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Context: Graduate medical education is currently facing major educational reforms. There is a lack of empirical evidence in the literature about the learning processes of residents in the clinical workplace. This qualitative study uses a 'grounded theory' approach to continue the development of a theoretical framework of learning in the clinical workplace by adding the perspective of attending doctors. Methods: A total of 21 Dutch attending doctors involved in the training of residents in obstetrics and gynaecology participated in 1 of 3 focus group sessions. They discussed their perceptions of how residents learn and what factors influence residents' learning. A grounded theory approach was used to analyse the transcribed discussions. Results: Three related themes emerged. The first concerned the central role of participation in work-related activities: according to attending doctors, residents learn by tackling the everyday challenges of clinical work. The second involved the ways in which attending doctors influence what residents learn from work-related activities. The final theme focused on attending doctors' views of the essential characteristics of residents and their development during residency. Conclusions: Attending doctors' perspectives complement current insights derived from similar research among residents and from related literature. As part of an ongoing effort to further develop understanding of how residents learn, this study adds several ways in which attending doctors strive to combine guidance in both patient care and resident training. Furthermore, attending doctors' perspectives draw attention to other aspects of learning in the clinical workplace, such as the role of confidence and the balance between supervision and independence. © 2007 Blackwell Publishing Ltd.

Introduction: The purpose of this study was to assess the agreement of Emergency Department (ED) attendings, ED residents, and neurology residents compared with stroke neurologists in the assessment of intravenous rt-PA eligibility. Methods: A convenience sample of patients presenting with possible stroke symptoms to the University of Michigan Hospital ED from June 2003 to July 2004 was identified. A physician from each of four groups: ED attending, ED resident, neurology resident, and stroke neurology attending independently evaluated each patient for eligibility for intravenous (IV) rt-PA. Accuracy, sensitivity, and positive predictive value (PPV) with 95% confidence intervals (CI) were calculated by physician type, compared with the stroke neurologist, for eligibility for IV rt-PA. Results: Exactly 36 (49%) out of the 73 evaluated patients were diagnosed with acute ischemic stroke and 11 were deemed eligible for treatment with IV tPA by the stroke neurologist. Agreement with the stroke neurologist for rt-PA eligibility was 93% [95% CI: 84%, 98%] (sensitivity = 82% [48%, 98%], PPV = 82% [48%, 99%]) for the ED attendings, 79% [65%, 90%] (sensitivity = 75% [35%, 97%], PPV = 43% [18% 71%]) for the ED residents, and 84% [73%, 92%] (sensitivity = 100% [74%, 100%], PPV = 52% [31%, 73%]) for the neurology residents. There were two false positive cases identified by ED attendings, eight, by ED residents, and 11 by neurology residents. Conclusions: This study suggests that the agreement between ED attendings and stroke neurologists for determination of rt-PA eligibility is good. There is room for improvement, however, in the determination of acute stroke therapy eligibility in the ED setting especially among trainees. © Humana Press Inc. 2007.

The pre-eminence of knowledge and skills as the sources of wealth creation and economic growth is one of the major issues in business at the beginning of the twenty-first century. As a result, human Resource Development has been propelled into a central role in management thinking. However, this has not always been reflected in practice since many of the methodologies for monitoring and assessment continue to reflect the previous importance of fixed capital, the industrial society and the quantity of labour employed. The police service like other public services has had to ensure that its staff is skilled to undertake an ever more complex role within society. This has traditionally been delivered through typical organisational training processes. The value of learning as opposed to training is rarely proposed. The 'soft' benefits of education, elements like critical thinking and emotional intelligence as well as learning, are rarely given sufficient emphasis. However, increasingly organisations are realizing the benefits of creating an open environment that allows informal learning to flourish. This article will explore the concepts of traditional training within policing before reviewing as a case study the introduction of a work-based and experiential learning paradigm within police development.

Needlestick/sharp injuries (NSIs/SIs) are a serious threat to medical/nursing students in hospital internships. Education for preventing NSIs/SIs is important for healthcare workers but is rarely conducted and evaluated among vocational school nursing students. We conducted an educational intervention for such students after their internship rotations before graduation. This program consisted of a lecture to the students after the internship training and a self-study brochure for them to study before their graduation. This study used the pre-test questionnaires completed by all students and the post-test questionnaires completed by 107 graduates after work experience as licensed nurses to assess the effectiveness of the intervention. After educational intervention, the incidence of NSIs/SIs decreased significantly from 50.5% pre-test to 25.2% post-test, and the report rate increased from 37.0% to 55.6%, respectively. In conclusion, this intervention significantly reduced the incidence of NSIs/SIs and increased the report rate of such events.

Objectives To ascertain the requirements in restorative dentistry that undergraduate dental students have to fulfil in order to sit the finals examinations in dental schools in the UK and Ireland and to compare those requirements with the competencies stipulated by the GDC in The first five years.Methods Fifteen anonymised questionnaires, of open and closed question design, were sent by post to academics in the university departments of restorative dentistry in each of the undergraduate dental schools in the UK and Ireland. The first section concerned numerical information regarding total numbers of procedures that were required to be completed in undergraduate restorative dentistry. The second section was designed to ascertain information as to how decisions are made with respect to an undergraduate's readiness to sit the finals examination in restorative dentistry (such as continual assessment and/or competency assessments).Results A total of 15 replies were received for analysis, a 100% response rate. Several institutions emphasised that they do not have 'requirements', but provide guidelines as to what should be achieved. Six institutions did not have set numerical requirements for direct placement restorations or bridges. The number of direct placement restorations required at the other nine institutions ranged from 50 to 160. Five institutions did not have numerical requirements for dentures; four institutions did not set numerical targets for crowns, veneers, inlays/onlays or endodontics. In institutions where numerical requirements were not used, forms of competency assessments were completed. The requirements across all institutions for periodontology, integrated treatment planning and completed cases were ill-defined.Conclusions This study shows that there is a wide disparity amongst institutions in the UK and Ireland with regards to finals requirements in restorative dentistry. Ideally, such requirements should be similar between institutions and should be closely mapped to the GDC's required learning outcomes (The first five years) for the UK institutions. © 2007 Nature Publishing Group.

Data from quantitative and qualitative sources were gathered from enterprises in five industry sectors (construction, manufacturing, services, transport and other) using targeted interviews, focus groups, a mailed questionnaire survey (N = 81) and a telephone interview survey (N = 69) to ascertain the level of importance employers place on their employees' qualifications. Analysis was undertaken to determine whether employers value qualifications differently by type of employee (e.g. job classification); the type of human resource management decision; and the business risk being managed. The study results suggest that employers generally value qualifications less than stakeholders inside the formal education and training system. Employer perspectives appear to vary according to enterprise size and other characteristics. However, all employers distinguish between formal qualifications and relevant experience. They seek outcomes from training consistent with their perception of business needs and how competence contributes to satisfying those needs (including minimising risks). © 2007 Australian human Resources Institute.

This paper presents the results of a study comparing student learning in an inquiry-based and a traditional course in biotransport. Collaborating learning scientists and biomedical engineers designed and implemented an inquiry-based method of instruction that followed learning principles presented in the National Research Council report "How People Learn" (HPL). In this study, the intervention group was taught a core biomedical engineering course in biotransport following the HPL method. The control group was taught by traditional didactic lecture methods. A primary objective of the study was to identify instructional methods that facilitate the early development of adaptive expertise (AE). AE requires a combination of two types of engineering skills: subject knowledge and the ability to think innovatively in new contexts. Therefore, student learning in biotransport was measured in two dimensions: A pre and posttest measured knowledge acquisition in the domain and development of innovative problem-solving abilities. HPL and traditional students' test scores were compared. Results show that HPL and traditional students made equivalent knowledge gains, but that HPL students demonstrated significantly greater improvement in innovative thinking abilities. We discuss these results in terms of their implications for improving undergraduate engineering education. © 2007 Biomedical Engineering Society.

Title. Resilience in the operating room: developing and testing of a resilience model Aim. This paper is a report of a study to examine the relation of perceived competence, collaboration, control, self-efficacy, hope, coping, age, experience, education and years of employment to resilience in operating room (OR) nurses. Background. Resilience is viewed as a vital attribute for nurses because it augments adaptation in demanding and volatile clinical environments such as ORs. However, there has been little research into the utility of resilience as a means of dealing with workplace stress, and there is only limited understanding of variables that explain resilience in the context of nursing. Method. A correlational cross-sectional survey design was used. Of a national sample of 2860 Australian OR nurses, 1430 were selected by systematic random sampling and invited to complete a questionnaire in 2006. The instrument included scales measuring perceived competence, collaboration, control, self-efficacy, hope, coping and resilience, and gathered information about the demographic characteristics of respondents. Results. Two regression models were used to develop a model of resilience. An initial model tested the hypothesis that a set of 12 explanatory variables contributed to resilience in OR nurses. Five variables (hope, self-efficacy, coping, control and competence) explained resilience at statistically significant levels. Age, experience, education and years of employment did not contribute to resilience at statistically significant levels. The final model explained 60% of the variance. In both models, the strongest explanatory variables were hope, self-efficacy and coping. Conclusion. Identification of explanatory variables that contribute to resilience in ORs may assist in implementing strategies that promote these behaviours, and thus retain nurses in this specialty. © Blackwell Publishing Ltd.

Background: Hand dermatitis, including irritant and allergic contact dermatitis (ACD), is common. Objective: To evaluate allergens, relevant irritants, sources and occupations associated with hand contact dermatitis using North American Contact Dermatitis Group (NACDG) data. Methods: A cross-sectional analysis of 22,025 patients patch tested between 1994 and 2004. Results: Hand involvement was found in 6953 patients; 959 had ACD as the only diagnosis. In these 959 patients, the 12 most frequent relevant allergens were quaternium-15 (16.5%), formaldehyde (13.0%), nickel sulfate (12.2%), fragrance mix (11.3%), thiuram mix (10.2%), balsam of Peru (9.6%), carba mix (7.8%), neomycin sulfate (7.7%), bacitracin (7.4%), methyldibromoglutaronitrile/phenoxyethanol 2.0% (7.4%), cobalt chloride (6.5%), and methyldibromoglutaronitrile/phenoxyethanol 2.5% (6.3%). Rubber allergens were most commonly associated with occupation. One third of patients with hand ACD had identifiable relevant irritants. Limitations: Cross-sectional analyses prevent evaluation of causal associations. Conclusion: In NACDG patients with hand ACD, the most common allergens included preservatives, metals, fragrances, topical antibiotics, and rubber additives. © 2007 American Academy of Dermatology, Inc.

Background and Purpose: Graduates of physical therapist education programs should be expected to function as competent clinicians. Instead, the benchmark for many clinical performance assessment tools has been "as good as an entry-level graduate." The authors developed the Clinical Internship Evaluation Tool (CIET), which measures clinical performance of the student relative to a "competent clinician." The purpose of this study was to provide evidence for validity of the tool. Subjects and Methods: The CIET was used to evaluate physical therapist student clinical performance from 1999 to 2003. Data from 228 student evaluations, a survey of 26 clinical instructors (CIs), and an item review by 7 faculty members were used to collect validity evidence. The relevance of items on the CIET was examined by the survey and the item review. Coefficient alpha was calculated to estimate internal consistency among the items. A Spearman correlation was used to examine the relationship between 2 measures of clinical competence. A repeated-measures analysis of variance (ANOVA) compared the student scores at each clinical time frame to confirm expected improvements in performance longitudinally. Evidence for practicality was collected by the CI survey. Results: Based on the faculty item review and the CI survey, all items were representative of skills and behaviors considered important for a clinically competent physical therapist. The internal consistency (alpha) was .98 for the patient management items. The average correlation of the 2 measures of clinical competence was .76. The repeated-measures ANOVA was significant and demonstrated improved patient management scores as the student progressed through the program. The CI survey results indicated that 96% of respondents agreed or strongly agreed that the instrument was short and easy to use. Discussion and Conclusion: The results of the study suggest that the CIET is representative of skills and behaviors necessary for students to perform at the level of a competent therapist and that the instrument is practical to use for busy clinicians. The CIET appears to be a valid tool for measuring student clinical performance and can be a time-efficient alternative for CIs in today's demanding clinical environment. © 2007 American Physical Therapy Association.