This case study examines the emergence of an autonomy-oriented assessment culture in Pediatric residency education in the School of Medicine at Queen’s University. Through a case study approach this research explores how an assessment system to capture residents’ performance in the clinical environment was initiated, how that process supported a shift in assessment cultural, and how assessment innovation is eclipsing departmental boundaries. The case has instrumental value in illuminating how an autonomy-oriented assessment system and culture can be cultivated in residency education. The analytic frame for the case was constructed based on research literature that identified weaknesses in assessment practices in residency education more generally. The approach was theoretical, with the intent to explain how a shift in assessment culture is emerging in Pediatrics. A longitudinal approach was adopted to expose shifts in the culture. The narrative structure distills the journey into a manageable story. Three watershed events that exemplified change were systematically selected from data collected over a three-year period and constitute the findings of this research. The central contribution this research makes is that it is possible to shift the culture of assessment within a Pediatric residency program. That shift can be understood to unfold over a prolonged period through a process of mediating both social and regulatory requirements. Beginning to shift the assessment culture in Pediatrics was achieved by: recognizing the need for change in assessment practice, re-conceptualizing and realizing that change, and engaging and empowering the community to support a shift in assessment culture. Strong leadership, widening community engagement and the Rubric Descriptor Bank supported this process. Five theoretically informed principles guided the emergence of the autonomy-oriented assessment culture in Pediatrics including: (a) conceptualizing learning as a social, active process: (b) focusing attention on residents’ multidimensional growth; (c) moving away from a high-stakes orientation to assessment based on the false dichotomy between formative and summative assessment and embracing it as a tool for supporting and monitoring growth over time and across contexts; (d) actively supporting residents’ learning strategy and assessment skill development; and (e) fostering a growth orientation to learning, embracing the concept of graduated autonomy. / Thesis (Ph.D, Education) -- Queen's University, 2012-12-19 21:04:59.344

Graduate nurses beginning their nursing career require a collaborative relationship with an expert nurse mentor to make this transition successful. However, high turnover among these experienced nurse mentors is causing a problematic gap in knowledge transfer, experience, and expertise in the nursing workforce. This project investigated whether nurse mentors who mentored in a Nurse Residency Program (NRP) remained with the organization longer and were more satisfied with their mentoring experience than nurse mentors who mentored outside of a NRP. The diffusion of innovations theory was used to support the project and process of dispersing information on the outcome of the project. Sources of evidence for the project included case-cohort studies, systematic reviews obtained via an exhaustive literature review, and the collection of nurse mentor retention and satisfaction data through the use of a cross-sectional survey. Data were assessed from 214 registered nurses at a hospital in Rapid City, South Dakota and divided into 2 groups: nurse mentor and NRP mentor. When compared to nurse mentors, 10% more NRP mentors reported being employed in their current position with the intent to remain employed for 10 or more years as well as being very satisfied with their mentorship experience, supporting the project question. This project substantiates the need for experienced nurse mentors to prepare new graduate nurses coming into the profession. Contribution to positive social change is as a result of mentorship in nursing that functions as a means of retaining both new graduate and experienced nurses simultaneously.

Evidence-based practice has resulted in better patient outcomes, higher patient satisfaction, and effective patient-centered care. Leadership of a large teaching hospital determined that new nurses lacked the education and experience to design and implement an evidence-based project at the bedside, which was an expected outcome for completion of the established nurse residency program. The purpose of this project was to develop a design-only project in which Masters of Science in Nursing-prepared mentors were added to the residency program to establish the required evidence-based project. A mentor workshop was developed to guide the mentors in this role using Benner's novice to expert theoretical model. A team of stakeholders, including an expert in the field of nursing education, provided ongoing process evaluation in the development of the outcome products including the Mentor Facilitation Guide, Mentor Workshop Curriculum, Mentoring Toolkit, Pre-and Post-Mentor Workshop Survey Assessment, and Mentor Implementation Plan. Stakeholders completed a summative evaluation on the processes, outcomes, and student leadership of the project. Findings showed that the project met 100% of the stated goals and objectives, as evidenced by the stakeholders' responses to the summative evaluation regarding the degree of effectiveness for the project, process, and leadership skills. Implementation and evaluation of the project, which was developed for use in the hospitals' existing nurse residency program, will occur post-graduation. Social change will occur if new nurses learn to use evidence-based practice to support their nursing actions, resulting in improved patient care outcomes and population health.

Evidence-based practice has resulted in better patient outcomes, higher patient satisfaction, and effective patient-centered care. Leadership of a large teaching hospital determined that new nurses lacked the education and experience to design and implement an evidence-based project at the bedside, which was an expected outcome for completion of the established nurse residency program. The purpose of this project was to develop a design-only project in which Masters of Science in Nursing-prepared mentors were added to the residency program to establish the required evidence-based project. A mentor workshop was developed to guide the mentors in this role using Benner's novice to expert theoretical model. A team of stakeholders, including an expert in the field of nursing education, provided ongoing process evaluation in the development of the outcome products including the Mentor Facilitation Guide, Mentor Workshop Curriculum, Mentoring Toolkit, Pre-and Post-Mentor Workshop Survey Assessment, and Mentor Implementation Plan. Stakeholders completed a summative evaluation on the processes, outcomes, and student leadership of the project. Findings showed that the project met 100% of the stated goals and objectives, as evidenced by the stakeholders' responses to the summative evaluation regarding the degree of effectiveness for the project, process, and leadership skills. Implementation and evaluation of the project, which was developed for use in the hospitals' existing nurse residency program, will occur post-graduation. Social change will occur if new nurses learn to use evidence-based practice to support their nursing actions, resulting in improved patient care outcomes and population health.

Non-profit organizations have provided substantial services and resources to society such as arts, education, and social services. The cultivation and generation of financial donations through fundraising and development efforts are critical to the operation of non-profit organizations. This reality compels these organizations to continually attract and retain donors. To assist non-profit organizations' efficacy in fundraising, prior research has indicated the need for more studies on individual donor actions which could lead to a comprehensive model of donor behavior. One variable that had not yet been studied in relation to donor behavior is the influence of residency on donor motivations, specifically donors that own homes in different communities. Extant research reports that differences exist for homeowners related to their primary and secondary residences. These differences are evidenced by disparity in place attachment for the homeowners and by a variance in their behaviors at each home. This study surveyed non-profit organization donors in South Florida who own primary and secondary homes in different communities to determine if donors would exhibit a difference in their motivations for giving based on their different residences. Partial Least Squares regression, augmented with permutation tests, was run to evaluate hypotheses: donors would exhibit a difference in various motivations for making donations to non-profit organizations based on their residences. Results indicate no significant difference in donor motivation between the two residences; however, the significance levels of the latent variables did exhibit differences. The motivation factor of affinity for a cause/organization indicates an area of significance to both researchers and practitioners. The results of the study point to no differences in the amount donated based on whether the donor is considering their primary or secondary residence. Based on these findings, fundraisers do not need to target potential donors based on "seasonal" versus "permanent" residency; altruism, egoism, and tangible/financial benefits are similarly applicable regardless of location. One useful finding for managers with future fundraising campaigns is donor-perceived differences in affinity for organizations/causes and affinity for community. Fundraising efforts that center on campaigns and activities that create greater bonds between the donor and the organization/cause/community could foster greater fundraising results than those that appeal to simply "doing good" and "being important".

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Through the combined efforts of the American Pathology Foundation (APF), the American Society for Clinical Pathology (ASCP), and the Program Directors Section (PRODS) of the Association of Pathology Chairs (APC), a needs assessment was performed via a survey on the PRODS listserv, workshops at the APC/PRODS annual meetings in 2009 and 2010, and a Work Group of representatives of APF, ASCP, and PRODS. Residency program needs and resource constraints common to training pathology residents in practice and laboratory management were identified. In addition, a consensus curriculum for management training was created to serve as a resource for residency training program directors and others. The curriculum was converted into a "wiki" design tool for use by program directors, residents, and faculty.

Prescription drug abuse has been a growing problem in Indiana and around the nation for almost two decades. In recent years, prescription drug overdoses have pushed drug poisonings ahead of motor vehicle crashes as the leading cause of injury death. However, deaths due to overdoses of prescription drugs are only the tip of the iceberg when it comes to the much larger problem of abuse. This study has characterized prescription drug abuse in Indiana and taken an in-depth look at how it is and can be addressed both through organizational policies and state legislation. Opioid painkillers such as hydrocodone, oxycodone, and methadone are the most commonly abused prescription drugs, and most of these prescriptions are written by primary care physicians. Because more than 70% of Indiana’s family medicine residents will remain in the state to practice medicine following the conclusion of their residencies, it is worthwhile to take a look at how these residents are being educated during their training. St. Vincent’s Family Medicine Residency program in Indianapolis is one of several residency programs in Indiana training their residents on best practices of prescribing controlled substances. A review of residents’ prescribing patterns before and after training on the subject went into effect showed significant reductions in the number of opioid painkillers being prescribed, and showed the same reductions for alprazolam, a benzodiazepine anxiolytic.

With the advent of non-culture based methods, researchers are now aware of the presence of a microbiome within the human lung. The constant presence of microorganisms requires a regulated immune system that can differentiate between infectious organisms and non-infectious commensals. B cells in the lungs are a key member of adaptive immunity by producing antigen specific antibodies as well as immune regulatory roles by secreting various cytokines. In this work, we utilized lung and blood samples paired by donor to test the theory that human lungs hold a unique B cell repertoire. By phenotypic analysis, we found a smaller proportion of CD19+, CD20+ B cells in the lung in respect to the blood. Of this initial pool of cells, a significant proportion were class-switched memory B cells (CS Bmem) and a much lower proportion were naïve B cells in the lung. We have also observed a greater proportion of the residency marker CD69 in CD27- B cells and CD27+ Bmems in the lungs. CS Bmem cells from lung or blood were sorted into a B cell culture system to generate monoclonal antibodies to attempt to analyze antigen-antibody binding through a protein array. Finally, we have analyzed the immunoglobulin variable region genes (IgVRGs) of CS Bmem that are CD69+ or CD69-. We have found that diversity from the unmutated common ancestor (UCA) in pulmonary CS Bmem was as similar as those in the blood. However, comparisons by branch length and mean branch to trunk ratios, we observed greater diversity in the lung compared to blood. We observed both gain and loss of CD69 expression within clones shared between the lungs and blood. The work presented here suggests a model where the lung retains specialized, mature Bmems within the tissue by the expression of CD69. Once stimulated by their antigen, the progeny born from the subsequent expansion would not only spread within the tissue, but also be capable of returning to circulation. This would form an expanded B cell presence at the local tissue level as well as in circulation and efficiently prevent the progress of a potential infection.

The debate over police residency requirements dates to the advent of the modern police force in the early 19th Century. Many reasons have been put forth regarding these requirements, from effectiveness to availability to economic impact. On the other hand, opponents have argued that quality of life, employee retention, and applicant pool should be considered in the decision to have residency mandates. This study seeks to determine the effectiveness of resident police officers within the context of the Routine Activities Theory. In particular, it considered whether police officers are more capable guardians when they live in the jurisdictions where they work, specifically when using a marked take home police vehicle as a place keeper. Data was collected regarding police residency, Group A crime, Group B crime, and social disorganization in 25 apartment complexes in Chesterfield County, VA, during a six month period. It was found that police residency had a statistically significant and moderately strong negative effect on the rate of Group A crime and signs of social disorganization, as measured by police calls for service. Police residency showed a weak negative effect on Group B crime, but it was not statistically significant.