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Background Rural US populations face a chronic shortage of physicians and an increasing gap in life expectancy compared to urban US populations, creating a need to understand how to increase residency graduates’ desire to practice in such areas. Objective This study quantifies associations between the amount of rural training during family medicine (FM) residencies and subsequent rural work. Methods American Medical Association (AMA) Masterfile, AMA graduate medical education (GME) supplement, American Board of Family Medicine certification, Accreditation Council for Graduate Medical Education (ACGME), and Centers for Medicare and Medicaid Services hospital costs data were merged and analyzed. Multiple logistic regression measured associations between rural training and rural or urban practice in 2018 by all 12 162 clinically active physicians who completed a US FM residency accredited by the ACGME between 2008 and 2012. Analyses adjusted for key potential confounders (age, sex, program size, region, and medical school location and type) and clustering by resident program. Results Most (91%, 11 011 of 12 162) residents had no rural training. A minority (14%, 1721 of 12 162) practiced in a rural location in 2018. Residents with no rural training comprised 80% (1373 of 1721) of those in rural practice in 2018. Spending more than half of residency training months in rural areas was associated with substantially increased odds of rural practice (OR 5.3-6.3). Only 4% (424 of 12 162) of residents spent more than half their training in rural locations, and only 5% (26 of 436) of FM training programs had residents training mostly in rural settings or community-based clinics. Conclusions There is a linear gradient between increasing levels of rural exposure in FM GME and subsequent rural work. © 2022, Accreditation Council for Graduate Medical Education. All rights reserved.

This study examines partnerships between schools and businesses that are intended to foster training and employment opportunities for secondary students with developmental and other disabilities in Saudi Arabia. A survey was developed to investigate employers’ perspectives on students’ skills, practical strategies for training, and their contribution. Fifty-two employers participated in the survey. The findings revealed the most valued skills on job sites, such as self- determination, social, and job skills, and believed that coordination, job matching, and joint supervision are successful practices that improve training. The employers concluded that some of their contributions to such partnerships include participation in curriculum development, training students in their workplaces under their supervision, and offering financial support. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

[No abstract available]

The growing contradiction between protection and livelihood is a common challenge for most protected areas in developing countries. Skill training is an important way to increase household income and alleviate the dilemma between conservation and development. However, its effects on household income around protected areas have rarely been explored. This paper aims to evaluate the effect of skill training on the income of households around four Biosphere Reserves in China and explore its mechanism. Based on the information collected from 381 households through face-to-face interviews, this study adopted descriptive analysis and multiple regression to yield consistent results. The results showed that agricultural and off-farm skill training had no impact on the total household income. The results from the mechanism analysis found that participation in off-farm skill training had a significant and positive effect on the total income of the households outside protected areas and participation in agricultural training had a positive effect on agricultural income. The findings indicate that the local government and protected area administration should increase the publicity for skill training, enrich the types training, appropriately supply livelihood support projects that reconcile conservation and development, and strengthen the infrastructure development around protected areas to promote off-farm employment and the circulation and sale of agricultural products. However, the impacts of any associated intensification should be carefully monitored. © 2022 by the authors.

Introduction: Prescribing of medications with well-known adverse effects, like antipsychotics or benzodiazepines, during hospitalisation is extremely common despite guideline recommendations against their use. Barriers to optimal prescribing, including perceived pressure from allied health professionals and fatigue, may be particularly pronounced for less experienced medical residents, especially during night shifts when these medications are often prescribed. Under these circumstances, physicians may be more likely to use ‘quick’, often referred to as System 1 choices, rather than ‘considered’ System 2 strategies for decisions. Understanding how medical residents use, these different cognitive approaches could help develop interventions to improve prescribing. Methods: To understand decision-making and contextual contributors that influence suboptimal prescribing during night coverage by medical residents, we conducted semi-structured qualitative interviews with residents in general medicine inpatient settings. The interviews elicited perspectives on shift routines, stressful situations, factors influencing prescribing decision making and hypothetical measures that could improve prescribing. Interviews were audio-recorded and transcribed. Data were analysed using codes developed by the team to generate themes using immersion/crystallisation approaches. Results: We conducted interviews with 21 medical residents; 47% were female, 43% were White, and 43% were Asian. We identified five key themes: (i) time pressures affecting prescribing decisions, (ii) fears of judgement by senior physicians and peers and being responsible for patient outcomes, (iii) perceived pressure from nursing staff, amplified by nurses' greater experience, (iv) clinical acuity as a key factor influencing prescribing, and (v) strategies to improve communication between members of the care team, like ensuring adequate hand-off by day teams. Conclusion: Medical residents highlighted numerous contextual factors that promote quick thinking rather than slower thinking when prescribing on night shifts, particularly time constraints, perceived pressure and patient clinical acuity. Interventions aimed at reducing prescribing should address how to manage stress and perceived pressure in decision making. © 2022 Association for the Study of Medical Education and John Wiley & Sons Ltd.

Background: Navigating workplace social interactions can be stressful for autistic people and be experienced differently by gender. A better understanding of the autistic experience of these difficulties is needed to inform effective policy, practice, and individualized support. Method: Fifty-five autistic individuals (n women=32; n men=22) participated in either an online survey or focus group. Data were analyzed using inductive thematic analysis. Results: The data suggests that the social and interaction expectations placed upon autistic individuals differ by gender and can contribute to occupational stress. Conclusions: The data provides a basis for further investigation considering Conservation of Resources Theory and its practical application to inform reasonable adjustments in the workplace for autistic people. What this paper adds: The gendered workplace experiences of autistic people is an emerging area of research. However, how workplace social interactions are experienced by each gender remains under-researched. An understanding of this could help decrease occupational stress, inform reasonable adjustments, and increase labor market participation in this population. This paper adds to the existing literature in showing that workplace social interactions for autistic people are experienced differently by gender. As such, the implications in the experience of occupational stress may also differ. Therefore, the importance of having reasonable adjustments in the workplace that account for gender is highlighted. © 2022 Elsevier Ltd

Aim: To define the concept of foundational competence as it pertains to prelicensure and graduate nursing students during their educational program, thereby informing pedagogical and assessment practices. Background: Competence has many definitions and uses, however a lack of consensus of a clear and useful definition in nursing persists. Without shared language, competence remains open for interpretation across and among groups and impedes the ability to teach and assess it in a competency-based education framework. Method: Using the Walker & Avant method of concept analysis, literature was reviewed and synthesized to define and explain the concept of foundational competence in nursing using evidence and practice from various disciplines. Findings: Antecedents, attributes, empirical referents and consequences of foundational competence were identified. Discussion: The components and uses of the concept of foundational competence are presented to guide pedagogical and assessment practices necessary for competency-based education in nursing. © 2022 Elsevier Ltd

Study Objectives: Primary care nurse practitioners (NPs) receive little sleep education in graduate programs but are often first-line providers for patients presenting with sleep-related symptoms. A pre-/postevaluation study was conducted using asynchronous, case-based sleep education modules in a cohort of primary care NP students enrolled in a single academic institution’s nursing master’s degree program. Methods: Six virtual, case-based modules addressed adult sleep health and disorders, prioritized based on prevalence and primary care presentation. Kirkpatrick Training Evaluation Model guided outcome selection. Descriptive and paired comparative analyses were conducted. Results: Participants were first-year NP students (n = 149; 88% female; 82% ≤ 35 years of age) in an adult primary care program that included psychiatric/mental health track. Participants reacted positively to course delivery methods and content. Insomnia was endorsed by 87% as most relevant to practice with healthy sleep (88%) and obstructive sleep apnea (50%) also frequently endorsed as practice relevant. Posttest knowledge scores significantly improved for all modules (P <.001). Self-rated confidence for future practice application was high. Conclusions: This novel asynchronous, virtual curriculum met Kirkpatrick levels 1 and 2 (positive reaction and knowledge transfer) in NP students who predicted an impact on their practice (Kirkpatrick level 3). Studies are needed to assess the benefits of increasing primary care NP knowledge in sleep medicine on quality of care and access to care (Kirkpatrick level 4). Future use of this novel sleep curriculum in other professional curricula, new-to-sleep clinical researchers, and practicing primary care providers may further potentiate care quality and sleep care access. © 2022 American Academy of Sleep Medicine. All rights reserved.

Background: Medical workforce shortages in rural and remote areas are a global issue. High-income countries (HICs) and low-and middle-income countries (LMICs) seek to implement strategies to address this problem, regardless of local challenges and contexts. This study distilled strategies with positive outcomes and success from international peer-reviewed literature regarding recruitment, retention, and rural and remote medical workforce development in HICs and LMICs. Methods: The Arksey and O’Malley scoping review framework was utilised. Articles were retrieved from electronic databases Medline, Embase, Global Health, CINAHL Plus, and PubMed from 2010-2020. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guideline was used to ensure rigour in reporting the methodology in the interim, and PRISMA extension for scoping review (PRISMA-ScR) was used as a guide to report the findings. The success of strategies was examined against the following outcomes: for recruitment-rural and remote practice location; for development-personal and professional development; and for retention-continuity in rural and remote practice and low turnover rates. Results: Sixty-one studies were included according to the restriction criteria. Most studies (n = 53; 87%) were undertaken in HICs, with only eight studies from LMICs. This scoping review found implementation strategies classified as Educational, Financial, and Multidimensional were successful for recruitment, retention, and development of the rural and remote medical workforce. Conclusion: This scoping review shows that effective strategies to recruit and retain rural and remote medical workforce are feasible worldwide despite differences in socio-economic factors. While adjustment and adaptation to match the strategies to the local context are required, the country’s commitment to act to improve the rural medical workforce shortage is most critical. © 2022 The Author(s).

Virtual care (VC) was rapidly introduced into mainstream health service delivery due to COVID-19. To maintain and integrate VC with in-person care, one important change management approach requires a holistic educational strategy for the health professions. Pratt's (1998) “five perspectives of teaching” is an effective framework to guide the development of VC education to holistically increase the knowledge and skills of health professionals and stimulate health system change through the Transmission, Apprenticeship, Developmental, Nurturing and Social Reform perspectives. This article then makes five recommendations to implement this strategy through purposeful involvement and collaborations between stakeholder organizations. © 2022 Longwoods Publishing Corp.. All rights reserved.