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Purpose: Surgical training is shifting toward competency-based models that promote earlier supervised autonomy. We assessed caregiver knowledge, willingness to consent, and opinions regarding trainee autonomy in their child's operation. Methods: At two academic children's hospitals, 100 caregivers of children aged 0–17 years completed an electronic survey in the pediatric surgery clinic (1/2018–4/2018). Knowledge, willingness to consent, and opinions of trainee involvement in their child's operation in standard and competency-based training models were assessed. McNemar's test compared willingness to consent with standard and competency-based training (p < 0.05). Results: Caregivers were 75% female, 41% age 30–39 years old, and 78% white. All provider roles were correctly identified by 14% of caregivers. For routine procedures, caregivers would consent to a fellow assisting (95%) or independently operating with the attending present (78%). They would less likely consent if the attending was not in the operating room (39%) or the hospital (25%). Competency-based training improved willingness to consent, but was significant only for independence with the attending present. Most caregivers wanted to know about (81%) and be asked permission for (82%) trainee involvement in their child's operation. Conclusions: This study suggests that surgeons in academic settings must balance transparency with trainee autonomy when obtaining caregiver consent. Level of evidence: Level III. © 2019 Elsevier Inc.

The aim of this study was to describe the employment experiences of persons with learning disabilities (LDs) in developing countries, such as Malaysia. Factors associated with respondents’ employment were also determined. A cross-sectional survey was conducted among young adults with LD who left the special education programs in secondary schools in Kuala Lumpur and Selangor. Ninety young adults with LD, aged 18 to 25 years were interviewed face-to-face at an agreed upon convenient place on their working experiences after leaving secondary schools. A total of 13 respondents were excluded from the analysis because their intellectual quotient (IQ) score demonstrated a high possibility of intellectual disability with IQ estimation <70. Of the 77 young adults analyzed, 74.0% reported having work experience and 64.9% were working at the time of interview. Statistical analysis showed significant associations between individual, family, and community factors with respondents’ employment. Two factors made a unique statistically significant contribution to the model (gender, p = 0.043 and adult service: Financial support p = 0.012). This study suggests the current school-to-work transition program at secondary and post-secondary schools should be improved to better prepare young adults with LD with necessary skills relevant for the current job market so that they could improve their employability. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.

Halpin PA, Donahue AE, Johnson KM. Undergraduate biological sciences and biotechnology students' reflective essays focus on descriptive details of experiential learning experiences. Adv Physiol Educ 44: 99-103, 2020; doi:10.1152/advan.00144.2019.-Experiential learning experiences (ELEs), opportunities for students to apply knowledge and skills critically in a hands-on environment, are fundamental to the apprenticeship model of biological and biotechnological sciences. ELEs enhance student-learning gains, increase career readiness, and provide important networking opportunities. However, students do not often recognize the benefits of ELEs. Reflection is a highly effective tool to articulate learning gains and connect new content with established knowledge. Therefore, senior undergraduate students (n β 23), majoring in biological sciences or biotechnology, wrote required reflective essays about their ELE, in response to an intentionally vague prompt. Qualitative assessment of the reflective essays identified themes present in the reflective essays that typically included descriptions of what students did, with whom they worked, and what they learned during their ELE, but lacked critical analysis or deep reflection about their experience. Differences were also present between different types of ELEs. These results provide a foundation for guiding students to deeper reflection, ultimately resulting in greater benefits from their ELEs. To promote more robust reflection, and, therefore, theoretically enhance learning gains from ELEs, we suggest multiple iterations of reflection, instructor feedback and coaching, and ELE-specific prompts that focus on the placement of ELEs within students' personal and professional trajectory. © 2020.

Current media is saturated with articles on ‘the future of work’ or, to be more specific, ‘the future with no work’. Reports (exampled by Frey, Osborne, & Holmes, 2016) predict almost half of present occupations will cease to exist in the near future. The challenges to the world of work as presently constituted include the more pervasive use of robots and artificial intelligences to replace humans (Frey et al., 2016). Workers are exhorted to ensure their skill and knowledge base keep up with the rapidly changing world of work. However, many occupations in the trades are deemed to be ‘durable’ by virtue of their inherent complexity, necessity for fine and controlled manual dexterity, constant diversity and variability and requirements to be continually innovative to meet changes wrought by digital technologies and consumer trends (Frey et al., 2016). © Springer Nature Singapore Pte Ltd 2020.

Introduction: Despite an increase in the number of undergraduate training positions, Australia faces a critical shortage of medical practitioners in regional, rural and remote communities. Extended rural clinical placements have shown great utility in undergraduate medical curricula, increasing training capacity and providing comparable educational outcomes while promoting rural medicine as a career. The Prevocational Integrated Extended Rural Clinical Experience (PIERCE) was developed to increase the training capacity of the Queensland Rural Generalist Pathway (QRGP) and strengthen trainee commitment to rural practice by offering an authentic, extended 15-week rural term that provided an integrated experience in anaesthetics, obstetrics and gynaecology, and paediatrics, while meeting the requirements for satisfactory completion of prevocational rural generalist training. This study sought to evaluate whether trainees believed PIERCE and/or traditional regional hospital specialty placements achieved their learning objectives and to identify elements of the placements that contributed to, or were a barrier to, their realisation. Methods: This translational qualitative study explored the experiences and perceptions of QRGP trainees who undertook a PIERCE placement in three Queensland rural hospitals (Mareeba, Proserpine and Stanthorpe) in 2015, with a matched cohort of trainees who undertook regional hospital placements in anaesthetics, obstetrics and gynaecology, and paediatrics at a regional referral hospital (Cairns, Mackay and Toowoomba base hospitals). The study used a realist evaluation framework that investigates What works, for whom, in what circumstances, in what respects and why? Results: PIERCE provided an enjoyable and valued rural training experience that promoted trainee engagement with, and contribution to, a rural community of practice, reinforcing their commitment to a career in rural medicine. However, QRGP trainees did not accept that PIERCE could be a substitute for regional hospital experience in anaesthetics, obstetrics and gynaecology, and paediatrics. Rather, trainees thought PIERCE and regional hospital placements offered complementary experiences. PIERCE offered integrated, hands-on rural clinical experience in which trainees had more autonomy and responsibility. Regional hospital placements offered more traditional caseload learning experiences based on observation and the handing down of knowledge and skills by hospital-based supervisors. Conclusion: Both PIERCE and regional hospital placements provided opportunities and threats to the attainment of the curriculum objectives of the Australian Curriculum Framework for Junior Doctors, the Australian College of Rural and Remote Medicine and the Royal Australian College of General Practitioners Fellowship in Advanced Rural General Practice curricula. PIERCE trainees enjoyed the opportunity to experience rural medicine in a community setting, a broad caseload, hands-on proficiency, continuity of care and an authentic role as a valued member of the clinical team. This was reinforced by closer and more consistent clinical and educational interactions with their supervisors, and learning experiences that address key weaknesses identified in current hospital-based prevocational training. Successful achievement of prevocational curriculum objectives is contingent on strategic alignment of the curricula with supportive learning mechanisms focused by the learning context on the desired outcome, rural practice. This study adds weight to the growing consensus that rural community-based placements such as PIERCE are desirable components of prevocational training. © 2020.

The “practice track” (PAT) at Goethe University Frankfurt provides students with the opportunity to focus on outpatient care during their medical studies. The aim of this article is to describe the objectives, conception and implementation of the program. At the Institute of General Practice, a new teaching concept has been developed in cooperation with the Dean’s Office of the Faculty of Medicine at Goethe University and further partners. Medical students generally receive their training in highly specialized hospitals. However, the new concept will allow them to gain a practical insight into the outpatient care provided by physicians in private practice during their medical studies. Every year, 15 interested students will be able to participate in the longitudinal program, which includes internships, seminars and mentoring sessions. In the three current PAT cohorts, all 45 places have been taken up, and the first cohort has now completed the pro-gram. In addition to practical skills in the disciplines of family medicine, internal medicine, surgery, gynecology and pediatrics, it has been possible to show students the full scope of ambulatory health care. However, legal limitations to the implementation of the program in registered medical practices have meant that some parts of it could only be carried out voluntarily. Against the background of the current and future situation in health care, it makes sense that registered physicians in private practice should teach medical students about outpatient care during their medical studies. In order to establish such programs and permit their complete integration into the medical curriculum, it is essential that the necessary changes are made to medical licensing regulations. © 2020 Becker et al.

Medical laboratory science students (MLSS), likewise health care workers (HCW), invariably get exposed to blood and body fluids (BBF) of patients. The degree of exposure of these students is even worsened due to their inexperience, which is usually revealed during their vocational training programme. This study therefore determined the prevalence of exposure to BBF and its risk factors among MLSS at the University of Health and Allied Sciences (UHAS). A cross-sectional survey was employed using simple random sampling to enrol 178 students into the study. The study was conducted from February 1 to March 31, 2018, after the annual vocational training programme completed in August 2017. Self-administered questionnaires based on the objectives of the study were given out to participants to complete after their consent was sought. Descriptive data were reported as absolute number with percentages, whereas bivariate and multiple logistic regressions were done to describe relationship between risk factors and exposure to BBF. The study findings revealed that, out of 178 MLSS that participated, 90 (50.6%) experienced at least one exposure to BBF. Also, work experience before university education increased the chances of exposure to BBF (AOR = 7.37, 95% CI = 1.22-44.43, pvalue = 0.029) compared with those with no experience. In contrast, adequate personal protective equipment (PPE) reduced the tendencies of exposure to BBF (AOR = 0.41, 95% CI = 0.20-0.88, p value = 0.023) compared with students who had insufficient PPE. The study showed high, 50.6% (95% CI: 43.0%-58.1%), exposure to BBF. Work history and sufficient PPE were the most significantly associated risk factors. In view of this, there is the need to promote training and education on exposure to BBF particularly among experienced students and also encourage health facilities to continue providing enough PPE for students during their annual obligatory vocational internship programmes. © 2020 Philip Apraku Tawiah et al.

The relationship between general practice (GP) registrars and their supervisors underpins the training experience for the next generation of medical practitioners. Building on recent research into the development and validation of a measure of the relationship between registrars and supervisors from the perspective of the supervisor, the current study focuses on the educational alliance from the perspective of the registrar. This paper presents an adaptation and initial validation of the clinical psychology supervisory relationship measure for GP registrars in an Australian context. Following an Expert Group review and adaptation of the items, 238 GP registrars completed the adapted tool. Using exploratory factor analysis and Procrustes confirmatory rotation, an optimal four factor model of the supervisory relationship was identified, reflecting measures of Safe base (α =.93), Supervisor investment (α =.96), Registrar professionalism (α =.90), and Emotional intelligence (α =.87). The general practice supervisory relationship measure for registrars (GP-SRMR) demonstrated excellent model fit, high internal consistency, and was theoretically consistent with the original tool. Implications for clinical education and future research are presented. © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Although assessing the cost of workplace injuries and illnesses as part of occupational health and safety management is important in ensuring workplace safety, the issue is generally neglected among informal auto-artisans in Ghana. This paper examines the costs of occupational injuries and illnesses in terms of productivity, financial and social aspects of selected auto-artisans who service or fabricate auto parts in Suame ‘Magazine’ in Kumasi, Ghana. Employing a descriptive cross-sectional design, data were collected from 957 auto-artisans selected through a multistage cluster sampling method. The study found that the most frequent occupational illnesses and injuries experienced by the auto-artisans are those related to sharp objects (83.9%), inhalation of dust particles (45.8%), objects falling from height (35.6%) and burns (21.8%). These injuries and illnesses have led to loss of productivity and income which affects family members with no variations between the various categories of auto-artisans (p = 0.976). It is concluded that occupational injuries and illnesses among informal auto-artisans presents enormous financial and emotional costs to survivors and their families. It is recommended that government should lead a policy dialogue on safety in the country’s informal sector, while supporting artisans to establish insurance schemes to support them in times of injuries and illnesses. © 2020 Informa UK Limited, trading as Taylor & Francis Group.

Globally there is an urban/rural divide in relation to health and healthcare access. A key strategy for addressing general practitioner shortages in rural areas is GP vocational training in rural places, as this may aid in developing practitioners’ scope, values and community orientation, and increase propensity for rural practice. This creates a need for deeper understanding of the nature and quality of this training. Rural GPs are well-positioned to reflect on vocational learning in ‘place’. We aimed to explore rural GPs’ perceptions and experiences of GP vocational learning in relation to rural places. Semi-structured interviews were conducted with 25 GPs based in smaller rural communities in Tasmania. Inductive and theoretical thematic analysis was undertaken. Rural places provide learning opportunities for GP registrars, which shape the relationships between GPs and registrars and their communities. Rural GPs are committed to developing the next generation and improving access to primary care for their communities. Rural places provide unique learning environments for general practice, including rich learning, relationships and community commitment. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.