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Background: The learning environment impacts many aspects of healthcare education, including student outcomes. Rather than being a single and fixed phenomenon, it is made up of multiple micro learning environments. The standard clinical learning environment measurement tools do not consider such diversity and may fail to adequately capture micro learning environments. Moreover, the existing tools are often long and may take a prohibitive amount of time to complete properly. This may have a negative impact on their usefulness in educational improvement strategies. In addition, there is no universal tool available which could be utilised across several healthcare student groups and placement settings. Aim: To create an evidence-based measurement tool for assessing clinical micro learning environments across several healthcare profession student groups. Methods: The measurement tool was developed through a step-wise approach: 1) literature review with iterative analysis of existing tools; 2) generation of new items via thematic analysis of student experiences; 3) a Delphi process involving healthcare educators; 4) piloting of the prototype; and 5) item reduction. Results: The literature review and experiential data from healthcare students resulted in 115 and 43 items respectively. These items were refined, leaving 75 items for the Delphi process, which produced a prototype with 57 items. This prototype was then completed by 257 students across the range of healthcare professions, with item reduction resulting in a 12-item tool. Conclusion: This paper describes a mixed methods approach to developing a brief micro learning environment measurement tool. The generated tool can be used for measuring student perceptions of clinical environments across several healthcare professions. Further cross-cultural and cross-professional validation studies are needed to support widespread use, possibly through mobile application. © 2020 The Author(s).

Background: The diverse rural medical education initiatives that have been developed in Australia to address the medical workforce maldistribution have been less successful in many smaller and remote communities. This study explored the factors that attract and retain GP registrars and supervisors and the impact that localised training (i.e., rural and remote workplace-based training and support) has on both GP registrars and supervisors, and the GP workforce in rural and remote underserved areas. Methods: A purposive sample of 79 GP registrars, supervisors, practice managers, health services staff and community representatives living and working in areas of low GP workforce in rural and remote Australia were invited to participate in semi-structured interviews and one focus group divided over two phases. Thematic analysis was used to explore themes within the data. Findings: Attractors and barriers to rural and remote practice were identified as the main themes. Attractors include family and community lifestyle factors, individual intrinsic motivators, and remote medicine experiences. In contrast, barriers include work related, location, or family factors. Further, localised GP training was reported to specifically influence GP registrars and supervisors through education, social and financial factors. Conclusion: The current study has provided a contemporary overview of the issues encountered in expanding GP training capacity in rural and remote communities to improve the alignment of training opportunities with community and workforce needs. Strategies including matching scope of practice to registrar interests have been implemented to promote the attractors and lessen the barriers associated with rural and remote practice. © 2020 The Author(s).

Background: Due to differences of residency training programs' emphases - inpatient vs office-based - internal medicine and family medicine residents consistently reported differences in preparedness to care for common adult conditions. Study's aim was to add knowledge about procedures that a) are performed by general internists working in primary care and b) should be learned during residency in general internists' appraisal. Methods: A cross-sectional postal survey was carried out by using a questionnaire that comprised 90 procedures relevant in primary care. Each procedure implied the two questions "Do you perform this procedure in your own practice?" and "How important do you think it is to learn this procedure during residency?" The final questionnaire was sent to 1002 general internists working in primary care in Germany in May 2015. Data analysis was performed using SPSS Version 24.0 (SPSS inc., IBM). Next to descriptive statistics subgroup analyses were performed using cross tabulation and Chi-square tests for evaluation of differences in the performance of most frequently performed procedures in urban or rural areas as well as by male or female physicians. Results: Twenty-eight percent of sent questionnaires (276/1002) could be included in analysis. Mean age of participants was 52 years with 13 years of practice experience; 40% were female. Twenty-nine (32%) of 90 given procedures were performed by at least half of the participants, foremost technical diagnostics, punctures, procedures of the integument and resuscitation. After Bonferroni correction, five of those procedures were performed by more male than female physicians and two procedures by more physicians working in a rural practice than physicians practicing in an urban location. Moreover, 46 (51%) procedures were assessed as important to learn during residency by at least 50% of participants. Conclusions: General internists working in German primary care perform a narrow scope of procedures offered by primary care physicians. In order to provide best ambulatory care for patients, residency training programs must ensure training in procedures that are necessary for providing high quality care. Therefore, a consensus aligned with patients' and health-systems' needs on procedures required for working as a general internist in primary care is necessary. © 2020 The Author(s).

Children starting school older consistently exhibit better educational outcomes. In this paper, we underscore child development as a mechanism driving this effect. Using unique administrative data on health examinations, we study the causal effect of school starting age (SSA) on a child's probability of being diagnosed with special educational needs in early grades. Results show that children with higher SSA are less likely to develop behavioral problems and speech impediments, whereas learning disabilities, ADHD, and dyslexia/dyscalculia remain unaffected. Importantly, these effects only arise after primary school entry and are not due to preexisting health conditions. We also find that teachers tend to over-refer relatively young children to special needs services, but this over-referring behavior is not driving the results, which are based on psychologists' diagnoses. The SSA effect persists throughout compulsory schooling, resulting in higher test scores and better quality vocational training contracts. However, SSA does not affect employment, earnings, or disability insurance benefits at labor market entry. © 2020 The Authors. Health Economics published by John Wiley & Sons Ltd.

Problem: Anger is usually defined as psychometric, rather than a theoretical model and generally, anger treatments have been developed for handling incompatible anger. Roy Adaptation Model-based intervention not only focuses on problematic behaviors but also on healthy behaviors and to evaluate the individual with a holistic perspective. The research aim was the examination of the effect of the Roy adaptation theory-based, cognitive-behavioral approach program on adolescent's anger management. Methods: In this study, the pretest–posttest control group experimental design, interview, and observation techniques were used. Carried out in a vocational training center, with 60 participants (experimental group 30 and control group 30), who meet the research criteria. The semi-structured interview forms, the state-trait anger expression inventory, multidimensional anger scale, and brief symptom inventory were used for data collection. Results have been evaluated to the 95% confidence interval and p <.05 significance level. In data analysis; descriptive statistics, Pearson's χ2 test, Mann–Whitney U test, and Wilcoxon Sign tests were used. Findings: There was a significant difference in anger management levels of the experimental group after the adaptation theory-based therapeutic approach program. Conclusion: Study results showed that the adaptation-base therapeutic approach is effective in adolescent's anger management. This program will contribute to theoretical and practical studies and field experts. © 2020 Wiley Periodicals, Inc.

Health professions education (HPE) researchers come from many different academic traditions, from psychology to engineering to rhetoric. Trained in these traditions, HPE researchers engage in science and the building of new knowledge from different paradigmatic orientations. Collaborating across these traditions is particularly generative, a phenomenon the authors call the multidisciplinary edge effect. However, to harness this productivity, scholars need to understand their own paradigms and those of others so that collaboration can flourish. This Invited Commentary introduces the Philosophy of Science series - a collection of articles that introduce readers to 7 different paradigms that are frequently used in HPE research or that the authors suggest will be increasingly common in future studies. Each article in the collection presents a concise and accessible description of the main principles of a paradigm so that researchers can quickly grasp how these traditions differ from each other. In this introductory article, the authors define and illustrate key terms that are essential to understanding these traditions (i.e., paradigm, ontology, epistemology, methodology, and axiology) and explain the structure that each article in this series follows. © 2020 by the Association of American Medical Colleges.

Most doctors working in New Zealand general practice undertake vocational training through the Royal New Zealand College of General Practitioners. We aimed to explore general practice registrar views on their academic learning needs during and following vocational training. An online survey of all current NZ GP trainees in 2019 was completed by 314 registrars (54% response rate). The majority (88%, 275/314) were completing RNZCGP Fellowship only, and of these half (55%, 152/275) were planning a further postgraduate qualification. A minority (12%, 33/275) indicated a desire to undertake a masters or PhD degree. Almost all (99%, 310/314) intended to work in general practice; 9% (8/314) intending to also work as rural hospital doctors. The five most common areas of interest for further training were clinical skills (68%), practice-based teaching (66%), specific clinical conditions (63%), age or life-stage specific (47%) and non-clinical areas (41%). There is a considerable gap between completing RNZCGP Fellowship, intending to undertake further (formal postgraduate) education and actually enrolling. This is concerning given the need for lifelong learning and critical evaluation of practice and health service delivery. The future New Zealand general practice workforce needs GPs to be diverse and highly skilled members or leaders of expert teams. © 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group.

Background: Metal work apprentices (MWAs) frequently develop work-related hand eczema (HE). Objectives: To evaluate the effect of health education on incidence of work-related HE in MWAs and to assess confounding factors. Materials/methods: In a prospective controlled intervention study, 131 MWAs received educational training on prevention of HE, whereas 172 MWAs and 118 office work apprentices served as controls. At baseline and during three yearly follow-ups, questionnaires were completed and hands were examined. Saliva samples were collected for assessment of filaggrin (FLG) null mutations and an explorative genome-wide association study (GWAS), and levels of various cytokines were assessed from stratum corneum samples. Results: The 2-year and 3-year incidence of HE in the metalwork control group was 20.9% and 32.6%, respectively, which was significantly higher than in the intervention group (odds ratio [OR] 2.63, 95% confidence interval [CI] 1.31 to 5.28, P <.01 and OR 3.47, 95% CI 1.88 to 6.40, P <.0001). The knowledge score was higher in unaffected MWAs (P <.05). Other factors significantly associated with developing HE in MWAs were smoking cigarettes (P <.01) and FLG mutations (P <.001). No significant associations were found regarding epidermal cytokine levels and GWAS. Conclusions: Health education is effective in primary prevention of HE in MWAs. Individual factors should be considered in targeted counseling. © 2020 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.

In initial surgical formation and continuing surgical education, simulation has become a compulsory technique. Just as becoming an airplane pilot requires skills, the acquisition of technical skills is essential to becoming a surgeon. The old apprenticeship model “I see, I do, and I teach” is no longer entirely compatible with the socio-economic constraints of the operating room, demands for guaranteeing patient safety, and the compulsory reduction in resident working hours. We propose a new surgical simulation model, using cadavers donated to science that are rendered dynamic with pulsatile vascularization and ventilation. Such models are available for simulation of both open surgery and laparoscopy. Surgery on a human body donated to science makes it possible to accurately reproduce the hand gestures characteristic of surgical procedures. Learning in an appropriate and realistic simulation context increases the level of skills acquired by residents and reduces stress and anxiety when they come to perform real procedures. © 2020

This article describes the development, implementation, and evaluation of the transdisciplinary “Successful Pathways to Employment for youth at Risk” (SUPER) program to raise the transition readiness of youth at risk (YAR) from school into participation in adults’ responsibilities and employment. More than 10% of adolescents are at risk of dropping out of school following poor academic attainments. Schools appraise academic merit but do not develop relevant educational programs to prepare youth to transition into adult working life. The SUPER program addresses a range of knowledge and skills required for this transition. Sixty YAR from three high schools participated in the 18-week SUPER program. Comparing the pre-and postintervention results revealed that the students’ engagement with responsibilities, objective knowledge about the work world, and self-rated self-advocacy skills improved as did their supervisor-rated work performance capacity. This study confirms the contribution of the SUPER model. Its concepts, tools, principles, and community labor-market involvement through workplace internships were effective and could apply in other contexts. The SUPER model provides evidence-based knowledge translation that can bring conceptual and practical changes towards successful transition and participation of YAR in adult working roles. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.