Quality of Radiotherapy Workforce Training within the USA

The training, competency requirements and scope of practice of professionals within a radiation oncology department vary across countries. The purpose of this review is to shed light on the current status of radiotherapy training in the USA by discussing current benchmarks for medical residency, physics residency, radiation therapy and dosimetry training programmes. Although there are notable strengths, the US radiotherapy workforce training system also faces several challenges when it comes to standardising education to develop a competent workforce that meets societal needs. Continued efforts are needed at a systemic level to improve training in areas such as brachytherapy and proton therapy, promote research involvement and develop trainees who are equipped to form a competent radiation therapy workforce.

RE-AIM applied to a primary care workforce training for rural providers and nurses: the Department of Veterans Affairs' Rural Women's Health Mini-Residency

Introduction

Application of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate workforce education and training programs targeting clinical health care staff has received relatively little attention. This paper aims to contribute to this area with RE-AIM findings from a women's health-focused workforce training program implemented by the U.S. Department of Veterans Affairs (VA). Over the past two decades, the rapid expansion of the women Veteran population in VA has necessitated a quick response to meet clinical demand. To address this health care need, the VA Offices of Rural Health (ORH) and Women's Health (OWH) partnered to deploy a primary care workforce development initiative for Rural Providers and Nurses-the Rural Women's Health Mini-Residency (Rural WH-MR)-to train VA clinicians in rural locations in skills for the care of women Veterans. Here we assess the applicability of RE-AIM as an evaluation framework in this context.

Methods

We evaluated the Rural WH-MR, relying on a primarily quantitative approach, rooted in RE-AIM. It included longitudinal and cross-sectional measurements from multiple quantitative and qualitative data sources to develop selected metrics. Data collection instruments consisted of pre-, post-, and follow-up training surveys, course evaluations, existing VA databases, and implementation reports. We developed metrics for and assessed each RE-AIM component by combining data from multiple instruments and then triangulating findings.

Results

Results from the Rural WH-MR program for fiscal years 2018-2020 indicate that RE-AIM provides an instructive evaluation framework for a rural workforce training program, particularly in eliciting clarity between measures of Reach vs. Adoption and focusing attention on both provider- and patient-level outcomes.

Discussion

We describe evaluation metric development and barriers to and facilitators of utilizing RE-AIM as an evaluation framework for a provider- and nurse-facing intervention such as this workforce training program. We also reflect upon RE-AIM benefits for highlighting process and outcomes indicators of a training program's success and lessons learned for evaluating rural workforce development innovations. Several of our observations have implications for training and evaluation approaches in rural areas with more limited access to health care services.

Expanding Developmental and Behavioral Health Capacity in Pediatric Primary Care

The Development and Behavior Access Clinic (DBAC) deploys a general pediatrician with brief/intensive training and proctoring by developmental-behavioral pediatricians (DBP) to provide developmental-behavioral (DB) care to children referred with mild/moderate complexity needs as determined by a team of clinical psychologists. This pilot study utilizes visit data, chart review, and surveys to assess wait times, need for subspecialty care, and referring clinician satisfaction. In its first 18 months, DBAC decreased the need for subspecialty DB care, providing initial services for 44% of patients referred for DB pediatric care from the study site; 89% did not require subsequent subspecialty evaluation. Among DBAC participants, average wait times for DB care decreased from a baseline of 218 to 41 calendar days. This pilot study provides a model for building DB clinical skills among interested general pediatricians, decreasing wait times, and building the capacity of primary care settings to address mild-to-moderate complexity DB concerns.

Lessening the Impact of Opioid Misuse at a Federally Qualified Health Center in New York: Outcomes of an Integrated Workforce Training Program

The COVID-19 pandemic has placed an unprecedented burden on patients, health care providers, and communities and has been particularly challenging for medically underserved populations impacted by the social determinants of health, as well as people with co-occurring mental health and substance use risks. This case study examines outcomes and lessons learned from a multisite low-threshold medication-assisted treatment (MAT) program at a federally qualified health center in partnership with a large suburban public university in New York to integrate and train Health Resources & Services Administration Behavioral Health Workforce Education and Training-funded graduate student trainees in social work and nursing in screening, brief intervention, and referral to treatment and patient care coordination, including social determinants of health and medical and behavioral comorbidities. The MAT program for the treatment of opioid use disorder has a low threshold for entry that is accessible and affordable, reduces barriers to care, and uses a harm reduction approach. Outcome data showed an average 70% retention rate in the MAT program and reductions in substance use. And, while more than 73% of patients reported being somewhat or definitely impacted by the pandemic, most patients endorsed the effectiveness of telemedicine and telebehavioral health, such that 86% indicated the pandemic did not affect the quality of their health care. The main implementation lessons learned were the importance of increasing the capacity of primary care and health care centers to deliver integrated care, using cross-disciplinary practicum experiences to enhance trainee competencies, and addressing the social determinants of health among populations with social vulnerabilities and chronic medical conditions.

Occupational adaptation as a social process for dementia care teams

BACKGROUND

Few studies have examined a group's collective experience of occupation using occupational therapy theoretical models. Dementia caregiving requires a diverse team of caregivers who learn and work together to resolve shared challenges. An Occupational Adaptation (OA) theory-based training program for dementia care teams was developed to better understand the team's adaptive process inherent in cooperative caregiving.

AIM/OBJECTIVES

Describe how the team learned together and how the training impacted their teamwork.

MATERIALS/METHODS

Fourteen employees at one continuing care retirement community underwent OA-based training. During the program, the team analysed and resolved challenging dementia care cases. Participant observations, participant journals, open-ended surveys, and follow-up semi-structured interviews were analysed.

RESULTS

The thematic framework included five steps: unite around a shared challenge, tap the collective adaptive repertoire, collaborate on case-specific plans, implement with teamwork, and return for ongoing problem solving and integration. The program enhanced appreciation for teammates' knowledge, skills, and experiences, learning from each other, and integration of team-centered OA process.

CONCLUSION/SIGNIFICANCE

The OA-based program appears to have facilitated adaptation that was complex, social, and generalisable. OA theory is enriched with a social view of occupational adaptation opening new opportunities for therapists and researchers to understand and facilitate adaptation among teams.

Attitudes towards diversity, equity, and inclusion across the CTSA Programs: Strong but not uniform support and commitment

Background

This study describes attitudes towards diversity, equity, and inclusion (DEI) among members of the Clinical and Translational Science Awards (CTSA) Program. It also explores associations between program members' roles and their perceived importance of and commitment to improving DEI and assesses the link between perceived importance of and commitment to improving DEI. Lastly, it ascertains barriers and priorities concerning health equity research, workforce development, CTSA consortium leadership, and clinical trials participation among respondents.

Methods

A survey was administered to registrants of the virtual CTSA Program 2020 Fall Meeting. Respondents reported their roles, perceived importance of and commitment to improving DEI. Bivariate cross-tabulations and structural equation modeling examined associations between respondents' roles, perceived importance of DEI, and commitment to improving DEI. Grounded theory was used to code and analyze open-ended questions.

Results

Among 796 registrants, 231 individuals completed the survey. DEI was "extremely important" among 72.7 percent of respondents and lowest among UL1 PIs (66.7%). Being "extremely committed" to improving DEI was reported by 56.3 percent of respondents and lowest among "other staff" (49.6%). Perceived importance of DEI was positively associated with commitment to improve DEI. Institutional and CTSA Commitment, Support, and Prioritization of DEI represented a key theme for improving DEI among respondents.

Conclusion

Clinical and translational science organizations must take bold steps to transform individual perceptions of DEI into commitment and commitment into action. Institutions must set visionary objectives spanning leadership, training, research, and clinical trials research to meet the promise and benefits of a diverse NIH-supported workforce.

A Worksite Health Promoting Program for Early Head Start and Head Start Workforce

INTRODUCTION

Early Head Start (EHS) and Head Start (HS) staff comprise a large segment of the public sector workforce and experience numerous risk and chronic factors for medical conditions or symptoms. Few health and wellness workplace interventions, however, specifically focus on EHS/HS staff.

METHODS

A train-the-trainer (TTT) approach was used to build capacity among directors and staff from 57 EHS/HS programs on how to strategically plan and implement a health promoting worksite program focusing on improving nutrition and physical activity practices among EHS/HS staff. Baseline and 3-month post-training questionnaires assessed EHS/HS staff changes on knowledge and practices related to nutrition and physical activity. Paired t-tests or chi2 statistics assessed changes in questionnaire responses over time.

RESULTS

1,363 staff from 57 programs completed baseline and follow-up surveys. Staff had high knowledge regarding healthful dietary patterns at baseline. Over one-third of staff reported drinking soda with meals and almost 50% identified soda as their most common drink. Roughly one-third of staff also reported no physical activity in the prior week at baseline. Staff demonstrated significant improvements in dietary, nutrition, and physical activity practices. Staff also improved grocery shopping behaviors.

IMPLICATIONS FOR PRACTICE

The TTT approach to disseminate an EHS/HS staff-focused health promotion program, "Eat Healthy, Stay Active!' provides a potentially promising strategy to build upon and disseminate more broadly to reach the over >300,000 EHS/HS staff workforce.

Gerontological nursing competencies: A crosswalk with the 4Ms framework of the age-friendly initiative

The Age-friendly Health Systems Initiative is a current multidisciplinary movement driving quality improvement across all health care settings. The 4Ms framework (What Matters, Medication, Mobility, and Mentation) provides a common evidence-based language and system of care that can be utilized by all health care providers. Faculty of one nursing program were interested in knowing whether the principles and language of the 4Ms framework align well with the current competencies used to guide undergraduate and beginning level practice for nurses. To answer this question, a crosswalk of curricular and competency guidelines for gerontological nursing was completed to identify how well the competencies aligned with the key concepts of the evidence-based 4Ms framework. Key findings of this crosswalk are being shared with educators for the purpose of describing a systematic way to ensure that the 4Ms are integrated into gerontological curricula and course design. The steps taken to complete the crosswalk are described to guide educators across all disciplines interested in creating curricula that will adequately prepare students to be collaborative partners and leaders in Age-friendly Health Systems.

The Texas Health Resources Clinical Scholars Program: Learning healthcare system workforce development through embedded translational research

Introduction

Texas Health Resources (THR), a large, nonprofit health care system based in the Dallas-Fort Worth area, has collaborated with the University of Texas Southwestern Medical Center (UTSW) to develop and operate a unique, integrated approach for Learning Health System (LHS) workforce development. This training model centers on academic health system faculty members conducting later-stage translational research within a partnering regional care delivery organization.

Methods

The THR Clinical Scholars Program engages early career UTSW faculty members to conduct studies that are likely to have an impact on care delivery at the health system level. Interested candidates submit formal applications to the program. A joint committee comprised of senior research faculty from UTSW and THR clinical leadership reviews proposals with a focus on the shared LHS needs of both institutions-developing high quality research output that can be applied to enhance care delivery. A key prioritization criterion for funding is the degree to which the research addresses a question relevant to THR as a high-volume network with multiple channels for consumers to access care. The program emphasis is on supporting embedded research initiatives using health system data to generate knowledge that will improve the quality and efficiency of care for the patient populations served by the participant organizations.

Results

We discuss specific strategic and tactical components of the THR Clinical Scholars Program including an overview of the academic affiliation agreement between the collaborating organizations, criteria for successful program applications, data sharing, and funding. We also share project summaries from selected clinical scholars as examples of the LHS research done in the program to date.

Conclusion

This experience report provides an implementation framework for other academic health systems interested in adopting similar LHS workforce training models with community partners.

Formative Evaluation of a Workforce Investment Organization to Provide Scaled Training for Home Health Aides Serving Managed Long-Term Care Plan Clients in New York State

As part of its Medicaid program restructuring, New York State funded 11 Workforce Investment Organizations (WIO) to support training initiatives for the long-term care workforce. Focusing on one WIO, this formative evaluation examined quality improvement training programs delivered to 11,163 Home Health Aides employed by home care agencies serving clients of Managed Long-Term Care plans. Results are presented from a thematic analysis of qualitative interviews with organizational and program stakeholders examining contextual factors influencing program objectives, implementation, barriers and facilitators, and perceived outcomes. Findings suggested that WIO training programs were implemented during a period of shifting organizational strategies alongside value-based payment reforms and challenges to aide recruitment and retention. Stakeholders appraised WIO training programs positively and valued program flexibility and facilitation of communication and collaboration between agencies and plans. However, delivery and implementation challenges existed, and industry-wide structural fragmentation led stakeholders to question the WIO's larger impact.

Clinician Attitudes, Training, and Beliefs About Cannabis: An Interprofessional Assessment

Background: Medical use of cannabis is growing in popularity across the United States, but medical education and clinician comfort discussing cannabis use for medical purposes have not kept pace. Materials and Methods: A total of 344 clinicians in the state of Pennsylvania (response rate 14%) completed a brief online survey about their attitudes, training, and experiences regarding medical cannabis and certifying patients to use medical cannabis. Results: Only 51% of clinicians reported completing any formal training on medical cannabis. Compared with noncertifying clinicians (pharmacists, nurse practitioners, and physician assistants), physicians were significantly more comfortable with patient use of medical cannabis, saw fewer risks, more benefits, and felt better prepared to discuss its use with vulnerable populations. All clinicians noted significant limitations to their understanding of how medical cannabis can affect patients, and many indicated a desire for more research and training to fill in gaps in their knowledge. Conclusions: Insufficient medical curricula on the medical uses of cannabis are available to interprofessional clinicians across their disciplines, and clinicians report significant deficits in their knowledge base about its effects. Additionally, these data suggest an urgent need to expand training opportunities to the full spectrum of clinicians as all are involved in caring for patients who use medical cannabis.

Beauty Is in the AI of the Beholder: Are We Ready for the Clinical Integration of Artificial Intelligence in Radiography? An Exploratory Analysis of Perceived AI Knowledge, Skills, Confidence, and Education Perspectives of UK Radiographers

Introduction: The use of artificial intelligence (AI) in medical imaging and radiotherapy has been met with both scepticism and excitement. However, clinical integration of AI is already well-underway. Many authors have recently reported on the AI knowledge and perceptions of radiologists/medical staff and students however there is a paucity of information regarding radiographers. Published literature agrees that AI is likely to have significant impact on radiology practice. As radiographers are at the forefront of radiology service delivery, an awareness of the current level of their perceived knowledge, skills, and confidence in AI is essential to identify any educational needs necessary for successful adoption into practice.

Aim: The aim of this survey was to determine the perceived knowledge, skills, and confidence in AI amongst UK radiographers and highlight priorities for educational provisions to support a digital healthcare ecosystem.

Methods: A survey was created on Qualtrics® and promoted via social media (Twitter®/LinkedIn®). This survey was open to all UK radiographers, including students and retired radiographers. Participants were recruited by convenience, snowball sampling. Demographic information was gathered as well as data on the perceived, self-reported, knowledge, skills, and confidence in AI of respondents. Insight into what the participants understand by the term “AI” was gained by means of a free text response. Quantitative analysis was performed using SPSS® and qualitative thematic analysis was performed on NVivo®.

Results: Four hundred and eleven responses were collected (80% from diagnostic radiography and 20% from a radiotherapy background), broadly representative of the workforce distribution in the UK. Although many respondents stated that they understood the concept of AI in general (78.7% for diagnostic and 52.1% for therapeutic radiography respondents, respectively) there was a notable lack of sufficient knowledge of AI principles, understanding of AI terminology, skills, and confidence in the use of AI technology. Many participants, 57% of diagnostic and 49% radiotherapy respondents, do not feel adequately trained to implement AI in the clinical setting. Furthermore 52% and 64%, respectively, said they have not developed any skill in AI whilst 62% and 55%, respectively, stated that there is not enough AI training for radiographers. The majority of the respondents indicate that there is an urgent need for further education (77.4% of diagnostic and 73.9% of therapeutic radiographers feeling they have not had adequate training in AI), with many respondents stating that they had to educate themselves to gain some basic AI skills. Notable correlations between confidence in working with AI and gender, age, and highest qualification were reported.

Conclusion: Knowledge of AI terminology, principles, and applications by healthcare practitioners is necessary for adoption and integration of AI applications. The results of this survey highlight the perceived lack of knowledge, skills, and confidence for radiographers in applying AI solutions but also underline the need for formalised education on AI to prepare the current and prospective workforce for the upcoming clinical integration of AI in healthcare, to safely and efficiently navigate a digital future. Focus should be given on different needs of learners depending on age, gender, and highest qualification to ensure optimal integration.

Training Public Health Professionals to Tackle Women, Children, and Families Health Issues: A "Skill-Based Qualitative Learning Approach"

Purpose: There are several teaching and learning approaches but finding the one that is appropriate for a particular field or training program is an arduous task. The purpose of this paper is to introduce the “Skill Based Qualitative Learning Approach” (SBQLA) in training health professionals.

Description: The SBQLA is a pedagogical approach via which learners are trained in developing qualitative questionnaires and interview skills to learn from experts in the Public Health (PH) field. This teaching approach arms students with interview skills that help them identify and address PH roadblocks and get them authentic information from experts. It also equips them with techniques on how to do formalized presentations and come up with projects and interventions that help mitigate and eliminate drivers of health problems among women, children and families.

Assessment: Learners' field experiences are shared in a professional presentation style in a class to help trainees benefit from each other's information and to get formalized feedback on their presentation. Assessment in this learning approach is based on a synthesis and an analysis of data collected from professionals.

Conclusion: Findings from this learning approach enables experts to shed light on true stories shared by real and authentic individuals whose faces can be associated with their shared experiences. This learning approach makes it possible for trainees to also initiate projects that help them tackle existing and emerging public health issues in their future work.

Pediatric oncology infrastructure and workforce training needs: A report from the Pediatric Oncology East and Mediterranean (POEM) Group

BACKGROUND

Inadequate numbers of trained health care providers (HCPs) contribute to poor pediatric oncology (PO) outcomes, particularly in low- and lower middle-income countries (L/LMICs). An understanding of the characteristics of the workforce challenges is vital for addressing these problems.

METHODS

The Pediatric Oncology East and Mediterranean (POEM) Group surveyed PO centers in countries of North Africa, Middle East, Central Asia, and Indian subcontinent on infrastructure and workforce capacity, service availability, and training opportunities for HCPs. Participating centers were categorized by the World Bank income levels for their countries and correlated with services, workload and staffing characteristics, and training needs.

RESULTS

Fifty of 82 member centers (61%) from 21 countries responded to the survey. Two hundred ninety-nine pediatric oncologists and 1176 nurses treated 12 496 new PO patients/year, with a 1451-bed utilization. The majority (71%) of new cases occurred in L/LMICs. The availability of HCPs correlated with country income level, as did pediatric subspecialty access, while availability of support services was unrelated. Twenty-five centers in 11 countries offered PO fellowship training for physicians, whereas 13 PO nurse training centers in nine countries had the capacity to train 273 nurses annually. The survey respondents indicated that, among their existing workforce, an average of 3.5 physicians and 14 nurses per institution would benefit from additional PO training opportunities.

CONCLUSIONS

The participating centers exhibited intraregional heterogeneity in financial resources, infrastructure, workload, workforce, and medical services. Our findings provide insight into the disparities and regional resources available to POEM, which can be mobilized to rectify specific deficiencies.

Developing the Future End-of-Life Health Care Workforce: Lessons Learned From a Survey of Advanced Health Professions Students

OBJECTIVE

To examine health professions trainees' end-of-life (EOL) care knowledge, attitudes, and intentions.

METHODS

IRB-approved online survey of 346 students/5 universities in final training years-public health, pharmacy, physician, physician assistant, occupational therapy, and physical therapy (April-May 2016). Queried knowledge, attitudes, and intentions toward EOL care.

RESULTS

Sufficient knowledge of palliative care was reported by 25% while sufficient knowledge of advance care planning (ACP) was 17%. Ninety-six percent thought it important to discuss EOL issues in training; 92% believed their professions played important roles in EOL care. Managing pain was chosen as the best example of palliative care by 93.6% and designating healthcare proxies was reported as the best example of ACP (5.8%). Pharmacy, public health, and rehabilitation therapy students were less likely than physician and physician assistant trainees to report intent to work in EOL care. Among those who want to work in EOL care, 65% reported having clinical experience with seriously ill or dying patients/clients. We discuss other findings related to perceptions of didactic preparation in palliative care, palliative care knowledge access/function, death/dying attitudes, and intentions toward seriously illness care.

DISCUSSION

There is interest in and knowledge of palliative care, including EOL care, among multiple health professions. Provides guidance for how we train health professionals to improve population health by optimizing EOL care.

Characteristics of nursing and allied health student placements in the Northern Territory over time (2017-2019) and placement satisfaction

OBJECTIVE

Assess nursing and allied health student satisfaction with their remote Northern Territory integrated learning placement and consideration of future rural/remote work Describe the characteristics of these students Examine changes in student characteristics over time.

DESIGN

A cross-sectional survey of students and a review of student placement data.

SETTING

Northern Territory, Australia.

PARTICIPANTS

Former students having a work integrated learning placement of more than 1 week in the Northern Territory from 2017 to 2019.

MAIN OUTCOME MEASURE(S)

Agreement with the statements 'This placement has encouraged me to consider living and working in a rural or remote location after I graduate' and 'Overall, I was satisfied with my placement.' The administrative record review examined student numbers, and placement length over time.

RESULTS

A total of 341 students responded to the online survey. Overall satisfaction with the placement was very high (93%), and 84% agreed/strongly agreed that the placement had encouraged them to consider working in a rural or remote setting. High-quality clinical supervision and educational resources were associated with overall placement satisfaction. Overall placement satisfaction, prior interest in working remotely and satisfaction with educational resources were associated with consideration of working remotely. The number of students having a placement increased by 29% in 2017 to 2019. The number of placement weeks also increased (35%).

CONCLUSIONS

The number/placement time of nursing and allied health students has increased in the NT. Satisfaction with remote work integrated learning placements is an the important pathway to growing a local health professional workforce in remote and rural settings.

Training Clinicians in Serious Illness Communication Using a Structured Guide: Evaluation of a Training Program in Three Health Systems

Background: Failure to initiate discussions about patients' values and goals in serious illness remains a common problem. Many clinicians are inadequately trained for these discussions. Objective: Evaluate whether a novel train-the-trainer model results in high-quality training that improves clinicians' self-reported competencies in serious illness communication. Design: Multimethod evaluation of an educational program. Setting/Context: In 2016, three faculty at Ariadne Labs (AL) conducted three train-the-trainer courses to equip faculty trainers at each of the three institutions to teach serious illness communication to clinicians. Measures: As collected by a post-training questionnaire, primary evaluation measure is clinicians' self-reported change in skills after the training compared with before. Secondary measures include a course evaluation and qualitative learnings. Results: From 2016 to 2018, AL trained 22 trainers (19/22 were palliative care specialists) in three systems, who trained 297 clinicians (49% physicians; 35% advanced practice clinicians; 12% registered nurses, social workers, or chaplain; 4.0% Other) spanning subspecialties (48%); primary care (28%); palliative care (17%); and other (7.1%). Clinicians reported statistically significant improvement in all skills for two of the systems, with a third system demonstrating improvement in all skills with two reaching statistical significance (p < 0.0001). Participants rated the quality of the training highly (95% mostly/extremely effective) and shared a diverse array of takeaways that reflect positive shifts in knowledge, attitudes, and skills. Conclusion: Serious illness communication training, delivered through a train-the-trainer model, was highly acceptable and resulted in significant self-reported improvements in competencies of clinicians. This may be a viable method for health systems seeking to train their clinical workforce.

Strategies for Building Computing Skills To Support Microbiome Analysis: a Five-Year Perspective from the EDAMAME Workshop

Here, we report our educational approach and learner evaluations of the first 5 years of the Explorations in Data Analysis for Metagenomic Advances in Microbial Ecology (EDAMAME) workshop, held annually at Michigan State University's Kellogg Biological Station from 2014 to 2018. We hope this information will be useful for others who want to organize computing-intensive workshops and will encourage quantitative skill development among microbiologists.IMPORTANCE High-throughput sequencing and related statistical and bioinformatic analyses have become routine in microbiology in the past decade, but there are few formal training opportunities to develop these skills. A weeklong workshop can offer sufficient time for novices to become introduced to best computing practices and common workflows in sequence analysis. We report our experiences in executing such a workshop targeted to professional learners (graduate students, postdoctoral scientists, faculty, and research staff).

Improving Drug Development and Patient Access With the Right People, Processes, and Culture: What Needs to Happen Right Now to Bring Better Medicines to the Patients Who Need Them

In a global environment where health care costs are soaring, R&D efforts are flatlining. Meanwhile, payers are demanding more value for their money. In this environment, the traditional siloed drug development model is not sustainable. Yet innovations such as adaptive trial designs, real-world data collection, precision medicine, and patient-centric trials that have been proven to streamline clinical trials, enrich the data they produce, and facilitate reimbursement have not been widely adopted. Why? Because the medicines ecosystem currently lacks 3 key prerequisites for innovative and sustainable change: (1) a highly trained workforce that can handle and interpret high volumes of fragmented data; (2) a dependable process for judging what constitutes value in medical innovation; and (3) corporate cultures that learn fast from failure and mine the competitive riches offered by a diverse workforce. Cultivating the right people, processes, and culture will require a concerted effort by industry, academia, governments, and nongovernmental organizations (NGOs) to devise efficient, effective solutions.

Training in patient-centered outcomes research for specific researcher communities

A number of publications have discussed approaches to training the scientific workforce in comparative effectiveness research (CER) and patient-centered outcomes research (PCOR). To meet this need, funders have offered resources for developing educational materials and establishing training programs. To extend these efforts into specific researcher communities, the Agency for Healthcare Research and Quality developed an R25 Funding Opportunity Announcement that called for basic, advanced, and experiential training for a specific researcher community in collaboration with associated program partners. This paper describes the strategies developed by the 5 subsequently funded programs, their specific researcher communities and program partners, and the challenges associated with developing in-person and online programs. We focus on lessons learned that can be translated into developing training programs nationwide and on training for the special populations of interest. We also discuss the creation of a sustainable network for training and the conduct of comparative effectiveness research/patient-centered outcomes research in targeted communities.

Moving toward integrated health: an opportunity for social work

With the passage of the Patient Protection and Affordable Care Act (PPACA) and ongoing health care reform efforts, this is a critical time for the social work profession. The approaches and values embedded in health care reform are congruent with social work. One strategy is to improve care for people with co-morbid and chronic illnesses by integrating primary care and behavioral health services. This paper defines integrated health and how the PPACA promotes integrated health care through system redesign and payment reform. We consider how social workers can prepare for health care reform and discuss the implications of these changes for the future of the profession.

Including oral health training in a health system strengthening program in Rwanda

OBJECTIVE

Rwanda's Ministry of Health, with the Clinton Health Access Initiative, implemented the Human Resources for Health (HRH) Program. The purpose of the program is to train and retain high-quality health care professionals to improve and sustain health in Rwanda.

DESIGN

In May 2011, an oral health team from Rwanda and the United States proposed that oral health be included in the HRH Program, due to its important links to health, in a recommendation to the Rwandan Ministry of Health. The proposal outlined a diagonal approach to curriculum design that supports the principles of global health through interconnected training for both treatment and collaborative prevention, rather than discipline-based fragmented training focused on isolated risk factors. It combined 'vertical' direct patient care training with 'horizontal' interdisciplinary training to address common underlying risk factors and associations for disease through primary care, program retention, and sustainability.

RESULTS

The proposal was accepted by the Ministry of Health and was approved for funding by the US Government and The Global Fund. Rwanda's first Bachelor of Dental Surgery program, which is in the planning phase, is being developed.

CONCLUSIONS

Competencies, the training curriculum, insurance and payment schemes, licensure, and other challenges are currently being addressed. With the Ministry of Health supporting the dental HRH efforts and fully appreciating the importance of oral health, all are hopeful that these developments will ultimately lead to more robust oral health data collection, a well-trained and well-retained dental profession, and vastly improved oral health and overall health for the people of Rwanda in the decades to come.