Challenges Faced by Medical Trainees in Outpatient Management Education in Acute Care Hospitals: A Thematic Analysis.

Introduction As societies age globally, medical education faces the challenge of adapting to the evolving healthcare needs of an aging population. This study focuses on the education of medical residents in outpatient departments in Japan, a country with a rapidly aging society. The research aims to understand the perceptions and challenges medical residents face in outpatient management, highlighting the areas for potential improvement in their educational framework. Method This study involved first-year medical residents at Fuchu Hospital in Osaka, using thematic analysis based on relativist ontology and constructivist epistemology. Data were collected through field notes and reflection sheets, documenting residents' interactions with patients, learning difficulties, and personal reflections. Semi-structured interviews were conducted to gain profound insights into their experiences and views on outpatient management education. Results Three main themes emerged from the analysis: The experience of continuity of care, the view regarding comprehensive management, and the gap between purposes and learning content. Residents expressed concerns about the limited opportunities for continuous patient care, leading to challenges in managing chronic diseases effectively. The focus on organ-specific specialties in acute care hospitals resulted in a fragmented understanding of patient care, particularly for elderly patients with multimorbidity. Furthermore, the study identified a discrepancy between the educational goals of outpatient management and the actual content delivered, highlighting the need for more observational experiences and practical guidance in outpatient settings. Conclusion The findings suggest a pressing need for a more structured, comprehensive, and personalized approach to outpatient management education for medical residents. As aging populations continue to grow, it is vital to equip medical professionals with the skills and knowledge to manage a wide range of patient conditions effectively. Improving the educational framework in outpatient departments can enhance patient care quality and prepare medical residents to meet the challenges of an aging society. This study contributes valuable insights into improving medical education in outpatient settings, particularly in aging societies like Japan.

Investigating the role of clinical exposure on motivational self-regulation skills in medical students based on cognitive apprenticeship model.

BACKGROUND: The importance of motivation regulation in medical students is highly significant due to their unique educational circumstances, such as clinical exposure. However, the role of clinical exposure in learning motivational self-regulation skills in students has not been explored thus far. This current study aims to investigate the role of clinical exposure on motivational self-regulation skills in medical students based on cognitive apprenticeship model. METHOD: This study was descriptive-analytical research conducted in 2022 on medical students. Data collection involved two questionnaires including Meta motivational Strategies in Medical Students Questionnaire and Maastricht Clinical Teaching Questionnaire. The research comprised two stages including measuring motivational self-regulation strategies in students before entering the clinical exposure phase, and simultaneous measurement of clinical exposure based on the student's viewpoint and their motivational self-regulation strategies at the end of the first term of clinical exposure. RESULTS: The results revealed a significant relationship between six dimensions of the cognitive apprenticeship model, including modeling, coaching, scaffolding, reflection, exploration, and learning environment, with motivational self-regulation strategies. However, there was no significant relationship between the articulation dimension of the cognitive apprenticeship model and motivational self-regulation strategies. CONCLUSION: Clinical exposure indirectly enhances students' metacognitive skills. Observing the behavior of clinical faculty in the clinical exposure setting leads to the improvement of motivational self-regulation strategies in medical students.

The cognitive apprenticeship model as a framework for desired precepting qualities to inform preceptor development.

INTRODUCTION: Positive learner perceptions of learning experiences have been linked to better learning outcomes. More information is needed on learners' desired qualities of preceptors and learning experiences to inform preceptor development. Aligning learners' perceptions with a teaching framework, such as the Cognitive Apprenticeship (CA) framework, may be useful to guide preceptor self-assessment and development. However, information is lacking regarding whether the CA framework is consistent with learners' expectations. The purpose of this study was to determine pharmacy learner perspectives on desired preceptor behaviors and qualities and to evaluate their alignment with the CA framework to inform preceptor development. METHODS: Twenty-two learners (nine residents and 13 introductory and advanced pharmacy practice students) participated in nine focus group interviews. Data were analyzed qualitatively by inductive coding and pattern coding and then condensed into themes. After initial analysis, the CA framework was adapted into codes and applied to the data to explore the alignment of quality preceptor characteristics with CA. RESULTS: Learners identified desired general preceptor characteristics, teaching behaviors, and qualities of sites and experience structure in their discussion. All four CA dimensions (Methods, Sociology, Sequencing, and Content) were represented in the described desired preceptor qualities. Most comments were connected to the Methods dimension. CONCLUSIONS: This study supports the use of CA as a framework to guide preceptor development and assessment for desired precepting qualities, preceptor behaviors, and learning environments. Additional research is needed for best practices in implementing CA in preceptor assessment and professional development.

Assessing Cognitive Apprenticeship Impact on Clinical Reasoning in Third-Year Student Pharmacists.

OBJECTIVE: The objective of this study was to evaluate the impact of implementing a cognitive apprenticeship theory (CAT) model into a Doctor of Pharmacy course in improving clinical reasoning skills of third-year student pharmacists over time and preparing them for Advanced Pharmacy Practice Experiences (APPEs). METHODS: This was a single center, nonrandomized, observational before-and-after study from January 2022 through May 2022. Third-year student pharmacists enrolled in the Critical Care Integrated Drugs and Disease pharmacotherapy course at the University of Kentucky College of Pharmacy were administered a well-established and nationally recognized clinical patient case assessment on weeks 1 and 15 of the course. Students were asked to prioritize patient problems and provide recommendations for therapy, goals, and monitoring. Responses were then scored using a predefined case key. In addition, student pharmacists were asked to self-evaluate their confidence in APPE readiness on a 5-point Likert scale. RESULTS: Of the 136 student pharmacists enrolled in the course, 92 (68%) student pharmacists completed both week 1 and week 15 clinical cases and self-assessment surveys, provided informed consent, and were included. Cumulative clinical case scores were significantly increased from week 1 to week 15 (34.8 vs 39.7). In addition, significant improvement was seen in overall problem prioritization, overall recommendations, and self-perceived preparedness for APPE rotations. CONCLUSION: The use of a CAT model into a 15-week pharmacotherapy course improved comprehensive scores of clinical reasoning assessment in third-year student pharmacists and was associated with increased self-perceived confidence and readiness for APPEs.

Integrating traditional apprenticeship and modern educational approaches in traditional Chinese medicine education.

BACKGROUND: The traditional apprenticeship system and modern educational models both contribute to traditional Chinese medicine (TCM) education in unique ways. This study aims to evaluate the advantages and disadvantages of these approaches and investigates their potential integration for optimal TCM teaching. METHODS: The study employs a comprehensive literature search strategy with specific keywords through Boolean Operators, focusing on articles discussing TCM education, sourced from the databases PubMed, Scopus, and CNKI. For comparative analysis, the study analyzes the advantages and disadvantages of three distinct approaches-traditional, modern, and hybrid-in TCM education. Finally, we use a spider plot methodology to visually evaluate across 11 critical educational aspects for these approaches. RESULTS: A comprehensive review of 70 articles on TCM education highlights the value of both conventional and modern approaches. Conventional methods often emphasize teacher-centered clinical training that aligns well with the apprenticeship model, serving to bridge formal academic learning with hands-on experience. Modern methods incorporate elements like technology and formal accreditation but caution that the absence of traditional apprenticeship could dilute core TCM principles. One recurring theme across multiple studies is the enduring importance of apprenticeship-a pedagogical cornerstone rooted in TCM's historical and cultural context-as well as its tension with modern methodologies that incorporate online resources and scientific frameworks. An integrated approach attempts to harmonize these strengths but reveals a gap in interactivity, suggesting that incorporating apprenticeship could offer a practical, hands-on method to improve student engagement. CONCLUSIONS: Conventional methods in TCM education emphasize teacher-centered clinical training akin to apprenticeship, modern methods incorporate technological advances and formal accreditation; however, the absence of traditional apprenticeship could compromise core TCM principles, and an integrated model, though striving to harmonize these elements, still falls short in the area of student interactivity.

Reflecting on Students' Experiences of an Innovative Teaching Model During Aged Care Visit in Clinical Placements: A Qualitative Pilot Study.

Purpose: Clinical placement teaching could be challenging due to time constraints, lack of effective teaching models and consensus approaches. Learner-centred approach facilitated deeper learning by demonstrating "seeing-patients-under-supervision" being ideal during Residential-Aged-Care-Facility (RACF)-visit in GP clinical placements. The study aimed to reflect on the students' experiences in aged-care visits by applying an innovative teaching model of "students-being-the-GP-clinician-in-charge-of-RACF-visit-ward-round-under-the-supervision-of-clinical-supervisor". Through students' reflections, this study identified 12 commonly managed RACF problems to be introduced into the curriculum to optimise clinical reasoning learning during RACF-visit. Methods: This qualitative study used online surveys and interviews. All participating students reported all the encountered cases during the RACF visit through an online survey. The participating students acted as GP in charge of all clinical interactions with patients, caregivers, and nurses during RACF visits and final management plan discussions with GP supervisors to ensure clinical-service safety and teaching-and-learning quality. The interview questionnaires applied standard-and-open-ended-questions to examine the impact of this innovative teaching model on clinical-reasoning-learning, clinical-competence-improvement, Objective Structured Clinical Exam (OSCE) preparation, limitations-from-students'-patients'-and-supervisors' perspectives, and intern readiness. Results: An online survey summarising students' encountered cases was returned by 30 students. The 12 most commonly-managed problems were tabulated. Falls, urinary tract infections, and behavioural and psychological symptoms of dementia were the three most commonly-managed problems. All thirty students' reflections indicated the positive impact of the innovative-teaching-models on "Improving-Clinical-Reasoning-Learning", "Enhancing-Clinical-Competency", "Enriching-Salient-Learning-Points", "Facilitating-Feedback-Discussion-with-Supervisor", "Strengthening-OSCE-exam-preparation", "Understanding-the-Limitation-from-students'-patients'-and-supervisors'-perspectives", "Enabling-intern-readiness". Twelve students' individual reflections were demonstrated. Conclusion: This qualitative pilot study demonstrated through students' reflection that "Student-doctor-in-charge-of-nursing-home-round" is an innovative teaching model for clinical reasoning learning. This model extended the concepts of "cognitive-apprenticeship" in the context of modern medical education. Students' reflections and summary of commonly managed problems indicated the need for further study to verify the feasibility of implementing this teaching model in the formal curriculum and creating a RACF-visit-specific curriculum for students.

The Shaman and Schizophrenia, Revisited.

This paper presents evidence that some-but not all-religious experts in a particular faith may have a schizophrenia-like psychotic process which is managed or mitigated by their religious practice, in that they are able to function effectively and are not identified by their community as ill. We conducted careful phenomenological interviews, in conjunction with a novel probe, with okomfo, priests of the traditional religion in Ghana who speak with their gods. They shared common understandings of how priests hear gods speak. Despite this, participants described quite varied personal experiences of the god's voice. Some reported voices which were auditory and more negative; some seemed to describe trance-like states, sometimes associated with trauma and violence; some seemed to be described sleep-related events; and some seemed to be interpreting ordinary inner speech. These differences in description were supported by the way participants responded to an auditory clip made to simulate the voice-hearing experiences of psychosis and which had been translated into the local language. We suggest that for some individuals, the apprenticeship trained practice of talking with the gods, in conjunction with a non-stigmatizing identity, may shape the content and emotional tone of voices associated with a psychotic process.

[The completion of trial apprenticeships is followed by the choice of an apprenticeship profession: Predicting the decision to pursue a trial apprenticeship profession in the career choice process]. / Nach den Berufswahlpraktika ist vor der Wahl des Ausbildungsberufs: Vorhersage des Entscheids für die Weiterverfolgung eines Praktikumberufs im Berufswahlprozess.

This article investigated the factors that lead adolescents to pursue a trial apprenticeship profession in their career choice process. Gottfredson's Theory of Circumscription, Compromise, and Self-Creation (TCCSC) served as the theoretical basis for the analyses. A longitudinal sample of 128 female and 202 male adolescents who completed standardized questionnaires in seventh and ninth grades and who indicated that they would begin vocational education and training after compulsory schooling was analyzed separately by gender. Regression models showed that the number of apprenticeship positions has the strongest effect for both female and male adolescents (significant positive effect). Only for female adolescents, the extent of enterprising requirements of the trial apprenticeship profession was shown to have a negative effect on the decision to pursue a trial apprenticeship profession, controlling for the number of apprenticeship positions. The results support the accessibility hypothesis postulated in the TCCSC, according to which individuals are more likely to pursue professions they perceive as more accessible, i.e., with a large number of apprenticeship positions. In light of the compatibility idea contained in the TCCSC, a possible explanation for the negative effect of enterprising requirements of trial apprenticeship professions among female adolescents is that they may assess their enterprising skills as too low. As a result, they perceive professions with high enterprising requirements as incompatible and turn away from these professions. This study was able to address a gap in career choice research by examining the role of trial apprenticeship professions and offers important reference points for future research.

A tripartite understanding of experiences of young apprentices: A case study of the London Borough of Hounslow.

In 2019, a decline in apprenticeship starts prompted the London Borough of Hounslow to make an apprenticeship pledge in its Corporate Plan 2019-2024, committing to create 4,000 new apprenticeships and training opportunities to help young people into work. This article investigates experiences of young apprentices in Hounslow before and during the COVID-19 pandemic. Exploring the perspectives of two apprentices, two employers and one training provider in a small-scale qualitative study, the authors identify key hindering and supporting factors affecting entry into and sustainability of apprenticeships, and progression towards professional employment. They found that labour market entry was intensely hindered by competition (with peers who had better maths and English qualifications, for a small number of apprenticeships) and organisational barriers (such as managers with prejudices against young people, stigmatising apprentices and apprenticeships). Supportive factors identified include personal characteristics (such as a positive mindset, enabling young people to persevere despite a disadvantaged socioeconomic background and lack of family support, for example) and supportive relationships (e.g. mentoring) between apprentices and their training providers or employers.

Compréhension tripartite des expériences de jeunes apprentis : étude de cas réalisée dans le quartier londonien de Hounslow ­ En 2019, un déclin du nombre de nouveaux contrats d'apprentissage a poussé le quartier londonien de Hounslow à prendre un engagement en faveur de l'apprentissage dans son plan 2019­2024 pour les entreprises, dans lequel il s'engageait à créer 4 000 places d'apprentissage et possibilités de formation pour aider les jeunes à entrer dans la vie active. Cet article se penche sur les expériences de jeunes apprentis à Hounslow avant et pendant la pandémie de COVID-19. Les auteurs ont examiné les points de vue de deux apprentis, de deux employeurs et d'un prestataire de formations dans une étude qualitative à petite échelle et ont identifié des facteurs décisifs freinant ou favorisant l'accession aux apprentissages, la viabilité de ces derniers et le parcours des apprentis vers l'emploi. Ils ont constaté que l'entrée sur le marché du travail était fortement freinée par la concurrence (avec des pairs mieux qualifiés en mathématiques et en anglais qui postulaient pour un nombre restreints de place d'apprentissage) et par des obstacles organisationnels (par exemple des managers qui avaient des préjugés à l'égard des jeunes, qui stigmatisaient les apprentis et les apprentissages). Parmi les facteurs favorables qu'ils ont identifiés, notons les traits de caractère personnels (par exemple un état d'esprit positif permettant aux jeunes de persévérer malgré leur milieu socio-économique défavorisé et l'absence de soutien de leur famille) et les relations de soutien (par exemple le mentorat) entre les apprentis et leurs prestataires de formation ou leurs employeurs.

Fostering Secondary Students' Historical Thinking: A Design Study in Flemish History Education.

A recent curriculum reform in Flanders (Belgium) has introduced historical thinking as a central goal for history education. Historical thinking aims to introduce students to the methods of historians and disciplinary ways of thinking. It is a complex act, requiring the application of substantive and second-order knowledge, and is difficult to foster among students. International (intervention) research has provided several guidelines for the design of instructional practices that are effective in promoting specific aspects of students' historical thinking. However, these studies do not approach historical thinking in a holistic manner, are often vague about how general design principles were adapted to history education, and rarely report on whether the designed curricula were considered relevant and useful by teachers. Taking into account the many difficulties that teachers encounter in designing practices aimed at historical thinking, this design research aims to gain more insight into the design of instructional practices that are both effective in fostering historical thinking in a holistic manner and that are considered socially valid by teachers. The designed artifact is a 12- to 14-h lesson series on the theme "decolonization after 1945," for students in the 12th grade. It applies the model of cognitive apprenticeship's (Collins et al., 1991) general design principles to the specific context of history and approaches historical thinking in a holistic manner. The initial lesson series was evaluated and revised in two rounds based on a pilot study, an expert review and an intervention study.

Advice for autistic people considering a career in academia.

LAY ABSTRACT: One of the recognised strengths of autistic people is their ability to absorb and retain large amounts of information; autistic children and adolescents are often described as 'little professors'. So, is the life of a university researcher or teacher the ideal career for an autistic person? In this study, 37 autistic people working in universities and colleges provide advice to young people considering a future career as an academic. They emphasise the importance of understanding the complexities and requirements of the role, understanding and valuing yourself and your strengths, and finding the right people to work with and learn from. They also discuss the importance of maintaining a balance between work and well-being, and between caution and passion. The life of an academic can be ideally suited to an autistic person, but it can also be very challenging.

Engaging Employers in Apprentice Training: Focus Group Insights from Small-to-Medium-Sized Employers in Ontario, Canada.

Several factors have been identified to influence the registration and retention of apprentices in the construction trades. Employer engagement is a key factor to promote growth in apprenticeships in the construction trades as participation rates continue to be low among small-to-medium-sized employers. In this study, we evaluated the effectiveness of the Ontario Electrical League's (OEL) employer mentorship program through the perspectives of small-to-medium-sized employers using a qualitative approach. Two focus groups were conducted virtually with 11 employers. Focus group audio transcripts were recorded and transcribed for thematic analysis. Themes were generated using a data-driven approach to examine the relationships between mentorship program outcomes and perspectives on industry-related recruitment and retention barriers. Three themes were identified: (a) long-term apprentice recruitment and retention challenges; (b) equity and mental health in the workplace; and (c) industry challenges and mentorship program outcomes. Generally, this sample of employers appreciated the value of the OEL mentorship program through praise of the continued educational support, employer management expertise, hiring resources, and apprentice onboarding tools despite industry barriers in trade stigma, equity and mental health in the workplace, and recruitment and retention challenges. Industry partners should work with these small-to-medium-sized employers to develop workplace initiatives and engage external partners to provide ongoing apprenticeship mentorship support to address the recruitment and retention barriers identified in this study.

Simulator-based training method in gastrointestinal endoscopy training and currently available simulators.

The apprenticeship-based training method (ABTM) is highly effective for gastrointestinal (GI) endoscopic training. However, the conventional ABTM has significant issues. Although many supplementary training methods (TMs) have been developed and utilized, they cannot entirely replace the ABTM, which remains the major TM strategy. Currently, new TM construction is crucial and necessary due to financial constraints, difficulty of obtaining sufficient training time due to patient safety-related regulations, and catastrophic damage caused by disasters such as the coronavirus disease 2019 pandemic. The simulator-based TM (SBTM) is widely accepted as an alternative to the ABTM, owing to the SBTM's advantages. Since the 1960s, many GI endoscopy training simulators have been developed and numerous studies have been published on their effectiveness. While previous studies have focused on the simulator's validity, this review focused on the accessibility of simulators that were introduced by the end of 2021. Although the current SBTM is effective in GI endoscopic education, extensive improvements are needed to replace the ABTM. Incorporating simulator-incorporated TMs into an improved ABTM is an attempt to overcome the incompleteness of the current SBTM. Until a new simulator is developed to replace the ABTM, it is desirable to operate a simulator-integrated and well-coordinated TM that is suitable for each country and institution.

Perceptions of nursing undergraduates about the challenges faced for training in the covid-19 pandemic / Percepciones de los licenciados en enfermería sobre los desafíos enfrentados para la formación en la pandemia del covid-19 / Percepções de graduandos de enfermagem acerca dos desafios enfrentados para formação na pandemia da covid-19

ABSTRACT Objective: to identify and discuss the challenges faced by nursing undergraduates of a public higher education institution during the COVID-19 pandemic. Method: exploratory, cross-sectional, quantitative study conducted with nursing undergraduates from a public university in Recife, Pernambuco State, Brazil. Data collection took place between July 2021 and February 2022, using exclusively digital questionnaires. Descriptive analyses and statistical tests such as Kolmogorov-Smirnov, Chi-square and Fisher's exact test were performed. Results: the study included 112 nursing undergraduates, mostly female, mean age of 20.9 years, white color/race, single, without children, with a family income of up to three minimum wages. The main challenges were: difficulty in adapting to remote teaching, changes in daily routine, distraction with subjects not discussed in class, fear and/or anxiety regarding the pandemic, difficulty in family support, influence of social isolation on interest in classes, need for institutional programs of financial and psychological support and government encouragement to disseminate measures against the coronavirus. Challenges such as difficulty in handling technological equipment and financial concerns were statistically associated with the variables computer and notebook ownership, quality of internet connection and private study environment. Conclusion: the study raised reflections that emerged from a scenario of health and educational crisis, indicating that the COVID-19 pandemic caused relevant challenges for undergraduate nursing students' learning.

RESUMEN Objetivo: identificar y discutir los desafíos que enfrentan los estudiantes de enfermería de una institución pública de educación superior durante la pandemia de COVID-19. Método: estudio cuantitativo, transversal, exploratorio, realizado con estudiantes de enfermería de una universidad pública de Recife, Pernambuco, Brasil. La recolección de datos se llevó a cabo entre julio de 2021 y febrero de 2022, utilizando cuestionarios exclusivamente digitales. Se realizaron análisis descriptivos y pruebas estadísticas, como Kolmogorov-Smirnov, Chi-cuadrado y prueba exacta de Fisher. Resultados: participaron del estudio 112 estudiantes de enfermería, en su mayoría del sexo femenino, edad media 20,9 años, color/raza blanca, solteros, sin hijos, con renta familiar de hasta tres salarios mínimos. Los principales desafíos fueron: dificultad de adaptación al aprendizaje a distancia, cambios en la rutina diaria, distracción con temas no discutidos en clase, miedo y/o ansiedad con respecto a la pandemia, dificultad en el apoyo familiar, influencia del aislamiento social en el interés por las clases, necesidad de apoyo institucional. programas de apoyo financiero y psicológico e incentivos gubernamentales para la difusión de medidas contra el coronavirus. Desafíos como dificultad en el manejo de equipos tecnológicos y preocupaciones financieras se asociaron estadísticamente con las variables posesión de computadora y notebook, calidad de conexión a internet y ambiente privado de estudio. Conclusión: el estudio suscitó reflexiones que emergieron de un escenario de crisis sanitaria y educativa, indicando que la pandemia de la COVID-19 provocó desafíos relevantes para el aprendizaje de los estudiantes de graduación en enfermería.

RESUMO Objetivo: Identificar e discutir os desafios enfrentados por graduandos de enfermagem de uma instituição de ensino superior pública durante a pandemia da COVID-19. Método: Estudo exploratório, transversal, quantitativo, realizado com graduandos de enfermagem de universidade pública, em Recife, Pernambuco, Brasil. A coleta de dados ocorreu entre julho de 2021 e fevereiro de 2022, mediante questionários exclusivamente digitais. Procederam-se às análises descritivas e aos testes estatísticos, como Kolmogorov-Smirnov, Qui-quadrado e teste exato de Fisher. Resultados: Participaram do estudo 112 graduandos de enfermagem, maioria do sexo feminino, idade média de 20,9 anos, cor/raça branca, solteira, sem filhos, com rendimento familiar de até três salários-mínimos. Os principais desafios foram: dificuldade na adaptação ao ensino remoto, alterações na rotina diária, distração com assuntos não discutidos nas aulas, medo e/ou ansiedade em relação à pandemia, dificuldade de apoio familiar, influência do isolamento social no interesse nas aulas, necessidade de programas institucionais de apoio financeiro e psicológico e incentivo governamental à divulgação de medidas contra o coronavírus. Desafios como dificuldade no manuseio de equipamentos tecnológicos e preocupações financeiras estiveram estatisticamente associados às variáveis posse de computador e notebook, qualidade de conexão à internet e ambiente de estudos privativo. Conclusão: O estudo suscitou reflexões que emergiram de um cenário de crise sanitária e educacional, indicando que a pandemia da COVID-19 provocou relevantes desafios para aprendizagem de estudantes de graduação em enfermagem.

Ejercer sin diploma, batallar por la licencia: encrucijadas en la historia de la profesionalización de la odontología en Colombia / Practicing without a diploma, battling for a license: crossroads in the history of the professionalization of dentistry in Colombia

Resumen Este artículo estudia la profesionalización de la odontología en Colombia en la primera mitad del siglo XX. Esta historia no puede comprenderse en todas sus dimensiones si se dejan de lado las tensiones entre los practicantes con diploma y los sin diploma. Como resultado de estas tensiones, los odontólogos ganaron autonomía profesional. Analizamos solicitudes de licencia para ejercer sin título profesional, entre ellas las de algunas mujeres. Los hallazgos muestran la transmisión de conocimientos por fuera de la enseñanza formal, el ejercicio sin título y sin restricciones por parte de un gran número de odontólogos "permitidos" que se enfrentaron a una pesada y centralizada burocracia diplomada.

Abstract This paper addresses the professionalization of dentistry in Colombia during the first half of the twentieth century. To fully comprehend such a process, we must consider the tensions between the practice of non-certified and certified dentistry. As an outcome of such tensions, dentists began to acquire professional autonomy. We analyze applications for license files to practice dentistry without a degree, some of which were of women. The findings show the informal transfer of knowledge outside formal apprenticeship and the unrestricted practice of dentistry by many non-professionals but "permitted" dentists who faced a centralized and powerful professional bureaucracy.

Are plumbing apprentice graduates safer than their non-apprentice peers? Workers' compensation claims among journey level plumbers by apprenticeship participation.

INTRODUCTION: Apprenticeships combine mentored on-the-job training with related instruction to develop a workforce with the skills sought by employers. Workplace safety is an important component of apprenticeship training. Whether that training results in fewer work injuries, however, is largely unknown. METHOD: We linked Washington's registered apprenticeship data, plumber certification (licensing) data, employment data, and workers' compensation claims to compare claim rates among journey level plumbers (JLP) by apprenticeship participation. We used negative binomial regression models to estimate rates of total claims, wage replacement/disability claims, acute injuries, and musculoskeletal disorders (MSD), adjusted for worker characteristics. RESULTS: Among JLP certified between 2000 and 2018, rates among JLP with no apprenticeship training were 46% higher for total workers' compensation claims (adjusted Rate Ratio (aRR) = 1.46, 95% CI: 1.26-1.69) and 60% higher for wage replacement/disability claims (aRR = 1.60, 95% CI: 1.22-2.11), compared to rates among JLP who completed a plumbing apprenticeship. Apprentice graduates experienced a greater decline in the rate of total claims between the 5 years preceding JLP certification and the years after certification (55.3% vs. 41.4% among JLP with no apprenticeship training). Greater rate reductions among JLP apprentice graduates were also observed for acute injuries and MSD, although the decline in MSD was not significantly different from the decline among JLP with no apprenticeship training. CONCLUSIONS: Successful completion of a plumbing apprenticeship program is associated with fewer work injuries throughout the career of a JLP. Apprenticeships appear to play a key role in reducing work injuries among JLP, especially acute injuries. PRACTICAL APPLICATIONS: Apprenticeships are an effective model for reducing workplace injuries. The mechanisms by which apprenticeship training improves workplace safety should be identified to better inform injury prevention efforts among apprentices as well as among workers outside of a formal apprenticeship arrangement.

Mental Health Outcomes among Electricians and Plumbers in Ontario, Canada: Analysis of Burnout and Work-Related Factors.

(i) Background: Working in the electrical and plumbing sectors is physically demanding, and the incidence of physical injury and work disability is high. This study aimed to assess the mental health and well-being of skilled trades workers working in the electrical and plumbing sectors; (ii) Methods: Forty participants completed an online survey assessing burnout, work-related factors, and mental health issues. Data were analyzed to determine the association between demographics, the availability, and importance of work-related factors, and burnout using a two-sample Mann-Whitney U test; (iii) Results: Our findings showed that among the work-related factors, workplace safety, family commitments, income and benefits, and full-time employment opportunities might be crucial factors to keep study participants working at their current position. Financial support for external training, which was found to be the most important factor in preventing colleague-related burnout, was available to the satisfaction of approximately 50% of the participants; (iv) Conclusion: Work-related factors such as workplace safety and the availability and support for external training may be protective against all types of burnout among this population. Future studies may consider a larger sample size with a more diverse group of participants and perform an intersectional analysis to incorporate minority identities in the analyses.

Development of a competency framework for the Assistant Wellbeing Practitioner (Renal) role.

BACKGROUND: Many people with kidney disease experience comorbid mental health difficulties that result in worse physical health outcomes alongside greater personal, treatment and societal costs. PROBLEM: Workforce expansion to treat comorbid mental health difficulties has focussed on psychological practitioners. This fails to capitalise on benefits arising from embedding roles to address biopsychosocial outcomes directly within the renal specialty. A competency framework to inform development and training for such a role has not been developed. METHODS: Five-phase process to develop a competency framework for an Assistant Wellbeing Practitioner (Renal) role. Following identification of competency frameworks for roles in psychological practice, health and social care, relevant competencies were synthesised to create a draft competency framework. This framework was revised through consultation events with professionals associated with the renal specialty and Kidney Patient Involvement Network with the framework informing a competency map. RESULTS: The competency map comprised three categories-Knowledge, Values and Principles, Core Skills and Meta-Competencies with specific competencies for an assistant practitioner role to work within the renal specialty identified. Core knowledge and skills included awareness of kidney treatments and common psychosocial difficulties, collaborative care and supporting evidence-based prevention approaches. CONCLUSIONS: Competencies associated with the Assistant Wellbeing Practitioner (Renal) role have the potential to promote mental wellbeing, better physical health and generate social and economic benefits. The competency map can inform training and role evaluation, although addressing implementation issues associated with commissioning physical and mental healthcare is required.

Describing Ultrasound Skills Teaching by Near-Peer and Faculty Tutors Using Cognitive Apprenticeship.

Phenomenon: Ultrasound skills are becoming increasingly important in clinical practice but are resource-intensive to teach. Near-peer tutors often alleviate faculty teaching burden, but little is known about what teaching methods near-peer and faculty tutors use. Using the lens of cognitive apprenticeship, this study describes how much time faculty and near-peer tutors spend on different teaching methods during abdominal ultrasound skills training. Approach: Sixteen near-peer and 16 faculty tutors were videotaped during one 55-min practical ultrasound lesson with randomly assigned students. Videos were directly coded using Cognitive Apprenticeship teaching methods and activities. Segment durations were summed up and compared quantitatively. Findings: All 32 tutors spent most of the time on observing and helping students (Coaching, Median 29:14 minutes), followed by asking open and stimulating questions (Articulation, 12:04 minutes and demonstrating and giving explanations (Modeling, 04:50 minutes). Overall, distributions of teaching methods used were similar between faculty and near-peer tutors. However, faculty tutors spent more time on helping students manually, whereas near-peer tutors spent more time on exploring students' learning gaps and establishing a safe learning climate. Cognitive Apprenticeship was well suited as observational framework to describe ultrasound skills. Insights: Ultrasound train-the-tutor programs should particularly focus on coaching and articulation. Near-peers' similar use of teaching methods adds to the evidence that supports the use of near-peer teaching in ultrasound skills education.

An innovative approach to using an intensive field course to build scientific and professional skills.

This paper reports on the design and evaluation of Field Studies in Functional Ecology (FSFE), a two-week intensive residential field course that enables students to master core content in functional ecology alongside skills that facilitate their transition from "student" to "scientist." We provide an overview of the course structure, showing how the constituent elements have been designed and refined over successive iterations of the course. We detail how FSFE students: (1) Work closely with discipline specialists to develop a small group project that tests an hypothesis to answer a genuine scientific question in the field; (2) Learn critical skills of data management and communication; and (3) Analyze, interpret, and present their results in the format of a scientific symposium. This process is repeated in an iterative "cognitive apprenticeship" model, supported by a series of workshops that name and explicitly instruct the students in "hard" and "soft" skills (e.g., statistics and teamwork, respectively) critically relevant for research and other careers. FSFE students develop a coherent and nuanced understanding of how to approach and execute ecological studies. The sophisticated knowledge and ecological research skills that they develop during the course is demonstrated through high-quality presentations and peer-reviewed publications in an open-access, student-led journal. We outline our course structure and evaluate its efficacy to show how this novel combination of field course elements allows students to gain maximum value from their educational journey, and to develop cognitive, affective, and reflective tools to help apply their skills as scientists.