Professional Development Research Articles

Authentic Assessment in Kurikulum Merdeka: Benefits, Challenges, and Implementation Strategies

Authentic assessment plays a crucial role in enhancing the relevance and effectiveness of education, particularly within the framework of Kurikulum Merdeka. This study aims to explore the benefits, challenges, and implementation strategies of authentic assessment in Indonesian schools. Using a qualitative approach through a systematic literature review, data were collected from scholarly articles, academic books, and official documents. The findings reveal that authentic assessment enhances student engagement, motivation, 21st-century skills, and provides actionable feedback for continuous improvement. Key challenges include significant time and resource requirements, maintaining consistent assessment standards, and the lack of teacher training. Proposed strategies include professional development programs, resource allocation, and the development of comprehensive guidelines. These findings highlight the importance of support systems to ensure the effective integration of authentic assessment, aligning with Kurikulum Merdeka’s goal of preparing students for real-world challenges.

Professional Reputation and Service Efficacy of Teachers in Public Elementary Schools

This study explored the professional reputation and service efficacy of teachers in Manay District, Division of Davao Oriental, employing a non-experimental quantitative research design with a correlational method. The study utilized universal sampling, involving 135 public elementary school teachers. Data were collected through validated survey instruments and analyzed using descriptive statistics, Pearson r, and regression analysis. The findings revealed that the professional reputation of public elementary school teachers, measured in terms of obligation, truthfulness, admiration, sympathy, and communal responsibility, was often manifested. Meanwhile, their service efficacy, assessed through collaboration, decision-making, resource utilization, and communication, was sometimes evident. A significant relationship was found between professional reputation and service efficacy. Furthermore, specific domains of professional reputation were significant predictors of service efficacy. These results have important implications for educators and policymakers, particularly in designing professional development programs that enhance both professional reputation and service efficacy. It is recommended that public-school teachers participate in conferences and training offered by the Department of Education (DepEd) to foster professional growth and improve their teaching practices. Limitations of the study include its reliance on self-reported data and the focus on a single district, which may affect the generalizability of the findings. Future research could explore similar relationships in other contexts or investigate additional factors influencing service efficacy.

Desarrollo profesional docente en educación infantil desde la investigación-acción

Teacher professional development is a key factor in enhancing pedagogical interactions. However, implementing programs that are tailored to teachers' specific needs and teaching contexts remains challenging. This article examines a professional development program in pedagogical mediation based on action research, designed for early childhood educators in Chile. The study employed a case study design, involving nineteen teachers and six trainer educators. Data was collected through semi-structured interviews and written reports, which were analyzed using reflexive thematic analysis. The findings highlight four key aspects for teacher professional development: reflective chaining, video-based training, the role of the critical friend, and work within professional learning communities. These categories form a continuous action-research and reflection spiral that enhances teaching professionalism and self-awareness of practice, promoting a shift from the individual to the collective and from the simple to the complex. This approach fosters a collaborative culture of improvement, strengthening professional development and serving as a model for other programs that contribute to quality in this educational level.

Qwen-2.5 Outperforms Other Large Language Models in the Chinese National Nursing Licensing Examination: Retrospective Cross-Sectional Comparative Study.

Large language models (LLMs) have been proposed as valuable tools in medical education and practice. The Chinese National Nursing Licensing Examination (CNNLE) presents unique challenges for LLMs due to its requirement for both deep domain-specific nursing knowledge and the ability to make complex clinical decisions, which differentiates it from more general medical examinations. However, their potential application in the CNNLE remains unexplored. This study aims to evaluates the accuracy of 7 LLMs including GPT-3.5, GPT-4.0, GPT-4o, Copilot, ERNIE Bot-3.5, SPARK, and Qwen-2.5 on the CNNLE, focusing on their ability to handle domain-specific nursing knowledge and clinical decision-making. We also explore whether combining their outputs using machine learning techniques can improve their overall accuracy. This retrospective cross-sectional study analyzed all 1200 multiple-choice questions from the CNNLE conducted between 2019 and 2023. Seven LLMs were evaluated on these multiple-choice questions, and 9 machine learning models, including Logistic Regression, Support Vector Machine, Multilayer Perceptron, k-nearest neighbors, Random Forest, LightGBM, AdaBoost, XGBoost, and CatBoost, were used to optimize overall performance through ensemble techniques. Qwen-2.5 achieved the highest overall accuracy of 88.9%, followed by GPT-4o (80.7%), ERNIE Bot-3.5 (78.1%), GPT-4.0 (70.3%), SPARK (65.0%), and GPT-3.5 (49.5%). Qwen-2.5 demonstrated superior accuracy in the Practical Skills section compared with the Professional Practice section across most years. It also performed well in brief clinical case summaries and questions involving shared clinical scenarios. When the outputs of the 7 LLMs were combined using 9 machine learning models, XGBoost yielded the best performance, increasing accuracy to 90.8%. XGBoost also achieved an area under the curve of 0.961, sensitivity of 0.905, specificity of 0.978, F1-score of 0.901, positive predictive value of 0.901, and negative predictive value of 0.977. This study is the first to evaluate the performance of 7 LLMs on the CNNLE and that the integration of models via machine learning significantly boosted accuracy, reaching 90.8%. These findings demonstrate the transformative potential of LLMs in revolutionizing health care education and call for further research to refine their capabilities and expand their impact on examination preparation and professional training.

The ruling from the field stands? Shedding light on officers’ interpretations of body-worn cameras footage

ABSTRACT Despite extensive research on the expanding use of body-worn cameras (BWCs) in law enforcement, the perceived evidentiary value of the resulting images remains unclear. Previous studies have shown that images do not inherently ‘speak for themselves’, emphasising the need for a deeper understanding of the information these technologies may offer to different viewers. This study examines, through semi-structured interviews and video elicitation with 43 officers from a Body-Worn Camera pilot programme in Quebec, Canada, how police officers interpret BWC footage and their beliefs about how citizens might interpret the same video. It aims to better understand how their distinctive police knowledge may shape their perceptions. The findings suggest that officers interpret situations based on their professional training and experiences, which provide them a ‘police lens’ to understand police intervention images. However, this lens is not uniform, as interpretations of certain sequences of the depicted events vary among the surveyed police officers. The findings also point to a prevailing sense of ‘naïve realism’, with some officers viewing the images as self-explanatory, while others believe that citizens would need context to fully comprehend the footage and overcome their biases. This study helps us understand how people and occupational cultures interpret BWC footage. It reminds us to be careful about using these images as solid evidence, whether in court or when shared with the public.

Las políticas educativas de la ingeniería civil en México. Una estratigrafía histórica

As a result of the social approach adopted in recent years by the Mexican Federal Government, a new strategy has emerged to promote higher education, focusing on the most marginalized individuals and communities, with the goal of fostering their inclusion in professional training at this level. This research presents the philosophical foundations of this initiative, based on the concept of “episteme”; it includes a review of the evolution of higher education in Mexico from the perspective of civil engineering, utilizing a stratigraphic model of knowledge. In particular, the creation of the Benito Juárez García System of Universities for Welfare and the Civil Engineering School in Texcoco, State of Mexico, is described. The latter serves as an alternative to address the consequences of educational policies implemented under the so-called neoliberal framework, representing a potential option for improved social participation in the development of specialized technical capacities. The results and conclusions demonstrate that the educational reforms implemented do not follow a continuous discursive line but rather emerge in response to the episteme or discursive stratum of the moment. As a case study, the current higher education model in civil engineering is presented. In the same way, the results of the new model of the University of Civil Engineering are presented.

Exploring Large Language Models Through a Neurodivergent Lens: Use, Challenges, Community-Driven Workarounds, and Concerns

Despite the increasing use of large language models (LLMs) in everyday life among neurodivergent individuals, our knowledge of how they engage with and perceive LLMs remains limited. In this study, we investigate how neurodivergent individuals interact with LLMs by qualitatively analyzing topically related discussions from 61 neurodivergent communities on Reddit. Our findings reveal 20 specific LLM use cases across five core thematic areas of use among neurodivergent users: emotional well-being, mental health support, interpersonal communication, learning, and professional development and productivity. We also identified key challenges, including overly neurotypical LLM responses and the limitations of text-based interactions. In response to such challenges, some users actively seek advice by sharing input prompts and corresponding LLM responses. Others develop workarounds by experimenting and modifying prompts to be more neurodivergent-friendly. Despite these efforts, users have significant concerns around LLM use, including potential overreliance and fear of replacing human connections. Our analysis highlights the need to make LLMs more inclusive for neurodivergent users and implications around how LLM technologies can reinforce unintended consequences and behaviors.

The Effect of Information Technology to the Performance of English Teachers in Selected Vocational Schools

Vásquez-Pajuelo et al. (2024) and Chaipidech (2022) have highlighted the growing use of digital tools in vocational schools, particularly for teaching English. The COVID-19 pandemic has accelerated the shift toward digital literacy, necessitating enhanced technological competencies in educational professionals. Chaipidech et al. (2022) highlight the potential of IT in facilitating individualized learning experiences, providing real-time feedback, and encouraging collaboration through online practice communities. Research shows that when educators have the appropriate digital skills and resources, their instructional practices improve, leading to improved student engagement and learning outcomes. However, there are still significant gaps in research, particularly in the China, where the digital divide and lack of comprehensive training programs pose challenges. The study reveals gaps in teachers' understanding of ICT's potential benefits due to inadequate infrastructure, technological support, and professional development. Despite positive attitudes, limited training and limited resources hinder ICT integration. The study suggests specific training programs, better ICT facilities, and a well-thought-out plan to make the most of ICT's effect on vocational school teachers' work and students' grades.

Evaluating the impact of faculty development programs at the workplace by using reflective critique writing technique

BackgroundThe professional development of faculty members is essential for improving the quality of education. Faculty development programs play a very vital role in continued professional development of faculty. Reflective Critique writing is an important tool for evaluation of faculty development programs, as it provides opportunities for self-reflection, self-critique and self-awareness. The experience of Reflective Critique writing, needs to be explored in order to encourage the faculty to engage in this practice and pursue their personal & professional growth. Aim of study is to determine the effectiveness of Reflective Critique writing in improving the teaching skills of faculty members after a formal faculty development program & to explore their experience using reflective critique technique to improve their professional & personal life.MethodIt was a mixed method study and design used was Explanatory Sequential Design. Quantitative part is Quasi experimental studies and Qualitative part is Exploratory. Purposive sampling technique was used for Quantitative part (27 faculty members) & Convenience sampling technique (10 faculty members) for Qualitative part of the studies. Case based learning facilitation skills workshop was conducted as a part of faculty development program in which participants were also trained on writing Reflective Critique texts on the “what, so what & now what” model. Participants also went through pre & posttest of the workshop & wrote their first Reflective Critique text. First evaluation for seeing improvement in teaching skills, learning transfer & behavior changes with Reflective Critique writing was carried out after 3 months at workplace (round 1) & second evaluation on the same pattern was carried out after 6 months of workshop at workplace (round 2). Participants wrote 3 Reflective Critique texts in total. At the end of the study, participants experience of Reflective Critique writing was explored in depth by semi-structured interviews of 10 faculty members.ResultsResults included the grading of reflective capacity of participants on REFLECT rubric & comparison of pre & posttest results. REFLECT rubric grading showed that in 3rd Reflective Critique writing almost 80% of the participants became critical reflectors, improving from an initial 60% progress in first writing, showing the effectiveness of the training program & increased effectiveness of teaching skills, learning transfer & behavior change at workplace. Evaluation was taken up to level 3 of the Kirkpatrick model. Results of pre & posttest showed marked improvement in results with a significant p-value indicating the success of intervention. Hence the data analysis showed the improved teaching skills, enhanced learning transfer at workplace with a positive behavior change which clearly indicated the effectiveness of Reflective Critique in improving the teaching skills of the participants & behavior change at workplace as well as their personal & professional development. Participants experience of Reflective Critique writing was explored further in the qualitative part of the studies and results showed multiple themes including ongoing teaching skills, increased higher order thinking and making sense of experience. Participants labelled Reflective Critique as: The Game Changer.ConclusionReflective Critique writing enabled the participants to get a deeper critical evaluation of the faculty development program, which in return enhanced their overall performance at workplace.

Exploring the Role of Cognitive Capacity and Adaptive Learning in Professional Education: A Scoping Review

Exploring the Role of Cognitive Capacity and Adaptive Learning in Professional Education: A Scoping Review

Perverse impacts of competitive funding: public school principals as revenue generators in the grant economy

ABSTRACT This paper focuses on competitive funding models for public schools, drawing on interviews with public school principals serving disadvantaged student cohorts in Australia. Public schools receive the majority of their funding from state governments, and we examine these principals’ experiences in competing for additional funding via government-initiated high-stakes competitive grants, for capital projects and sporting infrastructure within their schools. These competitive grants occur in the context of both recurrent and capital under-funding of public schools. As the competitive grant applications required expenditure and ‘investment’ to apply, the interviewed principals felt they were ‘gambling’ with their limited funding. We argue that the funding applications demand and compel responsibilisation of tasks traditionally assigned to the state, resulting in perverse systemic outcomes, fabrications and performativities as principals of disadvantaged public schools enter into a type of funding lottery. The paper seeks to illuminate how the government has adopted commercial logics in public school funding models, but rather than true ‘risk-taking’ or entrepreneurialism, principals instead take up risk-aversion strategies. As principals experience intensifying marketisation of school funding, the process engenders a radical distortion of their traditional role as school leader, superseding their fundamental position as a professional educator.

Acquisition of Competencies and Practical Skills in Theory and their Exercise in the Practical Field

Introduction: Society demands that higher education institutions prepare highly qualified, competent and committed professionals. Objective: As a result, the study examined the acquisition of practical skills and competencies, both in theory and in their application in real-world settings. Methods: Questionnaires were administered to students in health sciences programs who were undertaking their pre-professional internships (PPP). Results: Through the analysis of results from supervised learning (AI), significant data was obtained showing that the relationship between theory and practice, through didactic tools (ICT) and appropriate environments, strengthens the PPP. It was also observed that the most satisfied age group was between 22 and 32 years old. Conclusions: it can be asserted that the integration of Information and Communication Technologies (ICT), along with simulation spaces and other resources, will enhance the training of health professionals.

Critical Teacher Education for Social Sustainability: Voices from Zambian Student Teachers and Tutors

ABSTRACT This study aims to reveal the contributions of teacher education to social sustainability in an African context. The study explored the gaps and connections between multiple layers of policy, global, regional, and national educational targets, and the voices of teacher education tutors and students from a local teacher education college in the Copperbelt region of Zambia. Semi-structured interviews were employed to gather participants’ views on their aspiration, knowledge transformation and professional capacity. Employing a critical realist approach, the study identifies four key ‘moments’ in teacher education (Robertson and Dale, 2015) and reveals dedicated teacher education practices that aim to support national economic development local demands for specialised subject knowledge, along with family and individual human needs within communities. The findings lead to a discussion mapping critical teacher education that promotes social sustainability within the Global South, emphasising the significant roles of teacher education in fostering a comprehensive understanding of societies and human well-being, encouraging reciprocal knowledge exchange within communities, and supporting the continued professional development of teachers.

Recent Advances in Non-Invasive Digital Nursing Technologies for Chronic Pain Assessment and Management: An Integrative Review.

This integrative review aims to identify what nurses currently offer through digital technology and their success in managing chronic pain. An integrative review guided by Whittemore and Knafl was conducted. Five databases-CINAHL, Medline, PsycINFO, PubMed, and Scopus-were utilised to gather relevant studies from January 2018 to November 2024. Selected studies were assessed using the Mixed Methods Appraisal Tool and the Joanna Briggs Appraisal Tool. Braun and Clarke's thematic analysis was applied to identify pertinent themes. Digital nursing technologies such as telehealth and web-based interventions effectively deliver interventions to assess and manage chronic pain; these technologies can reduce healthcare resource utilisation and increase accessibility. This review highlights that nurses commonly deliver exercise, cognitive-behavioural therapy, acceptance and commitment therapy and self-management techniques through digital technology. This review indicates that web-based interventions and telemedicine are the primary digital technologies employed by nurses for chronic pain management providing psychosocial interventions, with evidence supporting their effectiveness. Digital and web-based technology is essential to bridge healthcare access gaps as nurses can provide this successfully with minimal nursing support and cost to the patient. Evidence supports nurses in providing psychosocial interventions for the management of chronic pain, particularly web-based psychosocial interventions. Nurses need to adopt digital technology to improve access to care and patient outcomes and to maintain professional development in an increasingly digital world. No patient or public contribution was used for this study.

The other side of PhD education: A systematic review of research on PhD students' development as university teachers

AbstractThe professional development of PhD students as university teachers is crucial not only for their academic career trajectories, but also for improving teaching quality at universities. However, research on PhD students' professional growth has mainly focused on their role as researchers. As a result, much less is known about the other side of PhD education—their development as university teachers. This systematic review aims to examine the characteristics of existing studies in this area, identify the support available and explore challenges encountered in PhD students' development as university teachers. This review is based on two literature searches that both followed Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) reporting guidelines and identified 40 publications in three databases: ProQuest, Scopus and Web of Science. The selected papers exhibit homogeneity, with most being based on qualitative research conducted in the North American context. The findings indicate a lack of attention to doctoral candidates' development as university teachers in the literature. The findings also highlight the types of support available and the challenges encountered during their development as university teachers. Based on these findings, we propose a framework consisting of courses, practica and mentoring to inform efforts to support PhD students' development as university teachers. Context and implicationsRationale for this study: This review aims to explore the existing literature on PhD students' development in the role of university teachers, highlighting research gaps and identifying the factors that contribute to their development.Why the new findings matter: This review offers insights into the challenges PhD students face in their development as university teachers and how they can be supported, and proposes a framework of factors contributing to their development.Implications for PhD students, researchers and higher education institutions: PhD students can use these insights to address challenges they face during their development as university teachers. Researchers are provided with a review of existing literature and trends that highlights areas to be explored in future research, thus advocating for future studies on PhD students' experiences in their development as university teachers across different contexts. Higher education institutions can refer to the proposed framework of contributing factors to offer support for PhD students in terms of courses, practical teaching experiences and mentoring, thus fostering an environment in which PhD students' development as university teachers is actively integrated into their candidature.

Healthcare professionals’ understanding of children’s rights: a systematic review of the empirical evidence-base

BackgroundThe concept of children’s rights emerged during the 1980s and emphasised the role of children as active participants in matters which concern them.AimThis review aims to identify and synthesise the empirical evidence base on healthcare professionals’ (HCPs) understanding of children’s rights.MethodsFive electronic databases (PubMed, CINAHL, Embase, PsycINFO, and the Web of Science) were systematically searched in May 2023. The Mixed Methods Appraisal Tool (MMAT) was used to quality appraise full-text papers included in the review. A descriptive narrative synthesis of the studies’ findings was performed.ResultsA total of 15 relevant studies from 10 countries were identified and included in the review. The number of participants included ranged from 6 to 1048 for HCPs with a broad range of sampling methods. Based on the narrative synthesis of the included studies, three main themes were identified: (1) Barriers to implementing children’s rights in healthcare, (2) Factors that contribute to children’s rights implementation, and (3) Study instruments used to measure outcomes.ConclusionsHCPs require a better understanding of children’s rights to implement these rights into practice. Listening to children, building trusting relationships with children, and continuing professional development of HCPs could help to address barriers to understanding children’s rights. There is a pressing need for the development of a tool that is capable of tracking changes in the understanding of children’s rights in healthcare environments as efforts to increase awareness become more widely recognised.

Analyzing the impact of higher education on economic growth in Qatar

The complex interaction of higher education and economic growth has, in recent years, become a significant issue of international concern (Hanushek & Woessmann, 2020). In this regard, higher education and economic development in Qatar, which is undergoing one of the most rapid economic transformations, are discussed in terms of dynamics, challenges, and opportunities. This research encompasses the role of the State of Qatar's educational system in highlighting its strengths, besides challenges faced by learners, especially those aggravated by the COVID-19 pandemic, through critical areas like research-based educational practices, increased parental involvement in education, and professional development of educators. The data series employed in the present study are from the years 2000 to 2022 and test key variables, including graduate employment rates, GDP, income inequality, foreign direct investment, industry-academia collaboration, innovation, educational attainment, and labor force skills. As such, it becomes evident that about 66.5% of the variability in the GDP of Qatar can be explained by the type of these predictors, whereas on the positive axis, employment rates, labor force skills, and GDP are positively related. On the other hand, negative correlations between industry-academia collaboration and educational attainment do suggest that more nuanced policy interventions will be called for to maximize the benefit of higher education for economic growth. The findings should have useful implications for policymakers in pursuit of increasing the role of the education sector in Qatar's economic development.

Examining the Impact of Social Media on Teacher Resilience and Learning Outcomes: A Behavioral Study

The widespread integration of social media has reshaped the educational landscape, influencing teacher resilience and student learning outcomes. Teacher resilience, defined as the ability to adapt to stressors, and learning outcomes, encompassing academic engagement and performance, are increasingly impacted by the strategic use of social media. This study aims to examine the effects of social media on teacher resilience and learning outcomes, providing actionable insights for educators and policymakers. The study employed a quantitative methodology rooted in a positivist paradigm. Data were collected from 233 educational professionals and teachers using a structured questionnaire designed to measure demographic characteristics, the impact of social media on teacher resilience, and its influence on learning outcomes. Responses were analyzed using SPSS software for descriptive statistics, correlation, and regression analyses. Findings reveal that social media significantly enhances teacher resilience by fostering emotional support, professional networking, and resource sharing (β = 0.65, p < 0.001). Similarly, social media positively impacts learning outcomes through improved engagement and collaboration (β = 0.58, p < 0.001). Teacher resilience was also found to significantly predict learning outcomes (β = 0.72, p < 0.001). However, excessive use of social media can lead to distractions and reduced productivity. Limitations include the cross-sectional design, reliance on self-reported data, and context-specific findings. Future research should consider longitudinal designs, diverse populations, and intervention studies to optimize social media use in education. These insights contribute to the discourse on digital education, highlighting the potential of social media to foster resilience and learning.

Competence-Based Education Pedagogy and Its Infusion into Primary School Learning Activities: Experiences from Teachers in A Selected Cluster in Eswatini

This study sought to explore how Competency-Based Education (CBE) pedagogy was implemented in the selected primary schools and to understand teachers' experiences with this pedagogical approach. The study was rooted in a mixed research method approach. For this study, 24 respondents were selected through a stratified random technique. Data was collected through an interview and semi-structured questionnaire. In quantitative data, percentages were used, and qualitative data was analyzed according to emerging themes. This created the platform for quantitative and qualitative data to corroborate each other. The analyzed and interpreted data revealed that seminars, peer tutoring, and workshops were commonly used to prepare teachers to integrate CBE pedagogy into all learning activities. The results showed that student-centered methods, such as problem-solving, inquiry-based, project-based, and design-based learning, were central to CBE pedagogy's integration into primary school learning activities. Integrating CBE pedagogy in primary school teaching and learning fosters flexible, personalized learning emphasizing skills development. Based on the results, the teachers in the selected primary school's cluster facilitated the infusion of CBE pedagogy into learning activities. Continuous teachers' professional development should enhance their competencies in implementing CBE pedagogy into learning activities.

Utilization and prescription patterns of topical steroids: a study at dessie comprehensive specialized hospital, Ethiopia

BackgroundTopical steroids are widely used in dermatology for their anti-inflammatory and immunosuppressive effects, but misuse can cause skin thinning and systemic issues. In Ethiopia, where skin conditions are common, understanding how topical steroids are prescribed and used is essential for ensuring their safe and effective use.ObjectiveThe study aimed to assess topical steroids’ prescription and utilization pattern in Dessie Comprehensive Specialized Hospital (DCSH) from February 1 to May 30, 2024.MethodologyThe study used a descriptive, cross-sectional design with a quantitative approach, analyzing data from 175 patient records on prescription and utilization patterns of topical steroids at DCSH. Participants were selected using a random sampling technique. Data were categorized and analyzed using Microsoft Excel 2010, with findings presented through descriptive statistics, including tables and figures.ResultEczematous dermatitis (31.49%) was the most common skin disease observed, followed by dermatophytosis (12.15%). Out of 304 drugs prescribed, averaging 1.73 per prescription, clobetasol (44.4%) and betamethasone (25.0%) were the most common topical corticosteroids. These steroids were primarily prescribed for eczema, dermatitis, pigmentary disorders, psoriasis, urticaria, and lichen planus. The commonly prescribed drugs were topical steroids 108[35.53%]. Generic names were used for 54.63% of the 108 topical steroids prescribed.ConclusionThe study found that dermatitis and eczema are the most common skin conditions treated in dermatology clinics, with topical steroids being the main treatment. However, many prescriptions lacked details on the application site, treatment duration, and quantity. To improve safety and effectiveness, the study recommends community education, better dermatological services, and increased oversight in professional training.