title: A systematic review of outcome and impact of master's in health and health care.
abstract: BACKGROUND
  The 'human resources for health' crisis has highlighted the need for more health (care) professionals and led to an increased interest in health professional education, including master's degree programmes. The number of these programmes in low- and middle-income countries (LMIC) is increasing, but questions have been raised regarding their relevance, outcome and impact. We conducted a systematic review to evaluate the outcomes and impact of health-related master's degree programmes.
  
  
  METHODS
  We searched the databases Scopus, Pubmed, Embase, CINAHL, ERIC, Psychinfo and Cochrane (1999 - November 2011) and selected websites. All papers describing outcomes and impact of health-related Master programmes were included. Three reviewers, two for each article, extracted data independently. The articles were categorised by type of programme, country, defined outcomes and impact, study methods used and level of evidence, and classified according to outcomes: competencies used in practice, graduates' career progression and impact on graduates' workplaces and sector/society.
  
  
  RESULTS
  Of the 33 articles included in the review, most originated from the US and the UK, and only one from a low-income country. The programmes studied were in public health (8), nursing (8), physiotherapy (5), family practice (4) and other topics (8). Outcomes were defined in less than one third of the articles, and impact was not defined at all. Outcomes and impact were measured by self-reported alumni surveys and qualitative methods. Most articles reported that competencies learned during the programme were applied in the workplace and alumni reported career progression or specific job changes. Some articles reported difficulties in using newly gained competencies in the workplace. There was limited evidence of impact on the workplace. Only two articles reported impact on the sector. Most studies described learning approaches, but very few described a mechanism to ensure outcome and impact of the programme.
  
  
  CONCLUSIONS
  Evidence suggests that graduates apply newly learned competencies in the field and that they progress in their career. There is a paucity of well-designed studies assessing the outcomes and impact of health-related master's degree programmes in low- and middle-income countries. Studies of such programmes should consider the context and define outcomes and impact.
authors: Area Leader Education, Royal Tropical Institute, Amsterdam, The Netherlands. P.Zwanikken@hetnet.nl
authors: Prisca A C
authors: PA
authors: Zwanikken
authors: Marjolein
authors: M
authors: Dieleman
authors: Dulani
authors: D
authors: Samaranayake
authors: Ngozi
authors: N
authors: Akwataghibe
authors: Albert
authors: A
authors: Scherpbier
mesh_terms: D003479:Curriculum; D004517:Education, Professional / Q000706:statistics & numerical data; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011634:Public Health / Q000193:education*
references: J Adv Nurs. 2002 Jun;38(5):524-35
references: 12028286
references: Bull World Health Organ. 2007 Dec;85(12):963-5; discussion 966-70
references: 18278257
references: Lancet. 2004 Oct 16-22;364(9443):1451-6
references: 15488222
references: Acad Med. 2008 Apr;83(4):365-70
references: 18367897
references: Hum Resour Health. 2007 Oct 19;5:24
references: 17949491
references: Hum Resour Health. 2011 Oct 21;9:26
references: 22018521
references: Med Teach. 2007 Sep;29(7):625-9
references: 18236247
references: Man Ther. 2011 Jun;16(3):285-90
references: 21251867
references: J Allied Health. 2001 Winter;30(4):223-8
references: 11828583
references: Med Teach. 1999;21(6):546-52
references: 21281173
references: Med Educ. 1999 Feb;33(2):130-5
references: 10211263
references: Int J Nurs Educ Scholarsh. 2004;1:Article18
references: 16646883
references: Man Ther. 2011 Dec;16(6):590-5
references: 21708476
references: Am J Health Syst Pharm. 2000 Dec 1;57(23):2196-201
references: 11127699
references: Public Health Rep. 2005 Sep-Oct;120(5):496-503
references: 16224982
references: J Public Health Manag Pract. 2004 Nov-Dec;10(6):556-63
references: 15643380
references: J Health Commun. 2005 Jan-Feb;10(1):5-25
references: 15764441
references: Hum Resour Health. 2010 Mar 30;8:7
references: 20353572
references: Man Ther. 2008 May;13(2):139-47
references: 17307015
references: J Health Adm Educ. 2000 Fall;18(4):375-89
references: 11211353
references: Bull World Health Organ. 2007 Dec;85(12):902-3
references: 18278241
references: Am J Occup Ther. 2008 Sep-Oct;62(5):600-10
references: 18826022
references: Lancet. 2004 Nov 27-Dec 3;364(9449):1984-90
references: 15567015
references: Med Teach. 2007 Oct;29(8):735-51
references: 18236271
references: J Adv Nurs. 2000 May;31(5):1072-80
references: 10840240
references: Educ Prim Care. 2006;17(2):147-154
references: 28240058
references: Aust New Zealand Health Policy. 2010 Jan 03;7:2
references: 20044939
references: Nurse Educ Today. 2008 Aug;28(6):751-759
references: 18242790
references: Acad Med. 2008 Apr;83(4):371-7
references: 18367898
references: J Nurs Educ. 2006 Jan;45(1):7-15
references: 16496732
references: Br J Gen Pract. 2010 Nov;60(580):e434-9
references: 21062540
references: BMJ. 2003 Apr 12;326(7393):810-2
references: 12689981
references: Nurse Educ Pract. 2010 Mar;10(2):64-9
references: 19395313
references: J Vet Med Educ. 2003 Fall;30(3):258-63
references: 14648500
references: Am J Prev Med. 2003 May;24(4):361-6
references: 12726875
references: Med Educ. 2012 Jan;46(1):89-96
references: 22150200
references: J Gerontol Nurs. 2004 Mar;30(3):6-13
references: 15061448
references: Med Teach. 2007 May;29(4):e85-92
references: 17786737
references: Health Educ Behav. 2003 Dec;30(6):683-94
references: 14655863
references: Physiotherapy. 2011 Sep;97(3):218-25
references: 21820540
references: J Rural Health. 2006 Summer;22(3):212-9
references: 16824164
references: Nurse Educ Today. 2010 May;30(4):333-7
references: 19811860