Training for Medical Tourism in Iran

The globalization of health care has led to a new form of tourism commonly known as health, or medical, tourism. Medical tourism has grown rapidly, and many countries are currently planning for the incorporation of this sector.1-3 Medical tourism is a situation wherein tourists seek alternative medical treatment opportunities in other countries.4-6 According to the World Tourism Organization (WTO), medical tourism is the use of services that lead to improved or increased health through medical interventions in a place outside the place of residence of an individual that lasts more than 24 hours.4,7,8 The concept of medical tourism was not commonly contemplated until recently. In fact, it was difficult to imagine a connection between the two very different sections of international travel and medical care. Medical tourists leave their country of origin to obtain effective medical services (high quality and low prices).9 This industry has grown rapidly over the last two decades, and due to high foreign exchange earnings in this industry, many countries are actively planning to enter this field.10 In a strategic and competitive situation, development needs to be strengthened and it must also strengthen its supporting industries.11 Formerly, the trend of medical tourism was the travel of wealthy people from less developed countries to developed countries to receive medical care.12,13 Medical tourism currently generates $60 billion a year globally, and the number of countries offering advanced medical care for foreign tourists is growing.14,15 Also, international trade in medical services has a very high economic potential for the global economy; thus, medical tourism is emerging as a particularly lucrative sector for developing countries. Investing in this sector results in a series of rising incomes, improving services, generating foreign exchange earnings, and the creation of a more favorable balance between trade and tourism.16-18 Today, human life is accompanied by amazing changes. Organizations must be prepared to face these massive changes. The purpose of this preparation should not be the preparation of technology and equipment; rather, it must be the expert staff, http://ijtmgh.com Int J Travel Med Glob Health. 2017 Sep;5(3):77-83 doi 10.15171/ijtmgh.2017.17 TMGH IInternational Journal of Travel Medicine and Global Health J


Introduction
The globalization of health care has led to a new form of tourism commonly known as health, or medical, tourism.][6] According to the World Tourism Organization (WTO), medical tourism is the use of services that lead to improved or increased health through medical interventions in a place outside the place of residence of an individual that lasts more than 24 hours. 4,7,8The concept of medical tourism was not commonly contemplated until recently.In fact, it was difficult to imagine a connection between the two very different sections of international travel and medical care.Medical tourists leave their country of origin to obtain effective medical services (high quality and low prices). 9This industry has grown rapidly over the last two decades, and due to high foreign exchange earnings in this industry, many countries are actively planning to enter this field. 10In a strategic and competitive situation, development needs to be strengthened and it must also strengthen its supporting industries. 11ormerly, the trend of medical tourism was the travel of wealthy people from less developed countries to developed countries to receive medical care. 12,13Medical tourism currently generates $60 billion a year globally, and the number of countries offering advanced medical care for foreign tourists is growing. 14,15Also, international trade in medical services has a very high economic potential for the global economy; thus, medical tourism is emerging as a particularly lucrative sector for developing countries.][18] Today, human life is accompanied by amazing changes.Organizations must be prepared to face these massive changes.The purpose of this preparation should not be the preparation of technology and equipment; rather, it must be the expert staff, i.e. an important, valuable capital.A successful organization pays more attention to human resources, which can be the key to its success. 19Training is considered paramount to medical tourism, because it reduces medical errors and increases satisfaction among medical tourists. 20Training is a tool for improving the quality of performance, solving managerial problems, empowering the human resources of an organization, and increasing efficiency. 19,21A literature review showed that to date no study has examined the parameters of medical tourism and educational requirements.Training programs should be created for the effective performance of relevant people who have specific roles and responsibilities in the tourism and healthcare sectors. 22pecialized factors play an important role in competition.Some of these factors are trained personnel, appropriate infrastructures, security, education, and proper research policies inherent to the competitive power of an industry. 23rained expert individuals are influential in the economic, social, and cultural sectors relating to medical tourism.The lack of knowledge and suitable skills will have a negative impact.Employees at every level need to acquire new knowledge and skills to better do their work. 24Today, the importance of tourism in terms of economics and job creation is such that it can be considered the driving economic force of any country.Tourism has many advantages and can be an important source of employment. 25oday, medical tourism and the attraction of foreign patients have been seriously addressed by professionals and politicians. 26Given its great value, many private sector investors tend to invest in medical tourism. 5,27Training as a factor in improving employee performance can be the basis for providing standards. 28There are challenges and obstacles that hinder medical tourism.The first challenge is linguistic differences.When practitioners cannot properly communicate with a patient, medical errors may arise, and this challenge alone is enough to affect the satisfaction of tourists.A second challenge is that of cultural differences which could obstruct the development of guidelines for international quality standards. 29A third challenge is religious differences.This challenge can sometimes influence treatment.Several studies have reported a reduction in errors by trained staff and increased effectiveness and productivity, which have positive impacts on trade. 30,31With the increased amount and functionality of new information, technologies have also gradually changed the basic assumptions about the role of ICT in organizations. 32Therefore, other issues that could lead to the development of tourism include ICT training for restaurant and hotel staff.4][35] Training in all sectors, such as marketing, is also a factor in the development of service quality. 36Because of the importance of medical tourism to a country's development, this paper surveyed the role of training in expanding medical tourism in Iran.

Methods
This study was designed as a narrative review of studies dated from February 2007 to June 2017 and aimed to investigate the importance of training in medical tourism in Iran.Library resources were reviewed, and reliable databases, i.e.Medline, ISI Web of Science, EMBASE, Scopus, PubMed, Ebsco, and Emerald were searched extensively for information on medical tourism in Iran.The search strategy was based on the following keywords: "Medical Tourism", "Medical Travel", "Health Tourism", "Curative Tourism", "Education", "Training", "Learning", "Training Tourism", "Learning Tourism".
To find additional articles or unpublished data, relevant study lists were searched by hand.The available studies were summarized and their results were reported.Four authors assessed the titles and abstracts of articles found through these search methods using predefined inclusion and exclusion criteria.Disagreements were resolved through discussion.Where a resolution was not reached, other authors were consulted.The authors extracted data using an extraction sheet, and disagreements were resolved in a group meeting.

Results
The results of this study indicate that training has a positive impact on the improvement of medical tourism.Moreover, training courses for medical tourism professionals is one of the indicators evaluated in medical centers. 37The neglect of medical tourism trainees is a deterrent to the growth of medical tourism. 38Thus, training increases satisfaction among staff and medical tourists.Investing in knowledge, skills, and human capital influences development and the competitive medical tourism market, [39][40][41] and acquiring skills in innovation and creativity leads to business success and development. 42][45] Such training should be followed by the establishment of international quality standards for the development of travel medicine, including linguistic and cultural education. 20,24,46ran is an Islamic country, and it is necessary for Islamic countries to have cultural competence in providing clinical services to Muslim medical tourists. 47Another challenge of medical tourism is the lack of proficiency in English or other foreign languages. 48In medical tourism, the health and education sectors focus their needs on education and their expectations on the relevant ministries and organizations of health, tourism, and education.There are several challenges to medical tourism, one of which is tourism and depends on a proper organizational structure, programming, and a trained workforce. 5nother necessity that subjects in this study identified was that all stakeholders from the public and private sectors must learn to improve their knowledge and qualifications and raise public awareness of laws relevant to medical tourism.Therefore, it is important to consider the possibly powerful potential of medical tourism for the development of a global health education system. 49Medical tourism recruitment factors include professional human resources from hospitals who have international work records, training courses, being fluent in English, and promoting all aspects of professional human resources. 50,51The hospitals are suitable for some standards (access to and continuity of treatment, patient evaluation, anesthetic care and drug management), but only adequate for others (patient and family rights, patient care, staff education, and patient education). 52Researchers emphasizing training human resources in medical tourism are listed in Table 1.

Discussion
It can be argued that training to increase the efficiency and productivity of employees is the most comprehensive method.In fact, investing in training promotes the performance of individuals in the organization. 53Training must be appropriate to the actual business and on the demand of the employers. 54Also, the pace of global change causes the existing educational needs to change. 55The development of tourism increases the living standards of local communities, but the attraction of tourists requires several solutions.One basic strategy is the educational planning for the development of human resources. 56Medical tourism as a form of tourism is not separate from these issues.Studies conducted to date in the field of medical tourism have focused on the relationship between the fields of economics, health, and politics. 57espite the importance of training in medical tourism and studies that consider the need training on medical tourism issues as necessary to improve employees' skills and knowledge and increase their and the public's awareness of medical issues, no source for principled and program-based training services related to medical tourism has been named in studies. 22The findings of the current study determined the important role of governments in developing medical tourism facilities and revenues, state-funded and private education systems which must pay specific attention to this subject, and training opportunities on this subject provided for all stakeholders.The government should develop rules and regulations that allow procedures to be more easily accomplished for medical tourists, the rules and regulations relevant to medical tourism should be understood and implemented both public and private sectors. 22,58Researchers are emphasizing e-learning and telemedicine at hospitals and health centers in medical tourism 59 ; providing national and international training courses to enhance the skills of professional human resources globally and recruiting trained specialists; and using information and communication technology were identified as the top priorities. 60However, despite academic disciplines in education, which is highlighted as a distinct part of the health sector, education has not been properly adopted. 22tudies in the field of medical tourism training are few.This may be due to the lack of other infrastructures, such as laws and regulations, equipment, and other facilities for medical tourism, 20,21,39 and the lack of attention to training, because it is qualitative. 56Studies have a positive effect on the development of medical tourism by influencing the training of staff, but most studies show a lack of training among staff members.Most of the data shows that training is not academic; it is held periodically, and participants will be given a certificate. 37avasan et al 22 identified the stakeholders of medical tourism and that each group should be provided training based on expert opinions.
In a study on the purpose of Islamic tourism, the issue of cultural and religious differences was proposed. 47Other studies emphasized the importance of training in increasing the efficiency and effectiveness of medical tourism programs. 42,61he overall results of studies suggest that medical tourism training should be developed. 1,11,17,49

Conclusion
The prosperity of the medical tourism industry in Iran can have many benefits to economic, political, social, and cultural development.One of the most important factors in the growth of medical tourism is training, because having a trained and experienced adviser in the field of medical tourism can help tourists choose their destination country.Consequently, to develop medical tourism in Iran, not only equipment, but also the necessary training should be provided, including an introduction to medical tourism and the medical tourist, the medical histories of medical tourists, the association of staff with medical tourism, and knowledge of the rules and regulations of medical tourism for stakeholders in two parts of medicine (hospitals and health centers) and the tourism sector, e.g., transportation agencies, residences, and restaurants.A training model must be designed for Iranian medical tourism.

Table 1 .
Medical Tourism Education Research in the WorldEffective factors in the growth of medical tourism include training and skills for staff, use of specialists, price of services, type and quality of services, and equipment and facilities.