The challenge of integrating new online education packages into existing curricula: a new model.

BACKGROUND: In 2009, The National Institute for Health and Clinical Excellence (NICE) developed an undergraduate online learning package on the practical application of evidence-based medicine with the intention that it would be integrated into existing medical curricula. METHODS: Complementary methodologies were used to yield a diversity of quantitative and qualitative data on how the online learning package was integrated. RESULTS: The modules of the online learning package received an overall positive reaction from the users but uptake of the modules was lower than expected. Even though some curriculum integration occurred, several students were unaware that the package existed, some lacked the time to use the package and others would have preferred to have had the package earlier in their course. CONCLUSIONS: A new model for the effective integration of online education packages into existing undergraduate medical curricula is proposed, especially when developed by external organisations. This new model should enable educationalists to better reveal and overcome the contextual and process challenges, barriers and solutions to implementing effective flexible learning approaches. When introducing new learning resources into a curriculum, many factors are important, especially the learners' perceived needs and how these vary at different stages of their course.

Evaluation of international recruitment of health professionals in England.

OBJECTIVES: To explore whether a period of intensive international recruitment by the English National Health Service (NHS) achieved its objectives of boosting workforce numbers and to set this against the wider costs, longer-term challenges and questions arising. METHODS: A postal survey of all pre-2006 NHS providers, Strategic Health Authorities and Deans of Postgraduate Medical Education obtained information on 284 (45%) organizations (142 completed questionnaires). Eight subsequent case studies (74 interviews) covered medical consultant, general practitioner, nurse, midwife and allied health professional recruitment. RESULTS: Most respondents had undertaken or facilitated international recruitment between 2001 and 2006 and believed that it had enabled them to address immediate staff shortages. Views on longer-term implications, such as recruit retention, were more equivocal. Most organizations had made only a limited value-for-money assessment, balancing direct expenditure on overseas recruitment against savings on temporary staff. Other short and long-term transaction and opportunity costs arose from pressures on existing staff, time spent on induction/pastoral support, and human resource management and workforce planning challenges. Though recognized, these extensive 'hidden costs' for NHS organizations were harder to assess as were the implications for source countries and migrant staff. CONCLUSIONS: The main achievement of the intensive international recruitment period from a UK viewpoint was that such a major undertaking was seen through without major disruption to NHS services. The wider costs and challenges meant, however, that large-scale international recruitment was not sustainable as a solution to workforce shortages. Should such approaches be attempted in future, a clearer upfront appraisal of all the potential costs and implications will be vital.