Minimum Training Requirements Research Articles

Inequality in English post-16 education

Abstract This commentary examines post-16 education in England from the perspective of equity, with a focus on technical education. It describes how the growth of higher education (HE) has disproportionately benefited those from advantaged backgrounds, and argues that a key equity objective should be to improve the quality of the technical alternatives to HE. This objective faces several obstacles, including a fragmented and volatile landscape of technical education, weak funding and a deregulated labour market. Apprenticeship has potential but is hampered by non-compliance with minimum requirements for wages and training. Numeracy and literacy weaknesses are also magnified in the 16–19 phase of education. In response, the report recommends strengthened funding for the technical alternatives to HE, robust enforcement of minimum wage and training requirements for apprentices and better access routes designed to reintegrate weaker performers into the skills system.

Training Requirements in Point of Care Ultrasonography of the Upper Airway: A Feasibility Study.

Point-of-care ultrasonography of the upper airway can be a useful supplement to conventional pre-anesthetic clinical evaluations. However, the reliability of such examinations is highly operator-dependent and proper training in sonoanatomy and ultrasound operational skills are required. The objective of this study aims to assess the minimum training requirements for applying a predefined upper airway scanning protocol in healthy volunteers by anesthesia trainees. Twenty-two healthy volunteer members of the Operating Room staff participated in the study. A predefined scanning protocol that included the identification of specific structures (hyoid bone, vocal cords, thyrohyoid membrane/epiglottis/pre-epiglottic space, cricothyroid membrane, and thyroid gland), as well as the performance of specific measurements (distance from the hyoid bone to skin, anterior commissure to skin, epiglottis to skin, and thyroid isthmus to skin) was taught in a single-day training course. The trainees' competence was assessed after multiple scanning repetitions performed over a week. Mixed effects regression models were applied for the trainee-instructor differences in all ultrasound measurements. Cricothyroid membrane visualization had the lowest success rate (88%). Trainee-instructor differences were statistically significant for hyoid bone-to-skin (P < .001) and epiglottis-to-skin distances (P = .016). Measurement of the distance from the epiglottis to the skin required more scanning repetitions to achieve minimum deviance compared with other measurements. Ten or fewer scanning repetitions were sufficient to achieve minimum deviance for all four measurements. At least 10 scanning repetitions of a pre-defined upper airway scanning protocol can be used as the minimum standard for training.

Health care for older adults in Europe: how has it evolved and what are the challenges?

Geriatric medicine has evolved to an accepted specialty in 23 European countries. Despite much heterogeneity of postgraduate geriatric curricula, European societies have succeeded in defining a common core curriculum with a list of minimum training requirements for obtaining the specialty title of geriatric medicine. Geriatricians play a leading role in finding solutions for the challenges of health care of multimorbid older patients. One of these challenges is the demographic shift with the number of adults aged 80years and older in Europe expected to double by 2050. Although geriatric units will play a role in the care of frail older patients, new care models are needed to integrate the comprehensive geriatric assessment approach for the care of the vast majority of older patients admitted to non-geriatric hospital units. Over the last few years, co-management approaches have been developed to address this gap. Innovative models are also in progress for ambulatory care, prevention and health promotion programs, and long-term care. Efforts to implement geriatric learning objectives in undergraduate training, and the generation of practice guidelines for geriatric syndromes may help to improve the quality of care for older patients.

Recommendations for Minimum Residency Training Requirements in Pediatric Hospital Medicine.

Recommendations for Minimum Residency Training Requirements in Pediatric Hospital Medicine.

Emergency medicine resident involvement in emergency medical services

Introduction: Emergency medical services (EMS) are a critical component to Emergency Medicine (EM) residency training. In the United States, the Accreditation Council for Graduate Medical Education (ACGME) has established minimum training requirements for EM residency programs. Since the last study exploring resident EMS involvement was performed, there have been over 100 new EM resident programs started. Given the rapid increase in new EM programs, we sought to determine EMS experiences provided to current EM residents. Materials and Methods: A 22-question anonymous online survey was distributed through E-mail to program directors of approved EM residencies in October 2020. A follow-up reminder was sent 3 weeks later. Results: In total, 51 of 257 programs responded (20% response rate). Forty-five percent of EM residents experience between 10 and 25 EMS calls during their residency, 31% experience 26–50, and 20% experience &gt;50 calls. The majority of programs (53%) have a separate EMS rotation where residents function as observers, 24% of residents function as providers, and 25% also have residents respond in a dedicated physician response vehicle. Aeromedical exposure is limited (47% have none and 43% average only 1–9 flights). Two-thirds of programs (67%) have residents provide online medical command during their ED shifts and 61% require residents to provide didactics to EMS clinicians. Despite ACGME requirements, only two-thirds of programs (69%) provide training about disaster/mass casualty incident (MCI) management and 67% have them participate in a disaster/MCI drill. About one-third of programs (31%) have decreased EMS experiences due to limited time in the residency curriculum, and 20% of programs have limited EMS experiences due to the COVID pandemic. Conclusions: The majority of responding EM residency programs meet ACGME EMS-related requirements. There is an opportunity for improvement around disaster education based on these data. Limited time in the curriculum and the COVID pandemic were cited as reasons that programs have limited their EMS experiences. The following core competencies are addressed in this article: Practice-Based Learning and Improvement, Medical Knowledge.

Leveraging Value-Based Purchasing to Improve Advance Care Planning.

Advance care planning (ACP) is an important component of person-centered care for older adults in nursing facilities. Although nursing facilities have a statutory obligation to offer ACP to residents, there are no minimum training requirements for staff. Lack of consistent ACP training contributes to significant variability in ACP conversation quality, inaccurate or incomplete documentation of preferences, and infrequent re-evaluation of prior decisions. Indiana added ACP training for nursing facility staff to the Value-Based Purchasing formula for 2019. Facilities received 5 points (of a 100-point total formula) if at least one staff member completed the designated ACP training during the year. ACP Foundations Training was developed by faculty at Indiana University and made available to all Indiana nursing facilities. A total of 1,087 participants, representing 94.2% (501 of 532) Indiana nursing facilities, completed the training. Approximately every participant (99.4%) agreed that the training had practical value. This academic-government partnership was successful in providing basic information about ACP to staff at most nursing facilities across Indiana and offers a model for states to provide critical educational content to nursing facility staff by incentivizing training. [Journal of Gerontological Nursing, 48(2), 31-35.].

Anaesthesia skills and simulation training during the COVID-19 pandemic

Due to COVID-19 restrictions in the clinical practice areas and theatres of the Academic hospitals in Bloemfontein (South Africa), 4 th and 5th-year medical students of the University of the Free State had limited access to routine clinical and emergency cases. As part of their Anaesthesia rotation, students needed access and exposure to these clinical and emergency cases to fulfil the minimum training requirements set out in their curriculum. These included ultrasound techniques, administration and management of patients for general anaesthesia and administration of spinal anaesthesia, airway management and Cardiopulmonary Resuscitation (CPR).

National survey of feasibility of NIV trials for management of children with bronchiolitis

BackgroundBronchiolitis is a major cause of admission to hospital in children. Non-invasive ventilation (NIV) support with continuous positive airway pressure (CPAP) or high-flow nasal cannula (HFNC) oxygen is routinely used...

Hiring Requirements and Qualifications of School Food Authority Directors Changed in Some Districts After Implementation of US Department of Agriculture Professional Standards

BackgroundIn 2015, the US Department of Agriculture set minimum education and training requirements (ie, professional standards) to ensure that school nutrition professionals have the knowledge and experience to operate school meal programs. No study to date has examined whether hiring requirements and qualifications of school food authority (SFA) directors have changed since 2015. ObjectiveTo assess changes in hiring requirements and qualifications of SFA directors since the US Department of Agriculture professional standards were established, overall and by district size. DesignCross-sectional analysis of nationally representative district-level data from the 2012 and 2016 cycles of the School Health Policies and Practices Study. Participants/settingIn 2012, 660 sampled districts completed the School Health Policies and Practices Study Nutrition Services questionnaire. In 2016, 599 sampled districts completed the questionnaire. Main outcome measuresHiring requirements for newly hired SFA directors and reported qualifications of SFA directors. Statistical analyses performedDifferences in prevalence estimates from 2012 to 2016 for all districts and by district size were assessed with χ2 tests. ResultsSignificant increases were found for 3 hiring requirements: degree in nutrition or related field, registered dietitian credential, and food safety certification. Significant changes in 4 of the 5 reported qualifications were found including an increase in the percentage of district directors with a degree in nutrition or a related field and decreases in the percentage of directors with a School Nutrition Specialist credential from the School Nutrition Association, School Nutrition Association certifications, and certified dietary managers. Changes were found in small and medium districts, but not large districts. ConclusionsDistrict hiring requirements and SFA director qualifications have changed since the implementation of the US Department of Agriculture professional standards, including some differences by district size. Future research could identify challenges facing districts in hiring directors who have a degree in nutrition or related fields or who have specialized nutrition credentials or certificates (eg, registered dietitians).

Understanding the nature of learning and opportunities to learn created by work-integrated learning: A perspective in vocational education

The Constitution for the Republic of South Africa (Act 108 of 1996) embraces language as a basic human right and multilingualism as a national resource. One latest foreign language to be given recognition by the Department of Basic Education (DBE) in 2015 is Mandarin, a Chinese language, for incremental implementation as a non-official optional language from 2016 in primary schools. One of the stakeholders at the centre of the implementation of this latest foreign language to be recognised, whose voice has not been heard, are teachers. The methodology adapted in the collection of data is quantitative in that pre-service teachers completed a questionnaire. The results indicate mixed attitudes with more appearing to be not entirely supportive of this move by the DBE. Teachers do not share the same sentiments that are expressed at political level about the significance of Mandarin for trade and globalisation. The findings suggest a need for the DBE to rethink this plan and training proportional to the minimum training requirements for the teaching of a foreign language to be provided to teachers. There would need to be some consultation to ensure a greater teachers’ support as the project continues to be piloted and implemented in more schools across the country.

Pre-service teachers’ attitudes toward the teaching of Mandarin in South Africa

The Constitution for the Republic of South Africa (Act 108 of 1996) embraces language as a basic human right and multilingualism as a national resource. One latest foreign language to be given recognition by the Department of Basic Education (DBE) in 2015 is Mandarin, a Chinese language, for incremental implementation as a non-official optional language from 2016 in primary schools. One of the stakeholders at the centre of the implementation of this latest foreign language to be recognised, whose voice has not been heard, are teachers. The methodology adapted in the collection of data is quantitative in that pre-service teachers completed a questionnaire. The results indicate mixed attitudes with more appearing to be not entirely supportive of this move by the DBE. Teachers do not share the same sentiments that are expressed at political level about the significance of Mandarin for trade and globalisation. The findings suggest a need for the DBE to rethink this plan and training proportional to the minimum training requirements for the teaching of a foreign language to be provided to teachers. There would need to be some consultation to ensure a greater teachers’ support as the project continues to be piloted and implemented in more schools across the country.

Pain Medicine Board Certification Status Among Physicians Performing Interventional Pain Procedures in the State of Florida Between 2010 and 2016

The US Department of Health and Human Services has recommended that physicians performing interventional pain procedures be credentialed based on criteria based guidelines and minimum training requirements. To quantitatively assess gaps in certification related to pain medicine fellowship requirements, we studied the distribution of such procedures in Florida between 2010 and 2016. This research involved a retrospective analysis with a sample size of n = 1,885,442 interventional pain procedures. Data describing interventional pain procedures performed in Florida between January 2010 and December 2016 were obtained from the Florida Department of Health. The National Provider Identifier file and board certification lists from the American Board of Medical Specialties (ABMS), the American Board of Pain Medicine (ABPM), and the American Board of Interventional Pain Physicians (ABIPP) corresponding to this time frame were also obtained. The datasets were linked to determine the specialty of physicians performing interventional pain procedures, and whether or not they were pain medicine diplomates of the ABMS, the ABPM, or the ABIPP. The similarity index theta was calculated for the distribution of interventional pain procedure codes among medical specialty groups, and with respect to the practitioners' pain medicine board certification status. Of the interventional pain procedures, anesthesiologists performed 63.5%, physiatrists 19.1%, neurologists or psychiatrists 5.2%, and other practitioners 12.3%. Among procedures performed by anesthesiologists, physiatrists, and psychiatrists or neurologists, 66.2%, 50.3%, and 50.4% were by ABMS pain board-certified practitioners, respectively. Practitioners without ABMS pain medicine boards performed 45.8% of interventional pain procedures. Practitioners without such boards from either the ABMS, ABPM, or ABIPP performed 37.7%. There was very large similarity (theta > 0.9) in the distribution of procedures comparing ABMS pain medicine board-certified practitioners to non-ABMS pain medicine board-certified anesthesiologists, physiatrists, or all other specialties. In countries other than the United States, where pain medicine board certification is relatively recent, there may be a higher percentage of interventional pain procedures performed by individuals without certification than we report. In "opt-out" states, where nurse anesthetists can independently perform interventional pain procedures, the percentage of interventional pain procedures performed by individuals without physician pain medicine board certification may also be higher. The datasets we used do not contain information to allow assessment of outcomes or effectiveness resulting from pain medicine board certification. Approximately one-third of interventional pain procedures were performed by physicians without at least 1 of the 3 pain medicine board certifications. In addition, the practitioners performed very similar distributions of procedures (i.e., those without pain medicine board certification, overall, have not restricted their practice). These results suggest the need for additional accredited pain medicine fellowship training positions for newly graduated residents. The results also show that, for the recommendations of the Department of Health and Human Services to be satisfied, physicians without board certification performing intervention procedures would need to obtain ABPM or ABIPP certification, or ABMS certification after completion of a full-time Accreditation Council of Graduate Medical Education pain medicine fellowship. Chronic pain, education, medical, graduate, specialty boards.

Prospective multicenter study to evaluate capsule endoscopy competency using a validated assessment tool

Capsule endoscopy (CE) is an established, noninvasive modality for examining the small bowel. Minimum training requirements are based primarily on guidelines and expert opinion. A validated tool to assess the competence of CE is lacking. In this prospective, multicenter study, we determined the minimum number of CE procedures required to achieve competence during gastroenterology fellowship; validated a capsule competency test (CapCT); and evaluated any correlation between CE competence and endoscopy experience. We included second- and third-year gastroenterology fellows from 3 institutions between 2013 and 2018 in a structured CE training program with supervised CE interpretation. Fellows completed the CapCT with a maximal score of 100. For comparison, expert faculty completed the same CapCT. Trainee competence was defined as a score≥90% compared with the mean expert score. Fellows were tested after 15, 25, and 35 supervised CE interpretations. CapCT was validated using expert consensus and item analysis. Data were collected on the number of previous endoscopies. A total of 68 trainees completed 102 CapCTs. Fourteen CE experts completed the CapCT with a mean score of 94. Mean scores for fellows after 15, 25, and 35 cases were 83, 86, and 87, respectively. Fellows with at least 25 interpretations achieved a mean score≥84 in all 3 institutions. CapCT item analysis showed high interobserver agreement among expert faculty (k= 0.85). There was no correlation between the scores and the number of endoscopies performed. After a structured CE training program, gastroenterology fellows should complete a minimum of 25 supervised CE interpretations before assessing competence using the validated CapCT, regardless of endoscopy experience.

Hiring and Training Requirements for Correctional Officers: A Statutory Analysis

U.S. state statutes provide the minimum hiring and training requirements for correctional officers (COs), but it is unclear whether COs have achieved professionalism. This article utilizes a statutory analysis to examine state hiring qualifications and training requirements for COs. The findings reveal that not all 50 have statutes outlining CO hiring and training requirements. Although some states are very specific, many provide only general standards. As such, statutes regarding CO hiring and training are far from uniform.

Dermoscopy for melanoma detection and triage in primary care: a systematic review

ObjectiveMost skin lesions first present in primary care, where distinguishing rare melanomas from benign lesions can be challenging. Dermoscopy improves diagnostic accuracy among specialists and is promoted for use by...

Cardiology Training in Brazil and Developed Countries: Some Ideas for Improvement.

Huge variations exist in cardiology training programs across the world. In developing (middle-income) countries, such as Brazil, to find the right balance between training improvements and social and economic conditions of the country may be a difficult task. Adding more training years or different mandatory rotations, for instance, may be costly and not have an immediate direct impact on enhancing patient care or public health. In this text, we compare the Brazilian cardiology training system with other proposals implemented in developed countries from North America and Europe, aiming to point out issues worth of future discussion. Factors such as training rotations and competencies, and program duration and distribution across the countries are presented. The number of first year cardiology trainees per inhabitants is similar between Brazil and the United States (0.24 medical residents/100,000 inhabitants in Brazil and 0.26 medical residents/100,000 inhabitants in the USA). These numbers should be analyzed considering the inequality in training program distribution across Brazil, since most centers are located in the Southeast and South regions. Having more residency programs in distant areas could improve cardiovascular care in these areas. Duration of cardiology Residency Training is shorter in Brazil (two years) in comparison with developed countries (> 3 years). Brazilian residency programs give less emphasis to scientific research and diagnostic methods. Unifying minimum training requirements across the globe would facilitate the development of international learning opportunities and even professional exchange around the world.

European postgraduate curriculum in geriatric medicine developed using an international modified Delphi technique.

Backgroundthe European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations.Methodsunder the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators.Resultsthe final recommendations include four different domains: ‘General Considerations’ on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), ‘Knowledge in patient care’ (36 sub-items), ‘Additional Skills and Attitude required for a Geriatrician’ (9 sub-items) and a domain on ‘Assessment of postgraduate education: which items are important for the transnational comparison process’ (1 item).Conclusionthe current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states.

The administration of blood components: a British Society for Haematology Guideline.

The administration of blood components: a British Society for Haematology Guideline.

Minimum education & training requirements for ultrasound practitioners.

Minimum education & training requirements for ultrasound practitioners.

Changing times

It is becoming apparent that the environment in which Executive Masters in Public Administration programmes operate has changed dramatically in the wake of economic crisis and subsequent cuts in public spending. Changes in the funding of public sector organisations has been compounded by a broader “crisis” in the wider public sector which has seen job losses, resources pressures, and the questioning of who delivers public services. Despite arguing for the need for public management education in the face of adversity and austerity, the reality is that the demand for traditional university based courses is falling and despite the proven success of XMPA courses, public sector employers are just not funding or releasing their staff in the way that they did to attend these courses. Arguably, they may have justifiable “business” arguments such as loss of funding and staff and increasing demands on resources, ironically some of the senior managers who are saying no to their staff are the very ones who benefitted from more generous employer support themselves. However what this means for the development and continuance of public management programmes is that public management educators have to seriously think how to continue to develop and sustain XMPA programmes and show that they are not a burden to the organization and the sector but are of great value and benefit. This paper argues for the need for public management courses, and in particular XMPAs, during a period of questioning and uncertainty in a changing public sector. It suggests some of the changes to courses and course delivery that are needed and uses the example of the XMPA, public management education programme at London South Bank University. Such suggestions include: Delivering “Bite size XMPA”, portfolio of course accumulation, a Ladders and Bridges Framework, and Continuing Professional Development (CPD). Changes to course curriculum and content, a flexible approach to course timing and delivering courses off site to organizations. Further developing Learning Communities to respond to specific workplace managerial challenges, creating a safe learning environment and developing case studies from students own professional and practical experiences. The aim of this paper is to consider ways in which public management educators can continue to provide relevant courses and skills and argues that despite the cuts in the public sector and the deprioritization of education and training, Executive Masters in Public Administration (XMPA) are much needed to enable managers to deal effectively with the managerial challenges and dilemmas in service provision, not least citizen’s expectations and demands for improved services at lower cost, brought about as a consequence of the fiscal crisis and resulting public service cuts. The emphasis is on external training in the form of post graduate academic degrees and CPD (which are outside mandatory clinical and essential professional minimum training requirements), and specifically XMPA programmes.