Workforce Gaps Research Articles

Expanding the Interdisciplinary Palliative Medicine Workforce: A Longitudinal Education and Mentoring Program for Practicing Clinicians

ContextThe disparity between gaps in workforce and availability of palliative care (PC) services is an increasing issue in health care. To meet the demand, team-based PC requires additional educational training for all clinicians caring for persons with serious illness. ObjectivesTo describe the educational methodology and evaluation of an existing regional interdisciplinary PC training program that was expanded to include chaplain and social worker trainees. MethodsFrom 2015 to 2017, 26 social workers, chaplains, physicians, nurses, and advanced practice providers representing 22 health systems completed a two-year training program. The curriculum comprises biannual interdisciplinary conferences, individualized mentoring and clinical shadowing, self-directed e-learning, and profession-focused seminar series for social workers and chaplains. Site-specific practice improvement projects were developed to address gaps in PC at participating sites. ResultsPC and program development skills were self-assessed before and after training. Among 12 skills common to all disciplines, trainees reported significant increases in confidence across all 12 skills and significant increases in frequency of performing 11 of 12 skills. Qualitative evaluation identified a myriad of program strengths and challenges regarding the educational format, mentoring, and networking across disciplines. ConclusionTeaching PC and program development knowledge and skills to an interdisciplinary regional cohort of practicing clinicians yielded improvements in clinical skills, implementation of practice change projects, and a sense of belonging to a supportive professional network.

Talent Management an Emerging Trend for Employee Effectiveness in Corporate Hospitals

Talent management is considered an important factor for attaining competitive advantage and development of the firm in the current era. It deals with filling a vacant position with a talented workforce than a skilled workforce for the long-run objective of the firm. The present study was carried with an objective to identify the effectiveness of talent management practices and strategies in corporate hospitals. The study was conducted with 290 respondents in corporate hospitals in the Madurai district using a structured questionnaire. The result indicates the intention of talent management practices and strategies was; to build a deeper reservoir of successors at every level, creating a culture that makes employees stay with the firm and to identify gaps in the current workforce and their competency level. But, the talent management practices and strategies are effective in; Aligning workforce with the mission and vision of the organization, creating suitable policies that encourage individual career growth and development opportunities and Identifying and locating the qualified professionals needed.

Workforce Gap Analysis in the Field of Headache Medicine in the United States

Vox Clamantis Workforce Gap Analysis in the Field of Headache Medicine in the United States Olivia Begasse de Dhaem MD, Corresponding Author Olivia Begasse de Dhaem MD begassededhaem@gmail.com Division of Headache, Department of Neurology, John R. Graham Headache Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA Address all correspondence to O. Begasse de Dhaem, Division of Headache, Department of Neurology, John R. Graham Headache Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA, email: begassededhaem@gmail.comSearch for more papers by this authorRebecca Burch MD, Rebecca Burch MD Division of Headache, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USASearch for more papers by this authorNoah Rosen MD, FAHS, Noah Rosen MD, FAHS Department of Neurology, Zucker School of Medicine Northwell Health, Hempstead, NY, USASearch for more papers by this authorKen Shubin Stein MD, MPH, MS, CPH, CFA, Ken Shubin Stein MD, MPH, MS, CPH, CFA Neurology, Northwell Health, Great Neck, NY, USASearch for more papers by this authorElizabeth Loder MD, MPH, Elizabeth Loder MD, MPH Division of Headache, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USASearch for more papers by this authorRobert E. Shapiro MD, PhD, Robert E. Shapiro MD, PhD Department of Neurological Sciences, Division of Headache Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USASearch for more papers by this author Olivia Begasse de Dhaem MD, Corresponding Author Olivia Begasse de Dhaem MD begassededhaem@gmail.com Division of Headache, Department of Neurology, John R. Graham Headache Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA Address all correspondence to O. Begasse de Dhaem, Division of Headache, Department of Neurology, John R. Graham Headache Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA, email: begassededhaem@gmail.comSearch for more papers by this authorRebecca Burch MD, Rebecca Burch MD Division of Headache, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USASearch for more papers by this authorNoah Rosen MD, FAHS, Noah Rosen MD, FAHS Department of Neurology, Zucker School of Medicine Northwell Health, Hempstead, NY, USASearch for more papers by this authorKen Shubin Stein MD, MPH, MS, CPH, CFA, Ken Shubin Stein MD, MPH, MS, CPH, CFA Neurology, Northwell Health, Great Neck, NY, USASearch for more papers by this authorElizabeth Loder MD, MPH, Elizabeth Loder MD, MPH Division of Headache, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USASearch for more papers by this authorRobert E. Shapiro MD, PhD, Robert E. Shapiro MD, PhD Department of Neurological Sciences, Division of Headache Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USASearch for more papers by this author First published: 27 January 2020 https://doi.org/10.1111/head.13752Citations: 13 Conflict of Interest: Dr. Begasse de Dhaem has nothing to disclose. She is an Assistant Editor for Headache. Dr. Burch has nothing to disclose. She is an Associate Editor for Headache. Dr. Rosen has the following disclosures: Allergan: honoraria for speaking, advisory board, and research support. Alder: honoraria for advisory board. American Headache Society: honoraria for speaking. American Academy of Neurology: honoraria for speaking. Amgen/Novartis: honoraria for advisory board. Biohaven: honoraria for advisory board. Eli Lilly and Company: honoraria for advisory board, research support. Promius: honoraria for advisory board. Revance: honoraria for consulting. Springer: honoraria for associate editorship. Supernus: honoraria for advisory board. Teva: honoraria for advisory board. Associate Editor for Headache and Current Pain and Headache Reports. Dr. Stein has nothing to disclose. Dr. Loder has nothing to disclose. Dr. Shapiro has received fees for consulting from Eli Lilly within the past 24 months. Funding: None Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume60, Issue2February 2020Pages 478-481 RelatedInformation

Reflective debrief and the social space: offload, refuel, and stay on course

Relentless workloads are birthing unprecedented levels of burnout, mental ill health, substance misuse, and suicide amongst clinical staff working in the NHS. The consequent epidemic of sickness absence, early retirement, and poor staff retention means the workforce gap is widening at an alarming rate within the caring professions. The clarion call rings out loud, clear, and with urgency for organisational engagement in preventative measures to invest in its human capital. Interventions for increasing clinician wellbeing and resilience must encompass strategies at the personal level, at peer groups and teams, right through to the level of the culture and practices - the "operating system" - of the whole organisation. In hospitals across the nation, where the pervading environment is one of "lack" - time, space, thanks, morale - significant casualties are a sense of "community at work" and sanctioned time for reflective practice. Relaxed, reflective group debrief cultivates relational connection, enables off-loading of the burdens associated with caring and guides reflective "work on work". Clinicians attending reflective groups appreciate the opportunity for a "space to breathe", for self-reflection, mindfulness, and self-care, whilst gaining professional robustness and a sense of value and team. Could the low-cost model of monthly, facilitated "clinician wellbeing and debrief" gatherings and the provision of "pop-up" departmental café spaces, as pioneered in Cambridge, UK, significantly enrich our healthcare system's culture of "lack"?

Critical Workforce Gaps in Dementia Education and Training.

The US Department of Health and Human Services and the Foundation for the National Institutes of Health, through private sector support, sponsored the National Research Summit on Dementia Care: Building Evidence for Services and Supports (Summit) in 2017. Various workgroups were asked to address topics of interest in dementia care and develop recommendations addressing the goals of the Summit. Workforce education and training was identified to be a key issue. As a result, a Workforce Development Workgroup (the Workgroup) was created and addressed two of the Summitʼs goals. The first goal is to improve the quality of care and support provided to persons living with dementia and those who care for them. The second goal is to accelerate the development, evaluation, translation, implementation, and scaling‐up of evidence‐based and evidence‐informed services for persons living with dementia, their families, and caregivers. In this article, the Workgroup identified gaps in educating and training a dementia‐capable workforce. The Workgroup consisted of an interprofessional team with expertise in dementia workforce development from academia, professional organizations, and the federal government. Four recommendations are presented concerning research topics that will advance the education and training of a dementia‐capable workforce, which includes health professions students, faculty, practitioners, direct care workers, persons living with dementia, and those who care for them. J Am Geriatr Soc 68:625–629, 2020

Challenges and Best Practices for Implementing Rurally Targeted Admissions in U.S. Medical Schools.

Student attributes can predict future rural practice, but little is known about how medical schools use these factors in admissions. This mixed-methods study examined admissions strategies to recruit and select students likely to practice rurally. Admissions personnel at U.S. allopathic and osteopathic medical schools were surveyed about rurally targeted admissions. Personnel from selected schools were interviewed to understand further targeted admissions practices. Among 185 medical schools, 133 (71.8%) responded. Schools engaged with students from four-year universities through career exploration (89.9%), admissions preparation (57.7%), academic enhancement (47.7%), and articulation agreements (42.9%). Applicant selection practices included preferential scoring in screening (38.2%) and admissions decisions (30.0%), modified MCAT (21.4%) and GPA cutoffs (18.8%), and reserved class slots (20.2%). Personnel from 10 schools identified key themes of motivations, resources, challenges, and recommendations. Understanding how schools identify and admit rurally inclined students is a first step in identifying best practices for addressing rural workforce gaps.

Interprofessional Master of Science in Palliative Care: On Becoming a Palliative Care Community Specialist.

Background: Palliative care (PC) is a limited resource in health care systems. Many providers develop a PC interest later in their careers when it is difficult to relocate and compete for a limited number of training positions. In communities without an academic tertiary medical center, interprofessional PC community specialists are poised to deliver high-quality accessible PC to patients/families with needs beyond what can be addressed by primary care providers. Objective: An interprofessional 36-credit Master of Science in Palliative Care (MSPC) provides evidence-based education to nurses, pharmacists, physicians, physician assistants, social workers, spiritual care providers, psychologists, counselors, and other allied health professionals. Design: The predominantly online curriculum, designed and taught by an interprofessional faculty, focuses on interdisciplinary teamwork, communication skills, and practical application of biomedical and psycho-sociocultural-spiritual-ethics content. The pedagogy is narrative based, emulating in-person clinical experiences, with patient cases progressing throughout the curriculum. We have enrolled four student cohorts. Measurements: Student self-assessments pre-mid-post program. Results: Students highly rate curriculum with demonstrated application of knowledge in case integration assignments, simulations with standardized patients, and Capstone Projects. Students' self-assessed skills on a 39-item scale increased on average to the highest level of 5 (able to perform independently and teach others). Conclusions: The inaugural student cohort reports high levels of engagement and satisfaction, including mastery and synthesis of didactic and experiential content through case integration projects. Students who worked in PC/hospice settings have advanced in their professions; others have transitioned to PC work. The MSPC has capacity to meet projected PC workforce gaps.

Accelerated programmes in children's nursing to tackle the workforce gap in the United Kingdom: A cost-consequences analysis

BackgroundWith alarming vacancy rates and dipping availability of European nurses, remedies for the shortage of nurses in the UK are urged. To accelerate the registration of new children's nurses, a health education funder commissioned two education programmes within its region. The first is a 1-year programme designed for UK-registered nurses in adult or mental health. The second is a 2-year programme for individuals, not registered as nurses, who are child or social care graduates with experience of working with children and young people. ObjectivesTo evaluate the economic effectiveness of two accelerated children's nursing education programmes. DesignEconomic evaluation. SettingsTwo accelerated children's nursing education programmes in two sites in England. ParticipantsNursing students enrolled in both programmes (N = 20). MethodsWe adopt a cost-consequences analysis to analyse the programmes' costs and outcomes. ResultsAll graduates were heading for posts within the region where they studied, a favourable outcome for the funder. However, the first programme would deplete the workforce in other nursing fields, whereas the second, by quickening the graduates' career progression, would not dent the long-term shortage in entry roles. Given our small sample size, these impacts may differ if the programmes have wider implementation. ConclusionsOur evaluation measures the effectiveness of two novel accelerated education programmes in tackling the nurses' shortage. Concurrently, it contributes to developing a standardised approach for future economic evaluations in nursing education.

Exploring health workforce regulation practices and gaps in Ethiopia: a national cross-sectional study

BackgroundHealth workforce regulation plays key roles in ensuring the availability of competent health workers and improving performance of the health system. In 2010, Ethiopia established a national authority aiming to ensure competence and ethics of health professionals. Subsequently, subnational regulators were established and regulatory frameworks were developed. Although there were anecdotal reports of implementation gaps, there was lack of empirical evidence to corroborate the reports. We conducted a national study to explore health professional regulation practices and gaps focusing on registration, licensing, ethics, scope of practice, and continuing professional development.MethodsWe conducted a mixed methods cross-sectional survey using structured interview with a national representative sample of health professionals and key informant interviews with health regulators and managers. We used two stage stratified cluster sampling to select health professionals. The quantitative data were subjected to descriptive and multivariable logistic regression analysis. We conducted thematic analysis of the qualitative data.ResultsWe interviewed 554 health professionals in the quantitative survey. And 31 key informants participated in the qualitative part. Nearly one third of the respondents (32.5%) were not registered. Many of them (72.8%) did not renew their licenses. About one fifth of them (19.7%) did nothing against ethical breaches encountered during their clinical practices. Significant of them ever practiced beyond their scope limits (22.0%); and didn’t engage in CPD in the past 1 year (40.8%). Majority of them (97.8%) never identified their own CPD needs. Health regulators and managers stressed that regulatory bodies had shortage of skilled staff, budget and infrastructure to enforce regulation. Regulatory frameworks were not fully implemented.ConclusionsHealth professionals were not regulated well due to limited capacity of regulators. This might have affected quality of patient care. To ensure effective implementation of health professional regulation, legislations should be translated into actions. Draft guidelines, directives and tools should be finalized and endorsed. Capacity of the regulators and health facilities needs to be built. Reinstituting health professionals’ council and regulation enforcement strategies require attention. Future studies are recommended for assessing effects and costs of weak regulation.

Workforce requirements for comprehensive ischaemic stroke care in a developing country: the case of Saudi Arabia

BackgroundIschaemic stroke care requires a co-ordinated multi-disciplinary approach to optimise patient outcomes. Current care provision in Saudi Arabia is below international recommendations, and with increasing patient numbers, variable access to new therapies, and sub-optimal co-ordination of staff, the Kingdom’s Ministry of Health has prioritised strategies to develop stroke care. Our objective was to use local epidemiological data to predict stroke incidence and to combine this with international staffing recommendations to estimate future staff requirements and their costs over a 10-year period.MethodsWe researched existing stroke services and staff availability within Saudi Arabia to establish current provision, undertook epidemiological modelling to predict stroke incidence, and used international staffing recommendations for acute and rehabilitation services to develop a care pathway to provide state-of-the-art stroke services. This information was used to determine the additional staff requirements, and their costs, across the Kingdom.ResultsOur research concluded that current staff numbers and services are inadequate to cope with the projected increase in the number of stroke cases. In order to provide acute and rehabilitation services which use the latest technologies, re-organisation of existing staff and services would be required, together with significant investment in new staff across several disciplines. An estimated additional 43.8 full-time equivalent stroke neurologists would be required, plus 53.5 full-time equivalent interventional neuroradiologists in addition to expansion of occupational therapy and psychology services. The total cost of additional staff over 10 years was estimated to be 862 390 778 Saudi Riyals ($229 970 874).ConclusionsProviding high-quality care for ischaemic stroke patients would involve significant investment in new staff in Saudi Arabia. Further research is required on the applicability of international staffing ratios to countries where there is a significant workforce gap. Nevertheless, this analysis provides a framework to inform stroke care planning and can be adapted to other regions or countries.

Home Health Care For Children With Medical Complexity: Workforce Gaps, Policy, And Future Directions.

With the medical and surgical advances of recent decades, a growing proportion of children rely on home-based care for daily health monitoring and care tasks. However, a dearth of available home health care providers with pediatric training to serve children and youth with medical complexity markedly limits the current capacity of home health care to meet the needs of patients and their families. In this article we analyze the workforce gaps, payment models, and policy challenges unique to home health care for children and youth with medical complexity, including legal challenges brought by families because of home nursing shortages. We propose a portfolio of solutions to address the current failures, including payment reform, improved coordination of services and pediatric home health training through partnerships with child-focused health systems, telehealth-enabled opportunities to bridge current workforce gaps, and the better alignment of pediatric care with the needs of adult-focused long-term services and supports.

Cybersecurity Interventions for Teens: Two Time-Based Approaches

<italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Contribution:</i> Intervention effectiveness is shown to vary in its influence on teenagers’ outcomes with cybersecurity problem-solving and engagement. In-depth, high-intensity types of intervention may be more effective for female students. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Background:</i> Instructional interventions are being developed to address both the critical shortage in cybersecurity talent and gender gaps in the cyber workforce. These interventions need rigorous evaluation. Specific types of instructional strategies are particularly effective for STEM learning. Also, gender differences are found in the benefit students derive from certain instructional methods. An important question is whether certain instructional methods are particularly effective for cybersecurity learning, and consistent in both male and female students. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Research Questions:</i> Do cybersecurity interventions affect problem-solving, cybersecurity engagement, and/or cybersecurity self-efficacy? Are there gender differences in terms of intervention effectiveness? <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Methodology:</i> Study 1 ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">${n}\,\, {=}$ </tex-math></inline-formula> 79) included a 60-min workshop model where participants, assigned to treatment and control groups, completed surveys pre- and post-intervention. The treatment group experienced a workshop on computer networking, without any technology. The control group did not receive the workshop. Study 2 ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">${n}\,\,{=}$ </tex-math></inline-formula> 34) was a week-long intervention whose participants had formal lessons, built websites, and defended themselves from an ongoing simulated cyberattack. Participants completed a survey on cybersecurity learning and engagement three times during the intervention. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Findings:</i> Study 1 showed no main treatment effect, but females experienced greater gains in problem-solving than males. In Study 2, there was positive growth over time and females experienced greater growth in cybersecurity self-efficacy relative to males.

The regional medical campus model and rural family medicine practice in British Columbia: a retrospective longitudinal cohort study.

Regional medical campuses have been implemented across North America to address gaps in the physician workforce. We report findings from a study that examined the association between a combined model of regional medical campuses and students' decision to enter rural family medicine practice. In 2004, the University of British Columbia added 2 regional medical campuses, 1 in a large population centre in a rural and coastal context and 1 in a medium-sized population centre in an isolated northern and rural context. Data were extracted from the University of British Columbia's Medical Education Database. Multivariable logistic regression examined the relationship of age, sex, rural background and campus location to students' choice of rural family medicine practice. There was an association between campus location and choice of family medicine versus other specialties. A rural background (odds ratio [OR] 2.59, 95% confidence interval [CI] 1.08-6.21) and training at either of the 2 regional medical campuses (OR 3.24, 95% CI 1.19-8.83 and OR 5.38, 95% CI 2.24-12.91) predicted rural family practice. Choosing to practise family medicine in a rural location was associated with having a rural background and having trained at a regional medical campus. These early results suggest that a combined regional campus model in medical education contributes to the rural family practice workforce.

Experiences of Community Youth Leaders in a Youth-Led Early Childhood Education Program in Rural Pakistan

Abstract. Youth-led early childhood care and education (ECCE) programs offer a promising model for achieving multiple Sustainable Development Goal targets. The program “Youth Leaders for Early Childhood Assuring Children are Prepared for School” (LEAPS) was developed to address the educational needs of children and female youth in rural Sindh, Pakistan. In LEAPS, community youth leaders (CYLs), aged 18–24 years, implement an ECCE program after receiving targeted, practical training and engaging in continuous mentoring and communities of practice. This paper focuses on the experience of LEAPS participation for ten CYLs. Using random intercept generalized linear latent and mixed models, significant improvements were observed in ECCE and professional skills. Quantitative analyses were triangulated with results from a qualitative analysis of two CYL exit focus group discussions. Findings suggest that, in some contexts, youth-led ECCE models can feasibly address ECCE workforce gaps while offering leadership and professional development opportunities for youth.

Public Health Workforce Development Needs: A National Assessment of Executives’ Perspectives

Workforce development is one of the ten essential public health services. Recent studies have better characterized individual worker perceptions regarding workforce interests and needs, but gaps remain around workforce needs from program managers' perspectives. This study characterized management perspectives regarding subordinate's abilities and training needs and perceived challenges to recruitment and retention. In 2017, the Directors Assessment of Workforce Needs Survey was sent to 574 managers at state health agencies across the U.S. Respondents were invited based on the positions they held (i.e., to be included, respondents had to be employed as managers and oversee specific program areas). In 2018, descriptive statistics were calculated, including Fisher's exact for inferential comparisons and Tukey's test for multiple comparisons, as appropriate. Response rate was 49% after accounting for undeliverable e-mails; 226 respondents met the inclusion criteria. The largest perceived barriers to staff recruitment were wages or salaries (74%) and private sector competition (56%). Similarly, wages or salaries were identified as the main cause of turnover by 70% of respondents, followed by lack of opportunities for advancement (68%), and opportunities outside the agency (67%). The Directors Assessment of Workforce Needs Survey fills important knowledge gaps and complements previously identified evidence to guide refinement of workforce development efforts. Although competition from the private sector remains challenging, these findings indicate that recruitment and retention must be top priorities in state health agencies nationwide. Prioritizing individual state health agency workforce gaps and committing to provide specific local-level interventions to those priorities is crucial for individual health agencies.

Addressing timely care, workforce shortage via telepsychiatry

The field continues to witness a rapidly growing demand for behavioral health services and the lack of psychiatrists to meet this demand. Leveraging staff to care for the influx of patients becomes even more important. Subsequently, some community mental health organizations are taking the leap into telepsychiatry services in order to fill expected workforce gaps.

Pregnant women with opioid use disorder and their infants in three state Medicaid programs in 2013–2016

BackgroundMaternal opioid use disorder (OUD) has serious consequences for maternal and infant health. Analysis of Medicaid enrollee data is critical, since Medicaid bears a disproportionate share of costs. MethodsThis study analyzes linked maternal and infant Medicaid claims data and infant birth records in three states in the year before and after a delivery in 2014–2015 (2013–2016) examining health, health care use, treatment, and neonatal outcomes. Diagnosis and procedure codes identify OUD and other substance use disorders (SUDs). ResultsIn the year before and after delivery, 2.2 percent of the sample had an OUD diagnosis, and 5.9 percent had a SUD diagnosis other than OUD. Of the women with OUD, 72.8% had treatment for a SUD in the year before and after delivery, but most had none in an average enrolled month, and only 8.8% received any methadone treatment in a given month. Pregnant women with OUD had delayed and lower rates of prenatal care compared to women with other substance use disorders (SUDs). Infants of mothers with OUD did not differ from infants of mothers with other SUDs in rate of preterm or low birth weight but had higher NICU admission rates and longer birth hospitalizations. Health care costs for women with an OUD were higher than those with other SUDs. ConclusionsThere is an urgent need for comprehensive, evidence-based OUD treatment integrated with maternity care. To fill critical gaps in care, workforce and infrastructure innovations can facilitate delivery of preventive and treatment services coordinated across settings.

David Oliver: Falling immigration could destroy the NHS.

Workforce gaps currently pose a major threat to the viability of our health services, as noted in a joint 2018 report by the King’s Fund, Nuffield Trust, and Health Foundation.1 One in 11 NHS clinical posts is currently unfilled, rising to one in eight nursing posts.2 The report estimates that, without concerted action, the current shortage of NHS staff employed by trusts in England—already around 100 000—will grow to an estimated 250 000 by 2030. Some of the proposed solutions have been put forward before, by organisations including NHS Providers3 and the Royal College of Physicians.4 These centre on training more staff at home and doing more to look after staff so that more of them stay in the workforce. But this will take years, so …

Sustainability of a field epidemiology and laboratory training programme: the Ghanaian story.

IntroductionField Epidemiology Training Programmes (FETPs) are functional ways of strengthening epidemiology, surveillance and outbreak response capacity in countries. However, sustainability of FETPs is a major challenge facing most countries especially in Africa. The Ghana Field Epidemiology and Laboratory Training Program (GFELTP) started in 2007 in the University of Ghana School of Public Health as a solution to gaps in the public health workforce. This paper assessed the sustainability strategies embedded in the Ghana Field Epidemiology and Laboratory Training Programme.MethodsWe assessed the sustainability of GFELTP by document reviews and interviews with programme staff and stakeholders to identify sustainability structures (programme, financial and institutional) that were in place. We grouped information into the following headings: programme structure, institutional, financial and political structures.ResultsAs of July 2017, a total of 350 public health experts have been trained in both frontline and advanced courses since the programme's inception. For funding structures, the programme is funded mainly by its partners and stakeholders who are local government organisations. They provide resources for running of programme activities. Under institutional and political structures, the programme was established as a Ministry of Health/Ghana Health Service programme based in the University of Ghana. The programme steering committee which is currently chaired by the Director Public Health of Ghana Health Service, jointly ensures its implementation. Other structures of sustainability observed were involvement of stakeholders and alumni in human resource of the programme; use of stakeholders as faculty for the programme. These stakeholders include staff from University of Ghana School of Public Health, Ghana Health Service and Veterinary Service Department, World Health Organization and Centers for Disease Control and Prevention. The programme showed evidence of stable sustainability strategies in all four structures evaluated.ConclusionThe assessment found the GFELTP to be sustainable. The main factors that contributed to rendering it sustainable were funding, programme, institutional and political structures embedded in the programme. One remarkable sustainability element observed was the strong collaboration that existed between stakeholders of the programme who worked hand in hand to ensure the programme runs smoothly. However, more sources of funding and other essential resources need to be considered to help the programme obtain a pool of resources for carrying out its activities.

MOOCs and upskilling in Australia: A qualitative literature study

Access to digital technology has demonstrated the ability to change learning in the workplace with easily available resources and flexibility through often self-paced learning environments, offering employees the ability to take control of their learning experiences. The scarce existing body of research suggests that 'specialised' [Massive Online Open Courses] MOOCs may be an effective means of upskilling the workforce. Whilst MOOCs offer a convenient, scalable and cost-effective means for businesses looking to increase or update skills within their workforce, much uncertainty still exists about both Australian employers' and employee perceptions and attitudes towards the use of MOOCs as a way of addressing the skills gaps. The aim of this study was to explore the potential for MOOCs in addressing the skills gaps in the Australian workforce through a systematic qualitative review of the literature. In total, 19 research and media articles were reviewed. Three major themes emerged: MOOCs and flexibility for learning, MOOCs for on-demand, lifelong learning in a rapidly changing workplace, and credentialing of MOOCs towards a formal qualification. This study aims to contribute to this growing area of research by exploring the extent to which MOOCs might help address skills shortages and upskill employees in an Australian context.