IQhealthcare, Center for Quality of Care Research, University Medical Center Nijmegen (UMCN), 6500 HB Nijmegen, The Netherlands.
BMC Fam Pract. 2009 Dec 15;10:80. doi: 10.1186/1471-2296-10-80.
Many physicians have medical experience in developing countries early in their career, but its association with their medical performance later is not known. To explore possible associations we compared primary care physicians (GPs) with and without professional experience in a developing country in performance both clinical and organisational.
A retrospective survey using two databases to analyse clinical and organisational performance respectively. Analysis was done at the GP level and practice level.517 GPs received a questionnaire regarding relevant working experience in a developing country. Indicators for clinical performance were: prescription, referral, external diagnostic procedures and minor procedures. We used the district health insurance data base covering 570.000 patients. Explorative secondary analysis of practice visits of 1004 GPs in 566 practices in the Netherlands from 1999 till 2001. We used a validated practice visit method (VIP; 385 indicators in 51 dimensions of practice management) to compare having experience in a developing country or not.
Almost 8% of the GPs had experience in a developing country of at least two years.These GPs referred 9,5% less than their colleagues and did more surgical procedures. However, in the multivariate analysis 'experience in a developing country' was not significantly associated with clinical performance or with other GP- and practice characteristics. 16% of the practices a GP or GPs with at least two years experience in a developing country. They worked more often in group and rural practices with less patients per fte GP and more often part-time. These practices are more hygienic, collaborate more with the hospital and score better on organisation of the practice. These practices score less on service and availability, spend less time on patients in the consultation and the quality of recording in the EMD is lower.
We found interesting differences in clinical and organisational performance between GPs with and without medical experience in developing countries and between their practices. It is not possible to attribute these differences to this experience, because the choice for medical experience in a tropical country probably reflects individual differences in professional motivation and personality. Experience in a developing country may be just as valuable for later performance in general practice as experience at home.
许多医生在职业生涯早期都有在发展中国家的医疗经验，但目前尚不清楚这与他们后来的医疗表现有何关联。为了探讨这种关联，我们比较了在发展中国家有专业经验和没有专业经验的初级保健医生（GP）在临床和组织方面的表现。
使用两个数据库进行回顾性调查，分别分析临床和组织表现。分析在 GP 层面和实践层面进行。517 名 GP 收到了一份关于在发展中国家工作相关经验的问卷。临床表现的指标包括：处方、转诊、外部诊断程序和小手术。我们使用了覆盖 570,000 名患者的地区健康保险数据库。对 1999 年至 2001 年间荷兰 566 家实践中的 1004 名 GP 的实践访问进行了探索性二次分析。我们使用了一种经过验证的实践访问方法（VIP；51 个实践管理维度中的 385 个指标）来比较是否有在发展中国家的经验。
近 8%的 GP 有至少两年在发展中国家的工作经验。这些 GP 的转诊率比他们的同事低 9.5%，手术量也更多。然而，在多变量分析中，“在发展中国家的工作经验”与临床表现或其他 GP 和实践特征没有显著关联。16%的实践中至少有一名 GP 有在发展中国家工作至少两年的经验。他们更多地在团队和农村实践中工作，每个 GP 的患者更少，更多的是兼职。这些实践更注重卫生，与医院合作更多，实践组织得更好。这些实践在服务和可用性方面得分较低，在咨询中花费的时间较少，电子病历的记录质量较低。
我们发现，有和没有在发展中国家工作经验的 GP 及其所在实践在临床和组织表现方面存在有趣的差异。这些差异不能归因于这种经验，因为选择在热带国家进行医疗工作可能反映了个体在职业动机和个性方面的差异。在发展中国家的工作经验可能与在全科医学中的后续表现一样有价值。
