Creating a Statewide Nurse Residency: Using an Apprenticeship Model.

The Institute of Medicine recommends residency programs be implemented for new graduates across all settings, yet hospitals have not consistently hardwired this into their organizations. The value proposition is in recruitment, retention, and the conservation of resources. New Jersey's experiences using the US Department of Labor apprenticeship model for nurse residency programs provides a strategy that can be implemented on a statewide basis.

Effectiveness and cost-effectiveness of embedded simulation in occupational therapy clinical practice education: study protocol for a randomised controlled trial.

BACKGROUND: Clinical placements are a critical component of the training for health professionals such as occupational therapists. However, with growing student enrolments in professional education courses and workload pressures on practitioners, it is increasingly difficult to find sufficient, suitable placements that satisfy program accreditation requirements. The professional accrediting body for occupational therapy in Australia allows up to 200 of the mandatory 1000 clinical placement hours to be completed via simulation activities, but evidence of effectiveness and efficiency for student learning outcomes is lacking. Increasingly placement providers charge a fee to host students, leading educators to consider whether providing an internal program might be a feasible alternative for a portion of placement hours. Economic analysis of the incremental costs and benefits of providing a traditional versus simulated placement is required to inform decision-making. METHODS/DESIGN: This study is a pragmatic, non-inferiority, single-blind, multicentre, two-group randomised controlled trial (RCT) with an embedded economic analysis. The RCT will compare a block of 40 hours of simulated placement (intervention) with a 40-hour block of traditional placement (comparator), with a focus on student learning outcomes and delivery costs. Six universities will instigate the educational intervention within their respective occupational therapy courses, randomly assigning their cohort of students (1:1 allocation) to the simulated or traditional clinical placements. The primary outcome is achievement of professional behaviours (e.g. communication, clinical reasoning) as assessed by a post-placement written examination. Secondary outcomes include proportions passing the placement assessed using the Student Practice Evaluation Form-Revised, changes in student confidence pre-/post-placement, student and educator evaluation of the placement experience and cost-effectiveness of simulated versus traditional clinical placements. Comprehensive cost data will be collected for both the simulated and traditional placement programs at each site for economic evaluation. DISCUSSION: Use of simulation in health-related fields like occupational therapy is common, but these activities usually relate to brief opportunities for isolated skill development. The simulated clinical placement evaluated in this trial is less common because it encapsulates a 5-day block of integrated activities, designed and delivered in a manner intended to emulate best-practice placement experiences. The planned study is rare due to inclusion of an economic analysis that aims to provide valuable information about the relationship between costs and outcomes across participating sites. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12616001339448 . Registered 26 September 2016.

The effects of a prelicensure extern program and nurse residency program on new graduate outcomes and retention.

Organizations are looking to new graduate nurses to fill expected staffing shortages over the next decade. Creative and effective onboarding programs will determine the success or failure of these graduates as they transition from student to professional nurse. This longitudinal quantitative study with repeated measures used the Casey-Fink Graduate Nurse Experience Survey to investigate the effects of offering a prelicensure extern program and postlicensure residency program on new graduate nurses and organizational outcomes versus a residency program alone. Compared with the nurse residency program alone, the combination of extern program and nurse residency program improved neither the transition factors most important to new nurse graduates during their first year of practice nor a measure important to organizations, retention rates. The additional cost of providing an extern program should be closely evaluated when making financially responsible decisions.

Analyzing international clinical education practices for Canadian rehabilitation students.

BACKGROUND: Clinical training in low-income countries has become increasingly popular among pre-licensure trainees from high-income countries. The Working Group on Ethics Guidelines for Global Health Training ("WEIGHT Guidelines") were designed to identify and inform the complex and contentious field of international clinical education. The purpose of this study was to use the WEIGHT Guidelines to evaluate an international clinical internship programme for Master's-level rehabilitation students at a Canadian university. METHODS: In-depth, semi-structured interviews were conducted with eight Canadian rehabilitation researchers, educations and/or clinicians responsible for administering international internships across three clinical training programmes. Interview questions were informed by the WEIGHT Guidelines. Directed content analysis was used to identify priorities for policy, practice and research. RESULTS: Five themes relating to strengthening international clinical education were identified: (1) from one-time internships to long-term partnerships, (2) starting a discussion about "costs", (3) a more informed approach to student selection, (4) expanding and harmonizing pre-departure training across disciplines, and (5) investing in post-internship debriefing. CONCLUSIONS: International clinical education is fraught with ethical, pedagogical and logistical issues that require recognition and ongoing management. This is the first study to use the WEIGHT Guidelines as a qualitative research tool for assessing an existing global health education programme. Results highlight new priorities for action at the Canadian "sending institution", including more explicit attention to the costs (broadly defined) borne by all parties. A crucial next step is deepened engagement with educational partners at the "receiving organizations" based in low-income countries to nurture dialogue regarding reciprocity, trust and sustainability of the partnership. Education research is also needed that evaluates models of pre-departure training and post-internship debriefing for trainees.

Resources used to support postgraduate year 1 pharmacy residencies: survey of residency program directors.

PURPOSE: The results of a survey to identify personnel time, funding, and other resources used to support existing postgraduate year 1 (PGY1) pharmacy residencies and to determine potential residency program expansion are reported. METHODS: An electronic survey was distributed to PGY1 residency program directors (RPDs). Respondents were asked to provide demographic information and to characterize resources used to support their training programs. RESULTS: The survey response rate was 62%, representing 493 respondents. About 21% indicated their formal job descriptions identified them as a PGY1 RPD, and 8% replied that time expectations to perform the residency functions were specified. Up to 69% of respondents estimated that the time spent performing residency functions was 5-16 hours weekly. Other personnel who facilitated pharmacy residency logistics included administrative assistants, coordinators, and pharmacists, devoting approximately 1-8 hours weekly to the residency program. Half of respondents indicated their PGY1 programs received funding through the Centers for Medicare and Medicaid Services (CMS) pass-through reimbursement; 30% were not eligible, 11% had not considered such reimbursement due to the amount of work required, and 9% did not know if their sites received such funding. CONCLUSION: A survey of PGY1 RPDs collected a wide range of information about the resources used to support their programs and about future plans. Almost half of respondents anticipated expanding their PGY1 residency program capacity, and responses made it clear that adequate documentation was important for programs applying for CMS pass-through reimbursement and facing an audit.

Value of pharmacy residency training: a survey of the academic medical center perspective.

PURPOSE: The results of a survey assessing the views of pharmacy directors, medical center executives, and pharmacists on the value of residency programs to their institutions are reported. METHODS: In a two-phase survey entailing face-to-face interviews and the use of an electronic questionnaire, representatives of the pharmacy departments and executive staffs of eight academic medical centers were asked to rate the impact of pharmacy residency programs in areas such as educational and research innovation, quality-of-care and cost outcomes, and opportunities for revenue generation. RESULTS: Seven hospital administrators, eight directors of pharmacy, 122 pharmacists serving as residency preceptors, and 91 nonpreceptor pharmacists participated in the survey. The survey responses indicated that hospital administrators view pharmacy residency programs as important contributors to their institutions' prestige, academic success, and capacity for delivering educational programs. All directors of pharmacy surveyed were in agreement that the costs associated with conducting a pharmacy residency program are outweighed by the cost savings achieved through resident contributions to patient care and medication error prevention. A large majority (90%) of preceptor pharmacists agreed or strongly agreed that residents help reduce medication errors by educating prescribers and other activities that promote rational medication use; only about half of nonpreceptor pharmacists shared that view, although 65% of nonpreceptors acknowledged the contributions of residents to overall pharmacy department success. CONCLUSION: All groups of survey respondents viewed residency programs as important assets to their institutions, especially in the areas of institutional prestige, staff recruitment, and professional development and education.

Return on investment of a pharmacy residency training program.

PURPOSE: The return on investment of pharmacy residency training at a Veterans Affairs hospital was estimated. METHODS: The financial costs and benefits associated with one year's training of eight residents were estimated retrospectively. The costs were compared with estimated costs for training newly hired pharmacists without institutional experience. The residents' work output as measured by notations in progress notes was compared with that of their pharmacist preceptors, and this ratio was used in establishing an amount the institution would be willing to pay for a resident's output. RESULTS: The estimated benefit-to-cost ratio for the residency program was favorable. Hiring its residents rather than new, untrained pharmacists for full-time positions was estimated to benefit the hospital. CONCLUSION: The benefit-to-cost ratio of the residency training program was estimated to be 1.5:1. Resident productivity was estimated to save the institution $563,936 annually.