8.1 Key dimensions to consider in scaling up clinical site capacity

BOX 8.1

Key dimensions to consider in scaling up clinical site capacity

Education mandate. All public health facilities and all private health facilities of a certain size or referral level or level of technical advancement (for example, having a magnetic resonance imaging scanner) could be legally required to accept health profession students. Private facilities that do not wish to participate in health worker education could pay a reasonable per bed fee each year. This fee would go toward scholarships for health profession students.

Patient rights and responsibilities. In all health facilities that have students, when patients arrive and register at the facility, they should be provided with a copy of their patient rights and responsibilities. The rights and responsibilities would explain that the facility is a teaching facility, that teaching is an essential part of its work, and that it is the responsibility of the patient to help in the education of the next generation of health workers. The rights and responsibilities will explain that in extreme cases patients can request not to be seen by students or by male students, but this is expected to be a rare exception.

Case-based teaching. To ensure that the nursing and physician staff at the new teaching sites are able to teach and mentor the students properly, Saudi Arabia could train them in case-based teaching (often called bedside teaching) and clinical mentoring.

Clinical practica curricula. because students traditionally receive some lectures during clinical practica, Saudi Arabia can ease the transition for new clinical sites by providing curricula and lecture materials. for some topics, the government may want to provide interactive webinars or taped lectures, which will be especially helpful in clinical sites that have large numbers of patients but few specialists.

Documentation of clinical experience. To ensure that each student sees a sufficient volume and diversity of patients and has sufficient opportunity for hands-on experience (including procedures such as suturing and lumbar punctures, and so on), there need to be agreed-on metrics for each program and a common methodology for documenting the experience. This documentation can be as simple as a paper booklet in which the student records cases and the supervising health worker signs, or it can be in the form of more sophisticated apps or websites.

Transportation and accommodation. As students start learning in sites outside of public academic centers, many of these sites will be a great distance from the medical or nursing school. Schools should then be obliged to provide transportation when the distance is commutable from the base school. If the clinical site is too far away to commute to, the school should provide free or affordable housing near the clinical site.

Saudi preclinical faculty. A shortage of preclinical faculty (biochemistry, anatomy, physiology, and so on) in Saudi Arabia hinders the expansion of both public and private health professional education. This shortage occurs mainly because preclinical faculty are not able to supplement their income with higher-paid clinical work the way clinical faculty can. Saudi preclinical faculty can be increased by creating tailored pipeline programs and improving the salaries and career paths of preclinical positions.

Increase role of private schools in production The government is unlikely to have sufficient funding to open the number of new medical schools, nursing schools, and other health professional schools for Saudi Arabia to become self-sufficient in training health workers. Therefore, while ensuring accreditation standards and monitoring performance and quality, the government will need to provide incentives to the private sector to expand existing private schools and to open new ones. These incentives can come in a variety of forms, including land, student financing, matching funds, social impact bonds, removal of administrative burdens, and reliance on pedagogic and administrative public goods. box 8.2 provides more detail.