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INTRODUCTION: In 1988, the New South Wales (NSW) Department of Health developed the NSW Rural Resident Medical Officer Cadetship Program (Cadetship Program) to help overcome a junior doctor workforce shortage in rural hospitals. A second aim was to increase recruitment to the rural medical workforce on the basis that positive exposure to rural medicine increases the likelihood of choosing to practice in a rural location. The Cadetship Program offers bonded scholarships which provide financial support for residents of NSW studying medicine during the final 2 years of their medical degree. In return, cadets are contracted to complete 2 of their first 3 postgraduate years in the NSW rural hospital network. NSW Rural Doctors Network has managed the Cadetship Program for the NSW Department of Health since 1993, and carried out an evaluation in 2004. The purpose of this evaluation was to track the career choice and practice location of medical students entering the Cadetship Program before 1999, and to comment on the impact of the Program on the rural medical workforce in NSW to date, and its implications for the future workforce. METHODS: The career choice and practice locations of 107 medical students who received cadetships between 1989 and 1998 were tracked. Students who did not graduate from medical school (n = 3) or who did not complete their rural service (13) were excluded from the analysis. Career choice was not available for a further nine former cadets and they were also excluded from the analysis. The NSW Rural Doctors Network was the major source of data on career choice and practice location due to its role in administering the Cadetship Program on behalf of the NSW Department of Health. Two brief questionnaires targeting specific groups of cadets were used to fill knowledge gaps about where cadets grew up, what vocational training they undertook, and where they were working in 2004. Where this information was not obtained from cadets first hand, it was sourced from the CD-ROM version of the Medical Directory of Australia. RESULTS: Forty-three percent of cadets entering the Program before 1999 were working in rural locations in 2004 (compared with 20.5% of medical practitioners nationally), 46% had attended primary school in a rural location and 44% chose to specialize in general practice. Career choice was the major determinant of practice location. Having a rural background did not appear to influence practice location; whereas, those specialising in general practice made up 70% of this cohort of cadets working in rural areas. All general practice trainees were in rural locations compared with only two of the 25 trainee specialists, which reflects the availability of accredited training places in rural Australia. CONCLUSIONS: The Cadetship Program, which ensures junior doctors work for 2 of their first 3 postgraduate years in a rural allocation centre, is an effective link between medical school and rural practice, particularly rural general practice. Providing vocational training opportunities in rural locations is central to this success, and needs to be considered in efforts to expand the rural specialist workforce, and in ensuring rural health capitalises on the increasing number of medical students moving through the education and training system in the next 4-10 years.

Aims and objectives. The objective of the study was to identify whether clinical education facilitators made a difference to the learning experiences of nurses in a large teaching hospital. Background. Strategies for enabling continuous professional development are well established in healthcare organizations as key components of approaches to lifelong learning. The benefits of continuous professional development include the maintenance of high standards of care, the improvement and development of services, ensuring the competency of all nursing staff and guaranteeing the accountability of nurses for their actions. The role of clinical education facilitator is relatively new and little evaluation of this role has been undertaken. Conclusions. This study highlights important issues to be considered in developing a 'learning culture' in a hospital organization, through the adoption of such roles as clinical education facilitators. Whilst the roles have had an important function in the active coordination of learning activities in the hospital, there is little evidence of the role directly impacting on the learning culture of clinical settings. Learning mechanisms have been identified. The results of this evaluation can be subjected to further testing through ongoing evaluation of the outcomes arising from the learning mechanisms in place. Given the emphasis on work-based learning and continuing professional development in health care, then this ongoing evaluation can yield important information about future directions for nurse education. Relevance to clinical practice. The study highlights the importance of supported learning in the workplace. However, more importantly, it identifies the need for a culture of professional practice to be developed in order to sustain learning in practice. Classroom-based learning alone, cannot create a culture of development in nursing and there is thus a need for models of work-based learning to be integrated into practice environments. © 2006 Blackwell Publishing Ltd.

[No abstract available]

An appropriate human resource policy infrastructure to support workplace learning has been advocated both within the literature on workplace learning and in official British Government guidance for healthcare organizations. Yet minimal empirical evidence exists to support the view that HR policies are able to promote greater use of workplace learning methods within organizations. This proposition was tested through collecting both quantitative and qualitative data from staff in British hospices. The findings demonstrated the limited effects of HR policies in this respect and five key factors were identified that appeared to influence HR policy implementation in this instance. These findings have wider significance for our understanding of the complex interrelationships that potentially exist between HR policies, their outcomes and the mediating factors associated with policy implementation. © 2006 Taylor & Francis.

Collaborative management of chronic illness is undermined by neglect of emotional and psychological factors in both the patient and doctor.

The ACGME requires adequate lengths of appointment for both the program director and faculty as being essential to maintaining an appropriate continuity of leadership (1). Although this requirement does not apply to the program coordinator, the ACGME does require that a program have a dedicated coordinator. Any list of coordinator duties is long, but underestimates the true volume of the coordinator's responsibilities. Although the program director is accountable for all aspects of the program, much of the director's work is delegated to the coordinator. The training period for a new coordinator is from months to years, and coordinator turnover can be very disruptive to the program. The coordinator must possess skills in communication, problem solving, decision making, administration, organization, and supervision. He or she must have a broad knowledge of academic medicine and radiology training. The coordinator is generally the first and last person to interact with resident candidates, visiting speakers, and ACGME site reviewers. His or her professional and administrative skills are a reflection of the quality of the program and effectiveness of the program director. The work of a coordinator involves managing many complex tasks at once, while maintaining the flexibility to accommodate changes in work priorities in the face of unexpected events. He or she should be seen as an advocate of both faculty and residents. The coordinator needs to work independently within prescribed guidelines, engage in continuous professional development and suggest initiatives to improve the quality of the program. When done well, the coordinator's work is accomplished effortlessly in the eyes of the program director, faculty, and residents. A highly skilled and experienced coordinator is a valuable asset to the program. Providing the coordinator with adequate support (i.e., clerical assistance, materials, training, and workspace) is a smart investment, the return on which can be substantial. © AUR, 2005.

The transition from school to vocational training is a developmental task whose completion is central to the ongoing career path. Until recently, the role played by emotions in the process of searching for apprenticeship positions has hardly been researched. The following paper uses the concepts of the Action Phase Model of Developmental Regulation (Heckhausen, 1999b) and Control-Process-Theory (Carver & Scheier, 1990) to derive predictions about the function of affective reactions during the apprenticeship search. These were tested using the data from a longitudinal study (N = 363) for the tenth grade at the Realschule (Secondary School in Germany up to GCSE level). Structural equation models showed that the students' application processes were correlated with their negative apprenticeship-specific affects. In contrast to unspecific measures of dispositional mood, there was evidence for the goal-specific negative affect as the mediating variable between the point in time when success in the application process was achieved and the subsequent application cycle. Even after controlling for gender, mathematics grades, and the social class of the areas served by the schools, the negative affect proved to be predictive for an increase in application activity during the second half of tenth grade. Implications of the findings are discussed. © Hogrefe Verlag Göttingen 2005.

Purpose - The classical form of dual vocational training in Switzerland is on-the-job training combined with theoretical education in a school. In order to be an attractive educational choice for both enterprises and pupils, the apprenticeship model has to be constantly adapted to the demands of the labour market. As a potential model for future apprenticeship training, large firms started to concentrate their apprenticeship training in one or a few sites. More recently, independent external firms have been set up with the express purpose of training apprentices for other companies. This article aims to discuss these new developments. Design/methodology/approach - This article bases its discussion of the developments on the basis of a unique data set comprising more than 2,300 training companies in Switzerland. Findings - The observations reported in this article suggest that training in a training centre is a viable alternative to the usual in-house apprenticeship system where the apprentice is trained within the company. However, training centres will never be an ideal solution for all occupations or for every company. Training centres are primarily worthwhile for investment-intensive occupations where the main objective is to invest in an apprentice's human capital and thus help ensure a steady supply of highly qualified workers. Originality/value - The article presents useful developments in the use of training centres. © Emerald Group Publishing Limited.

In the face of the serious problem of lack of access to health care in the United States, with over 45 million uninsured,1 there exist many models of collaborative local programs serving the uninsured. One such approach is the student-run free clinic, small projects managed by health professional students, supervised by licensed health professionals, offering free health services to those without health access. The purpose of this article is to describe the UCSD Student-Run Free Clinic Project, its history, mission, partners, clinical services, curriculum, funding, replicability, outcomes, elements of success, transdisciplinary nature, and hopes for the future.

Aim and objectives. This paper reports the views of teaching staff and clinical assessors on their experience of programme delivery and assessment. Background. In 2001, the Irish Department of Health and Children developed a vocational training programme for healthcare assistants. This programme was piloted nationally across 14 hospital and community sites. Teaching staff and clinical assessors at each site delivered the programme. Method. One-to-one semi-structured interviews were undertaken with 16 clinical staff and 26 teaching staff. With consent, all interviews were tape-recorded, from which the transcripts were subject to content analysis. Results. A lack of experience and preparation among teaching staff and clinical assessors was evident. The staff's commitment to their role on the programme while maintaining their normal duties caused frustration and uncertainty. Not withstanding, the value of the programme in terms of increased motivation, satisfaction and knowledge of healthcare assistants and the impact on care delivery, was recognized by respondents. Conclusions. This programme represents the provision of a national standard training programme for healthcare assistants. It provides an insight into the delivery of such a programme and the educational and training needs of healthcare assistants through the views of staff that taught and assessed on it. Relevance to clinical practice. Findings suggest that the development and implementation of a national training programme for healthcare assistants is achievable. © 2005 Blackwell Publishing Ltd.