the latest knowledge and

advances in health care. However, there are major flaws in how CPD is conducted,

financed, regulated, and evaluated. Furthermore, the science underpinning CPD for health

professionals is fragmented and underdeveloped. Some countries may have system of

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mandatory recertification programs, however, this system have not been successful

because of lack of motivation, absence of need base accredited programs, incentives and

legal bindings (1). Transforming CPD effectively with a new, comprehensive vision is

needed to ensure health needs.

For health professionals, continuing professional development is an important avenue

towards individual career progression, and the lack of available post-graduate training has

often been cited by doctors as a reason for emigration from their countries of origin. The

ability to attain further academic qualifications and to work with advanced equipment and

medical infrastructure were thought to be critical for the doctors’ career advancement (5).

Community health outcomes can also be improved by continuing professional

development programs. (6). On-the-job training programs give students and newly

qualified nurses a realistic picture of nursing practice and expose them to a wide variety of

experiences (7). While nurses may graduate their programs with appropriate clinical skills,

nurses in a supervisory role want newly qualified nurses to have skills in patient safety,

working as a team member, and handling confidentiality issues (8, 9 ).

There is a need to align undergraduate, postgraduate and CPD into a

harmonized/seamless continuum. Transformative CPD and in-service training should

reflect local needs with a stronger focus on building national/institutions, infrastructure

and capacity.

_______________________________

1. Regional Guidelines for continuing medical education (CME)/continuing professional development (CPD) activities. Geneva, World Health Organization, Regional office for South-east Asia, 2010.

2. Merriam-Webster on-line dictionary http://www.merriam-webster.com/ 3. World health report. Working together for health. Geneva, World Health

Organization, 2006. http://www.who.int/whr/2006/whr06_en.pdf 4. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, and et al. Health professionals

for a new century: transforming education to strengthen health systems in a interdependent world. Lancet , 2010, 376:1923-1958.

5. Bach, S. International mobility of health professionals: brain drain or brain exchange? United national university, World Institute for Development Economics

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Research, 2006. 6. Henriksson S, Isacsson G. Increased antidepressant use and fewer suicides in

Jämtland county, Sweden, after a primary care educational programme on the treatment of depression. Acta Psychiatrica Scandinavica, 2006, 114(3):159-167

7. Saeki K, Izumi H, Uza M, Murashima S. Factors associated with the professional competencies of public health nurses employed by local government agencies in Japan. Public Health Nursing, 2007, 24(5):449-457.

8. Baillie, L. Preparing adult branch students for their management role as staff nurses: An action research project. Journal of Nursing Management, 1999, 7(4):225-234.

9. Mullan F, Frehywot S, Ross H, Sharac J, Rainey J. WHO-GW Commissioned Study: Transformative Medical, Nursing and Mid-wifery Education-a Global Analysis. The Washington, DC, Department of Health Policy, George Washington University, 2011.

2.0 Objective

(a) To assess the effect of CPD, which supports/reflects reforms in education, and the

engagement and active participation of education and training institutions in CPD, on

quantity, quality and relevance of health professionals

(b) To assess the effect of using, or building the capacity of, existing education and training

institutions to conduct in-service training programmes, compared with training that

does not use those institutions, on quality, quantity 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:

PICO

sub item

Population Intervention Comparison Outcome

(a)

Health professionals: Doctors, Nurses, Midwives, Pharmacists, Dentists and Paramedics

CPD which is linked to active participation of education and training institutions

CPD which is NOT linked to active participation of education and training institutions

Quantity, Quality and Relevance of health professionals

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(b) Health professionals; Doctors, Nurses, Midwives, Pharmacists, Dentists and Paramedics

In-service training supported by external organization(s) which is integrated with local training infrastructure

In-service training supported by external organization(s) which is NOT integrated with local training infrastructure

Quantity, Quality and Relevance of health professionals

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 Appendix A and B. 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

EMBASE

CINAHL

Cochrane Library (CDSR)

Health Systems Evidence (PPD/CCNC)

UK Pubmed Central

NHS Evidence

Databases for social sciences

ISI Web of knowledge

Campbell Library

Social Science Research Network

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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)

General databases

Google Scholar

Open Grey

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

Assessment & Evaluation in Higher Education

American Journal of Health Studies

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Teaching and Teacher Education

Academic Medicine

Journal of Interprofession Care

Journal of Dental Education

International Journal of Nursing Education Scholarship

Academic Medicine

Medical Teacher

International Journal for Academic Development

Biomed (http://www.biomedcentral.com/)

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) and the Open

Grey System for Information on Grey Literature in Europe (http://opensigle.inist.fr/)

New York 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)

INTUTE http://www.intute.ac.uk/

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JICA Project Reports

University Research Co., LLC - Center for Human Services

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

Tana Wuliji, PhD, BPharm, Senior Quality Improvement Advisor for Healthcare

Workforce Development, University Research Co., LLC - Center for Human Services,

7200 Wisconsin Avenue, Suite 500, Bethesda, MD 20814, USA, Office: (+1-301) 941-8456

/ Mobile:(+1-202) 573-8442 / Fax: (+1-301) 941-8427, Email:twuliji@urc-chs.com

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 (LS, BS)

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 the Health professionals including;

Medical Doctors - both Generalist and Specialist Practitioners, and Public Health

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Doctors

Nursing Professionals- both Generalist and specialist practitioners, including nurse

practitioners and Public Health Nurses

Midwifery Professionals, including Public Health Midwives

Dentists

Pharmacists

Paramedical practitioners as defined in the ISCO-08 minor group 224 and Mullan and

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:

1. Continuing professional development which is linked to active participation of

education and training institutions.

2. In-service training supported by external organization which is integrated with local

training infrastructure

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 (Appendix D). Other important outcomes include

values and preferences, resource use/costs, benefits and harms, as well as all other

unintended effects of the intervention.

4.3 Exclusion criteria

Editorials, newspaper articles and other forms of popular media will be excluded.

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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 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.

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

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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 TIMESCALE

Evidence retrieval protocol development Up to 27th July 2011

Identifying and retrieving the evidence

Conduct literature review, hand searching

and contacts with experts and network

27th July – 31 August 2011

Summarizing evidence in Descriptive

Evidence Tables (Table 1. Summary of

systematic literature reviews, Table 2.

Summary of relevant literature)

1 September 2011 – 15 September

Development of GRADE Evidence Tables in

collaboration with WHO, Geneva, and the

GRADE network methodologist

15-30 September, 2011

9.0 References

When citing articles, please use the WHO standard citation format, called the Vancouver

style. Some examples:

Article in a Journal

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Burt BA, Pai S. Sugar consumption and caries risk: a systematic review. Journal of Dental

Education, 2001, 65:1017–1023.

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 for PICO Question C5 (a)

The effect of CPD, which supports/ reflect reforms in education, the engagement and

active participation of education and training institutions in CPD on quality, quantity and

relevance

Population: Health professionals

Intervention: CPD which is linked to active participation of education and training

institutions

Comparison: CPD which is NOT linked to active participation of education and training

institutions

Outcome: Quantity, Quality and Relevance of Health professionals

Search terms

Search Concept MeSH headings Keywords/ Text words

Population Physicians [MeSH]

Nurses [MeSH]

Nursing Staff [MeSH]

Nurse Midwives [MeSH]

Dentists [MeSH]

Dental Staff, Hospital [MeSH]

Pharmacists [Mesh]

Physician Assistants [Mesh]

Allied Health

Personnel[Mesh:NoExp]

Physician [tw]

Physicians [tw]

Doctor [tw]

Doctors [tw]

Dental staff [tw]

Dentists [tw]

Dentist [tw]

Nurse [tw]

Nurses [tw]

Public health nurse [tw]

Public health nurses [tw]

Midwife [tw]

Midwives [tw]

Public health midwives [tw]

Public health midwife [tw]

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Pharmacist [tw]

Pharmacists [tw]

Physician Assistant [tw]

physician assistants[tw]

Physicians' Assistants[tw]

Physician's Assistants[tw]

Physicians Assistants[tw]

Physicians' Assistant [tw]

Physicians' Extenders[tw]

Physician Extender[tw]

Physician Extenders[tw]

Physician's Extenders[tw]

Physicians' Extender[tw]

Doctor's Assistants[tw]

Doctor Assistants[tw]

Doctor's Assistant[tw]

Medex[tw]

Feldshers[tw]

Feldsher[tw]

Assistant Medical Officers[tw]

Assistant Medical Officer[tw]

Clinical Officers[tw]

Clinical Officer[tw]

Health Assistants[tw]

Health Assistant[tw]

Health Officers[tw]

Health Officer[tw]

Medical Assistants[tw]

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Medical Assistant[tw]

Nurse Clinicians[tw]

Nurse Clinician [tw]

Nurse Practitioners[tw]

Nurse Practitioner[tw]

Non-physician clinician [tw]

Non-physician clinicians [tw]

Non physician clinician [tw]

Non physician clinicians [tw]

Intervention Education, Continuing [MeSH]

Continuing medical education

[MeSH]

Continuing professional

development [tw]

Education, Continuing Medical [tw]

Medical Education, Continuing [tw]

Continuing Medical Education [tw]

Seminars [tw]

Workshops[tw]

Conferences[tw]

Symposium[tw]

Training program[tw]

Training

Institution

Schools, Medical [MeSH]

Schools, Nursing [MeSH]

Schools, Dental [MeSH]

Schools, Pharmacy [MeSH]

Schools, Public Health [MeSH]

Academies and Institutes [MeSH]

Graduate school [tw]

Postgraduate school [tw]

Post-graduate school [tw]

Graduate schools [tw]

Postgraduate schools [tw]

Post-graduate schools [tw]

Medical school[tw]

Medical schools[tw]

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Nursing school[tw]

Nursing schools[tw]

Midwifery school[tw]

Midwifery schools[tw]

Dental school[tw]

Dental schools[tw]

Dentistry school[tw]

Dentistry schools[tw]

Pharmacy school[tw]

Pharmacy schools[tw]

Health professional school[tw]

Health professional schools[tw]

School of medicine[tw]

Schools of medicine[tw]

School of nursing[tw]

Schools of nursing[tw]

School of midwifery[tw]

Schools of midwifery[tw]

School of dentistry[tw]

Schools of dentistry[tw]

School of dental medicine[tw]

Schools of dental medicine[tw]

School of pharmacy[tw]

Schools of pharmacy[tw]

School of pharmaceutical

science[tw]

Schools of pharmaceutical

science[tw]

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School of health science OR Schools

of health science OR School of

health sciences OR Schools of

health sciences OR Faculty of

medicine[tw]

Faculties of medicine[tw]

Faculty of nursing[tw]

Faculties of nursing[tw]

Faculty of midwifery[tw]

Faculties of midwifery[tw]

Faculty of dentistry[tw]

Faculties of dentistry[tw]

Faculty of dental medicine[tw]

Faculties of dental medicine[tw]

Faculty of pharmacy[tw]

Faculties of pharmacy[tw]

Faculty of pharmaceutical

science[tw]

Faculties of pharmaceutical

science[tw]

Faculty of health science OR

Faculties of health science OR

Faculty of health sciences OR

Faculties of health sciences OR

Department of medicine[tw]

Departments of medicine[tw]

Department of nursing[tw]

Departments of nursing[tw]

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Department of midwifery[tw]

Departments of midwifery[tw]

Department of dentistry[tw]

Departments of dentistry[tw]

Department of dental medicine[tw]

Departments of dental

medicine[tw]

Department of pharmacy[tw]

Departments of pharmacy[tw]

Department of pharmaceutical

science[tw]

Departments of pharmaceutical

science[tw]

Department of health science [tw]

Departments of health science [tw]

Department of health sciences [tw]

Departments of health sciences

[tw]

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 (CPD/CME) AND

Training institution. An example search outlining the appropriate combination of terms

is detailed below, executed using PubMed on the 25th July 2011.

Search limits

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Limit category Specified limit

Languages English, Japanese

Publication type None

Date of publication 1995-2010

Study design None

Other limits Human data

Search sources

Category Sources

Healthcare databases MEDLINE

EMBASE

CINAHL

Web of knowledge

CENTRAL

UK Pubmed Central

J-STAGE (Japanese)

BDSP (French)

EASTVIEW (China/Russia)

Index-F (Spanish)

eLIBRARY (Russian)

WHO Global Index Medicus

WHO portal of clinical trials

Evidence based reviews Bandolier

Cochrane library (CDSR)

Guidelines NHS Clinical Knowledge Summaries

National Library of Guidelines

Grey literature Web of science

NHS Evidence

OpenSIGLE – system for information on grey literature in Europe

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Influenza vaccine manufacturers (GlaxoSmithKline, MASTA,

Novartis, Pfizer, Sanofi Pasteur MSD, Solvay Healthcare,

Medimmune, CSL limited)

Consultation with domain experts – Andrew Hayward (UCL), John

Watson (HPA), Arnold Monto (Michigan University)

Internet searching Google

Google scholar

Search output PICO C5 (a) – Pub Med (27th July 2011)

No. Search term Hits

1 Physicians [MeSH] 73,960

2 Nurses [MeSH] 63,826

3 Nursing Staff [MeSH] 49,406

4 Nurse Midwives [MeSH] 5,522

5 Dentists [MeSH] 13,832

6 Dental Staff, Hospital [MeSH] 211

7 Pharmacists [Mesh] 8,712

8 Physician Assistants [Mesh] 3,758

9 Allied Health Personnel[Mesh:NoExp] 9,401

10 Assistant Medical Officers[tw] 11

11 Assistant Medical Officer[tw] 6

12 Clinical officers [tw] 77

13 Clinical Officer[tw] 29

14 Health Assistants[tw] 80

15 Health Assistant[tw] 51

16 Health Officers[tw] 553

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17 Health Officer[tw] 338

18 Medical Assistants[tw] 288

19 Medical Assistant[tw] 162

20 Nurse Clinicians[tw] 7219

21 Nurse Clinician [tw] 197

22 Nurse Practitioners[tw] 15234

23 Nurse Practitioner[tw] 3393

24 Non-physician clinician [tw] 0

25 Non-physician clinicians [tw] 35

26 Non physician clinician [tw] 0

27 Non physician clinicians [tw] 35

28 Dental staff [tw] 2,262

29 Dentists [tw] 23,777

30 Dentist [tw] 17,025

31 Public health nurse [tw] 884

32 Public health nurses [tw] 1,656

33 Public health midwives [tw] 10

34 Public health midwife [tw] 8

35 Continuing professional development [tw] 753

36 Education, Continuing [MeSH] 48,805

37 Continuing medical education [MeSH] 18,713

38 Symposium[tw] 25,933

39 Conference[tw] 50,784

40 Workshop[tw] 17,687

23/35

41 Seminars[tw] 2,425

42 Meeting[tw] 59,602

43 Training program[tw] 10,190

44 Continuing professional development [tw] 754

45 Schools, Medical [MeSH] 18,857

46 Schools, Nursing [MeSH] 4,995

47 Schools, Dental [MeSH] 5,147

48 Schools, Pharmacy [MeSH] 677

49 Schools, Public Health [MeSH] 770

50 Academies and institutes [MeSH] 10,558

51 School of allied health sciences [tw] 0

52 Graduate school [tw] 490

53 Postgraduate school [tw] 22

54 Post-graduate school [tw] 14

55 Graduate schools [tw] 98

56 Postgraduate schools [tw] 11

57 Post-graduate schools [tw] 5

58 Medical school[tw] 15,483

59 Medical schools[tw] 23,944

60 Nursing school[tw] 1,115

61 Nursing schools[tw] 5,494

62 Midwifery school[tw] 47

63 Midwifery schools[tw] 35

64 Dental school[tw] 2,432

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65 Dental schools[tw] 5,941

66 Dentistry school[tw] 19

67 Dentistry schools[tw] 13

68 Pharmacy school[tw] 119

69 Pharmacy schools[tw] 751

70 Health professional school[tw] 3

71 Health professional schools[tw] 57

72 Faculty of health science OR Faculties of health science OR

Faculty of health sciences OR Faculties of health sciences [tw] 42,904

73 OR/ 1-34 (*population) 239,983

74 OR/ 35-44 (*intervention ) 204,630

75 OR/45-117 (*training institutions) 174,375

76 73AND 74 AND 75 1,320

77 76 [Limit to: (Date of Publication 1995-2011, Languages

English or Japanese)] 1,052

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Appendix B: Search strategy for PICO Question C5 (b)

The effect of using, or building the capacity of, existing education and training

institutions to conduct in-service training programmes, compared with training that

does not use those institutions (e.g in hotels), on quality, quantity and relevance

Population: Health professionals

Intervention: In-service training supported by external organization which is

integrated with local training infrastructure

Comparison: In-service training supported by external organization which is NOT

integrated with local training infrastructure

Outcome: Quantity, Quality and Relevance of health professionals

Search terms

Search

Concept

MeSH headings Keywords/ text words

Population Physicians [MeSH]

Nurses [MeSH]

Nursing Staff [MeSH]

Nurse Midwives [MeSH]

Dentists [MeSH]

Dental Staff, Hospital [MeSH]

Pharmacists [Mesh]

Physician Assistants [Mesh]

Allied Health

Personnel[Mesh:NoExp]

Physician [tw]

Physicians [tw]

Doctor [tw]

Doctors [tw]

Nurse [tw]

Nurses [tw]

Midwife [tw]

Midwives [tw]

Pharmacist [tw]

Pharmacists [tw]

Physician Assistant [tw]

Physician assistants[tw]

Physicians’ Assistants[tw]

Physician’s Assistants[tw]

Physicians Assistants[tw]

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Physicians’ Assistant [tw]

Physicians’ Extenders[tw]

Physician Extender[tw]

Physician Extenders[tw]

Physician’s Extenders[tw]

Physicians’ Extender[tw]

Doctor’s Assistants[tw]

Doctor Assistants[tw]

Doctor’s Assistant[tw]

Medex[tw]

Feldshers[tw]

Feldsher[tw]

Assistant Medical Officers[tw]

Assistant Medical Officer[tw]

Clinical Officers[tw]

Clinical Officer[tw]

Health Assistants[tw]

Health Assistant[tw]

Health Officers[tw]

Health Officer[tw]

Medical Assistants[tw]

Medical Assistant[tw]

Nurse Clinicians[tw]

Nurse Clinician [tw]

Nurse Practitioners[tw]

Nurse Practitioner[tw]

Non-physician clinician [tw]

Non-physician clinicians [tw]

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Non physician clinician [tw]

Non physician clinicians [tw]

Intervention Inservice Training [MeSH]

On-the-Job Training [tw]

On the Job Training [tw]

Orientation Programs, Employee [tw]

Employee Orientation Program [tw]

Orientation Program, Employee [tw]

Employee Orientation Programs [tw]

Training

Institution

Schools, Medical [MeSH]

Schools, Nursing [MeSH]

Schools, Dental [MeSH]

Schools, Pharmacy [MeSH]

Schools, Public Health [MeSH]

Academies and Institutes [MeSH]

Graduate school [tw]

Postgraduate school [tw]

Post-graduate school [tw]

Graduate schools [tw]

Postgraduate schools [tw]

Post-graduate schools [tw]

Medical school[tw]

Medical schools[tw]

Nursing school[tw]

Nursing schools[tw]

Midwifery school[tw]

Midwifery schools[tw]

Dental school[tw]

Dental schools[tw]

Dentistry school[tw]

Dentistry schools[tw]

Pharmacy school[tw]

28/35

Pharmacy schools[tw]

Health professional school[tw]

Health professional schools[tw]

School of medicine[tw]

Schools of medicine[tw]

School of nursing[tw]

Schools of nursing[tw]

School of midwifery[tw]

Schools of midwifery[tw]

School of dentistry[tw]

Schools of dentistry[tw]

School of dental medicine[tw]

Schools of dental medicine[tw]

School of pharmacy[tw]

Schools of pharmacy[tw]

School of pharmaceutical

science[tw]

Schools of pharmaceutical

science[tw]

School of health science OR Schools

of health science OR School of

health sciences OR Schools of health

sciences OR Faculty of medicine[tw]

Faculties of medicine[tw]

Faculty of nursing[tw]

Faculties of nursing[tw]

Faculty of midwifery[tw]

Faculties of midwifery[tw]

29/35

Faculty of dentistry[tw]

Faculties of dentistry[tw]

Faculty of dental medicine[tw]

Faculties of dental medicine[tw]

Faculty of pharmacy[tw]

Faculties of pharmacy[tw]

Faculty of pharmaceutical

science[tw]

Faculties of pharmaceutical

science[tw]

Faculty of health science OR

Faculties of health science OR

Faculty of health sciences OR

Faculties of health sciences OR

Department of medicine[tw]

Departments of medicine[tw]

Department of nursing[tw]

Departments of nursing[tw]

Department of midwifery[tw]

Departments of midwifery[tw]

Department of dentistry[tw]

Departments of dentistry[tw]

Department of dental medicine[tw]

Departments of dental medicine[tw]

Department of pharmacy[tw]

Departments of pharmacy[tw]

Departments of pharmaceutical

science[tw]

30/35

Department of health science [tw]

Departments of health science [tw]

Department of health sciences [tw]

Departments of health sciences [tw]

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 (Inservice training

[MeSH] AND (international agencies [MeSH] OR Organization [MeSH]) AND Training

Institution. An example search outlining the appropriate combination of terms is

detailed below, executed using Pub Med on the 25th July 2011.

Search limits

Limit category Specified limit

Languages English, Japanese,

Publication type None

Date of publication 1995-2010

Study design None

Other limits Human data

Search sources

Category Sources

Healthcare databases MEDLINE

EMBASE

CINAHL

Web of knowledge

31/35

CENTRAL

UK Pubmed Central

J-STAGE (Japanese)

BDSP (French)

EASTVIEW (China/Russia)

Index-F (Spanish)

eLIBRARY (Russian)

WHO Global Index Medicus

WHO portal of clinical trials

Evidence based reviews Bandolier

Cochrane library (CDSR)

Guidelines NHS Clinical Knowledge Summaries

National Library of Guidelines

Grey literature Web of science

NHS Evidence

OpenSIGLE – system for information on grey literature in Europe

Influenza vaccine manufacturers (GlaxoSmithKline, MASTA,

Novartis, Pfizer, Sanofi Pasteur MSD, Solvay Healthcare,

Medimmune, CSL limited)

Consultation with domain experts – Andrew Hayward (UCL), John

Watson (HPA), Arnold Monto (Michigan University)

Internet searching Google

Google scholar

Search output PICO C5 (b) – PubMed (27th July 2011)

No. Search term Hits

1 Physicians [MeSH] 73,960

2 Nurses [MeSH] 63,826

3 Nursing Staff [MeSH] 49,406

32/35

No. Search term Hits

4 Nurse Midwives [MeSH] 5,522

5 Dentists [MeSH] 13,832

6 Dental Staff, Hospital [MeSH] 211

7 Pharmacists [Mesh] 8,712

8 Physician Assistants [Mesh] 3,758

9 Allied Health Personnel[Mesh:NoExp] 9,401

10 Assistant Medical Officers[tw] 11

11 Assistant Medical Officer[tw] 6

12 Clinical officers [tw] 77

13 Clinical Officer[tw] 29

14 Health Assistants[tw] 80

15 Health Assistant[tw] 51

16 Health Officers[tw] 553

17 Health Officer[tw] 338

18 Medical Assistants[tw] 288

19 Medical Assistant[tw] 162

20 Nurse Clinicians[tw] 7219

21 Nurse Clinician [tw] 197

22 Nurse Practitioners[tw] 15234

23 Nurse Practitioner[tw] 3393

24 Non-physician clinician [tw] 0

25 Non-physician clinicians [tw] 35

26 Non physician clinician [tw] 0

27 Non physician clinicians [tw] 35

33/35

No. Search term Hits

28 Dental staff [tw] 2,262

29 Dentists [tw] 23,777

30 Dentist [tw] 17,025

31 Public health nurse [tw] 884

32 Public health nurses [tw] 1,656

33 Public health midwives [tw] 10

34 Public health midwife [tw] 8

35 Inservice training [MeSH] 20,928

36 On-the-Job Training [tw] 114

37 On the Job Training [tw] 114

38 Employee Orientation Program [tw] 3

39 Schools, Medical [MeSH] 18,857

40 Schools, Nursing [MeSH] 4,995

41 Schools, Dental [MeSH] 5,147

42 Schools, Pharmacy [MeSH] 677

43 Schools, Public Health [MeSH] 770

44 Academies and institutes [MeSH] 10,558

45 School of allied health sciences [tw] 0

46 Graduate school [tw] 490

47 Postgraduate school [tw] 22

48 Post-graduate school [tw] 14

49 Graduate schools [tw] 98

34/35

No. Search term Hits

50 Postgraduate schools [tw] 11

51 Post-graduate schools [tw] 5

52 Medical school[tw] 15,483

53 Medical schools[tw] 23,944

54 Nursing school[tw] 1,115

55 Nursing schools[tw] 5,494

56 Midwifery school[tw] 47

57 Midwifery schools[tw] 35

58 Dental school[tw] 2,432

59 Dental schools[tw] 5,941

60 Dentistry school[tw] 19

61 Dentistry schools[tw] 13

62 Pharmacy school[tw] 119

63 Pharmacy schools[tw] 751

64 Health professional school[tw] 3

65 Health professional schools[tw] 57

66 Faculty of health science OR Faculties of health science OR

Faculty of health sciences OR Faculties of health sciences [tw] 42,904

67 OR/ 1-34 (*population) 239,983

68 (35 OR 36 OR 37 OR 38) (*intervention ) 21,188

69 OR/ 39-66 (*training institutions) 174,375

70 66 AND 67 AND 68 424

71 69 [Limit to: (Date of Publication 1995-2011, Languages

English or Japanese)]

390

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