The shortage of healthcare workers and doctors in the developing world compared to the developed world is a problem, and will continue to be so, due to the continual migration of qualified professionals and the inability of the state to remedy these shortfalls. A shortage of healthcare workers and specialist doctors will seriously hamper the Government’s National Health Insurance (NHI) plan, as well as the sustainability of the private health care sector. In addition, the duration of medical training in South Africa is exceptionally long. The three major hospital groups and other private corporates have over the last number of years taken limited initiative to fund education projects in conjunction with the academic institutions. However, these projects have been poorly focused and have been managed in an unstructured and detached manner. There is a desire from the private sector to get involved in these projects on a much larger scale through more formalised structures. Given this background, the primary objective of this research is to develop a business model for medical subspecialty training to complement the current academic subspecialty training in South Africa. A trial model for training subspecialists in reproductive medicine was developed as a first attempt to address the threatening shortages and training duration. This trial programme is the basis of this research. A two-phased process was used in collecting data. In Phase 1 data was collected from stakeholder groups. The results of this survey assisted in generating variables to include in the measuring instrument for the survey in Phase 2. In Phase 2 the perceptions and expectations of sub-specialists (reproductive subspecialists and cardiologists) regarding sub-specialty training was collected. The results of the demographic variables confirm the aging profile of subspecialist and the need to ensure succession. The results further showed that cardiologists and reproductive subspecialist expectations of the training of subspecialists are very similar except for their expectations on the training duration. Reproductive subspecialist respondents agreed more than cardiology subspecialist respondents that the training duration is too long. The biggest gap between perceptions and expectations is also with the factor training. The results showed that the expectations of subspecialists are not met for training. From these results a business model for the training of medical subspecialists is proposed. This proposed business model can play a complementary role to the existing state controlled system and form the bases of Public Private Partnerships (PPP) in medical training. This proposed business model will fit a developing country were the focus is on primary healthcare, with financial and capacity constraints. The proposed model would require role players to bring about change to accommodate a larger scale Public Private Partnership (PPP) to ensure the implementation of the model. The proposed decentralised business model for training subspecialists would allow the trainee subspecialist to practise as a specialist thus maintaining an acceptable income, and enable an expedited completion and lead to a wider dissemination of medical expertise that can be delivered in a wider national foot print. It further will provide for a structured Public Private Partnership.

Based on the survey results of 150 South Korea toddler caregivers about training needs, I developed a relationship-based approach for a toddler caregiver training program. The training program was modified using suggestions provided by 6 South Korean professors, who were asked to review the program. Survey findings revealed that: (a) All participants (toddler caregivers) perceived that it is necessary for caregivers to attend training. However, most (72.2%) found that it was difficult to attend training programs more than 1 time per year because it was hard to find a substitute teacher (64%). Participants desired to attend training programs on toddler care because of the lack of in-service education (26%), curriculum (24%), and training programs (15.3%); (b) Caregivers who had the third-degree caregiver certification preferred to learn parent education more than child development. However, caregivers who had a higher degree of caregiver certification preferred to learn child development more than parent education; and (c) Caregivers who had more than 5 years of teaching experience preferred to learn about the teacher's role more than caregivers who had fewer than 4 years of teaching experience. Future studies need to evaluate the effect of this relationship-based training program for toddler caregivers in relation to improvement in the quality of child care and interaction between caregivers and toddlers. A large-scale study would increase the generalizability of research findings. A larger sample size from different cities in South Korea and random sampling would generate more reliable findings.

MSc. Thesis / Introduction: In 2018, the College of Midwives of Ontario expanded the scope of practice for registered midwives to include performing point of care ultrasound (POCUS) to aid their obstetrical clinical assessments. This project evaluated learner sonography knowledge, skill acquisitions, and integration of this technology following an innovative POCUS curriculum developed for midwives to understand the impacts of this training. Methods: Concurrent triangulation with mixed methods was used in this study through surveys and interviews. First, the surveys were used to collect data across four time points including before and after the intervention. Five- and seven-point Likert scale questions were analyzed through descriptive statistics. Open-ended questions were qualitatively analyzed using thematic analyses. Second, the semi-structured interviews were conducted to better understand participants’ attitudes and clinical behaviours. Interviews were coded and analyzed using a combination of Corbin and Strauss as well as Charmaz approaches to grounded theory. Results: The findings demonstrated how there was a positive growth in learner comfort with POCUS and a desire to continue using it during clinical practice. The frequency of POCUS use within antenatal care increased with common applications including fetal presentation and assessment of pregnancy viability. The interviews highlighted five themes: facilitating learning, improving care, refining the role of the midwife, serving community, and maintaining competency. Access to clinical placements and the cost of a device were identified as barriers to promoting POCUS skill sets. Participants who had access to a device and completed the clinical practicum are continuing to use sonography within their clinics to provide more comprehensive client care. Conclusions: This project demonstrates how POCUS training can positively impact midwives particularly with aiding clinical decision making such as those regarding fetal viability and presentation. However, the challenges with obtaining a clinical practicum to ensure competency and the cost and access to a device, are significant barriers that unless they are addressed, may result in minimal integration within community practices. / Thesis / Master of Health Sciences (MSc) / The ability to conduct ultrasounds has recently been included in Ontario midwives’ scope of practice. This project evaluated a newly developed Point of Care Ultrasound (POCUS) curriculum for practicing midwives to understand how midwives can learn and apply POCUS into their clinical work. Learners completed surveys at four time points from pre-course to one-year post-course to share their experiences of knowledge and skill acquisition and applying this training to their clinical work. Five midwives also participated in an interview to share their perspectives about the course more in-depth. It was found that Ontario midwives were very interested to learn POCUS to improve client care. Unfortunately, they struggled finding time and opportunities to refine their sonography skills such as securing a clinical practicum or the funds to purchase a device. However overall, POCUS in midwifery was well received, this technology and its respective education should continue to be supported in Ontario.

Thesis (PhD (Education))--University of Stellenbosch, 2006. / During the past twelve years of democracy health care services in South Africa have been influenced by political, social and economic change. As a result of the transformation of health care services and the change of political policy, the focus on primary health care increased. During the early stages of the transformation of health care services stakeholders realized that in order to provide an extensive health care service specialized training is required. Various educational institutions provided formal and informal programmes in order to meet the new challenges of the nursing profession. Although minimum requirements of the content and clinical practice have been established by the nursing council, the mode of presentation, costs, duration and type of qualification awarded to clinical nursing practitioners differed substantially. Uniformity in terms of programme content was lacking, neither were any scientifically founded attempts made to establish whether these programmes fulfilled the needs of the student in the rural community. Although a variety of training programmes exist the number of trained clinical nursing practitioners is still inadequate. In addition training is focused on the urban community. The objective of the research was to determine the opinion of the rural nurse on clinical nursing education, and to develop a training framework based on their input which would meet their needs. This research was conducted from an explanatory-descriptive paradigm. The case study was used as research design. A literature study on the development of primary health care both internationally and nationally was done. The literature study revealed the development of training programmes for clinical nurses. Chapter three of the literature study is dedicated to the theoretical aspects of the design of a student centered training framework for the adult student. A student centered training framework has created from data gathered via questionnaires completed by clinical nurses and semi-structured interviews with semi-qualified nurses. Semistructured interviews have also been conducted with the supervisors of nurses working in clinics and community health centres in the Northern Cape. The conclusion that respondents showed a positive attitude towards training in clinical nursing was encouraging. The majority of respondents indicated that they would welcome an additional qualification which will improve their knowledge and would result in better patient care. The respondents highlighted staff shortages, financial constraints and family responsibility as the main obstacles towards these qualifications. During the research it became clear that no formal training is currently available in Kimberley. This is as a result of the absence of mentors. Although the respondents have limited access to computers they indicated that they would prefer computer supported training in conjunction with physical contact sessions. The research indicated that no formal policy on the training of clinical nurses exists in the rural Northern Cape. In the absence of a training framework the research further contributed towards the development of a student centered training framework for clinical nurses in rural Northern Cape. The research succeeded in highlighting the necessity for formal policy on the training of clinical nurses in rural Northern Cape.

The purpose of this explanatory sequential mixed methods study was threefold. First, this study compared the effects of two different simulation-based instructional strategies on athletic trainers’ clinical competence in performing cardiovascular screening with cardiac auscultations. Second, this study identified the athletic trainers’ perceptions of learning through simulation-based instructional strategies. Third, this study attempted to identify and offer instructional recommendations based on the outcomes. The quantitative phase analyzed cognitive and diagnostic reasoning knowledge and history-taking and clinical skills specific to cardiovascular screenings with cardiac auscultations as it was taught to athletic trainers (ATs) at a continuing professional education (CPE) course. The quantitative results found that high-fidelity and low-fidelity simulation-based instructional strategies significantly increased cognitive and diagnostic reasoning knowledge and history-taking and clinical skill from pre-test to post-test assessment on all dependent variables. When comparing the two fidelity types to each other, the analysis found that the participants in the high-fidelity simulation group gained significantly more skill when compared to the low-fidelity group. In the qualitative analysis of this study, three themes emerged specific to the perceptions of the athletic trainers’ experiences as they learn through simulation-based instructional strategies. The first theme that emerged was a clear indication that participants’ exhibited positive perceptions of learning through simulation-based instructional strategies. The second theme that emerged was that the high-fidelity simulation experience during the pre-assessment and post-assessment raised an awareness of the deficit of knowledge and skills in performing a comprehensive cardiovascular screening with cardiac auscultations. Lastly, the third theme that emerged was specific to the perceived limitations in the effectiveness of low-fidelity simulation and the perceived strengths in the effectiveness of high-fidelity simulation. A few instructional recommendations emerged from this dissertation study. Simulation-based instructional strategies are an ideal teaching method to utilize during continuing professional education courses with athletic trainers. Specifically, this study identified that both, high-fidelity and low-fidelity simulation, are effective in teaching cardiovascular screening with cardiac auscultations. Additionally, the participants perceived influences of a pre-test on the identification of their knowledge and skills deficit suggests that there are benefits of utilizing an authentic simulation pre-test as part of CPE courses. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2016. / FAU Electronic Theses and Dissertations Collection

This investigation was concerned with the problem that the staff development needs of child-care personnel in juvenile detention facilities in the State of Texas have not been identified and described. The study utilizes the Delphi technique in determining juvenile detention administrators' perceptions of the skills/knowledge required to be a competent detention child-care worker. The assumption was made that detention administrators can supply relevant input to study.

This research explores final year dental students’ knowledge and attitudes towards the treatment and management of patients with Intellectual and Developmental Disabilities (I/DD) as related to variations in the dental practices in Special Health Care Needs (SHCN) training they received. A quantitative, non-experimental study was conducted, employing survey data collection methods, to address descriptive, comparative, and correlational questions. One cohort, Class 2020, attended extramural rotations in specialized clinics for patients with I/DD and in-person lecture concerning this topic. However, due to the COVID-19 pandemic and its health-related restrictions, another cohort, Class 2021, did not have the same opportunity as rotations were cancelled and the lecture was prerecorded and viewed online. Responses from a 35-item survey, distributed through an online platform, were obtained from both cohorts (n= 14 for Class 2020; n= 19 for Class 2021), addressing descriptive, comparative, and correlational research questions. Results revealed higher levels of knowledge and more positive perceptions of the program from Class 2020, the group that received clinical guidance, than Class of 2021. Analysis revealed positive relationships between students’ confidence levels and whether they had examined, assisted, or treated patients with I/DD. Associations were also found between students’ confidence and willingness to treat patients with I/DD. Although only correlational, this study’s findings suggest ways to foster students’ confidence and induce positive attitudes in dental school graduates that are likely to improve equitable access to healthcare for those with I/DD.

Thesis (PhD)--University of Stellenbosch, 2006 / ENGLISH ABSTRACT: Zambia is reported to have high levels of maternal morbidity and mortality due to low contraceptive prevalence rates, over 50% of births not being attended to by skilled persons, and teenage pregnancies. A number of organisations (stakeholders) have invested in the training of adolescent reproductive health peer educators with the aim of empowering them to be role models to their peers in reproductive health, but Zambia does not have a generic and locally developed training programme for peer educators. The purpose of this study was to develop a training programme that would produce competent and more effective peer educators for Zambia. The objectives were to determine the characteristics of the ideal peer educator. Further objectives were to ascertain the factors that contribute to or impair the development of the ideal peer educator, and to determine whether training programmes that were being used were producing ideal peer educators and enhancing healthy lifestyle behaviours. Key stakeholders participated in group interviews were they presented and critiqued their training programmes. Emerging out of this process was a draft training programme, developed by the stakeholders. Focus Group Discussions (FGDs) were held with adolescent peer educators from Lusaka, Kafue, Livingstone and Maheba refugee camp. Data were analysed by triangulating the outcomes of the group interviews (with the stakeholders) with the outcomes of the FGDs and reviewed literature. The FGDs highlighted the characteristics of an ideal peer educator as well as factors that contribute towards his/her competence development. Numerous factors were reported that had a negative impact on the development of an ideal peer educator. The peer educators reported that their training had had a positive effect on their lifestyle behaviours. While they had gained more knowledge on HIV and AIDS, they recommended more training on other health issues. The study found that at community level, peer educators were not being given adequate respect because the concept of voluntary work was not readily accepted and they were regarded as failures in life. Major demotivating factors were the lack of payment of incentives and the fact that peer educators were not certified. Peer educators did not receive sufficient support from programme managers/coordinators to enable them to become more effective at community level. Weaknesses in the way the training programmes were conducted were also discerned. Based on the findings of this study, it is recommended that more life skills’ development be promoted for peer educators. Training should be contextualised for the communities in which the peer educators work. The developed training programme, which should be used as a guide, should be repackaged to suit the profiles (e.g. values) of the different communities. Adolescents and various social sectors (inclusive of indicated stakeholders) ought to be involved in diagnosing community needs so as to influence both peers and communities in a way that would promote adolescent reproductive health. This study also recommends a more informal way of practising peer education, which would produce trainees who would be peer educators and role models in any given setting. / AFRIKAANSE OPSOMMING: Na berig word is die hoë siekte- en sterftesyfers onder moeders in Zambië daaraan te wyte dat voorbehoedmiddels nie algemeen gebruik word nie, dat meer as 50% van geboortes plaasvind sonder die bystand van bekwame persone, en dat daar ‘n hoë voorkoms van tienerswangerskappe is. ‘n Aantal organisasies (belanghebbers) het in die opleiding van adolessent- portuurgroep-opvoeders in reproduktiewe gesondheid belê ten einde hierdie portuurgroep-opvoeders te bemagtig om as rolmodelle in reproduktiewe gesondheid op te tree. Zambië het egter nie ‘n eie generiese, plaaslik-ontwikkelde opleidingsprogram vir portuurgroep-opvoeders nie. Die doel van hierdie studie was om ‘n opleidingsmodel en opleidingsprogram te ontwikkel wat bekwame en meer effektiewe portuurgroep-opvoeders vir Zambië sou kon oplewer. Die doelstellings was om die kenmerke van ‘n ideale portuurgroep-opvoeder te bepaal en om die faktore te identifiseer wat óf tot die ontwikkeling van ‘n ideale portuurgroep-opvoeder bydra óf sy/haar ontwikkeling strem. Daar moes ook vasgestel word of bestaande opleidingsprogramme ideale portuurgroep-opvoeders oplewer en gevolglik gesonde leefstylgedrag bevorder. Die navorser het groeponderhoude gebruik en betekenisvolle belanghebbers genooi om hulle opleidingsprogramme aan te bied, te beoordeel en krities te bespreek. ‘n Konsepopleidingsprogram wat deur die belanghebbers ontwikkel is, het uit hierdie proses ontstaan. Fokusgroepbesprekings (Engels: Focus Group Discussions of FGDs) is met adolessente portuurgroep-opvoeders van Lusaka, Kafue, Livingstone en die Maheba-vlugtelingekamp gehou. Data is ontleed deur die uitkomste van die groeponderhoude (met die deelhebbers) met die uitkomste van die fokusgroepbesprekings en die bespreekte literatuur te trianguleer. Die fokusgroepbesprekings het die soeklig op die kenmerke van die ideale portuurgroepopvoeder asook op die faktore wat tot sy/haar bekwaamheidsontwikkeling bydra, laat val. Talle faktore wat ‘n negatiewe uitwerking op die ontwikkeling van ‘n ideale portuurgroep-opvoeder het, is ook vasgestel. Die portuurgroep-opvoeders het bevestig dat hul opleiding ‘n positiewe invloed op hul lewenstylgedrag gehad het. Terwyl hulle genoem het dat hulle meer kennis oor MIV en VIGS opgedoen het, het hulle aanbeveel dat daar ook meer klem op ander gesondheidskwessies behoort te wees. In hierdie studie is daar bevind dat portuurgroepopvoeders op gemeenskapsvlak nie met voldoende respek behandel word nie. Die begrip van vrywillige werk word nie geredelik aanvaar nie, en die opvoeders word as mislukkings beskou. Faktore wat besonder ontmoedigend inwerk is die gebrek aan ‘n aansporingsloon en die feit dat portuurgroep-opvoeders nie sertifikate ontvang nie. Portuurgroep-opvoeders het ook nie voldoende ondersteuning van programbestuurders/- koördineerders ontvang om hulle in staat te stel om meer effektief op gemeenskapsvlak op te tree nie. Daar is voorts swakhede opgemerk in die wyse waarop die opleidingsprogramme uitgevoer is. Gegrond op die bevindinge van hierdie studie, word daar aanbeveel dat die ontwikkeling van lewensvaardighede tot ‘n groter mate bevorder word. Opleiding behoort gekontekstualiseer te word vir die gemeenskappe waarbinne die opvoeders werk. Die bestaande opleidingsprogram, wat as ‘n riglyn gebruik behoort te word, behoort herstruktureer te word om by die profiele (bv. die waardes) van die verskillende gemeenskappe in te pas. Adolessente en verskillende sosiale sektore (insluitend die aangeduide belanghebbers) behoort betrokke te wees by die bepaling van die gemeenskap se behoeftes ten einde beide portuurgroepe en gemeenskappe so te beïnvloed dat adolessente- reproduktiewe gesondheid bevoordeel sal word. Hierdie studie beveel ook aan dat portuurgroep-opvoeding op ‘n informeler grondslag beoefen behoort te word sodat die kwekelinge uiteindelik in enige gegewe omgewing suksesvolle portuurgroepopvoeders en rolmodelle sal kan wees.

Thesis (MPhil (Industrial Psychology. Africa Centre for HIV/AIDS Management))--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: “Treatment failure, defaulter rate, patients lost to follow up”. These are the words usually spoken by health care workers at the CCMT clinics in the country. These are words that they try at all times to come with solutions to, without much success. Much as both the health care workers and patients know the importance of taking medication, often medication is not taken as required. Adherence is defined as the degree to which a patient follows a treatment regimen which has been designed in the context of a consultative partnership between the client and the health care worker. This obligation is comprehensive as it tends to examine all factors that can affect adherence. It includes characteristics such as the treatment regimen, the provider behaviour, social and environmental factors that may hinder adherence on the patient. There are several factors that lead to non-adherence to treatment. The factors may be classified as Biomedical, Psychological and Social factors. The major tool that can be used to address such issues is adequate training of all staff members working at the CCMT clinics. The researcher explored training needs and gaps at a CCMT site that will assist to combat problems of non-adherence to treatment. Health care works at an identified site where questioned on the level of training they have received and on what they need to improve their management of patients and adherence. It was realised that some categories of staff at the clinic do not receive training as expected and that others do not receive adequate training that will assist them in adherence counselling. Recommendations made by staff members were that training should be readily available to all staff members and that it should also be rolled out to other departments and sections within the hospital so there is continuum of care of HIV positive patients. Non adherence to antiretroviral treatment is a challenge faced by health care providers as well as patients themselves. It results in treatment failure, a decrease in the quality of life of the patient and an increase in morbidity and mobility. Non-adherence means any reason where the patient is not taking recommended doses, not sticking to the recommended time or not taking it in the recommended way. / AFRIKAANSE OPSOMMING: Navolging word gedefinieer as die mate waarop die pasiënt die behandeling wat voorgeskryf is in samewerking tussen die pasiënt en die gesondheidsorgwerker, nakom. Hierdie vepligting is omvattend omdat dit geneig is om alle faktore wat die nakoming kan beinvloed, ondersoek. Dit sluit eienskappe in soos die behandeling regimen, die verskaffersgedrag, sosiale en omgewingsfaktore wat ‘n struikelblok kan wees vir die nakoming van die pasiënt. Daar is verskeie faktore wat kan lei tot nie-nakoming van behandeling. Die faktore kan geklassifiseer word as bio-mediese, sielkundige en sosiale faktore. Die belangrike instrument wat gebruik word om sulke sake aan te spreek, is voldoende opleiding van alle personeellede wat by CCMT klinieke werk. Die navorser ondersoek opvoedkundige behoeftes en leemtes by ‘n CCMT perseel, wat sal help om probleme van nie-nakoming van behandeling sal bestry. Gesondheidsorgwerkers by ‘n geïdentifiseerde perseel, was ondervra oor die vlak van opleiding wat hulle ontvang het en wat hulle nodig het vir beter bestuur van pasiënte en nakoming van behandeling deur pasiënte. Daar is gevind dat sommige kategorieë van personeel by die klinkiek nie die opleiding ontvang het wat nodig is nie en dat ander personeellede nie voldoende opleiding ontvang het wat hulle sal help met nakoming van berading nie. Personeellede het aanbeveel dat opleiding geredelik beskikbaar gemaak moet word aan alle personneel en dat dit na ander departemente en afdelings binne die hospitaal uitgebrei moet word om die voortsetting van sorg vir MIV/VIGS-positiewe pasiënte te verseker. Nie-nakoming van antiretrovirale behandeling is ‘n uitdaging vir beide gesondheidsorgwerkers en pasiënte. Dit lei tot die mislukking van behandeling, ‘n afname in die kwaliteit van die pasiënt se lewe en ‘n verhoging in morbiditeit en mobiliteit.

The aging population in the U.S. is dramatically increasing; it is predicted that not only will individuals live longer but also that they will live with multiple chronic diseases that could require high levels of medical and social resources. While the aging population increases, the number of health care providers choosing to specialize in caring for the elderly is decreasing just as dramatically. Teams are believed to be a possible response to more efficiently use the providers available, take advantage of alternative provider types, and integrate a range of health and social services to meet patient needs more effectively. Interdisciplinary teams are the best practice in the care of older adults, who require both medical and social services. However, maintaining functional collaborative teams has been an ever-present challenge to health and social care organizations. Research has found that institutional support is critical for teams to benefit patients and organizations alike. This study examined the role of institutional context in supporting interdisciplinary teams (IDT) in the care of older adults through interviews of the management and staff of the Program for All-Inclusive Care of the Elderly (PACE) in six states. PACE organizations must commit to an interdisciplinary model of care consisting of 11 different disciplines from across the professional spectrum. The research question posed for this study was: What elements of institutional context support the use of interdisciplinary teams in the care of older adults? Due to the standardized team structure used, PACE was selected as the model to see how institutions at macro and micro levels support the work done by PACE teams and possibly highlight where support is still lacking. A case study approach drawing upon qualitative methods was used to examine policy-regulative, cultural-cognitive, normative, relational, and procedural elements of institutional context and the extent to which they support collaborative teamwork. Thirty-two interviews were conducted with administrators and team members from seven PACE programs across the country. For these PACE programs, five elements and 14 categories of support were identified by the interviewees. Policy and regulatory elements constrain and systematize behavior. PACE IDT experience these constraints and systems through regulatory body practices, resource allocation, and quality measurement. Cultural-cognitive elements mediate between an IDT's external environmrder to make sense of what is happening. PACE IDTs create meaning through their interactions with their external environments through interdependence, demographic characteristics, and organizational structure. Normative findings constrain behavior and confer the rights and duties of IDT members, which arise from organizational mission and values, leadership, and professient and the response of the IDT in oonal boundaries. Relational elements emphasize relationships among IDT members and team interaction with the organization's environment. Social constructs within the team affect role definition and communication, which support IDT practice. Procedural support standardizes practices to maintain highly functional teams. In order to support IDT practice, PACE organizations highlighted recruitment and retention, time and space, and training and education as the primary ways to support IDTs. These categories illustrate the complexity of supporting teams and actualizing teamwork in practice. These findings suggest that PACE is succeeding in supporting the IDT model and provides lessons for other organizations that wish to do the same.