Measurement of sustainable higher education development: Evidence from China

This paper constructs the 6E evaluation index system, a comprehensive index including the dimensions of economy, effectiveness, efficiency, equity, earnings and equality, to measure the sustainable higher education development of the 31 provincial regions of China by utilizing the information entropy weight-TOPSIS method. This paper then makes a spatial and temporal analysis of the coupling coordination relationship among the dimensions of sustainable higher education development by using the coupling coordination model. In addition, this paper proposes specific and applicable countermeasures for sustainable higher education development. The results show that the comprehensive degrees of sustainable higher education development in most regions are not high, and the coastal regions and the Central-south China regions have higher grades; in addition, for most regions, the coupling coordination degrees mainly remain stable, with mild growth in the respective classifications, and the gap between the west and other regions is declining. The improved method is applicable to measure the sustainable development of higher education and to propose detailed and appropriate suggestions for further development.

Analysis of Educational Debt and Income Among Pharmacists and Other Health Professionals

Objective. To evaluate educational debt-to-income trends in pharmacy, dentistry, medicine, optometry, and veterinary medicine in the United States from 2010 to 2016. Methods. A retrospective analysis of educational debt and income for selected health professions was conducted. Data on student loan debt were collected from professional organizations and data on income were collected from the American Community Survey. Ratios of the mean educational debt of graduating students to the median annual income for their respective profession were calculated for 2010 through 2016. Average change per year in debt, income, and debt-to-income ratio were calculated. Results. Debt-to-income ratios for all selected health professions except medicine exceeded 100%. For physicians, debt-to-income ratios ranged from 89% to 95%. On average, physicians (-0.3 percentage point) and optometrists (-0.5 percentage point) had negative changes in their debt-to-income ratios from 2010 to 2016. Average increases per year in debt-to-income ratio of veterinarians, pharmacists, and dentists were 5.5, 5.7, and 6.0 percentage points, respectively. From 2010 to 2016, dentists had the largest average increase per year in debt ($10,525), while physicians had the largest average increase per year in income ($6667) and a minimal average debt increase per year ($5436). Pharmacists had the second largest average increase per year in debt ($8356). Conclusion. Educational debt-to-income ratios in the United States increased considerably over the past decade among pharmacists, dentists, and veterinarians and can negatively impact health professionals as well as patient care. Innovative strategies are needed to alleviate the educational debt burden.

Scholarship Support for Veterans Enrolling in MD, JD, and MBA Programs

This study compares Veterans Administration (VA) scholarship support for veterans enrolling in degree-granting medical schools vs law or business programs at the same institutions.

Cost-effectiveness of a domestic violence and abuse training and support programme in primary care in the real world: updated modelling based on an MRC phase IV observational pragmatic implementation study

OBJECTIVES

To evaluate the cost-effectiveness of the implementation of the Identification and Referral to Improve Safety (IRIS) programme using up-to-date real-world information on costs and effectiveness from routine clinical practice. A Markov model was constructed to estimate mean costs and quality-adjusted life-years (QALYs) of IRIS versus usual care per woman registered at a general practice from a societal and health service perspective with a 10-year time horizon.

DESIGN AND SETTING

Cost-utility analysis in UK general practices, including data from six sites which have been running IRIS for at least 2 years across England.

PARTICIPANTS

Based on the Markov model, which uses health states to represent possible outcomes of the intervention, we stipulated a hypothetical cohort of 10 000 women aged 16 years or older.

INTERVENTIONS

The IRIS trial was a randomised controlled trial that tested the effectiveness of a primary care training and support intervention to improve the response to women experiencing domestic violence and abuse, and found it to be cost-effective. As a result, the IRIS programme has been implemented across the UK, generating data on costs and effectiveness outside a trial context.

RESULTS

The IRIS programme saved £14 per woman aged 16 years or older registered in general practice (95% uncertainty interval -£151 to £37) and produced QALY gains of 0.001 per woman (95% uncertainty interval -0.005 to 0.006). The incremental net monetary benefit was positive both from a societal and National Health Service perspective (£42 and £22, respectively) and the IRIS programme was cost-effective in 61% of simulations using real-life data when the cost-effectiveness threshold was £20 000 per QALY gained as advised by National Institute for Health and Care Excellence.

CONCLUSION

The IRIS programme is likely to be cost-effective and cost-saving from a societal perspective in the UK and cost-effective from a health service perspective, although there is considerable uncertainty surrounding these results, reflected in the large uncertainty intervals.

We must convince the government to invest in the health workforce

In New York on 21 September, a potentially game-changing report was submitted to the secretary general of the United Nations.

Implementation of HIV Palliative Care: Interprofessional Education to Improve Patient Outcomes in Resource-Constrained Settings, 2004-2012

Palliative care (PC), introduced early in the management of chronic illness, improves patient outcomes. Early integration of a palliative approach for persons with HIV has been documented to be effective in identifying and managing patient-level concerns over the past decade in African settings. The experience of implementing PC in multiple African and other resource-constrained settings (RCSs) emphasizes the need for essential palliative competencies that can be integrated with chronic disease management for patients and their families facing life-limiting illness. This article is an historical description of how basic palliative competencies were observed to be acceptable for health workers providing outpatient HIV care and treatment during eight years of U.S. implementation of "care and support," a term coined to represent PC for persons living with HIV in RCS. The need for team building and interprofessional education is highlighted. The model is currently being tested in one U.S. city and may represent a mechanism for expanding the palliative approach into management of chronic disease. Such competencies may play a role in the development of the patient-centered medical home, a critical component of U.S. health care reform.

Leading the way: changing the focus from teaching to learning in large subjects with limited budgets

To lead positive change in the teaching practice of teams that service large numbers of diverse students from multiple degree programs provides many challenges. The primary aim of this study was to provide a clear framework on which to plan the process of change that can be utilized by academic departments sector wide. Barriers to change were reduced by adapting and utilizing Kotter's principals of change specifically by creating a sense of urgency and defining a clear goal designed to address the problem. Changing attitudes involved training staff in new teaching and learning approaches and strategies, and creating a collaborative, supportive team-based teaching environment within which the planned changes could be implemented and evaluated. As a result senior academics are now directly involved in delivering sections of the face-to-face teaching in the new environment. Through promoting positive change we enabled deeper student engagement with the theoretical concepts delivered in lectures as evidenced by favorable student evaluations, feedback, and improved final exam results. A collaborative team-based approach that recognizes the importance of distributed leadership combined with a clearly articulated change management process were central to enabling academics to design, try, and evaluate the new teaching and learning practices. Our study demonstrates that a concerted focus on "change management" enabled teaching team members to adopt a major shift in the teaching and learning approach that resulted in measurable improvements in student learning.

Canadian demand for highly qualified personnel for therapeutic evaluation: an opportunity for academic institutions

Achievement of optimal therapeutics requires individuals with analytic skills appropriate to the balancing of enterprise, innovation and the need for rigorous scientific validation. A synergistic convergence of discovery research, clinical investigation, evaluative, regulatory and implementation sciences will be essential. None of the needed research capacities are likely to prove obtainable on demand. On the contrary, they require accurate projection of future needs and careful planning of post-secondary training programs. A survey conducted for Health Canada in 2010 revealed significant shortfalls in research skills available outside government and industry. This commentary argues that such an environment represents an outstanding opportunity for the academic community to demonstrate that it is eager to meet the needs of the Canadian public. University leaders should be assertive about their commitment to the ideals of patient oriented research and all governments should be clear about deliverables anticipated in return for consistent post-secondary funding.

Issues of rigor and feasibility when observing the quality of program implementation: a case study

Program evaluators have paid little attention in the literature to the manner in which measuring the quality of implementation with observations requires tradeoffs between rigor (reliability and validity) and program evaluation feasibility. We present a case example of how we addressed rigor in light of feasibility concerns when developing and conducting observations for measuring the quality of implementation of a small education professional development program. We discuss the results of meta-evaluative analyses of the reliability of the quality observations, and we present conclusions about conducting observations in a rigorous and feasible manner. The results show that the feasibility constraints that we faced did not notably reduce the rigor of our methods.

Challenges to recruit and retain American Indian and Alaskan Natives into social work programs: the impact on the child welfare workforce

There is a shortage of professionally trained American Indian/Alaskan Native (AI/AN) social workers available to provide services including child welfare services to tribal communities. This study used a mixed-model survey design to examine the perceptions of 47 AI/AN BSW and MSW students enrolled in social work programs across the to determine the challenges associated with recruitment and retention. The findings are supported in the literature. Findings indicate that social work academic programs have not made substantial gains in the recruitment and retention of AI/AN students over several decades. Students identified the following seven major barriers to successful recruitment and retention: (1) a lack of AI/AN professors; (2) a shortage of field placement agencies that serve AI/AN clients; (3) conflicts between students' academic obligations and responsibilities to their families and tribal communities; (4) students' feelings of cultural isolation; (5) the need for AI/AN role models and mentors; (6) a lack of understanding by universities of cultural customs and traditional values; and (7) racism. Implications for policy and practice are offered.

Dysphagia training for speech-language pathologists: implications for clinical practice

There are competency standards available in countries with established speech-language pathology services to guide basic dysphagia training with ongoing workplace mentoring for advanced skills development. Such training processes, however, are not as well established in countries where speech-language pathology training and practice is relatively new, such as Malaysia. The current study examines the extent of dysphagia training and workplace support available to speech-language pathologists (SLPs) in Malaysia and Queensland, Australia, and explores clinicians' perceptions of the training and support provided, and of their knowledge, skills, and confidence. Using a matched cohort cross-sectional design, a purpose-built survey was administered to 30 SLPs working in Malaysian government hospitals and 30 SLPs working in Queensland Health settings in Australia. Malaysian clinicians were found to have received significantly less university training, less mentoring in the workplace, and were lacking key infrastructure needed to support professional development in dysphagia management. Over 90% of Queensland clinicians were confident and felt they had adequate skills in dysphagia management; in contrast, significantly lower levels of knowledge, skills, and confidence were observed in the Malaysian cohort. The findings identify a need for improved university training and increased opportunities for workplace mentoring, training, and support for Malaysian SLPs.

Connecting dental education to other health professions

The health care delivery system is poised for substantial change in the coming years. The foremost vector driving this change is economics. However, use of evidence-based principles of practice and a high desire, if not a national mandate, for increased quality in health care delivery are also very important factors. Nestled within this large national health care debate are a set of issues that directly impact dental education and practice. Among them is the potential impact of expanded intraprofessional and interprofessional collaborations among dentists, dental therapists, dental hygienists, and nurse practitioners, among others, in search of better oral and general health care for all Americans. This article explores many of the issues involved in this possible transition with special reference to the impact of the changes on dental education.

Vision and change in biology undergraduate education: Vision and change from the funding front

The purpose of this short article is to (a) briefly summarize the findings of two important recent resources concerning the future of biology in the 21(st) century; one, Vision and Change, A Call to Action [AAAS, 2009. AAAS, Washington, DC], concerned with undergraduate education in biology, the other, A New Biology for the 21st Century [National Research Council, 2009. National Academies Press, Washington, DC], concerned with advances within the discipline itself; (b) urge you, the reader of BAMBED, to review the material on the Vision and Change website [AAAS, 2009. AAAS: Washington, DC] and then to think how you might change things at your own institution and within your courses, and; (c) make readers aware of the programs at the National Science Foundation (NSF) that might support change efforts, as well as refer you to efforts other funding agencies are making to help biology undergraduate education respond to the challenges and opportunities chronicled in these two reports. Although NSF funding opportunities are specifically available to US investigators, the recommendations of the two reports should be of interest to a wide spectrum of international researchers.

Cost effectiveness of changing health professionals' behavior: training dental hygienists in brief interventions for smokeless tobacco cessation

OBJECTIVE

Disseminating effective interventions to health care professionals is a critical step in ensuring that patients receive needed advice and materials. This cost effectiveness analysis compared two methods of disseminating an effective protocol for smokeless tobacco cessation intervention.

METHOD

Interested dental hygienists (N = 1051) were recruited in 20 Western and Midwestern U.S. communities and randomized by community to receive workshop training, self-study with mailed materials, and delayed self-study training, in 1996-98. Hygienists were surveyed about their smokeless tobacco-related activities with patients at baseline and post-intervention. Data on intervention costs were collected, and incremental costs per unit of behavior change were calculated.

RESULTS

Self-study was more cost effective than workshop training under a wide range of assumptions: change in group versus individual behavior, hygienists' time and travel costs included or excluded, and hygienist wage rates at the national median or substantially lower. However, workshops may be as cost effective in producing behavior change among hygienists earning wages substantially higher than the national median.

CONCLUSION

Self-study may be a more cost effective method than workshops to achieve behavior change among motivated health professionals.

[Examinations and exercises in medical technology utilizing a personal computer and the web]

The practice of e-learning in our department utilizing freeware without additional cost has been introduced: 1) Examinations and exercises are performed on the Web. Using the form-filling format of HTML, multiple-choice questions are asked. When the examinee submits the answers, the server will process the data using active server pages and send the result to the examinee with the score and explanations. So far, the students have given the Web examination (exercise) system a good evaluation. Concerning the effect of the explanations given in the Web exercises on the written test, some improvements were observed in the enumeration-type questions. On the other hand, no such improvements were clearly observed in the explanation-type questions, which require essential understanding of the principle. This suggests that effective utilization of the materials strongly depends on the students' eagerness to study. 2) To understand the chemical structures of body constituents, an exercise to draw structural formulae on the personal computer (PC) is performed. The students had difficulty in the fine control of arranging the whole shape of the formula, in addition to setting the format of characters such as super- and subscripts. In respect of understanding, they had significant difficulty in finding the structures and in distinguishing stereoisomers; however, the students had fun with the structure-drawing software and found it convenient to draw structures. These findings suggest that PC exercises will be attractive to students of the "PC generation", and thus helpful for the understanding of and training in data analysis in medical technology.

Following the money: economic inhibitors of change affecting graduate education in clinical psychology

C.R. Snyder and T.R. Elliott (this issue, pp. 1033-1054) offer a thoughtful and elaborate model for future training in graduate clinical psychology, couched in visionary optimism. However, they interpret history and present trends in a manner that seems to ignore the realistic demands of economic forces. They propose thoughtful, constructive, pro-social directions, but seem at least partially oblivious to underlying economic forces destined to impede meaningful implementation of their model.

Twenty-first century education: toward greater emphasis on context-social, economic, and educational

In calling for a greater emphasis on the social, economic, and educational contexts, the discussion presented in this article is generally supportive of C.R. Snyder and T.R. Elliott's (this issue, pp. 1033-1054) vision of 21st century graduate education in clinical psychology. Attention is directed toward the asocial nature of professional psychology, a brief analysis of the influence of economics on the development of clinical psychology education, and the American Psychological Association's accreditation process as it shapes professional psychology education.

Professional development in the youth development field: issues, trends, opportunities, and challenges

This chapter reviews key issues in professional development in the youth development field, describing important work done over the past two decades and lessons learned from major philanthropic investments in capacity building both nationally and locally.

Trends in dental and allied dental education

BACKGROUND

Educational programs play an important role in preparing a qualified dental work force. This article reviews the current status and trends in dental, advanced dental and allied dental education programs in the United States and examines their impact on the dental work force.

OVERVIEW

This analysis focuses on survey data collected by the American Dental Association during the past 10 to 15 years and compares recent patterns in applications, enrollment and graduation with previous trends. The numbers of educational programs, applicants, enrollees and graduates have increased in dentistry, dental hygiene and dental assisting, while dental laboratory technology has declined in all measures. The proportion of women in dentistry has increased, while the ethnic profile of dental and allied personnel has shown little change. Both the cost of dental education and student debt continue to increase.

CONCLUSIONS

Despite increases in the number of educational programs and overall numbers of graduates from dental and allied dental education programs, the proportion of underrepresented groups still lags behind their representation in the overall population, and the number of allied personnel falls short of practice needs.

PRACTICE IMPLICATIONS

Patterns in applications, enrollment and graduation are important determinants of the dental and allied dental work force. The cost and funding of education significantly affect the attractiveness of dental careers and the sustainability of educational programs and should be monitored carefully by the profession.

Where's the support for clinical laboratory science education?

I frequently leave the biweekly program director meetings at our community college amazed at how health-care organizations are stepping up to the plate to support nursing education. Local hospitals are begging the college to increase the number of students in the nursing program, while I struggle to find clinical rotations for the students in our medical laboratory technology (MLT) program. Several local hospitals have initiated "Learn and Earn" programs to support individuals in their pursuit of a nursing degree, while it seems that every semester we lose at least one new MLT student because of financial difficulties. Two hospitals have even loaned nurse educators to our nursing program so that more students can be accepted. These nurses are being paid by the hospitals at the much higher industry salaries. I started to wonder, "Where's the support for clinical laboratory science (CLS) education?" We have a shortage, too. In fact, in 2001, CLMA declared a clinical laboratory staffing emergency. I decided to do some research to try to understand why nurses get all the attention and to compare what is being done to overcome the two shortages. The more I investigated, the more I could see that CLS professional organizations are developing a campaign to reverse the CLS shortage that is modeled after the nursing campaign. My concern is that I don't see many initiatives at the grassroots level. The professional organizations can't do it alone. They are primarily volunteer organizations with limited human and financial resources. If a national campaign is to be successful, each laboratory leader is going to have to mount a local campaign to support the profession and CLS education, the future of our profession.

Looking over the horizon: an Internet-based international course in healthcare management

The International Course in Healthcare Management is predicated on the belief that comparative benefits can most effectively be 'taught' by enabling students to work directly with colleagues in other countries, sharing views, discussing differences, and checking understandings on how healthcare is structured and managed in different countries. The course focuses on four countries--Canada, Germany, Finland and Ireland--which offer an interesting range and mix of approaches to healthcare, and yet are sufficiently similar to ensure relative ease of understanding. The course, which is delivered and taught jointly by faculty from five participating institutions in the four countries using the Internet as the distance delivery medium, is an integral component of each institution's participating department's graduate program. The aims of the course are: to enable the participants to develop an in-depth understanding of the healthcare systems of each country; to foster a deeper understanding, through comparative analysis, of each participant's own healthcare system; and to facilitate the development of new insights into ways of addressing common concerns in healthcare management. The course is structured around a series of case studies organized under four main themes: financing and funding; delivery issues; impact of health service reforms; and evidence-based management.

The Native Hawaiian Health Professions Scholarship program's impact on the community of Ko'olau Loa: a program report

The Native Hawaiian Health Professions Scholarship was established as one component of the Native Hawaiian Health Care Act of 1988, which was later reauthorized as the Native Hawaiian Health Care Improvement Act of 1992. The Scholarship program was designed to develop Native Hawaiian primary health care professionals who would return to work in Native Hawaiian communities. To ensure this, scholarship recipients fulfill their scholarship agreement by working in medically unserved and underserved communities throughout Hawai'i. Since 1991, 121 scholarships have been awarded to Native Hawaiians training in different primary care professions including medicine, dentistry, nursing, midwifery, social work, and public health. Although the service obligation is attached to the scholarship as a means of "paying back," the intent is to provide an opportunity for graduates to establish a sense of social responsibility for the communities most in need. One of the communities benefiting from this program is Ko'olau Loa, a community that spans from Ka'a'awa to Pupukea on Windward O'ahu. Native Hawaiian Health Scholarship recipients, Kehau Santiago, Michele Shimizu, and Stephany Vaioleti live and continue to serve in the very community in which they fulfilled their service obligations. This article focuses on how the Native Hawaiian Health Scholarship Program--in particular, the three scholars--affected Ko'olau Loa.

Training and research for implementation of health care system reform in Cambodia

One important objective of Technical Co-operation is institutional strengthening. Human resource development is understood as a means of improving the implementation of health care system development and an important factor for sustainability. Health care system reform is also a concern in Cambodia, where it has suffered from a period of war and insecurity previously, and now is beginning to aim for long term development. The implementation of the reform started four years ago with external support. This paper will show how capacity can be built and services developed under the specific circumstances of Cambodia, with technical cooperation and support from neighbouring countries through the SEAMEO TROPMED network. Training courses have been developed and research studies have been conducted to strengthen the role of the National Institute of Public Health and to aim for quality improvement. In addition, impact of training to improve management at provincial/district level was measured.

The importance of funding palliative care education: a look to the future

This article outlines the position statement agreed by the Midlands Palliative Care Teachers' Professional Forum. Written by a member of the group, it includes suggestions from other members and was submitted for publication before the recent announcement of funds being available for palliative education for district nurses. The article highlights the challenges facing the adequate funding of specialist palliative care education and, in particular, for education departments within independent hospices. The statement recognizes the sensitive nature of subjects that ought to be included in palliative care education. Emphasis is placed on the provision of holistic multiprofessional and uniprofessional courses dedicated to enhancing the quality of palliative care. The article confirms the commitment of palliative care educationalists to this end and looks to continued commitment of adequate funding from NHS trusts and regions in supporting existing palliative care education and its ongoing development in response to clinical need.

Distance learning in academic health education

Distance learning is an apparent alternative to traditional methods in education of health care professionals. Non-interactive distance learning, interactive courses and virtual learning environments exist as three different generations in distance learning, each with unique methodologies, strengths and potential. Different methodologies have been recommended for distance learning, varying from a didactic approach to a problem-based learning procedure. Accreditation, teamwork and personal contact between the tutors and the students during a course provided by distance learning are recommended as motivating factors in order to enhance the effectiveness of the learning. Numerous assessment methods for distance learning courses have been proposed. However, few studies report adequate tests for the effectiveness of the distance-learning environment. Available information indicates that distance learning may significantly decrease the cost of academic health education at all levels. Furthermore, such courses can provide education to students and professionals not accessible by traditional methods. Distance learning applications still lack the support of a solid theoretical framework and are only evaluated to a limited extent. Cases reported so far tend to present enthusiastic results, while more carefully-controlled studies suggest a cautious attitude towards distance learning. There is a vital need for research evidence to identify the factors of importance and variables involved in distance learning. The effectiveness of distance learning courses, especially in relation to traditional teaching methods, must therefore be further investigated.

Trends in allied dental education: an analysis of the past and a look to the future

Allied dental healthcare providers have been an integral part of the dental team since the turn of the 19th century. Like dental education, allied dental education's history includes a transition from apprenticeships and proprietary school settings to dental schools and community and technical colleges. There are currently 258 dental assisting programs, 255 dental hygiene programs, and 28 dental laboratory technology programs according to the American Dental Association's Commission on Dental Accreditation. First-year enrollment increased 9.5 percent in dental hygiene education from 1994/95 to 1998/99, while enrollment in dental assisting programs declined 7 percent and declined 31 percent in dental laboratory technology programs during the same period. Program capacity exceeds enrollment in all three areas of allied dental education. Challenges facing allied dental education include addressing the dental practicing community's perception of a shortage of dental assistants and dental hygienists and increasing pressure for career tracks that do not require education in ADA Commission on Dental Accreditation accredited programs. The allied dental workforce may also be called upon for innovative approaches to improve access to oral health care and reduce oral health care disparities. In addition, allied dental education programs may face challenges in recruiting faculty with the desired academic credentials. ADEA is currently pursuing initiatives in these and other areas to address the current and emerging needs of allied dental education.

The Ecumenical Institute, Cherokee, Iowa

The mission of the Ecumenical Institute is to provide quality pastoral education through an accredited training center by certified personnel on an ecumenical, non-discriminatory basis in compliance with all local, state, and federal laws and to provide these services primarily on behalf of the people of Northwest Iowa. Special concern is directed to meeting the needs of rural communities and to serving as a public trust in all matters related to the financial support of these educational services.

A review of the evaluation literature on health professions training and enrichment programs for minority/disadvantaged students

This paper includes the authors' review of the outcome evaluation articles of federal and non-federal training programs to prepare minority/disadvantaged students for entry into health programs as managers and practitioners. It provides information from the senior author's 1987-1993 Health Careers Opportunity Program grant for comparison purposes. The paper makes an argument for the standardization of outcome variables so that cross-program comparisons may be made. Until now, the variables reported in the literature have been very disparate. This paper suggests which kind of training program may have the most chance for success. Finally, it provides information rarely found in the evaluation literature: success rates for different ethnic groups and costs for running such programs. These data are provided for Health Care Administration faculty who could use planning information for similar grant applications.