Up to the middle of the 1970's most government policies dealing with physician manpower dealt with the problems of increasing the supply of physicians, rather than changing the geographic disparity of physicians between urban and rural areas. In 1983 the British Columbia government introduced legislation (passed in a modified form in 1985) that would restrict certain groups of physicians from obtaining Medical Service Plan billing numbers in certain areas of the province, in an attempt to change the geographic distribution of physicians in this province. Regulation is only one of a number of approaches to altering the distribution of physicians. The purpose of this study is to attempt to recommend other approaches that could be used to alter the geographic distribution of physicians, based on the factors which the residents and interns of British Columbia would consider necessary before they will establish practices in the rural areas of the province. The literature was examined to determine the present supply and distribution of physicians in the province of British Columbia. It was shown that the metropolitan areas had much higher concentrations of physicians than did the non-metropolitan regions. The literature was then searched to determine what types of policies had been used in an effort to change this geographic disparity and also to determine what factors influence physicians to locate their practices where they do. From this research a questionnaire was developed and mailed to all residents and interns registered in the University of British Columbia medical program in the academic year 1984-85. A response rate of 31.8% was obtained in this survey. It was found that many physicians were raised in large communities and planned to locate their practices in similar geographic areas to where they were raised. It was also found that the factors which the residents and interns considered to be the most important fell into the "Fixed Determinant" category, that is factors that are personal preferences of the physician. This makes it very difficult to formulate any type of non-regulatory policy to affect the geographic distribution of physicians in British Columbia / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

The purpose of this evidence-based project was to compare one-year outcomes for newly licensed Registered Nurses (NLRNs) in three organizations within the same healthcare system. All three have lower than nationally reported turnover and strategies for NLRN retention. Only one is using a Nurse Residency Program (NRP). NRPs are recognized as an effective strategy to retain newly licensed registered nurses (NLRNs) in their first year of employment (Institute of Medicine [IOM], 2010; The Advisory Board, 2007; Spector, 2007). The Commission on Collegiate Nursing Education (CCNE) (2008) defines an NRP as a series of learning sessions and work experiences that occur continuously over a 12-month period designed to assist NLRNs as they transition into their first professional nursing role. This cross-sectional, descriptive study utilized the Casey-Fink Graduate Nurse Experience Survey and intent to stay questions to collect data on NLRNs at one year post hire. Results indicated no statistically significant differences between the three sites and the subscales of the survey. There was a trend of a more positive score for professional satisfaction with Site A. Turnover was also similar between sites and lower than the reported 10% average, with Site A at 2%, Site B at 5%, and Site C at 4%. There was a statistically significant difference between Site A and C in the intent to stay in their current position, with Site A longer than Site C. The study supports the literature and evidence that a NRP is an effective strategy to decrease first year turnover. Further study is needed related to the effectiveness of the components of the NRP, length of time for mentorship, and the impact of accumulation of cohorts.

Orientador: Newton Kara-José / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T06:38:20Z (GMT). No. of bitstreams: 1 Machado_MariaCecilia_D.pdf: 4131542 bytes, checksum: 79b4c6bd84ec9e19f141e524cd32505c (MD5) Previous issue date: 2013 / Resumo: O serviço de oftalmologia do Centro Oftalmológico Prof. Dr. Newton Kara-José foi analisado quanto à satisfação dos ex-residentes e funcionários. A pesquisa avalia a percepção dos ex-residentes sobre a validade do estágio extramuros na sua formação médica e a percepção e satisfação dos funcionários sobre o serviço. O estudo foi transversal e descritivo. Dois tipos de questionários autoaplicáveis coletaram informações dos ex-residentes e funcionários. A amostra foi composta por 186 ex-residentes e 14 funcionários. Em relação aos ex-residentes: quanto o estágio influenciou na sua formação geral:92,44% consideraram muito bom; quanto o estágio influenciou na sua formação clínica:76,86% consideraram muito bom; quanto o estágio influenciou na sua formação cirúrgica :90,13% consideraram muito bom; quanto o estágio influenciou de seu relacionamento médico-paciente: 78,47% consideraram muito bom; quanto o estágio influenciou na sua capacidade de fazer diagnósticos :77,8% consideraram muito bom; quanto o estágio influenciou no desenvolvimento da autoconfiança:96,22% consideraram muito bom. Em relação aos funcionários: estão no serviço mais de 11 anos:64%; satisfação com o serviço:71,4% consideraram muito bom; quanto ao relacionamento com os colegas:57,1% consideraram muito bom; quanto ao relacionamento com os médicos:71,4% consideraram muito bom; quanto ao relacionamento com os pacientes:85,7% consideraram muito bom; como classifica o relacionamento médico-paciente:100% consideraram bom; como você classifica o tratamento dos pacientes pelos funcionários da clínica:85,7% consideraram bom; sente prestigiado no serviço:100% sim; quanto você sente que seu trabalho é útil para a comunidade:78,5% consideraram muito bom; quanto você é treinado para melhorar seu desempenho:71,4% consideraram muito bom; você acha que procura ser cada vez melhor no tratamento com os pacientes:100% sim; você recomendaria o serviço para os seus parentes e amigos=100% sim; Você comenta com amigos e conhecidos a qualidade do serviço:100% sim; como você o classifica:100% consideraram muito bom. Concluiu-se que na percepção dos ex-residentes de oftalmologia, o estágio extramuros foi considerado muito bom e necessário para sua formação de prestador de serviços na comunidade e deve continuar que os funcionários revelaram alto grau de satisfação com o serviço e com o relacionamento com os colegas, médicos, e pacientes. Eles sentem prestigiados no serviço, procuram melhorar cada vez mais o atendimento aos pacientes, consideram que a qualidade do serviço está melhorando e o recomendam aos parentes e amigos. / Abstract: This research aims to evaluate, in the perception of the former resident doctors, the validity of extramural stage in their medical training and even the perception and satisfaction of the employees with employees on two occasions: the data from the first phase were collected through questionnaires. A descriptive cross-sectional study was conducted. Two types of self-administered questionnaires collected information from former residents and posted by e-mail from 23rd to27th April 2010 to them. The data from the second phase, referring the employees, were collected from 14th to 18th June 2010. The sample was composed of 186 former residents and 14 employees. Regarding the former residents: the stage influenced in their general education: 92,44%, rated very good, as the internship influenced their clinical training: 76,86%,rated very good as the stage influenced their surgical training: 90, 13%, rated very good, as the stage in their training influenced the doctor-patient relationship: 78,47%, rated very good as the internship influenced their ability to make diagnoses:7 7,8%, rated very good as the stage influenced the development of self-confidence: 96.22 %, very good. Regarding the employees who are in service over 11 years: 64%; service satisfaction: 71.4%,rated very good, about the relationship with coworkers:57.1%, rated very good, about the relationship with doctors: 71.4%,rated very good, about the relationship with patients: 85.7%, rated very good; ranks as doctor-patient relationship: 100%, rated good, how do you rate the treatment of patients by clinic staff: 85.7%, rated good, how they feel their service prestige: 100% yes, as they feel their work is useful for community: 78.5%, rated very good, as they are trained to improve their performance: 71.4%, rated very good, as they look for improving their relationship with patients: 100% yes, would you recommend the services to their relatives and friends: 100% yes, if they comment the quality of service to friends and acquaintances:100% yes, how do you rank: 100%, rated very good. Evaluated the responses, it was concluded first that the perception of the former residents of ophthalmology, extramural stage was considered very good and necessary for their formation as training services provider in the community and secondly that employees were highly satisfied with the service, with the relationship with colleagues, physicians and patients. They feel prestigious in service, increasingly seeking to improve patient care, consider the quality of service is improving and recommend to friends and relatives. / Doutorado / Ciencias Biomedicas / Doutora em Ciências Médicas

A formação em serviço realizada pelo programa de Residência Multiprofissional em Saúde (RMS) é uma estratégia educativa que visa a mudança do perfil dos profissionais da saúde para atuação no Sistema Único de Saúde (SUS). Dentre as profissões que compõem as residências, a terapia ocupacional foi eleita como foco deste estudo com o objetivo de conhecer e refletir sobre os desafios e tendências do processo de educação profissional e interprofissional na perspectiva de tutores, preceptores e residentes terapeutas ocupacionais. A metodologia eleita foi a abordagem qualitativa com realização de entrevistas e análise de conteúdo para a elaboração dos resultados e discussão. Foram realizadas 17 entrevistas em três programas de RMS de diferentes municípios do estado de São Paulo com cenários educativos realizados na atenção hospitalar e na atenção básica. Duas categorias empíricas foram identificadas nos resultados: (i) \"Residência multiprofissional de saúde como dispositivo de mudança\" dividida em duas subcategorias: \"Trabalho em equipe\" e \"Trabalho na perspectiva do SUS\" e (ii) \"Singularidades na formação do terapeuta ocupacional em RMS\" agrupada nas subcategorias: \"Particularidades da inserção profissional do terapeuta ocupacional nos cenários educativos\", \"Produção de identidades e a fragmentação da atuação do terapeuta ocupacional nas RMS\" e \"Terapia ocupacional e as práticas colaborativas e interprofissionais no SUS\". A pesquisa permitiu conhecer o potencial de mudanças dos programas de RMS em relação à formação dos residentes e à disseminação de práticas em saúde, colaborativas em equipe e sob a perspectiva do SUS. Os resultados apontaram a singularidade do processo formativo de terapeutas ocupacionais nas RMS que sofrem impactos pela insuficiente contratação de profissionais nos serviços, pelo desconhecimento do papel profissional do terapeuta ocupacional e pela fragmentação da atuação profissional nos cenários de prática; experiências que geram insegurança de residentes e profissionais quanto aos limites da atuação profissional e interprofissional no trabalho em equipe. O foco da terapia ocupacional nas atividades e cotidianos das pessoas no processo do cuidado em saúde e a mediação do cuidado de pessoas com deficiência e transtornos mentais foram identificados como contribuições da terapia ocupacional para as práticas colaborativas e interprofissionais no SUS. Conclui-se que o potencial de mudanças dos programas para a atuação dos residentes como futuros profissionais está diretamente relacionado com as estratégias pedagógicas desenvolvidas nos cenários educativos. A formação de terapeutas ocupacionais nas RMS depende das características dos cenários educativos, no que se refere a sua organização e interação interprofissional pré-existente, à suficiência do número de preceptores, à consolidação de fluxos assistenciais e ao (re)conhecimento da Terapia Ocupacional pelos demais profissionais dos serviços. Por fim, os participantes afirmaram a importância da RMS para a aprendizagem de saberes e práticas - próprios da profissão, comuns aos profissionais de saúde e construídos em equipe de forma colaborativa - com o propósito da qualificação do cuidado em saúde / The in-service education carried out by the multi-professional residency in health (MPRH) is a strategy that aims at a profile change of health professionals in order to prepare them to work in the Brazilian Unified Health System (SUS). Among the professions included in MPRH, the occupational therapy was selected as the focus of this study in order to explore and reflect on the challenges and tendencies of the professional and inter-professional education process from the perspective of occupational therapy tutors, preceptors, and residents. The selected methodology was the qualitative approach, carried out by means of interviews and content analyses that led to the elaboration of results and discussions. Seventeen interviews were carried out in three MPRH programs of different municipalities in the State of São Paulo, and had their educational scenarios centered in hospital care and basic health care. Two empiric categories were identified in the results: (i) \"MPRH as a means of change,\" divided into two subcategories: \"Team Work\" and \"Work from the perspective of SUS ,\" and (ii) \"Singularities in the education of the occupational therapist in MPRH\", which was grouped in the following subcategories: \"Particularities of the inclusion of occupational therapists into the educational scenarios,\" \"Production of identities and the fragmentation of the occupational therapists\' work in MPRH\" and \"Occupational Therapy and the collaborative and inter-professional practices in SUS.\" The research allowed for the identification of possibilities of changes brought about the MPRH regarding the professional education of residents and the dissemination of collaborative practices among health service professionals from the perspective of SUS. Results pointed out the singularity of the educative process of occupational therapists in the MPRH, which are impacted by the insufficient professional staffing, the unawareness of the occupational therapist\'s professional role and the fragmentation of the professional work in practice settings; experiences which cause insecurity to residents and professionals regarding the limits of the professional and inter-professional team work. The occupational therapy focus on the activities and daily life of people in health care and the mediation of the care given to people with physical and mental disabilities were identified as occupational therapy contributions to collaborative and inter-professional practices in SUS. The conclusion is that the potential for change that programs provide for the activities of residents as future professionals is directly related to the pedagogical strategies developed in the educational settings. The education of occupational therapists in MPRH depends on the characteristics of the practice settings, regarding their organization and the pre-existing inter-professional interaction, a sufficient number of preceptors, the consolidation of assistance flows, and the recognition of occupational therapy by other health professionals. Finally, the participants restated the importance of the MPRH for the learning of knowledge and practices - particular to the profession, common to health professionals, and accrued through collaborative team work - as the purpose of the qualification in health care services

Le système de fabrication des plaquettes de silicium (wafer) est la partie la plus complexe et la plus coûteuse du processus de fabrication des semi-conducteurs et son ordonnancement pour la production a un impact significatif sur la rentabilité économique. Le système d’outils Multi-cluster pour la fabrication de plaquettes est un système de type multi-boucles, largement utilisé dans la fabrication de plaquettes de 300 mm et 450 mm. Le problème d’ordonnancement dans ce système de production présente des caractéristiques pour les modèles de flux de plaquettes compliqué, des contraintes résidentielles strictes et des conflits de ressources à gérer, ce qui rend le problème très complexe. Dans cette thèse, l'outil multi-cluster est étudié et les recherches se concentrent principalement sur les caractéristiques des contraintes sur le temps de séjour, les contraintes sur les ressources utilisés et les flux plaquettes de silicium. Plus particulièrement, cette thèse traite trois problèmes d'ordonnancement: le problème d'ordonnancement cyclique unitaire pour un flux unique de plaquettes, le problème d'ordonnancement cyclique multi-unitaires dans un modèle de flux unique de plaquettes et le problème d'ordonnancement non-cyclique. Pour résoudre ces problèmes, des modèles robustes sont développés ainsi que certains algorithmes heuristiques efficaces sont construits pour atteindre les objectifs. L'objectif principal étant d'améliorer la performance des outils multi-cluster et d'augmenter le rendement des flux des plaquettes de silicium. Des tests de simulation et des analyses sont effectuées afin d’évaluer la performance des algorithmes proposés. Les résultats montrent la stabilité et l'efficacité de ces algorithmes. / Multi-cluster tool is a highly automated and costly wafer fabrication system with multi-loop coupling structure, and scheduling of such equipment directly affects the overall efficiency of semiconductor manufacturing enterprises. Multi-cluster tools scheduling problem has the features of large scale, complex wafer flow patterns, strict residency time constraints and intense resource conflict, which are significantly different from any other manufacturing system. Since the existing literatures have proved that most of the wafer fabrication systems scheduling problems are NP-hard, it’s difficult to obtain the optimal solution by using exact algorithms. Thus, how to develop an efficient heuristic algorithm to solve the multi-cluster tools scheduling problem attracts considerable attention both in academia and in industry. After reviewing the literatures, it is found that the research on the cyclic scheduling problem of multi-cluster tools rarely takes into account the characteristics of residency constraints. The scale of the object is limited to three single cluster tools, and the proposed scheduling methods are mostly mathematical programming and simple scheduling rules. Therefore, in this thesis, the multi-cluster tool is studied and our research mainly focuses on the characteristics of residency constraints, resource constraints and wafer flow patterns. Based on the descriptions of research domains, some solid models are developed for different scheduling problems and some efficient heuristic algorithms are constructed to realize the objectives. To deal with the problem, different approaches are proposed: A non-linear mixed-integer programming model, a two-stage = approximate-optimal scheduling algorithm, and a chaos-based particle swarm optimization-tabu search hybrid heuristic algorithm. Simulation experiments and analysis demonstrate the effectiveness of these algorithms. Results show the stability and efficiency of proposed algorithms.

Over the course of American schooling scholars note that democratic education and citizenship have not been abandoned, but perhaps marginalized or pushed aside, as test scores and achievement have become the most desired outcomes. Democratic education must move out of the margins and into high priority. The current political climate of increased division and divisiveness could not illustrate this need any more. Another well-documented challenge within the American educational system, particularly in high need areas is the need for highly qualified teachers. Urban Teacher Residency (UTR) programs have offered a possible solution to this growing problem in recruiting, training, and retaining highly qualified teachers in urban settings. UTRs are designed to alleviate one of the longstanding education challenges of both, quality and quantity of educators within some of the most underserved schools. While the rise in teacher residency programs, particularly in urban settings, and the marginalization of democratic education may seem unconnected, an effort to illuminate their potential relationships guides this study. Qualitative case study methodology (including analysis of program documents, interviews with teachers, and interviews with staff) was undertaken to understand the inclusion of democratic habits in one UTR, as well as the resulting enactment of democratic education by the UTR residents and alumni in one UTR, Mid-Atlantic Teacher Residency (MATR). Findings reveal the use of democratic habits by the residents and in the MATR program was mixed. Democratic habits of associated living, collaboration, student voice, critical inquiry, and student-centered learning were the most prevalent through the MATR program components of coursework, mentorship, and the cohort during the residency year. As teachers, the resident alumni exhibited democratic habits through their professional relationships and attitudes towards student-centered instruction, particularly through the use of activities. A few of the alumni exhibited aspects of democratic education through their discussion of social justice and their commitment to citizenship development. Overall, however, limited evidence of a commitment to democratic education was present in the data, which may be in part due to the program’s relatively low emphasis on democratic education. Other barriers that emerged in the data included: classroom management struggles, administrative support and policies, a lack of promoting democratic education through the program, a disconnect from the residents’ coursework to their classroom practices, and being new teachers. While it does not appear that MATR or other UTRs are currently foregrounding democratic education or democratic principles, I close by discussing why UTRs should emphasize democratic education and offering suggestions for how they might do so.

Traditionally, medical residency positions have been primarily funded by the federal government. However, due to declining governmental funding support over time, medical schools have resorted to fund these programs through other means such as clinical fees and payments for services. This change has affected the number and types of residencies available to medical school graduates. The purpose of this study was to measure how the availability of fiscal resources shape mission-related outputs, particularly medical residency positions at medical schools. Using academic capitalism as the theoretical framework provided a lens through which to examine how federal policies have shaped the availability and funding of medical residencies today at the institutional level. This concept has been studied in traditional colleges and universities and how they balance mission and money, but less so in the context of medical schools. This study used a fixed effect panel analysis to study the impact of selected variables over a 10-year period on financing of medical residencies. Findings included that tuition revenues, paid for by undergraduate medical students, are increasingly funding medical residency positions. There was little to no effect from hospital revenues and federal research monies on increasing the number of medical residency positions. The funding of university based medical education is particularly timely and of national importance to understand the consequences of federal policies for medical schools and how medical residency funding caps and limits have affected one of the missions of medical schools which is to train physicians.

This study investigated international medical graduates (IMGs), registered between January 1, 2007 and April 14, 2011, at the Access Centre for Internationally Educated Health Professionals in Ontario. By way of logistic regression in a cross-sectional design, it was found that permanent residents who were recent immigrants had lesser chances of being employed full-time at registration (baseline). By way of survival analysis in a cohort design, it was found that younger IMGs who have been in Canada less than 5 years and who have taken the Medical Council of Canada Evaluating Exam (MCCEE) have the greatest chances of securing residency positions in Canada or the US, whereas IMGs from Eastern Europe, South Asia and Africa have lesser chances. It was revealed that registered IMGs are a vulnerable population, and certain groups may be disadvantaged due to underlying characteristics. These groups can be targeted for specific interventions.

Flera olika källor har fastställt att många av Malmös thaimassagesalonger erbjudersexuella tjänster mot betalning. Syftet med denna studie har varit att delsundersöka hur omfattande den påstådda problematiken är samt att tydliggöravilken utsatthet en del av kvinnorna på salongerna lever i. En viktig del i studienhar varit att lyfta fram vilket stöd som professionella aktörer kan erbjuda dessakvinnor. Erfarenheter och kunskaper från de professionella aktörerna, bådefrivilligorganisationer, kommunala verksamheter samt myndigheter, har legat tillgrund för studiens resultat. Informationen har hämtats genom kvalitativaintervjuer med personal från ovan nämnda aktörer. Det framgår tydligt att detförekommer försäljning av sex på thaimassagesalonger i Malmö.Samtliga respondenter i intervjuerna bekräftar att många av kvinnorna på Malmösthaimassagesalonger lever i en särskild utsatthet. En beroendeställning gentemotsin arbetsgivare eller sin svenska man, tillsammans med en bristande kunskap omsvenska lagar och rättigheter, har varit det som bidragit till kvinnornaslivssituation. En rädsla för att mista sitt uppehållstillstånd har varit en faktor somökat deras beroendeställning. Enligt en del intervjupersoner kan arbetet med att nåut till denna målgrupp bli väsentligt mycket bättre. / Multiple sources determine that many of Malmö’s Thai massage parlours offersexual services. The goal of this study has been to investigate how extensive thealleged problem is, and to clarify the type of vulnerable situations some of thewomen working in the massage parlours live in. An important part on this studyhas been to highlight the type of support professionals can offer these women.Experiences and knowledge from professionals, voluntary organizations, andmunicipalities has been the bases for this study. Data has been gained throughqualitative interviews with professionals from the above mentioned actors. Theinterviews show that sexual services are sold in Thai massage parlours in Malmö.The interviewees confirm that many of the women that work in Thai massageparlours live in especially vulnerable situations. A combination of dependency ontheir employer, on a Swedish husband and a lack of understanding of Swedishlaws and rights, have contributed to these women’s vulnerability. A fear of losingtheir residency is a factor that has increased their dependency. According toseveral interviewees, outreach work toward this group can become substantiallyimproved.

A refugee faces many issues on their journey to safety, but the issues do not end once they reach a host country. Applying for asylum is an arduous process with long waiting times in most European countries, and a low acceptance rate. Lack of integration into a new community is one of the main issues faced during this time. Studies show that labour market opportunities are a successful tool to aid integration and help to close the employment gap between native residents and new arrivals. The employment gap exists due to lack of local language, employment connections, transference of existing skills, legal issues, and personal and health issues. This paper argues that early commencement of language learning, transference of qualifications and picking up the necessary new skills for employment, is a positive way to use the long waiting time to benefit asylum seekers. It is also important to support newly accepted refugees during their integration into the community. Reflecting on organisations and networks that currently exist for refugees, a new civic space is proposed in the city to improve the integration of users through labour market training and opportunities. Looking at the legislations in place for integration and existing pathways to residency, an example is shown of how it can be manipulated to encourage involvement in the labour market.