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Graduate medical education (GME) funding comes from predominantly two public sources: Medicare and Medicaid. In recent years, concerns have been voiced as to whether these GME payments to teaching hospitals and other entities are sufficiently transparent and publicly accountable. Most of these concerns have been directed at the financing and governance of Medicare GME payments. In the past 10 years, two major reports examined this issue.The main premise of the first report, a 2014 study by the Institute of Medicine (nowthe National Academy ofMedicine), is that Medicare GME payments, and federal funding for GME more broadly, lack a clear purpose. Medicare does not produce enough physicians prepared to practice in the most needed specialties or geographic areas and has insufficient oversight and infrastructure to measure GME program outcomes and reward performance. In terms of accountability, the study found that the stewardship of the public's investment in GME was critically absent. In particular, any data that teaching hospitals are required to report to the federal government has limited use for program oversight, workforce analysis, or policy development; consequently, the report concluded that most questions about the effectiveness of the Medicare GME program are unanswerable.

Observational gait analysis is a widely used skill in physical therapy. Meanwhile, the skill has not been investigated using objective assessments. The present study investigated the differences in eye movement between professionals and trainees, while observing gait analysis. The participants included in this study were 26 professional physical therapists and 26 physical therapist trainees. The participants, wearing eye tracker systems, were asked to describe gait abnormalities of a patient as much as possible. The eye movement parameters of interest were fixation count, average fixation duration, and total fixation duration. The number of gait abnormalities described was significantly higher in professionals than in trainees, overall and in limbs of the patient. The fixation count was significantly higher in professionals when compared to trainees. Additionally, the average fixation duration and total fixation duration were significantly shorter in professionals. Conversely, in trunks, the number of gait abnormalities and eye movements showed no significant differences between groups. Professionals require shorter fixation durations on areas of interest than trainees, while describing a higher number of gait abnormalities.

In the nearly fifty years since the adoption of the Higher Education Act of 1965, financial aid programs have grown in scale, expanded in scope, and multiplied in form. As a result, financial aid has become the norm among college enrollees. Aid now flows not only to traditional college students but also to part-time students, older students, and students who never graduated from high school. Today aid is available not only to low-income students but also to middle- and even high-income families, in the form of grants, subsidized loans, and tax credits. The increasing size and complexity of the nation's student aid system has generated questions about effectiveness, heightened confusion among students and parents, and raised concerns about how program rules may interact. In this article, Susan Dynarski and Judith Scott-Clayton review what is known, and just as important, what is not known, about how well various student aid programs work. The evidence, the authors write, clearly shows that lowering costs can improve college access and completion. But this general rule is not without exception. First, they note, the complexity of program eligibility and delivery appears to moderate the impact of aid on college enrollment and persistence after enrollment. Second, for students who have already decided to enroll, grants that tie financial aid to academic achievement appear to boost college outcomes such as persistence more than do grants with no strings attached. Third, compared with grant aid, relatively little rigorous research has been conducted on the effectiveness of student loans. The paucity of evidence on student loans is particularly problematic both because they represent a large share of student aid overall and because their low cost (relative to grant aid) makes them an attractive option for policy makers. Future research is likely to focus on several issues: the importance of program design and delivery, whether there are unanticipated interactions between programs, and to what extent program effects vary across different types of students. The results of this evidence will be critical, the authors say, as politicians look for ways to control spending.

Junior doctors in the UK must complete various educational components during their two year Foundation training programme. It is important that mandatory learning is informative and engaging. The aim of this study was to evaluate trainee doctors' perceptions of a Technology Enhanced Learning (TEL) programme developed to improve prescribing competency. Focus groups and interviews were conducted at three hospital sites in the West Midlands. Codes, sub-themes and themes were determined using deductive and inductive thematic analysis. Data were collected from 38 Foundation trainee doctors. Results revealed major themes relating to prescribing education, the user experience and user engagement. Key findings included the positive impact of preparedness following undergraduate education on the user experience of the TEL programme at the postgraduate level; the impact of content, structure, and individual learning needs and styles on the user experience; and the impact of motivation and time on engagement. Most trainees engaged with the programme owing to its mandatory nature; however, some trainees also used the programme voluntarily, for example, to acquire knowledge prior to starting a new placement. It is important to ensure that learners are willing to engage with mandatory TEL, and that they have the time and motivation to do so. It is also important to ensure that learners have a positive user experience and that in designing TEL individual differences in learning styles and needs are taken into account. These findings have implications for educators and system developers in the construction and design of mandatory eLearning programmes.

Background: Levels of student loan debt have been increasing, but very little research has assessed if this is associated with poor health. The aim was to examine the association between student loans and psychological distress in Japan. Methods: We conducted a cross-sectional web-based self-administered questionnaire survey in 2017. The sample comprised of 4,149 respondents aged 20–34, with 3,170 graduates and 979 current university students. The independent variables were whether or not current students had student loans, and for graduates, the total amount of their student loan debt. The dependent variable was severe psychological distress assessed using the Kessler Psychological Distress Scale (K6; the cut-off point was 12/13). Covariates were demographic and parents’ socioeconomic variables. A Poisson regression analysis with a robust error variance was conducted to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Because there was a significant interaction between current student status and the status of borrowing student loans, stratified analyses were conducted. Results: The percentage of those with student loans was 33.8% among graduates and 35.2% among current university students. Among graduates, student loan debt was significantly associated with a high possibility of having severe psychological distress after adjusting for covariates (PR of ≥4 million yen, 1.44; 95% CI, 1.02–2.03). Among current university students, there was no significant association (PR of borrowing student loans, 0.91; 95% CI, 0.60–1.37). Conclusions: There was a significant association between student loan debt and psychological distress among graduates but not current university students.

Objective. To evaluate educational debt-to-income trends in pharmacy, dentistry, medicine, optometry, and veterinary medicine in the United States from 2010 to 2016. Methods. A retrospective analysis of educational debt and income for selected health professions was conducted. Data on student loan debt were collected from professional organizations and data on income were collected from the American Community Survey. Ratios of the mean educational debt of graduating students to the median annual income for their respective profession were calculated for 2010 through 2016. Average change per year in debt, income, and debt-to-income ratio were calculated. Results. Debt-to-income ratios for all selected health professions except medicine exceeded 100%. For physicians, debt-to-income ratios ranged from 89% to 95%. On average, physicians (-0.3 percentage point) and optometrists (-0.5 percentage point) had negative changes in their debt-to-income ratios from 2010 to 2016. Average increases per year in debt-to-income ratio of veterinarians, pharmacists, and dentists were 5.5, 5.7, and 6.0 percentage points, respectively. From 2010 to 2016, dentists had the largest average increase per year in debt ($10,525), while physicians had the largest average increase per year in income ($6667) and a minimal average debt increase per year ($5436). Pharmacists had the second largest average increase per year in debt ($8356). Conclusion. Educational debt-to-income ratios in the United States increased considerably over the past decade among pharmacists, dentists, and veterinarians and can negatively impact health professionals as well as patient care. Innovative strategies are needed to alleviate the educational debt burden.

Background Plastic surgery training is undergoing major changes however there is paucity of data detailing the current state of training as perceived by plastic surgical trainees. Our aim was to determine the quality of training as perceived by the current trainee pool and their future plans. Methods A 25-item anonymous survey with three discrete sections (demographics, quality of training, and post-graduate career plans) was developed and distributed to plastic surgery residents during the academic year 2013. With the confidence interval of 95% and margin of error of 10%, our target response rate was 87 responders. Results We received a total of 114 respondents with all levels of Post Graduate Year in training represented. Upon comparison of residents with debt of <100,000 to residents with a debt of >250,000, those with higher debt were significantly less interested in fellowship training (p value 0.05) and were more likely to pursue private practice (p value <0.01). Disciplines within plastic surgery least offered as a separate rotation were microsurgery (45%) followed by aesthetic surgery (33%). 53.7% of the residents felt that they were least trained in aesthetic surgery followed by burn surgery 45.4%. Of note 56.4% intended to seek additional training after residency. Moreover residents with an average of 6.4 months of experience in an individual subspecialty were more likely to feel comfortable with that specialty. Conclusions This survey highlights the areas and subspecialties that deserve attention as perceived by the current trainee pool.

A 2014 Institute of Medicine report called for innovative approaches to financing graduate medical education to improve the match between the physician workforce and national health care needs. The author discusses objections articulated by the AAMC and other stakeholders. For more than three decades, administrations from that of Republican Ronald Reagan (1981–1989) to Democrat Barack Obama have proposed sharp reductions in the robust support by Medicare of graduate medical education (GME) programs. Teaching hospitals, the major recipients of an annual federal GME investment of more than $15 billion in 2012, have withstood most of these incursions because senior Democrats who chaired the congressional committees that oversaw Medicare and represented areas with heavy concentrations of training programs, such as New York, Massachusetts, and Illinois, strongly opposed these cuts. Their advocacy was reinforced by academic medical centers that house GME programs, . . .

Context: Transitioning into clinical practice can be stressful for the newly credentialed athletic trainer (AT). The support provided by mentors, peers, and athletic training faculty can increase confidence and enhance the transition. To create specific initiatives for a smoother transition, the perspectives of those in the secondary school setting are needed. Objective: To examine the transition to practice and mentorship of newly credentialed ATs providing medical care in the secondary school setting. Design: Qualitative study. Setting: Secondary school setting. Patients or Other Participants: A total of 14 ATs (2 men, 12 women; age = 23.0 ± 2.0 years) participated in our study. They were employed in the secondary school setting through graduate assistantships, had been credentialed for less than 1 year, and had completed professional bachelor's degree programs. Data Collection and Analysis: We completed 14 semistructured phone interviews. Interviews were recorded and transcribed verbatim. Two researchers independently following the stepwise progression of a general inductive approach completed the data analysis. Trustworthiness was established through multiple-analyst triangulation, peer review, and member checks. Results: Two major themes emerged regarding the support received by our participants: past mentors and current networks of professionals. Past mentors provided autonomous learning opportunities during clinical education and then served as resources for guidance and advice. Current networks of professionals were defined by 2 subthemes: professional medical care providers and non-medical care providers within the secondary school setting (ie, athletic directors, coaches, parents). Conclusions: Former preceptors and faculty provided resources and support to help develop the newly credentialed AT's confidence and facilitate the transition. Preceptors should allow increased independence to help their students develop as clinicians. The creation of networks within the community, that is, the secondary school itself, is also critical in the transition as it provides the AT with role legitimation. (Autor).

Retention and recruitment of part time clinical adjunct faculty members in dental education is becoming increasingly difficult as dental schools come to rely on this workforce for their increased involvement in clinical education. Contributing factors include full time faculty shortage, aging workforce, practice and student debt, practice and family commitments, and financial compensation. This study attempts to ascertain barriers to teaching so appropriate strategies can be formulated to address this issue. In the spring of 2016 an email survey was sent to current and former adjunct faculty members to ascertain demographics and retention and recruitment strategies. Descriptive analyses were completed for all variables in the sample. Twenty nine of forty six subjects responded to the survey with a response rate of 63%. Subjects over the age of sixty comprised 55% with only 17% being under the age of forty five. Overall family and practice commitments along with compensation were the primary barriers to teaching part time. For new dentists, student loan debt was the primary barrier to teaching. Travel to teach was also a barrier as 70% of respondents drove 200 miles or less to the dental school. The study demonstrated that the aging part time work force is a great concern and new part time clinical adjunct faculty members must be recruited. Barriers to recruitment and retention of faculty must be considered and addressed to sustain this teaching model.