Additional Year Of Experience Research Articles

How to Evaluate Online Education for General Practitioners: Development of a Tailored Questionnaire for Heart Failure Education.

Physician-oriented online education could be a pathway to improve care for patients with heart failure, however, it is difficult to measure the impact of such education. Self-efficacy is a potential outcome measure. In this article, we develop a methodology for analyzing an educational intervention for general practitioners (GPs) using self-efficacy as a concept. This study was partly conducted within the setting of an observational study, IMPACT-B, where we developed online education for GPs. We designed and refined a 24-item questionnaire using item analysis, and exploratory and confirmatory factor analysis. Ninety-one GPs completed the questionnaire before and after the online education. Follow-up data after 6 months was available for 13 GPs. Item analysis revealed a high degree of internal consistency (coefficient alpha 0.95) and validity. Each additional year of experience was associated with an average baseline self-efficacy score of 0.50 points (95% CI [0.21-0.80]), and each additional patient in HF follow-up with an average score of 2.0 points (95% CI [0.48-3.5]). Items that differentiated most between GPs with high and low self-efficacy were the treatment of congestion as well as titrating medication and MRA in heart failure with reduced ejection fraction. Factor analysis reduced the number of questions to 14, mapping to three factors (diagnosis, treatment, and follow-up), and improved the model fit as measured by the goodness-of-fit indicator comparative-fit-index (from 0.83 to 0.91). We demonstrated a method to assess the impact of online education on general practitioners. This led to a questionnaire that was reliable, valid, and convenient to use in an implementation context.

It's Worth What You Can Sell It for: A Survey of Employment and Compensation Models for Clinical Ethicists.

This article reports results of a survey about employment and compensation models for clinical ethics consultants working in the United States and discusses the relevance of these results for the professionalization of clinical ethics. This project uses self-reported data from healthcare ethics consultants to estimate compensation across different employment models. The average full-time annualized salary of respondents with a clinical doctorate is $188,310.08 (SD=$88,556.67), $146,134.85 (SD=$55,485.63)for those with a non-clinical doctorate, and $113,625.00 (SD=$35,872.96) for those with a masters as their highest degree. Pay differences across degree level and type were statistically significant (F = 3.43; p < .05). In a multivariate model, there is an average increase of $2,707.84 for every additional year of experience, controlling for having a clinical doctorate (ß=0.454; p < .01). Our results also show high variability in the backgrounds and experiences of healthcare ethics consultants and a wide variety of employment models. The significant variation in employment and compensation models is likely to pose a challenge for the professionalization of healthcare ethics consultation.

Corporotomy localization in inflatable penile implant surgery: learning curve and comparing different surgical approaches in high volume surgeons

Inflatable penile prostheses (IPP) is a viable solution for patients with erectile dysfunction unresponsive to or with contraindications for conservative treatment. In contrast to rapporting of IPP design and material modifications, no data exist regarding the effect of different surgical approaches during IPP implantation on the corporotomy site. The purpose of the present multi-center study was to investigate different IPP implantation surgical approaches and their influence the corporotomy site, while the effect of learning curve on the corporotomy site was also evaluated. Data was collected from 6 high-volume IPP surgeons. Surgical notes were searched for incision site, proximal and distal corporal length measurement, total length measurement, total cylinder length, length of rear tip extenders (RTE), surgery time, type of implant and reservoir placement while postoperative complications were also reported. The association between proximal/distal corporal length, the recorded covariates and infectious complications were examined. 1757 patients with virgin 3-piece IPP implantation were included in the analysis. The proximal/distal ratio averaged at 0.829 (SD ±0.293) in penoscrotal incisions (N=782), 0.687 (SD± 0.245) in infrapubic (N=1664) and 0.724 (SD± 0.179) in subcoronary (N=972) incisions. No significant differences where observed in the three highest volume surgeons. Correcting for significant covariates (diabetes mellitus, RTE, age) did not change this outcome. In the three highest volume surgeons, a more proximal incision resulted in significantly less RTE use. There was no difference in infectious complications with different surgical techniques (p = 0.280). Focusing on the data of the principal center, we found a decrease in the proximal/distal ratio of 8.41% per additional year of experience. We were unable to draw a firm conclusion about the difference in corporotomy site between different surgical approaches as such, but we found no significant difference between the highest volume surgeons using different techniques. Nevertheless, a significant effect of experience on the proximalization of the corporotomy was reported. none

Practice Patterns for Mohs Surgeons of Varying Clinical Experience: A Cross-Sectional Analysis of a Medicare Claims Database.

Use of Mohs micrographic surgery (MMS) is highly prevalent, but little data are available on how surgeon experience affects surgical practice patterns. To determine differences in use of MMS among surgeons of varying experience. This cross-sectional study sampled from clinicians billing ≥200 mean annual Mohs surgery claims from the 2012 to 2018 Medicare Public Use File. The primary outcome was mean annual Mohs surgery claims for clinicians of varying experience. Secondary outcomes included use of flaps/grafts and prescribing of oral antibiotics, benzodiazepines, and opioids. Among 1,759 unique surgeons, those with 16 to 20 years of experience performed the most mean annual (95% confidence interval) Mohs surgical cases (578.7 [556.7-600.6]). Surgeons with 21 to 25 years of experience prescribed the most antibiotics (240.2 [216.5-263.8] mean annual claims), whereas those with >35 years of experience prescribed the longest courses (15.3 [14.2-16.4] days). Midcareer surgeons performed the most mean annual Mohs surgery cases, whereas later career surgeons prescribed more frequent and longer courses of antibiotics suggesting changing practice patterns with additional years of experience.

The return to big-city experience: Evidence from refugees in Denmark

We offer causal evidence of higher returns to experience in big cities. Exploiting a natural experiment that settled refugees across labor markets in Denmark between 1986 and 1998, we find that refugees initially earned similar wages across locations. However, those placed in Copenhagen exhibited 35% faster wage growth with each additional year of experience. Faster sorting of workers toward the type of establishments, occupations, and industries typically found in cities accounts for the vast majority of this urban wage-growth premium.

Is a reputation for misconduct harmful? Evidence from corporate venture capital

This paper examines the effect of reputation on a corporate venture capital firm’s ability to attract potential investments. We find that a reputation for experience, active involvement in the startup, and misconduct are all positively associated with the CVC ability to attract investments. An additional year of experience, a policy of taking seats on the boards of new ventures, and each additional lawsuit against the investors all bring at least one new venture to their portfolios. A reputation for misconduct does not deter startups when the CVC has a reputation for experience. However, when the CVC firm has a reputation for active engagement with its portfolio companies, every two additional lawsuits result in a loss of at least one investee. The results hold despite controlling for generalized favorability of the parent corporation. Our study suggests that finer grained measures are needed when studying the complex relationship between reputation and performance.

The role of experience, specialty certification, and practice ownership in the gender wage gap for veterinarians in the United States.

To explore the role of various factors in the wage gap between male and female veterinarians in the United States in 2016 and 2017. 2,760 veterinarians across the United States. Data from the Census of Veterinarians Survey administered by the AVMA Economics Division in 2016 and 2017 were analyzed. The Kolmogorov-Smirnov 2-sample test was used to determine whether a difference existed between male and female income distributions at various levels of experience. Quantile regression was performed separately for male and female respondents to determine the direct effects of individual factors on incomes and compare the effects of practice ownership versus nonownership on income. Income distributions of men and women were unequal at lower experience ranges but equal at higher experience ranges. Income increased for men with each additional year of experience and with practice ownership. For women, practice owners in the lowest income quantile had a negative return to income; overall, their income benefited most from ownership in the form of partnerships. For certain groups, incomes of both genders were lower when they had absences from the workforce. Findings suggested that the largest source of gender income disparity for veterinarians was attributable to female practice owners earning less than their male counterparts. Indeed, women earned more from specialty certifications than from owning a clinic. To decrease income disparities between genders, ways should be identified to support women-owned practices and promote equal pay.

Why we succeed and fail in detecting fetal growth restriction: A population-based study.

The objective of this study was to explore the association between detection of fetal growth restriction and maternal-, healthcare provider- and organizational factors. A historical, observational, multicentre study. All women who gave birth to a child with a birthweight <2.3rd centile from 1 September 2012 to 31 August 2015 in Zealand, Denmark, were included. The population was identified through the Danish Fetal Medicine Database. Medical charts were reviewed to obtain data regarding maternal characteristics and information on the healthcare professionals. Date of authorization for the midwives and obstetricians involved was extracted from the Danish Health Authorization Registry. Multivariable Cox regression models were used to identify predictors of antenatal detection of fetal growth restriction, and analyses were adjusted for hospital, body mass index, parity, the presence of at least one risk factor and experience of the first midwife, number of midwife visits, number of visits to a doctor, the experience of the consultant midwife or the educational level of the doctor, the number of scans and gaps in continuity of midwife-care. Antenatal detection was defined as an ultrasound estimated fetal weight <2.3rd centile (corresponding to -2 standard deviations) prior to delivery. Among 78 544 pregnancies, 3069 (3.9%) had a fetal growth restriction. Detection occurred in 31% of fetal growth-restricted pregnancies. Clinical experience (defined as years since graduation) of the first consultation midwife was positively associated with detection, with a hazard ratio [HR] of 1.15, 95% confidence interval [CI] 1.03-1.28), for every 10years of additional experience. The hazard of detection increased with the number of midwife consultations (HR 1.15, 95% CI 1.05-1.26) and with multiparity (HR 1.28, 95% CI 1.03-1.58). After adjusting for all covariates, an unexplained difference between hospitals (P=.01) remained. The low-risk nullipara may constitute an overlooked group of women at increased risk of antenatal non-detection of fetal growth restriction. Being screened by experienced midwives during early pregnancy and having access to multiple midwife consultations may improve future diagnosis.

Paying for expertise: The effect of experience on insurance demand

AbstractThis paper investigates whether corporations purchase insurance for the real services that insurers provide. We examine the real‐service efficiency hypothesis in the insurance industry by exploiting within firm‐year variation in reinsurance usage and experience at the line of business level. Our results show that insurers purchase reinsurance to access reinsurers’ expertise and specialized knowledge. We find that, within the same year, the average multi‐line insurer purchases 2.4%–3.3% points more reinsurance for new lines relative to existing lines. The demand for reinsurance declines by 0.55%–0.80% points with each additional year of experience. The size of these effects differs by the line of business, indicating that the development of internal expertise and specialized knowledge varies by line.

Does Education and Experience Matter in the Distribution of Wages in Nepal? A Quantile Regression Approach

 Labor market returns depend on the level of education as well as experience of the labors. Though education is argued to be the key determinant of wage rate, other factors such as the sector of employment, gender of the employee, marital status and work industry also matter. This paper investigates the returns from years of schooling and experience by examining the wage structure in formal, informal and agriculture sectors of Nepal. The Mincerion wage equation and quantile regression technique has been used to analyze such impact by utilizing the recent labor force survey data of Nepal. Our results show that wage returns are positively associated with schooling in all the three sectors. However, return to experience has negative association in case of agriculture sector. Furthermore, return to schooling has higher impact at higher quantile along with the distribution of wages in formal sector and informal sector. The maximum effect of education is 4 percent at 0.90 quantile in formal sector. An additional year of experience has high impact at lower-wage group in case of informal and formal sector. The effect varies from 9.2 percent at 0.1 quantile and 4.9 percent at 0.9 quantile in formal sector. The experience effect is higher at median (4.06 percent) in case of informal sector.

Economic Analysis of Supply Functions, Private Returns to Investment in Education and Skill Mismatch in Egypt

Education provides good health, empowerment and employment to all people in the society. Accordingly, education can make a lifelong difference in individuals’ lives. It is proved that, on average, there is a positive relationship between each additional year of schooling and the income of an individual. The main objective of this paper is to estimate the demand and supply functions for schooling in Egypt using the data of the Egypt Labor Market Panel Survey 2012. It is estimated that the private rate of return to education is 4.5%. Moreover, the rate of return to the number of years of experience is 2.6%, i.e. each additional year of experience will increase the earnings of an individual by 2.6% on average. It is concluded that individuals from poor families have an increased likelihood of receiving financial aid, which decreases their discounting rate of interest.

Does midwife experience affect the rate of severe perineal tears?

Our aim was to study whether midwife experience affects the rate of severe perineal tears (3rd and 4th degree). A retrospective cohort study of all women with term vertex singleton pregnancies, who underwent normal vaginal deliveries, in a single tertiary hospital, between 2011 and 2015, was performed. Exclusion criteria were instrumental deliveries and stillbirth. All midwives used a "hands on" technique for protecting the perineum. The midwife experience at each delivery was calculated as the time interval between her first delivery and current delivery. A comparison was performed between deliveries in which midwife experience was less than 2years (inexperienced), between 2 and 10years (moderately experienced), and more than 10years (highly experienced). A multivariate regression analysis was performed to assess the association between midwife experience and the incidence of severe perineal tears, after controlling for confounders. Overall, 15146 deliveries were included. Severe perineal tears were diagnosed in 51 (0.33%) deliveries. Women delivered by inexperienced midwives had a higher rate of severe perineal tears compared with women delivered by highly experienced midwives (0.5% vs 0.2%, respectively, P=.024). On multivariate regression analysis, midwife experience was independently associated with a lower rate of severe perineal tears, after controlling for confounding factors. Each additional year of experience was associated with a 4.7% decrease in the risk of severe perineal tears (adjusted OR 0.95 [95% CI 0.91-0.99, P=.03). More experienced midwives had a lower rate of severe perineal tears, and may be preferred for managing deliveries of women at high risk for such tears.

Speak up! Barriers to challenging erroneous decisions of seniors in anaesthesia.

'Speaking up' or the ability to effectively challenge erroneous decisions is essential to preventing harm. This mixed-methods study in two parts explores the concept of 'barriers to challenging seniors' for anaesthetic trainees, and proposes a conceptual framework. Using a fully immersive simulation scenario with unanticipated airway difficulty, we investigated how junior anaesthetists (one to two years of training) challenged a scripted error. We also conducted focus groups with senior trainees (three to seven years of training) and undertook a 'thematic network analysis' of responses. Junior anaesthetic trainees challenged erroneous decisions effectively, but trainees with an additional year of experience challenged more quickly and effectively, combining 'crisp-advocacy-inquiry challenge' with 'non-verbal cues'. Focus group analysis conceptualised a 'barrier network' with three main themes: concerns around relationships; decision-making; and risk/cost-benefit. Emotional maturity is an important protective layer around decisions to challenge. Despite significant multifactorial barriers, systematic training in effective 'speaking up' could improve the confidence and ability of juniors to challenge erroneous decisions.

Are There Returns to Experience at Low-Skill Jobs? Evidence from Single Mothers in the United States Over the 1990s

Policy changes in the United States in the 1990s resulted in sizable increases in employment rates of single mothers. We show that this increase led to a large and abrupt increase in work experience for single mothers with young children. We then examine the economic return to this increase in experience for affected single mothers. Despite the increases in experience, single mothers’ real wages and employment have remained relatively unchanged. The empirical analysis suggests that an additional year of experience increases single mothers’ wage rates by less than 2 percent, a percentage lower than previous estimates in the literature.

Managerial Experience and Organizational Performance: A 15‐Year Panel Study of Local Assessors

AbstractThe proposition that managerial experience improves performance is an empirical claim, yet panel studies with long time dimensions exploring the relationship are uncommon. This article investigates the impact of managerial experience on organizational performance using a 15‐year panel of local property assessors in Washington State from 1999 to 2013. Each additional year of experience improves assessment quality as measured by the coefficient of dispersion by three‐tenths of a percent. However, although the relationship is statistically significant, the size of the effect is quite small, with administrative practices and the environment surrounding the assessment task being stronger predictors of assessment performance.

Succession planning in local health departments: results from a national survey.

Succession planning has received scant attention in the public health sector, despite its potential to generate operational efficiencies in a sector facing chronic budgetary pressures and an aging workforce. We examined the extent to which local health departments (LHDs) are engaged in succession planning and assessed the factors associated with having a succession plan. We conducted a national cross-sectional Web-based survey of workforce recruitment and retention activities in a sample of LHDs responding to the National Association of County & City Health Officials' 2010 Profile Study and then linked these data sets to fit a multivariable logistic regression model to explain why some LHDs have succession plans and others do not. Top executives in a national sample of LHDs. Presence or absence of succession planning. Two hundred twenty-five LHDs responded to the survey, yielding a 43.3% response rate, but no statistically significant differences between respondents and nonrespondents were detected. Only 39.5% reported having a succession plan. Performance evaluation activities are more common in LHDs with a succession plan than in LHDs without a plan. In adjusted analyses, the largest LHDs were 7 times more likely to have a succession plan than the smallest. Compared with state-governed LHDs, locally governed LHDs were 3.5 times more likely, and shared governance LHDs were 6 times more likely, to have a succession plan. Every additional year of experience by the top executive was associated with a 5% increase in the odds of having a succession plan. Local health departments that report high levels of concern about retaining staff (vs low concern) had 2.5 times higher adjusted odds of having a succession plan. This study provides the first national data on succession planning in LHDs and sheds light on LHDs' readiness to meet the workforce-related accreditation standards.

Maintenance of Certification and Its Association With the Clinical Knowledge of Family Physicians

To examine the relationship between maintenance of certification (MOC) and the clinical knowledge demonstrated by family physicians as they move further away from formal training. Performances of 10,801 examinees-2,440 seeking initial certification; 8,361 seeking MOC-on the summer 2009 American Board of Family Medicine (ABFM) certification examination were compared across 30 cohorts that represented recent residency program graduates and already-certified family physician diplomates with varying years of clinical experience. Experience was defined as the time in years since the year of initial certification. This study employed a natural-groups, cross-sectional design; however, it was used to draw longitudinal inferences. Family physicians who maintained certification performed better than recent graduates. They increased their examination scores by almost 17 points each successive time that they took the exam, with scores reaching their highest point 28 to 31 years after initial certification. Multiple comparison analyses confirmed that the trend was significant; however, subanalyses revealed that this trend remained significant only for U.S. medical graduates (USMGs) but not international medical graduates. Those family physicians that did not maintain their certification performed significantly worse than recent graduates. The findings suggest that ABFM diplomates who are USMGs and maintain their certification perform better on the ABFM certification examination with additional years of experience until approximately 30 years after residency training.

Mentorship: A New Strategy to Invest in the Capital of Novice Nurse Practitioners

In 2010, over 8,000 students graduated from nurse practitioner (NP) programs in the United States and began the transition from NP student to professional practitioner.1 Prior to gaining admittance into graduate NP programs, the majority of applicants had a minimum of 1 year of clinical experience as a registered nurse, and most had additional years of experience. NPs have found the transition from expert nurse to novice practitioner challenging and overwhelming. The NP may be the sole NP within the facility, practicing aside physicians. The NP may also be the sole provider within a facility, particularly in rural clinic settings. Mentorship programs can help bridge the gap between education and professional practice.2 However, healthcare organizations have limited resources and therefore must be convinced mentorship programs are beneficial (and profitable). Furthermore, the terms mentorship, preceptorship, orientation, and collaboration are often used (inappropriately) interchangeably, resulting in various interpretations of the role and function of a mentor. Healthcare facilities may confuse mentorship with the orientation process or the collaborative relationship between a physician and an NP, and assume the organization already has such a program in place. The author conducted a literature review to explore the benefits of mentorship, the true meaning of mentorship, and the mentorship needs of NPs.

The Effects of Human Capital on Agricultural Productivity and Farmer’s Income in Cameroon

This study evaluates how human capital affects agricultural productivity and farmer’s income in Cameroon. Precisely, this study adopts methodologies that evaluate agricultural productivity, establish the stochastic frontier model and specify the returns to human capital. The database used to produce the empirical results is the Third Cameroonian Household Survey conducted by the National Institute of Statistics. Results obtained indicate that an additional year of experience and levels of education increases agricultural productivity. However, an additional year of experience squared denotes that the producer reduced his level of inefficiency. While an additional unit of education reduces the level of inefficiency. In addition, an additional year of education and years of experience squared increases farmer’s income. To provide a solution to the problem of food insecurity, the government should allow farmers to endow more in human capital.

Does Worker Loyalty Pay? Evidence from Transition Economies

Does worker loyalty benefit workers? While the preponderance of studies identify benefits to firms of worker loyalty, few investigate whether workers benefit. We address this question using data collected from over 10,880 employees in over 655 workplaces in six transition economies (Armenia, Azerbaijan, Kazakhstan, Kyrgyzstan, Russia and Serbia), focusing on two specific aims. First, we document the nature of worker loyalty using three alternative measures, and use ordered probit regression analysis, clustering by firm, to investigate the link (1) between loyalty and expected rewards, identifying where differences between intrinsic and extrinsic rewards emerge, and (2) between loyalty and worker performance, using a composite measure constructed from three items which asked participants to evaluate their work in comparison to others doing a similar job. Second, we use regression analysis to identify the association between earnings and loyalty among participating workers in these six countries. Regarding the first specific aim, we find that, generally, loyalty is positively associated with expected rewards and positively associated with performance, as is true in developed market economies. We find little evidence that workplace tenure (seniority) is a good proxy for worker loyalty among participants in our study. Regarding the second specific aim, we find that loyalty is positively associated with earnings, and statistically significant in four countries. In three cases, the magnitude of the loyalty effect is equal to or greater than that associated with an additional year of experience. Based on our findings, we suggest strategies to pursue to instill and enhance worker loyalty.