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It is widely acknowledged that higher education is failing to meet the needs of students and employers, while educational costs and student debt are rapidly increasing. Our aim was to address these issues in an innovative fashion through a structured review combined with recommendations for best practices. Specifically, we aimed to identify and systemize failings of higher ed based on current scholarship, propose solutions, and identify institutions of higher education (IHEs) that have begun to successfully put these solutions in practice. Based on our literature review, this is the first time such a study has been conducted. We performed a structured literature review and identified four key failings in higher education: quality, relevance, access, and cost. From the reviewed literature we extracted a rubric to identify and evaluate twelve IHEs that are effectively applying new and innovative models that address these four problems. We conclude by recommending best practices for the successful redesign of IHEs. The overarching problem we identified was lack of student preparedness to succeed in a highly complex, competitive, and increasingly global, digital world—curricula lack relevance. IHEs are failing to teach the skills and tools needed for sustained success in the workplace: critical and creative thinking, problem-solving, co-operation, tolerance, and collaboration (which incidentally align with the skills and tools needed for effective citizenship) and when they do, they are not using evidence-based pedagogical strategies drawn from research on the science of learning. Additionally, IHEs are failing to provide accessible, high-quality, affordable postsecondary education. Financial and geographic inaccessibility, opaque admissions processes, attrition, poor attention to student health and well-being, lack of Indigenous inclusion, weak utilization of technology, and outmoded teaching methods and content contribute to the barriers to student success. The twelve IHEs we identified are geographically, economically, and pedagogically diverse, each serving as a model for the future of higher education. The novel contributions offered here are (i) a systematic review of higher education’s failings as they impact students and employers, (ii) identification of specific programs and initiatives that can ameliorate these failings, and (iii) identification of IHEs that are engaging in best practices with respect to (i) and (ii).

Background Given the prevalence of mental health comorbidity in the paediatric population, it is important that paediatricians/paediatric trainees possess competence in the management of acute psychiatric emergencies, including agitation. Experiential learning through simulation is used for safety training when high-risk decisions must be made safely and rapidly. Simulation-based training in the management of acutely agitated patients has been studied in the context of psychiatric training programs; however, limited studies exist to inform effective methods of training paediatric residents in the management of agitation. Objectives This study assessed a simulation-based workshop on the knowledge, competence and confidence of paediatric trainees in the management of agitated patients compared to a didactic lecture or no formal educational intervention. Design/Methods This was a prospective comparative cohort study. Paediatric residents were divided among three study groups: Group 1 - a 1-hour didactic lecture on agitation management; Group 2 - a simulation-based workshop on managing the agitated patient; and Group 3 -no intervention. Confidence and knowledge were assessed in groups 1 and 2 using a pre- and post- intervention self-efficacy questionnaire and a clinical vignette. All three groups completed an agitated patient station in the 2018 in-training Objective Structured Clinical Examination (OSCE) assessment. Univariate analysis was completed on the pre- and post- intervention self-efficacy questionnaires, and clinical vignette scores were analyzed using a t-test. Analysis of variance was used to compare OSCE scores between groups. A subgroup analysis was performed to assess OSCE scores by postgraduate year (PGY). Results Simulation-based workshop participants performed better in the OSCE scenario as demonstrated by their OSCE score (mean 81.7%, CI: 75.1–88.3) compared to those from groups 1 (mean 74.6%, CI: 71.4–77.8) and 3 (mean 71.6%, CI: 69.2–74.0). The most significant difference was present between groups 2 and 3 (p=0.0055), whereas differences in the means between groups 1 and 2 were not as prominent (p=0.0577). No difference in mean OSCE scores was found between groups 1 and 3 (p= 0.1424). Subgroup analysis of OSCE scores by PGY of training did not demonstrate a statistically significant difference (p=0.0615). Scores for this scenario did not improve with increased level of training, demonstrating a persistent knowledge gap amongst trainees. Conclusion Simulation-based learning may be an effective educational strategy for paediatric residents to acquire skills in managing acute agitation.

Construction costs, furniture, fixture and equipment costs, obtaining permits and fees, architectural, engineering and consulting services, internal costs and contingency money are all included in the overall budget. Rob Moyer, WVU director of facilities planning, said this was because the hall is a freshman dorm.