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"Humans"

Introduction: The nationwide shortage of mental health professionals is especially severe in rural communities in the USA. Consistent with national workforce statistics, Nebraska's mental health workforce is underrepresented in rural and frontier parts of the state, with 88 of Nebraska's 93 counties being designated as federal mental health professional shortage areas. Seventy-eight counties have no practicing psychiatrists. However, supply statistics alone are inadequate in understanding workforce behavior. The objective of this study was to understand mental health recruitment and retention issues from the perspectives of administrators and mental healthcare professionals in order to identify potential solutions for increasing the mental health workforce in rural communities. Methods: The study used semi-structured focus groups to obtain input from administrators and mental health providers. Three separate focus groups were conducted in each of four regions in 2012 and 2013: licensed psychiatrists and licensed psychologists, licensed (independent) mental health practitioners, and administrators (including community, hospital, and private practice administrators and directors) who hire mental health practitioners. The transcripts were independently reviewed by two reviewers to identify themes. Results: A total of 21 themes were identified. Participants reported that low insurance reimbursement negatively affects rural healthcare organizations' ability to attract and retain psychiatrists and continue programs. Participants also suggested that enhanced loan repayment programs would provide an incentive for mental health professionals to practice in rural areas. Longer rural residency programs were advocated to encourage psychiatrists to establish roots in a community. Establishment of rural internship programs was identified as a key factor in attracting and retaining psychologists. To increase the number of psychologists willing to provide supervision to provisionally licensed psychologists and mental health practitioners, financial reimbursement for time spent in this activity was identified as important. Conclusions: The present study showed that a comprehensive approach is needed to address workforce shortage issues for different types of professionals. In addition, systemic issues related to reimbursement and other financial aspects must be resolved to strengthen the overall rural mental healthcare delivery system. © S Watanabe-Galloway, L Madison, KL Watkins, AT Nguyen, L-W Chen, 2015.

Several industrial accidents, some of them fatal, have been reported in Uganda. Causes could include training gaps in vocational training institutions (VTIs) and workplaces. This study investigated how occupational safety training in VTIs and workplaces is implemented. The study was carried out in five selected VTIs and workplaces in Kampala. Data were collected from instructors, workshop technicians, students, workshop managers, production supervisors, machine operators and new technicians in the workplaces. A total of 35 respondents participated in the study. The results revealed that all curricula in VTIs include a component of safety but little is practiced in VTI workshops; in workplaces no specific training content was followed and there were no regular consultations between VTIs and industry on safety skills requirements, resulting in a mismatch in safety skills training. The major constraints to safety training include inadequate funds to purchase safety equipment and inadequate literature on safety. © 2015 Central Institute for Labour Protection -National Research Institute (CIOP-PIB).

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Background: People are increasingly living for longer with multimorbidity. Medical education and healthcare delivery must be re-orientated to meet the societal and individual patient needs that multimorbidity confers. The impact of multimorbidity on the educational needs of doctors is little understood. There has been little critique of how learning alongside healthcare provision is negotiated by patients, general practitioners and trainee doctors. This study asked 'what is known about how and why concurrent healthcare delivery and professional experiential learning interact to generate outcomes, valued by patients, general practitioners and trainees, for patients with multimorbidity in primary care?' Methods: This realist synthesis is reported using RAMESES standards. Relationship-centred negotiation of needs-based learning and care was the primary outcome of interest. Healthcare, social science and educational literature were sought as evidence. Data extraction focused on context, mechanism and outcome configurations within studies and on data which might assist understanding and explain; i) these configurations; ii) the relationships between them and; iii) their role and place in evolving programme theories arising from data synthesis. Mind-mapping software and team meetings were used to aid interpretative analysis. Results: The final synthesis included 141 papers of which 34 contained models for workplace-based experiential learning and/or patient care. Models of experiential learning for practitioners and for patient engagement were congruent, frequently referencing theories of transformation and socio-cultural processes as mechanisms for improving clinical care. Key issues included the perceived impossibility of reconciling personalised concepts of success with measurability of clinical markers or adherence to guidelines, and the need for greater recognition of social dynamics between patients, GPs and trainees including the complexities of shared responsibilities. A model for considering the implications of concurrency for learning and healthcare delivery in the context of multimorbidity in primary care is proposed and supporting evidence is presented. Conclusions: This study is novel in considering empirical evidence from patients, GPs and trainees engaged in concurrent learning and healthcare delivery. The findings should inform future interventions designed to produce a medical workforce equipped to provide multimorbidity care. Trial registration: PROSPERO International prospective register of systematic reviews CRD42013003862 © 2015 Yardley et al.; licensee BioMed Central.

This paper addresses trends in education-specific unemployment risks at labor market entry in West Germany from the mid-1970s to the present. In line with previous research it shows that vocationally qualified school-leavers have relatively lower unemployment risks than school-leavers with general education. Over time, the gap in unemployment risks between the low-educated and medium- and highly educated labor market entrants substantially widened for both sexes. The literature identifies two different mechanisms for this trend: structural or cyclical crowding out. While in the former scenario low-educated become increasingly unemployed due to an oversupply of tertiary graduates and displacement from above, in the latter their relative unemployment risk varies with the business cycle. The results provide evidence for cyclical rather than structural crowding-out in West Germany. Since macroeconomic conditions became generally worse over time, this strongly explains the widening unemployment gap between the low-educated and all other education groups. © 2014 Elsevier Inc..

In successful community pharmacy business enterprises suitably responsive actions to meet ever-increasing change require capable pharmacy managers who readily learn and adapt. Capability as a concept is generally understood to be the ability of a manager to identify and act to solve unfamiliar problems in unfamiliar situations. Capability is characterized by adaptability and flexibility. However, different understandings of the concept 'capability' and what it means to be 'capable' are indirect and incomplete. This paper aims to clarify current theories regarding the concept of 'capability' at the level of the individual, and through this to make more explicit what is known about the phenomenon, but more particularly, how we know what we know. The analysis includes the concept of 'competence' because explanations of capability include competence, and the two concepts are not clearly separated in the literature. By probing the epistemological origins of current theory concerning both concepts, the limiting taken for granted assumptions are revealed. Assumptions about context and time, and the psychological theory through which individuals are assumed to perceive, know and learn, are illuminated. The analysis, in connection with the literature, shows how the interpretive philosophic research approach may reveal a different and useful theoretical perspective for explaining capability as a dynamic performance. It is suggested that such a perspective may narrow the gap between the theory of capability and its practice. The interpretive perspective holds potential to reveal how capability, as performed by successful community pharmacy managers, might be further researched and strengthened. This paper supports the challenging suggestion that pharmacy social research needs to rebalance the dominance of purely empirical research by exploring interpretive methodologies to better understand human actions and relations in the context of pharmacy. © 2015 Elsevier Inc.

Although field experiments have documented the contemporary relevance of discrimination in employment, theories developed to explain the dynamics of differential treatment cannot account for differences across organizational and institutional contexts. In this article, I address this shortcoming by presenting the main empirical findings from a multi-method research project, in which a field experiment of ethnic discrimination in the Norwegian labour market was complemented with forty-two in-depth interviews with employers who were observed in the first stage of the study. While the experimental data support earlier findings in documenting that ethnic discrimination indeed takes place, the qualitative material suggests that theorizing in the field experiment literature have been too concerned with individual and intra-psychic explanations. Discriminatory outcomes in employment processes seems to be more dependent on contextual factors such as the number of applications received, whether requirements are specified, and the degree to which recruitment procedures are formalized. I argue that different contexts of employment provide different opportunity structures for discrimination, a finding with important theoretical and methodological implications. © London School of Economics and Political Science 2014.

Student populations are diverse such that different types of learners struggle with traditional didactic instruction. Problem-based learning has existed for several decades, but there is still controversy regarding the optimal mode of instruction to ensure success at all levels of students' past achievement. The present study addressed this problem by dividing students into the following three instructional groups for an upper-level course in animal physiology: Traditional lecture-style instruction (LI), guided problem-based instruction (GPBI), and open problem-based instruction (OPBI). Student performance was measured by three summative assessments consisting of 50% multiple-choice questions and 50% short-answer questions as well as a final overall course assessment. The present study also examined how students of different academic achievement histories performed under each instructional method. When student achievement levels were not considered, the effects of instructional methods on student outcomes were modest; OPBI students performed moderately better on short-answer exam questions than both LI and GPBI groups. High-achieving students showed no difference in performance for any of the instructional methods on any metric examined. In students with low-achieving academic histories, OPBI students largely outperformed LI students on all metrics (short-answer exam: P < 0.05, d = 1.865; multiple-choice question exam: P < 0.05, d = 1.166; and final score: P < 0.05, d = 1.265). They also outperformed GPBI students on short-answer exam questions (P < 0.05, d = 1.109) but not multiple-choice exam questions (P = 0.071, d = 0.716) or final course outcome (P = 0.328, d = 0.513). These findings strongly suggest that typically low-achieving students perform at a higher level under OPBI as long as the proper support systems (formative assessment and scaffolding) are provided to encourage student success.

The process of developing effective science educators has been a long-standing objective of the broader education community. Numerous studies have recommended not only depth in a teacher's subject area but also a breadth of professional development grounded in constructivist principles, allowing for successful student-centered and inquiry-based instruction. Few programs, however, have addressed the integration of the scientific research laboratory into the science classroom as a viable approach to professional development. Additionally, while occasional laboratory training programs have emerged in recent years, many lack a component for translating acquired skills into reformed classroom instruction. Given the rapid development and demand for knowledgeable employees and an informed population from the biotech and medical industries in recent years, it would appear to be particularly advantageous for the physiology and broader science education communities to consider this issue. The goal of this study was to examine the effectiveness of a laboratory-based professional development program focused on the integration of reformed teaching principles into the classrooms of secondary teachers. This was measured through the program's ability to instill in its participants elevated academic success while gaining fulfillment in the classroom. The findings demonstrated a significant improvement in the use of student-centered instruction and other reformed methods by program participants as well as improved self-efficacy, confidence, and job satisfaction. Also revealed was a reluctance to refashion established classroom protocols. The combination of these outcomes allowed for construction of an experiential framework for professional development in applied science education that supports an atmosphere of reformed teaching in the classroom.