Postgraduate training in Iceland

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Background

The current situation regarding postgraduate training for health professionals in Iceland is reasonable with various learning opportunities, such as programmes leading to university diplomas or masters-of-science and doctoral degrees. Students can undertake training in many health- care institutions or through distance learning. The main shortcoming is that personnel working in health-care

institutions cannot find the time to teach and instruct students, owing to their heavy workload.

In Iceland, student innovations are transferable from school to institution and between institutions. The country’s, Health Policy. A policy for Iceland’s health services until 2030 (Health 2030 Iceland) (1) stresses the importance of good leadership in all parts of the health system to meet the challenges of the future. The policy also encourages creativity and innovation in both technological matters and working procedures. Health 2030 Iceland (1) provides a perfect entry point for introducing innovations in postgraduate training.

Delivery

Iceland uses a mixed model of postgraduate training. Most courses for nurses take place in the country. Physician training mainly occurs abroad, but for some specialities the first year or two are taken in Iceland. In recent years, some physician speciality training has been available in Iceland, for example, in primary health care for general practitioners and nurses.

Iceland could improve the organization of postgraduate training by increasing funding for teachers in universities and providing more educational opportunities. The most urgent measures would be to:

1. make better use of learning and teaching opportunities over a 24-hour period (at present, these are available mostly during daytime working hours);

2. increase the numbers of clinical teachers in hospitals and other health-care institutions;

3. allocate more funding for postgraduate training.

Universities in Iceland collaborate with universities abroad, but cooperation between agencies and ministries in the country could be improved.

The Ministry of Education covers all aspects of education in the country. The salaries of health-care professionals are the responsibility of the Ministry of Finance. The Ministry

Postgraduate training in Iceland

of Health has the task of providing the health services with adequate numbers of health professionals.

Initiatives

The Minister of Health has put a special focus on human resources for health. In autumn 2019, the Ministry established 4 working groups, 3 relating to the education of doctors, nurses and nurse assistants and the fourth to working conditions and how to address or manage shortages of nurses and other health workers. A municipality in the north of Iceland has made a special effort to help health professionals integrate into the community.

Health 2030 Iceland aims to improve the health system and ensure the best possible services for all at any given time to protect the mental, physical and social health of the population (1). One chapter is devoted to human resources for health and stresses the importance of ensuring that health-services staff are well educated, competent and motivated. Since 2015, extra efforts have been made to bring nurses more to the forefront of primary health care. Task sharing/shifting has also been increasing over the last 10 years.

Postgraduate training in Iceland could be improved by: creating more dialogue among stakeholders; strengthening teamwork;

making more use of task sharing/shifting (for example, in drafting new regulations whereby nurses and midwives can issue prescriptions for birth-control pills); and forecasting manpower needs for health-care services.

Data

The universities in Iceland have overviews of both past and present graduates (2,3). The Directorate of Health also has a list of health professionals that have been granted licences to work (4). As almost all health professionals are members of trade unions, data on this group are also available from this source.

Post-training data on health professionals are also needed, including, for example: number working, type of profession;

place of employment after graduation; reasons for deciding on place of employment; place(s) of employment 5 and 10 years after graduation; number of hours worked per week; gender, average age of working individuals; and length of time working after graduation for each profession.

It would be helpful if the data were compiled in one place, updated annually, easy to access and divided into the following

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Postgraduate training in Iceland

categories: type of postgraduate training undertaken; number of and reasons for dropouts; and reasons for changing profession.

Role of postgraduate training in reducing brain drain

Local postgraduate-training programmes can enhance the likelihood of health professionals remaining in the country on completion of training. There are also advantages to health professionals undertaking postgraduate training abroad and bringing newly acquired knowledge back to the country, often knowledge they could not have gained in Iceland. In order to reduce brain drain, the issuing of grants and benefits for postgraduate training abroad should be conditional to the receiver’s working in Iceland for a certain amount of time after training.

The Ministry of Education, Science and Culture of Iceland has proposed changes to the Act on the Icelandic Student Loan Fund (5). If the Parliament agrees, the revised Act (5) would include a provision on encouraging students to work in areas with staff shortages, as well as in vulnerable communities. An increase in the availability of diverse specialist education in Iceland would reduce the number of people seeking education abroad and not returning afterwards.

Challenges and enablers

The main challenges related to the organization and delivery of postgraduate training in Iceland are the lack of health-care workers in health institutions with time dedicated to teaching and instructing students, and the small size of the health- care delivery system. Another difficulty relates to finding ways to increase the number of health-care workers who are willing to and capable of providing tuition in clinical settings.

Cooperation between ministries can also be a challenge.

One way of improving the organization and delivery of postgraduate training in Iceland would be to make better

use of 24-hour and all-year training cycles. At present, this training is conducted mostly during daylight hours in the winter season due to the availability of human resources and lower costs in this season. Increased cooperation between ministries, schools and health-care institutions would facilitate this work.

Regular forecasts of health-care requirements in terms of human resources would make it possible to plan postgraduate training properly (the last forecast was made in 2006). WHO’s designation of 2020 as the “Year of the nurse and the midwife”

might facilitate the collection of data on human resources for health although, for countries with scarce resources, this might present a challenge.

Cross-country collaboration

Iceland is open to cross-country collaboration. Students who undertake their education abroad can be valuable resources in sharing their knowledge and experiences on return to the country.

WHO support needed

WHO statements and resolutions can play an important role in motivating the improvement of postgraduate training in Iceland.

WHO can also assist in collecting and comparing country data, as was done for the forthcoming “State of the World’s Nursing report 2020” in connection with which countries were requested to respond to a questionnaire. It can, however, be a challenge for small countries like Iceland to dedicate the necessary resources to the completion of such questionnaires, which often have short time frames.

Advice/how to improve postgraduate training

It is important to facilitate access to education, for example, by providing government-sponsored economic assistance, subsidizing student loans and assisting financially vulnerable communities. The use of welfare technology that improves working conditions for health professionals, as well as the delivery of patient services, should also be implemented.

References

1. Health Policy. A policy for Iceland’s health services until 2030. Reykjavík: Ministry of Health, 2019 (https://www.government.is/

news/article/2019/08/23/Health-Policy.-A-policy-for-Icelands-health-services-until-2030/, accessed 25 February 2020).

2. The School of Health Sciences at the University of Iceland. In: University of Iceland [website]. Reykjavik: University of Iceland;

2020 (https://english.hi.is/school_of_health_sciences, accessed 13 March 2020).

3. Degree seeking students. In: University of Akureyri [website]. Akureyri: University of Akureyri; 2020 (https://www.unak.is/

english/study/education/degree-seeking-students, accessed 13 March 2020).

4. The Directorate of Health. In: Directorate of Health [website]. Reykjavik: Directorate of Health; 2014 (https://www.landlaeknir.

is/english/, accessed 25 February 2020).

5. About the Icelandic Student Loan Fund [website]. Reykjavik: Icelandic Student Loan Fund; 2020 (https://www.lin.is/english/, accessed 25 February 2020).

WHO/EURO:2020-1301-41051-55731