Breastfeeding support for mothers and their babies historically was the informal work of family and community members. In the United States today, breastfeeding support is embedded in the biomedical system, and is provided by a new allied health professional: the International Board Certified Lactation Consultant (IBCLC). This dissertation explores this professionalization of breastfeeding support and the origins of this new profession. It studies how IBCLCs working in the U.S. cultural context perceive and practice the profession and examines the relationship between the profession of lactation consulting and the medicalization of breastfeeding. Oral history interviews with 17 founders of the profession, which was established in 1985, and a content analysis of the professional journal (the Journal of Human Lactation) from 1985 to 2010, allowed me to build the story of how and why breastfeeding support became professionalized and how experiential breastfeeding knowledge entered the domain of expert knowledge. While constrained by the biomedical system in which they created the profession, the founders exhibited a both agency and creativity in their production and reproduction of professional values and practices. Interviews with 30 currently certified IBCLCs and observations of the clinical practice of 3 IBCLCs provided insight into the daily practice of IBCLCs working in different settings--hospitals, WIC clinics, pediatric offices, and private practice. The data collected from these ethnographic methods demonstrated how the medical knowledge base of IBCLCs translates into clinical practice with patients, and allowed me to understand the relationship between the profession of lactation consulting and the medicalization of breastfeeding. While IBCLCs' draw on medicalized knowledge and evidence about breastfeeding and human lactation, their interactions with clients are best described as empathetic and humanistic, and are derived from nursing and mother-to-mother breastfeeding support models rather than from a technocratic, biomedical approach to care. While the appropriation of certain biomedical values and standards helped to legitimize the professionalization efforts of the founders, in practice, lactation consultants apply their medical knowledge and clinical experience in a way that reflects the compassionate, empowering care approach of mother-to-mother breastfeeding support and that thus resists the overt medicalization of breastfeeding.

Geriatric Education Centers (GECs), as funded by the Health Resources and Services Administration, promote interdisciplinary geriatric education and training for more than 35 health-professions disciplines including medicine, dentistry, pharmacy, nursing, and social work. GECs are charged with becoming self-sustaining beyond the period of their funding. Sustainability in this application means that a GEC can fund itself through the generation of multiple revenue sources. This study seeks to explore changes in the structure, activities, and relationships of GECs over time in their pursuit of sustainability, and hypothesizes that GECs have shifted from the old economy, or the public good knowledge regime, to the new economy, or the academic capitalist knowledge/learning regime, and from the manufacturing to the networking economy. The theoretical framework of academic capitalism and the knowledge/learning regime will be used as a lens in this qualitative multiple case study.Sources included structured, in-depth, on-site interviews and observations, as well as documentary and virtual (website) evidence. While GECs are engaging in market-like behaviors, creating markets and circuits of knowledge, developing interstitial and intermediary organizations, and expanding managerial capacity, they have been unable to connect with related markets, as these markets lack a profit motive, and have ultimately been unsuccessful in their pursuit of sustainability. Continued federal funding for GECs is justified based on the public good argument that without public encouragement, these services would not be provided by the private sector. The study concludes with recommendations to enhance opportunity structures for GECs.

This study was conducted to determine if specialty areas are emerging in the magnetic resonance imaging (MRI) profession due to advancements made in the medical sciences, imaging technology, and clinical applications used in MRI that would require new developments in education/training programs and national registry examinations. In this exploratory study, statistical analysis incorporated the use of factor analysis and chi square. Factor analysis was used to group tasks performed by MRI technologists into factors to better identify emerging specialty areas within the MRI profession. Chi square was used to analyze the association between the tasks performed in (a) the employment setting, and (b) hospital size. Factor analysis identified four meaningful factors. The four named factors were: (a) Routine Imaging non-Central Nervous System Imaging; (b) Advanced Imaging; (c) Routine Imaging with Central Nervous System Imaging; and (d) Musculoskeletal and Spine Imaging. From the four named factors, three emerging specialty areas were identified: (a) central nervous system imaging; (b) vascular/cardiovascular imaging; and (c) musculoskeletal imaging. Chi square analysis identified 47 of the 78 tasks as being significant when finding an association between the employment setting and the frequency of tasks performed. Cramer's V was used to measure the strength of their association. The more complicated the procedure the more likely this procedure is performed in either a university or private hospital. Further, chi square analysis identified 42 of the 78 tasks as being significant when finding the association between the hospital size and the frequency of tasks performed. Gamma was used to measure the strength of their association. This means the larger the hospital, the more frequent the tasks were performed.

This paper examined the critical factors and potential predictors necessary for successful admission to dental school for students participating in the credential enhancing Oral Health Sciences (OHS) master’s program at Boston University. The academic parameters of OHS-DMD and traditional (four year) college graduate DMD students were compared to determine if OHS graduates performed at a comparable academic level in dental school as DMD students who entered dental school without completing a credential enhancing master’s program. To accomplish this, we examined data from students who matriculated to the Oral Health Sciences program from 2006 to 2015 and collected demographic, undergraduate grade point average (GPA), dental admissions test (DAT) scores and Oral Health Sciences GPA from Admissions and Registrar records for our analyses. To compare dental school performance and success on national board exams we obtained data for both OHS-DMD and traditional DMD students who enter the Boston University Goldman School of Dental Medicine. We performed unpaired T-tests to evaluate differences in undergraduate GPA, DAT and OHS GPA data for those OHS students matriculating to any dental school to determine what criteria, if any, can be used to predict success. We found that two factors were significant in determining acceptance to dental school: the Oral Health Sciences GPA (3.501 ± 0.301 vs 2.914 ± 0.336, p <0.0001*) and DAT scores (18.380 ± 2.089 vs 17.231 ± 1.833, p= 0.0365*). Comparison of academic performance between DMD and OHS-DMD at BU dental school found that students perform equally as well in Year 1 but dropped lower in Year 2 when comparing GPA (3.40 ± 0.052 vs 3.290 ± 0.259*, p=0.043). Lastly, first attempt fail rates on national board examinations (8.3% + 4.78 vs 7.4% + 5.1, p=0.024) between traditional DMD and OHS-DMD students were reduced however retake pass rates were equivalent (p=0.120). These studies demonstrate that both OHS-GPA and DAT scores are significant factors in successful admission to dental school for those who had been unable to gain acceptance without the credential enhancing master’s program. Additionally, students performing well in the Oral Health Sciences program matriculate to dental school and are nearly as successful academically and on board exams as traditional four-year students DMD. Lastly, in keeping with the original mission of the OHS program, we have been largely successful in allowing underachieving and/or underrepresented minority and socioeconomically disadvantaged students to gain acceptance dental school.

Background. A constantly changing reform agenda has frequently changed NHS management arrangements. Impacts are documented for medicine and nursing but much less so for the third largest profession, physiotherapy. Aims. To evaluate the impact of NHS reforms on physiotherapy analysing whether the resulting management structures impacted on staff and patient care; comparing English and Welsh arrangements with previous periods. Method. Observational mixed methods including a narrative literature review; questionnaire census; semi-structured interviews; physiotherapy narrative history; and a normative evaluation of physiotherapy management structures. Results. NHS reforms had impacted on the structure of physiotherapy management and organisation. Of the eight management structures described in Øvretveit’s (1992) schema: Three were not observed; two were observed but needed modification; three were observed and empirically applicable with small modifications; social enterprises had evolved with management structures similar to those in the NHS. The main changes to physiotherapy managers’ roles between1989-2014 were substantial reorganisations affecting the employing organisation and role of the managers with a reduction in Community Trusts and the introduction of competing providers into English NHS physiotherapy. Clinical autonomy had been extended with advanced practice roles in some areas. The role of the professional body and TU (the CSP) was generally well-regarded by managers. The differences between England and Wales related more to management structures than national policy differences. Conclusions. Most physiotherapists were managed within cross-AHP structures. Devolved structures were increasingly emerging but physiotherapy managers preferred professionally-led structures. Physiotherapy managers ranked the AHP Directorate the highest and the Fragmented structure the lowest. The AHP professions will need to consider merging to conserve their power as professions and to maximise their combined contribution to patient care and organise to meet fiscal challenges in both countries.

The purpose of this study was to evaluate the effectiveness of the committee of preliminary inquiry (in the context of professional conduct committees) of the Health Professions Council of South Africa, with specific reference to maxillo-facial and oral surgery. An evaluation was done of cases that were referred by the committee for preliminary inquiry to this specific professional conduct committee of the Medical and Dental Professions Board. Where necessary, these cases were supplemented by relevant cases from other professional conduct committees. In order to achieve this goal, a comprehensive literature study was conducted on the broad concept of medical and dental misconduct and negligence. Specific attention was paid to the issues of expert testimony and witnesses and consent. Furthermore, a study was conducted to determine the legal framework in which these committees are supposed to function. In the cases where inquiries into the complaints against the registered practitioners followed, a detailed evaluation of the so-called legal process was done, as well as the findings in each case (in the context of the professional conduct committees). The results of this study have shown that the investigative system of the committee for preliminary inquiry preceding professional conduct inquiries into complaints against registered practitioners has certain shortcomings, especially in the more complex cases. The following proposals have been made (in order of most importance): 1. Both the committee for preliminary inquiry and professional conduct committee must abide by the rules of natural justice, as pertained in the Constitution of the Republic of South Africa. 2. Establishment of a Forum of Expert Witnesses that will evaluate all cases of alleged professional misconduct and negligence pertaining to the field of maxillo-facial and oral surgery, after it was evaluated and referred by the Ombudsman. 3. Appointment of a maxillo-facial and oral surgeon as Ombudsman to evaluate all cases brought before the committee for preliminary inquiry pertaining to the field of maxillo-facial and oral surgery. 4. Acceptance of the proposed test of medical negligence, i.e. the ‘reasonable person’s test’, subjected to that of the ‘reasonable specialist’ as standard for evaluation of cases of alleged negligence in maxillo-facial and oral surgery. 5. The proposed patient’s consent form serves as an example of a legitimate patient consent form. It follows that the legal requirements, especially in cases of extensions and deviations of medical interventions, must be adhered to. 6. It is advisable to belong to an organisation providing indemnity cover (such as Medical/Dental Protection Society) in order to receive proper assistance in the handling of these cases of alleged unprofessional/disgraceful conduct. The recommendations consequential to this study would provide a more streamlined, cost- and time effective investigative system to investigate claims of unprofessional conduct for possible further disciplinary action. / Thesis (PhD (Dentistry))--University of Pretoria, 2006. / Maxillo-Facial and Oral Surgery / unrestricted

Traditional models for public health professional education tend to be didactic, with brief, discrete practica appended. National reports of both practitioners and academicians have called for more competency-driven, interdisciplinary-focused, community-based, service-oriented, and experientially-guided learning for students across the curriculum. East Tennessee State University began its own curricular revisioning in health professions education nearly 2 decades ago with a grant from the W.K. Kellogg Foundation, emphasizing competencies development through community-based learning in community-academic partnerships. This article describes 3 examples that grew from that initiative. In the first example, students in multiple classes delivered a longitudinal community-based employee wellness intervention for a rural county school district. BS public health students conducted needs assessments and prepared health education materials; MPH students conducted health assessments and worked with school wellness councils to deliver client-centered interventions; DrPH students supervised the project and provided feedback to the schools using participatory methods. In the second example, MPH students in a social-behavioral foundations course used experiential learning to investigate the region's elevated cancer mortality ranking. Following meetings with multiple community groups, students employed theoretical constructs to frame regional beliefs about cancer and presented findings to community leaders. One outcome was a 5-year community-based participatory research study of cancer in rural Appalachia. In the third example, MPH students in a health-consulting course assessed local African Americans' awareness of the university's health and education programs and perceptions of their community health issues. Students learned consultation methods by assisting at multiple regional African American community meetings to discover issues and interest that resulted in the organization of a regional African American health coalition, multiple community health interventions, and the region's first health disparities summit. Lessons learned are presented which identify key elements of success and factors that influence adoption of community-based teaching and learning in public health.

Objective: A collaborative campus-community partnership program provided the framework for an intervention to reduce motor vehicle accident fatalities along a rural Appalachian highway. Students from public health, nursing and medicine worked with community members to identify the problem and plan the strategy to address it. Methods: An inquiry-based learning model proved to be an appropriate approach to engage student teams with community leaders in identifying and resolving health needs. Inquiry-based strategies place students in guided learning situations where their investigations lead to working solutions. The inquiry-based model matched the curricular objectives of the Community Partnership Program (CPP) more closely than the classroom oriented problem-based learning approach. Implementation: In the spring of 1994, students, along with citizens and officials of a rural Appalachian county, initiated a community-based prevention project focused on reducing deaths from motor vehicle accidents employing the principles of an inquiry-based learning model. Discussion: This project effectively demonstrates the role that students can play in mobilizing diverse elements of the community to address identified health and safety concerns. It provides an illustration that a longitudinal, community-based, service-learning approach to health professions education is beneficial to both student learners and communities. Conclusions: Through the use of inquiry-based learning methods, students gained real life experience in applied principles of health statistics, epidemiology, community organization, health risk communication, health education planning and program implementation. Outcomes of the project included a measurable reduction in automobile-related fatalities and the initiation by the state department of transportation of a series of investigations expected to pave the way for physical improvements to the roadway.

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My thesis examines patients’ and caregivers’ perspectives on educating healthcare providers(HCPs). Specifically, it examined two research questions: 1) What do patients think about their involvement in the education of HCPs? and 2) What roles do patients want to have in the education of HCPs? It is important for educational leaders and HCPs to understand answers to these questions, from patients’ own perspectives, to make effective changes in current and future health professions education and ultimately, the delivery of patient-centred care. I conducted semi-structured interviews with 27 patients and caregivers for this study. Through conventional content analysis, I identified five themes for what patients think about their involvement in the education of HCPs. Namely, patient involvement in the education of HCPs: (1) is challenging because of power-differentials between themselves and HCPs; (2) requires patient training; (3) needs to start early in HCPs’ education process; (4) can improve patient-HCP partnerships; and (5) requires compensation for patients. I also identified three roles that patients want to have in the education of HCPs. Specifically, they want to: (1) teach HCPs about patients’ expectations, experiences, and perspectives through case studies, storytelling, and research; (2) provide direct feedback to HCPs; and (3) advise on curricula development and admission boards for HCPs. My research adds to the limited research on patients’ and caregivers’ perspectives on their involvement in the education of HCPs, identifies barriers to patient involvement, and provides a foundation that HCPs and educational leaders can use to improve patients’ active involvement in the education of HCPs. Further, it highlights that patients’ voices are important to the education of HCPs. It also illuminates my own perspectives on patient involvement in the education of HCPs, which I share as part of my positionality as a researcher who conducted this study.