Workforce Outcomes Research Articles

The role of education, occupational match on job satisfaction in the behavioral and social science workforce

While many studies that have been conducted in recent years examining the education and workforce outcomes of STEM graduates, few have focused on the behavioral and social sciences (BSS). Federal agencies, such as National Institutes of Health (NIH), are implementing policies to foster multidisciplinary research in an effort to find more effective solutions to complex problems. As a result, there is growing interest in the career pathways of BSS scientists. This study seeks to increase our understanding of how BSS graduates, particularly women and underrepresented minorities, transition to employment within their respective fields. The focus of this research is the impact of horizontal mismatch, defined as the misalignment between a worker's degree and occupational fields, on job satisfaction and wage outcomes. This analysis of returns to education when mismatch occurs, including a comparison among majors and various demographic groups, provides insights into the labor market experiences of these scientists. Mismatched graduates were found to be much more vulnerable, earning less, and having lower job satisfaction, than their counterparts employed in jobs that aligned with their field of study. Additional job-related training was found to have a positive influence on these outcomes. Also of interest in this study were variations in wage penalties and job satisfaction between groups having different gender and race diversity characteristics. These findings are useful to human resource development (HRD) professionals, governmental policymakers, and other stakeholders seeking strategies to improve the workforce outcomes of BSS scientists.

Interprofessional Education and Development (IPED): A longitudinal team-based learning course introducing teamwork/collaboration, values/ethics, and safety/quality to health professional students

Abstract The task of developing large-scale interprofessional education (IPE) across multiple health professions schools to meet accreditation standards is daunting. This curricular resource describes Interprofessional Education and Development (IPED), a required longitudinal course addressing essential interprofessional competencies for entry-level health professions students. Competency domains include teamwork/collaboration, values/ethics, and quality/safety. Materials developed by interprofessional curriculum committees include content from our longstanding Ethics in the Health Profession course 1 as well as TEAMSTEPPS 2 and the Institute for Healthcare Improvement (IHI) Open School. 3 IPED uses team-based learning (TBL) methodology to create active individual and team learning experiences standardized for a large number of student teams using a small number of faculty. As outcomes of the course, students are able to: 1. Demonstrate knowledge, skills and behaviors of teamwork/collaboration, values/ethics, and quality/safety as an interprofessional team member. 2. Demonstrate collaboration, teaming skills and behaviors as an interprofessional team. 3. Identify the unique roles and responsibilities of each health care professional within the interprofessional team. 4. Articulate a shared, interprofessional identity as a health care professional. Individual readiness assurance tests (iRAT) and final exam scores demonstrate knowledge acquisition across competency domains for each student (Outcome 1). Team readiness assurance test (tRAT) scores demonstrate team acquisition of knowledge, skills and abilities (Outcome 2). Students’ self-assessed ability to explain skills necessary for effective team functioning (Outcome 2) and roles and responsibilities (Outcome 3) increase significantly from before to after the course. The majority of students agree that IPED improves their ability to work collaboratively with other health professionals, and helps prepare them to participate as a member of a collaborative interprofessional workforce (Outcome 4). This intervention is important because it demonstrates that large-scale IPE for entry-level health professions students is feasible in a longitudinal TBL format, and that it successfully develops necessary baseline knowledge and skills for interprofessional practice.

Nursing in Chilean Hospitals: A Research Agenda to Inform Health Policies and Improve Patient Outcomes.

The ongoing challenge for Chilean hospitals of meeting population health needs merits attention to the health care workforce. No studies have explored how nursing might contribute to addressing this challenge. International research shows that organizational characteristics of the nursing workforce and practice environment are associated with patient outcomes. Chile lacks actionable evidence that applies to its context of care. First, a review of international literature was developed to synthesize evidence on the association between organizational characteristics of the nursing workforce and patient outcomes. Second, a review of literature and other nonacademic sources was performed to describe the context of care and data pertaining to nurses in Chilean hospitals. Third, a research agenda for efficient utilization of the hospital nursing workforce in Chile was proposed. International evidence shows that low patient-to-nurse ratios, high skill mix, and good practice environments are associated with better patient outcomes. Chilean hospitals have financial constraints that greatly influence the context of nursing practice and the scarce data about nursing organization call for greater attention. The establishment and implementation of a research agenda is needed to build local evidence regarding effective organization of nurses to inform policies and to improve patient outcomes in Chile.

Evidence-based Nurse Staffing: ICN's New Position Statement.

Evidence-based Nurse Staffing: ICN's New Position Statement.

Impact of nurse staffing on patient and nurse workforce outcomes in acute care settings in low- and middle-income countries: a systematic review protocol.

The objective of this review is to demonstrate the effect of nurse staffing on patient and nurse workforce outcomes in acute care settings in low- and middle-income countries.

Rural training pathways: the return rate of doctors to work in the same region as their basic medical training

BackgroundLimited evidence exists about the extent to which doctors are returning to rural region(s) where they had previously trained. This study aims to investigate the rate at which medical students who have trained for 12 months or more in a rural region return to practice in that same region in their early medical career. A secondary aim is to investigate whether there is an independent or additional association with the effect of longer duration of rural exposure in a region (18–24 months) and for those completing both schooling and training in the same rural region.MethodsThe outcome was rural region of work, based on postcode of work location in 2017 for graduates spanning 1–9 years post-graduation, for one large medical program in Victoria, Australia. Region of rural training, combined with region of secondary schooling and duration of rural training, was explored for its association with region of practice. A multinomial logistic regression model, accounting for other covariates, measured the strength of association with practising in the same rural region as where they had trained.ResultsOverall, 357/2451 (15%) graduates were working rurally, with 90/357 (25%) working in the same rural region as where they did rural training. Similarly, 41/170 (24%) were working in the same region as where they completed schooling. Longer duration (18–24 vs 12 months) of rural training (relative risk ratio, RRR, 3.37, 1.89–5.98) and completing both schooling and training in the same rural region (RRR: 4.47, 2.14–9.36) were associated with returning to practice in the same rural region after training.ConclusionsMedical graduates practising rurally in their early career (1–9 years post-graduation) are likely to have previous connections to the region, through either their basic medical training, their secondary schooling, or both. Social accountability of medical schools and rural medical workforce outcomes could be improved by policies that enable preferential selection and training of prospective medical students from rural regions that need more doctors, and further enhanced by longer duration of within-region training.

Evidence-Based Teacher Preparation: Policy Context and What We Know

Teacher preparation programs (TPPs) have received a great deal of policy and research attention of late. And despite the commonsense notion that preparation for formal classroom responsibilities should improve the readiness of teacher candidates, the value of formalized preservice teacher education is unclear. In this review of the quantitative evidence about TPPs, I find that most studies show only minor differences in the value added of teachers who graduate from different programs, and that there are only a few studies that focus on the association between the features of teacher preparation and teacher workforce outcomes. The lack of evidence on the importance of the features of teacher preparation is primarily due to data deficiencies: data often do not permit connections between TPP features and teacher workforce outcomes. As a consequence, feedback loops that could theoretically provide TPPs with actionable information about program design typically do not exist.

Two decades of building capacity in rural health education, training and research in Australia: University Departments of Rural Health and Rural Clinical Schools.

This review article reports on the contribution of university Departments of Rural Health and Rural Clinical Schools to the development of rural health and the rural health workforce and is set at the Australian Government's university Departments of Rural Health and Rural Clinical Training and Support Programs. The main outcome measures include educational infrastructure, clinical academic workforce, student numbers, community engagement, research outputs, rural health and workforce outcomes. As a result, university Departments of Rural Health and Rural Clinical Schools have established a substantial geographical footprint covering most of the rural and remote populations and regions across Australia. They have a large distributed rural clinical academic workforce that exceeds 1300. Medical student numbers on long-term placements have increased threefold from inception to 1200 annually. Allied health and nursing numbers doubled over 10years to 4000 in 2013 and are projected to double again by 2018. In 2013, they published 363 peer-reviewed papers - half of which specifically addressed rural and/or remote health issues. High levels of intention to practise rurally and uptake of rural and remote practice following exposure to rural training have been reported, especially for medicine. Thus, university Departments of Rural Health and Rural Clinical Schools constitute a national network of academic units that deliver academically enriched clinical education and training for medical, nursing and allied health students and fulfil an essential academic role for the health system in rural and remote Australia. Community engagement and accountability to region are hallmarks of the program. Early evidence of the uptake of rural and remote practice following exposure to rural training has set expectations for the Rural Health Multidisciplinary Training Program.

Workforce Retention and Wages in Nursing Homes: An Analysis of Managerial Ownership.

Owner-managers are administrators that hold significant equity interests in the facility they operate. We examine how the presence of owner-managers is related to the workforce outcomes of retention and wages in nursing homes (NHs). Using a sample of for-profit NHs in Ohio from 2005 to 2015, multivariate regression analysis compares workforce outcomes in facilities operated by owner-managers to salaried managers. On average, owner-managed NHs have higher workforce retention rates, with larger effects among chain-affiliated NHs. Better retention is not achieved through higher wages, as we do not find higher wages at owner-managed NHs. Further qualitative studies are warranted to identify the exact mechanisms which lead to owner-managers having better staff retention rates. Plausible mechanisms include greater autonomy to allocate resources and create policies that foster a work environment that achieves better retention while maintaining financial sustainability.

The impact of rural outreach programs on medical students\u2019 future rural intentions and working locations: a systematic review

BackgroundSignificant investment has been undertaken by many countries into ‘Rural Clinical Training Placement Schemes’ for medical students in order to deal with shortages of trained health care professionals in rural and remote locations. This systematic review examines the evidence base of rural educational programs within medical education and focusses on workforce intentions and employment outcomes. The study provides a detailed description of the methodological characteristics of the literature, thematic workforce outcomes and key related factors are identified, study quality is assessed, and the findings are compared within an international context.MethodsA systematic review looking at international literature of rural placement programs within medical education between January 2005 to January 2017 from databases including; Medline, Embase, NursingOVID, PubMed and Cochrane. The study adopted the PRISMA protocol. A quality assessment of the literature was conducted based on the Health Gains Notation Framework.ResultsSixty two papers met the inclusion criteria. The review identified three program classifications; Rural Clinical Placement Programs, Rural Clinical Placement Programs combined with a rural health educational curriculum component and Rural Clinical School Programs. The studies included were from Australia, United States, Canada, New Zealand, Thailand and Africa.Questionnaires and tracking or medical registry databases were the most commonly reported research tools and the majority were volunteer programs. Most studies identified potential rural predictors/confounders, however a number did not apply control groups and most programs were based on a single site. There was a clear discrepancy in the ideal rural clinical placement length. Outcomes themes were identified related to rural workforce outcomes. Most studies reported that an organised, well-funded, rural placement or rural clinical school program produced positive associations with increased rural intentions and actual graduate rural employment.ConclusionsFuture research should focus on large scale methodologically rigorous multi-site rural program studies, with longitudinal follow up of graduates working locations. Studies should apply pre-and post-intervention surveys to measure change in attitudes and control for predictive confounders, control groups should be applied; and in-depth qualitative research should be considered to explore the specific factors of programs that are associated with encouraging rural employment.

Health workforce planning: which countries include nurse practitioners and physician assistants and to what effect?

BackgroundAn increasing number of countries are introducing new health professions, such as Nurse Practitioners (NPs) and Physician Assistants (PAs). There is however limited evidence, on whether these new professions are included in countries’ workforce planning. MethodsA cross-country comparison of workforce planning methods. Countries with NPs and/or PAs were identified, workforce planning projections reviewed and differences in outcomes were analysed, based on a review of workforce planning models and a scoping review. Data on multi-professional (physicians/NPs/PAs) vs. physician-only models were extracted and compared descriptively. Analysis of policy implications was based on policy documents and grey literature. ResultsOf eight countries with NPs/PAs, three (Canada, the Netherlands, United States) included these professions in their workforce planning. In Canada, NPs were partially included in Ontario’s needs-based projection, yet only as one parameter to enhance efficiency. In the United States and the Netherlands, NPs/PAs were covered as one of several scenarios. Compared with physician-only models, multi-professional models resulted in lower physician manpower projections, primarily in primary care. A weakness of the multi-professional models was the accuracy of data on substitution. Impacts on policy were limited, except for the Netherlands. ConclusionsFew countries have integrated NPs/PAs into workforce planning. Yet, those with multi-professional models reveal considerable differences in projected workforce outcomes. Countries should develop several scenarios with and without NPs/PAs to inform policy.

Occupational outcomes for Australian computing/information technology bachelor graduates and implications for the IT bachelor curriculum

ABSTRACTIn Australia, the IT workforce and employment outcomes for university IT bachelor graduates have a complex interrelationship. The likelihood of IT bachelor graduates to work in a professional IT role is infrequently discussed in the research literature. It has been suggested that “deficient” undergraduate IT curricula are one contributor to poor employment outcomes for graduates. Using the latest available Australian national census data, we present a detailed analysis of the occupational outcomes for graduates of undergraduate IT programmes, and the makeup of the IT workforce in Australia. This analysis presents important findings for those designing undergraduate IT curricula that seek to equip students to prepare for the best employment outcomes. The finding that, even immediately post-graduation, a significant proportion of Australian IT bachelor graduates do not work in IT roles, even though professional IT job roles outnumber IT bachelor graduates nearly two-to-one, has implications for undergraduate IT education.

Does specialist physician supply affect pediatric asthma health outcomes?

BackgroundPediatrician and pediatric subspecialist density varies substantially among the various Canadian provinces, as well as among various states in the US. It is unknown whether this variability impacts health outcomes. To study this knowledge gap, we evaluated pediatric asthma admission rates within the 2 Canadian provinces of Manitoba and Saskatchewan, which have similarly sized pediatric populations and substantially different physician densities.MethodsThis was a retrospective cross-sectional cohort study. Health regions defined by the provincial governments, have, in turn, been classified into “peer groups” by Statistics Canada, on the basis of common socio-economic characteristics and socio-demographic determinants of health. To study the relationship between the distribution of the pediatric workforce and health outcomes in Canadian children, asthma admission rates within comparable peer group regions in both provinces were examined by combining multiple national and provincial health databases. We generated physician density maps for general practitioners, and general pediatricians practicing in Manitoba and Saskatchewan in 2011.ResultsAt the provincial level, Manitoba had 48.6 pediatricians/100,000 child population, compared to 23.5/100,000 in Saskatchewan. There were 3.1 pediatric asthma specialists/100,000 child population in Manitoba and 1.4/100,000 in Saskatchewan. Among peer-group A, the differences were even more striking. A significantly higher number of patients were admitted in Saskatchewan (590.3/100,000 children) compared to Manitoba (309.3/100,000, p < 0.0001).ConclusionsSaskatchewan, which has a lower pediatrician and pediatric asthma specialist supply, had a higher asthma admission rate than Manitoba. Our data suggest that there is an inverse relationship between asthma admissions and pediatrician and asthma specialist supply.

Health workforce cultural competency interventions: a systematic scoping review

BackgroundAddressing health workforce cultural competence is a common approach to improving health service quality for culturally and ethnically diverse groups. Research evidence in this area is primarily focused on cultural competency training and its effects on practitioners’ knowledge, attitudes, skills and behaviour. While improvements in measures of healthcare practitioner cultural competency and other healthcare outcomes have been reported, there are concerns around evidence strength and quality. This scoping review reports on the intervention strategies, outcomes, and measures of included studies with the purpose of informing the implementation and evaluation of future interventions to improve health workforce cultural competence.MethodsThis systematic scoping review was completed as part of a larger systematic literature search conducted on cultural competence intervention evaluations in health care in Canada, the United States, Australia and New Zealand published from 2006 to 2015. Overall, 64 studies on cultural competency interventions were found, with 16 aimed directly at the health workforce.ResultsThere was significant heterogeneity in workforce intervention strategies, measures and outcomes reported across studies making comparisons of intervention effects difficult. The two main workforce intervention strategies identified were cultural competency training and other professional development interventions including other training and mentoring. Positive outcomes were commonly reported for improved practitioner knowledge (9/16), skills (7/16), and attitudes/beliefs (5/16). Although health care (6/16) and health (2/16) outcomes were reported in some studies there was very limited evidence of positive intervention impacts. Only four studies utilised existing validated measurement tools to assess intervention outcomes.ConclusionTraining and development of the health workforce remain a principle strategy towards the goal of improved cultural competence in health services and systems. Diverse approaches are available to increase health workforce cultural competence. However, the effects of interventions beyond practitioner knowledge and attitudes remains unclear. Assessment of practitioner behavioural outcomes as well as measures of intervention impact on healthcare and health outcomes are needed to build a stronger evidence base.

Stakeholder views of rural community-based medical education: a narrative review of the international literature.

Rural community-based medical education (RCBME), in which medical student learning activities take place within a rural community, requires students, clinical teachers, patients, community members and representatives of health and government sectors to actively contribute to the educational process. Therefore, academics seeking to develop RCBME need to understand the rural context, and the views and needs of local stakeholders. The aim of this review is to examine stakeholder experiences of RCBME programmes internationally. This narrative literature review of original research articles published after 1970 utilises Worley's symbiosis model of medical education as an analysis framework. This model proposes that students experience RCBME through their intersection with multiple clinical, social and institutional relationships. This model seeks to provide a framework for considering the intersecting relationships in which RCBME programmes are situated. Thirty RCBME programmes are described in 52 articles, representing a wide range of rural clinical placements. One-year longitudinal integrated clerkships for penultimate-year students in Anglosphere countries were most common. Such RCBME enables students to engage in work-integrated learning in a feasible manner that is acceptable to many rural clinicians and patients. Academic results are not compromised, and a few papers demonstrate quality improvement for rural health services engaged in RCBME. These programmes have delivered some rural medical workforce outcomes to communities and governments. Medical students also provide social capital to rural communities. However, these programmes have significant financial cost and risk student social and educational isolation. Rural community-based medical education programmes are seen as academically acceptable and can facilitate symbiotic relationships among students, rural clinicians, patients and community stakeholders. These relationships can influence students' clinical competency and professional identity, increase graduates' interest in rural careers, and potentially improve rural health service stability. Formal prospective stakeholder consultations should be published in the literature.

Pathway to better patient care and nurse workforce outcomes in home care 1

Het groeiende tekort aan goede verpleegkundigen is een probleem waar veel westerse landen mee kampen. Als mogelijk antwoord hierop is eind vorige eeuw in de VS het concept van magneetziekenhuizen ontwikkeld met als doel verpleegkundigen te werven en behouden.

In-Place Training: Optimizing Rural Health Workforce Outcomes through Rural-Based Education in Australia

The medical workforce shortfall in rural areas is a major issue influencing the nature of undergraduate medical education in Australia. Exposing undergraduates to rural life through rural clinical school (RCS) placements is seen as a key strategy to address workforce imbalances. We investigated the influence of an extended RCS placement and rural origin on the rural principal place of practice (PPP) of the first 3 graduate cohorts (2012–2014) from a Joint Medical Program offered by two universities based in northern New South Wales. Data was available for 426 eligible graduates. Participation in an extended RCS placement (odds ratio (OR), 6.075, 95% confidence interval (CI) 2.716–13.591), rural background (OR 3.613, 95% CI 1.752–7.450) and being 25 years or older at completion of a medical degree (OR 2.550, 95% CI 1.252–5.194) were all independently associated with rural PPP. Being bonded into a program to practice rurally was not associated with rural PPP. Participation in an extended RCS placement is strongly associated with rural practice in the first 3 to 5 years of practice for graduates from both rural and metropolitan backgrounds. This finding indicates that strategies to improve the rural workforce should focus on the promotion of rural placements, in addition to rural background.

Factors that affect general practice as a choice of medical speciality: implications for policy development.

Objective This article critically appraises the range of personal, professional and social factors that affect the choice of speciality across medical students, prevocational doctors, general practice registrars and general practitioners. Methods This qualitative study applied constructs from the fields of decision theory and career theory to better understand the complex nature of choosing a speciality. In all, 47 in-depth interviews were conducted with participants at different stages of their career cycle. The data was codified and analysed using NVivo to identify key factors that influenced speciality choice. Results The research identified 77 individual findings influencing general practice as a choice of medical speciality. These were distilled into a matrix to show that factors such as money, prestige and peer interaction did not have a compelling effect, whereas clinical and academic role models, flexibility, work-life balance, scope of practice, connection with patients, training environment and practical opportunities did. Conclusion The findings indicate that the decision in relation to the choice of medical speciality is a complex cognitive process that is undertaken within a personal, social and professional context particular to each individual. What is known about the topic? Current literature aims to quantify changes in attitudes towards choice of speciality or the effect of particular variables in isolation while ignoring the complexity of this decision process and how the numerous variables compare with each other. What does this paper add? The present study is the first intergenerational research on this topic in the Australian context and the paper dismisses the role of prestige and remuneration as key drivers of choice in picking general practice as a speciality, noting that money is merely a 'hygiene factor'. What are the implications for policy makers? A policy framework outlining 10 key principles is presented to assist policy makers seeking to affect workforce outcomes by applying policy levers to influence doctors' choice of speciality.

Non‐cognitive skills: Potential candidates for global measurement

AbstractSkills are widely considered as key elements that contribute to the sustainable development of nations and the well‐being of individuals. Given the increasing interests in the international comparisons of skills for informing educational policy, it is necessary to understand the definitions, measurement, and development of key skills. Using literature from economics, sociology, and psychology, this article focuses on non‐cognitive skills that have a positive effect on life outcomes and can be better developed through education and training. Three non‐cognitive skills – grit, self‐control and social skills are illustrated and thoroughly reviewed here. Although some progress has been made in developing and measuring non‐cognitive skills, there is currently no systematic global measure. Several factors hinder the global monitoring of non‐cognitive skills and inhibits effective non‐cognitive skills assessment across countries. These include a lack of solid evidence showing which soft skills predict academic and workforce outcomes and how does the strength of this relationship differ by situation.

The rural pipeline to longer-term rural practice: General practitioners and specialists

BackgroundRural medical workforce shortage contributes to health disadvantage experienced by rural communities worldwide. This study aimed to determine the regional results of an Australian Government sponsored national program to enhance the Australian rural medical workforce by recruiting rural background students and establishing rural clinical schools (RCS). In particular, we wished to determine predictors of graduates’ longer-term rural practice and whether the predictors differ between general practitioners (GPs) and specialists.MethodsA cross-sectional cohort study, conducted in 2012, of 729 medical graduates of The University of Queensland 2002–2011. The outcome of interest was primary place of graduates’ practice categorised as rural for at least 50% of time since graduation (‘Longer-term Rural Practice’, LTRP) among GPs and medical specialists. The main exposures were rural background (RB) or metropolitan background (MB), and attendance at a metropolitan clinical school (MCS) or the Rural Clinical School for one year (RCS-1) or two years (RCS-2).ResultsIndependent predictors of LTRP (odds ratio [95% confidence interval]) were RB (2.10 [1.37–3.20]), RCS-1 (2.85 [1.77–4.58]), RCS-2 (5.38 [3.15–9.20]), GP (3.40 [2.13–5.43]), and bonded scholarship (2.11 [1.19–3.76]). Compared to being single, having a metropolitan background partner was a negative predictor (0.34 [0.21–0.57]). The effects of RB and RCS were additive—compared to MB and MCS (Reference group): RB and RCS-1 (6.58[3.32–13.04]), RB and RCS-2 (10.36[4.89–21.93]). Although specialists were less likely than GPs to be in LTRP, the pattern of the effects of rural exposures was similar, although some significant differences in the effects of the duration of RCS attendance, bonded scholarships and partner’s background were apparent.ConclusionsAmong both specialists and GPs, rural background and rural clinical school attendance are independent, duration-dependent, and additive, predictors of longer-term rural practice. Metropolitan-based medical schools can enhance both specialist and GP rural medical workforce by enrolling rural background medical students and providing them with long-term rural undergraduate clinical training. Policy settings to achieve optimum rural workforce outcomes may differ between specialists and GPs.