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ObjectivesThe ‘Good Rostering Guide’1 published by NHS Employers recommends that ‘junior doctor’ rotas should be structured around training needs and ensure sufficient in- built time for training. However, with only a quarter of NHS staff working rotas that are sufficiently staffed,2 training is often sacrificed to maintain service provision.Template rotas cannot adapt to the challenges of understaffing or increasing numbers of less than full time (LTFT) staff. Current automated rostering solutions, which have been shown to be effective in reducing the number of unfilled shifts,3 attempt to mimic the heuristic shift-centric approach to rostering. In this project we investigate whether moving from shift-centric to a clinician-centric rota-design approach can safeguard training needs while maintaining safe staffing levels.MethodsA new algorithm was developed jointly with trainees as part of Lantum (workforce management platform) to create estimated generic work schedules that can adapt to the number of clinicians available. The output was compared to a traditional rolling rota template for rotas with different degrees of understaffing. Specific comparison was made for the number of:‘Training shifts’ (defined as clinical shifts with direct consultant supervision), based on targets defined by each rota manager.Unfilled essential shifts (defined as shifts that would require temporary staffing cover).ResultsAt the time of submission data is available for 1 pilot comparison of a rota with 6.6 full time equivalent (FTE) clinicians compared to 9 FTE clinicians required for the existing rolling rota template.Using the novel predictive algorithm all clinicians could take their full annual leave and study leave entitlements and were allocated at least 5 ‘training shifts’ every 6 weeks, corrected for FTE. Using the rolling rota template this was only achieved for 4 of the 8 clinicians as ‘training shifts’ were sacrificed to cover unfilled shifts. This predominantly affected full-time clinicians.The rota produced with the novel algorithm also had a 7 fewer unfilled shifts (35 vs 42).Data collection from 15 additional comparisons is underway and will be ready to present by the time of the conference.ConclusionNovel approaches, utilising advanced predictive and optimisation algorithms have previously demonstrated improved efficiency of medical rotas in a time where understaffing is common.3 Thus far these algorithms have been implemented in a heuristic manner – imitating the processes used by humans to generate rotas. However the data presented suggests that moving from the current shift-centric approach to a clinician-centred model may yield additional training benefits.ReferencesGood rostering guide, NHS Employers, 2018.NHS in a nutshell: NHS workforce, The King’s Fund, 2023.The Good, The Bad and the Rota – solving workforce challenges and promoting flexible working through clinician-led innovative rostering technology, Archives of Disease in Childhood, 2023.

Why did you do this work?The climate crisis is a global emergency that disproportionately affects children and young people. The RCPCH’s climate change action plan calls on paediatricians to be role models in mitigating climate change personally and professionally.1 Road transport is the largest contributor to UK CO2 emissions, with average car commuters (33km round-trip) directly emitting 1.1 metric tonnes of CO2 annually (MTCO2e).2 3 Understanding the environmental cost of commuting for paediatric training is crucial for exploring mitigation strategies. Given that rotational training placements are often outside trainees’ control and assigned on short notice—making green commuting options like carpooling challenging—this study aimed to estimate the CO2 emissions associated with commuting for paediatric rotational training in the East of England (EoE).What did you do?An anonymous electronic survey was distributed to all EoE paediatric trainees in June 2024, with reminders given at regional study days. The survey collected data on commuting modality currently and to furthest rotational placement, home outcodes, LTFT status, and concern for environment and ranked factors influencing commuting choices. Commute distances were calculated using RStudio’s ‘gmapsdistance’ package, and CO2 emissions were derived from UK government data.4 5 Annual emissions were based on 20 round trips per month, adjusted for full-time equivalent (FTE) status over 12 months. Total emissions for all trainees were calculated as a sum of mean emissions per trainee stratified by number of trainees per level of training.What did you find?Of 225 EoE Paediatric trainees, 34% (n=77) responded. Individual car use, mostly fossil-fuelled, is the dominant mode of commuting among trainees. Despite concerns about environmental impact, commute choices were primarily influenced by time, caring responsibilities, and cost and least by environmental concerns. The mean daily round-trip commute to current placements was 84.7km (UK average: 33km), and to furthest placements 141km. Annually, trainees averaged 8,968km commuting to current placements, equivalent to 1.94MTCO2e, and 14,641km to their furthest placements, equivalent to 3.4MTCO2e. Extrapolating these figures to all EoE paediatric trainees estimates 435.8MTCO2e attributable to paediatric training annually.What does it mean?Paediatric rotational training generates significant CO2 emissions, primarily from car commuting. Trainees are concerned about the environmental impact, but cost, time, and caring responsibilities primarily influence their commute choices. As paediatricians, we must reflect on the necessity of frequent rotations and their environmental impact. The RCPCH should consider strategies to alleviate this and lead by example: promoting remote training opportunities, improved longitudinal rota design and facilitating or incentivising green transport options including transition to electric vehicles. These initiatives would reflect the College’s commitment to sustainability, environmental responsibility, and trainee wellbeing.ReferencesThe impact of climate change on global child health – position statement RCPCH. Available from: https://www.rcpch.ac.uk/resources/impact-climate-change-global-child-health-position-statement#key-messages-for-health-professionalsOffice for National Statistics. Available from: https://www.ons.gov.uk/visualisations/dvc99999/covid-emissions-gh-pages/index.html?2020 UK Greenhouse Gas Emissions. Available from: https://www.ipcc-nggip.iges.or.jp/public/wetlands/index.html;UK Government – Department for Energy Security and Net Zero. Greenhouse gas reporting: conversion factors 2023. Available from: https://www.gov.uk/government/publications/greenhouse-gas-reporting-conversion-factors-2023Melo R, Zarruk D. Distance and travel time between two points from google maps. 2016.

OpusCapita Group is a Finnish company offering financial processes and outsourcing services to medium-sized companies and large corporations. OpusCapita particularly focuses on comprehensive Purchase-to-Pay and Order-to-Cash processes. In hopes to stay ahead of the curve in financial process automation, OpusCapita is betting on Robotic Process Automation (RPA). This teaching case presents challenges faced by Mr. Petri Karjalainen, Senior Vice President at OpusCapita Group, who is looking for ways to introduce RPA to the market, and provide added value to new and existing customers.

Prior testing can facilitate subsequent learning, a phenomenon termed the forward testing effect (FTE). We examined a metacognitive account of this effect, which proposes that the FTE occurs because retrieval leads to strategy optimizations during later learning. One prediction of this account is that tests that require less retrieval effort (e.g., multiple-choice relative to cued-recall) should lead to a smaller benefit on new learning. We examined the impact of interpolated multiple-choice or cued-recall testing (relative to no prior testing) on new learning of a four-section STEM text passage. The effect sizes associated with the FTE were numerically, though not significantly larger when the prior tests were cued-recall than multiple-choice, but only when interpolated judgments of learning were not queried. Further, when multiple-choice tests were made more difficult through lure similarity, the FTE was similarly increased. Finally, the FTE was eliminated entirely when participants provided four JOLs after reading each text section. We believe this elimination of the FTE stemmed from an increase in performance for the control participants induced by reactivity from repeated metacognitive queries requiring deep metacognitive reflection. Taken together, these experiments support a metacognitive account of FTE and have important implications for how educators and students should employ retrieval practice and leverage the benefits of metacognitive reflection to improve new learning.

The current mental health crisis is affecting athletes in significant and concerning ways. Several contemporary or newly-appreciated factors may be interacting to contribute to this crisis and to its impact in sport. Those factors include: emerging adulthood as a particularly challenging phase of life; discrimination and racism; increasing professionalization of sports at younger ages; lack of mental health literacy and resources; the impact of technology and the 24/7 world; and the COVID-19 pandemic. Fortunately, at the same time, mental health stigma is showing signs of lessening. To further decrease stigma and enhance help-seeking, all stakeholders should appreciate mental health as inseparable from other aspects of physical health in athletes. Simultaneous with working to decrease risk factors in sport, we should work to optimize protective factors. Specifically, we should work toward a culture of mental health literacy, cultural competency, and positive supports in the sporting environment.

Background: In the evolving landscape of health care, the need for highly skilled nursing professionals has never been greater. Central to meeting this demand is the collaboration between academic institutions and health care settings, particularly through faculty practice partnerships. Method: An academic-practice partnership in a safety-net hospital partnered with doctorally prepared faculty from a private university and a public community college to create an academic-practice partnership triad. This triad addresses every level of need, including the clinical placements of licensed practical nurses; associate, baccalaureate, and master's students; and doctoral candidates completing their research in the facility. Results: These collaborations between academic institutions and health care organizations aimed to enhance new graduate nurse readiness, improve health care quality, and strengthen workforce development. Conclusion: Through shared resources, interdisciplinary learning, and real-world application, this partnership not only benefits students and professionals but also strengthens the health care system as a whole.

The study examines the impact of various types of performance-based funding (PBF) policies on institutional resources across postsecondary institution types. Although 41 states have implemented PBF over time, the design and dosage of PBF policies look very different across PBF-adopting states. We leverage multiple quasi-experimental approaches and find that high-dosage PBF policies had a negative impact on state funding for four-year historically Black colleges and universities (HBCUs) and four-year institutions serving an above-average share of racially minoritized students. We also show that sporadic positive effects of PBF policies on state funding are concentrated primarily among non-minority serving institutions (non-MSIs) and institutions serving below-average shares of racially minoritized or low-income students. Taken together, our findings reveal the unequal impacts of PBF policies and suggest that PBF policy design is an important consideration with critical implications for under-resourced institutions and the underserved students they educate.

Developed as an integral component of many higher education programs, internships provide a multitude of benefits for participating students. However, there is a lack of tools designed to measure internship-related learning outcomes. Therefore, this article will present the process of constructing and validating a scale that can be used to evaluate students' internship-related learning outcomes. Content validity of the scale was established with an extensive review of relevant literature, interviews with current interns along with checking the adequacy of the scale content with interns and academics. Construct validity was established with exploratory and confirmatory factor analyses. Through that process, the resulting scale was proven to have achieved construct reliability as well as convergent and discriminant validity. The article discusses the use of the scale, its weaknesses, and implications for organizing internships so that the effectiveness of this form of work-integrated learning can be continuously improved. (HRK / Abstract übernommen).

Private nonprofit colleges are increasingly using tuition resets, or a decrease in sticker price by at least 5%, to attract new students and counter declining demand. While discounting tuition with institutional aid is a common practice to get accepted students to matriculate and to increase affordability, a tuition reset is a more transparent approach that moves colleges away from a high aid/high tuition model. The authors find minimal evidence that these policies increase student enrollment in the long run, but that there may be short-term impacts. As expected, institutional aid decreases and varies directly with the size of the sticker price reduction. The average net price students pay decreases, but this effect may be driven by changes in the estimated non-tuition elements of the total cost of attendance. Finally, net tuition revenue appears unrelated to tuition resets. These findings call into question the efficacy of this practice.