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Purpose Method Results Conclusions Student‐led clinics generate a range of benefits to multiple stakeholder groups. Students receive important educational opportunities to advance in their training. Patients with limited access to care may access effective care or a higher amount of effective care and so reduce burden on the health care system. The financial viability of student‐led clinics run by universities is uncertain, and establishing this is complicated by the range of stakeholder costs and benefits that may be involved. This systematic review aimed to synthesise evidence related to the costs and benefits of student‐led clinics and report the methods that have been used to measure these costs and benefits.We conducted a systematic search of MEDLINE All, PsychInfo, CINAHL, A+ Education (Informit), ERIC (ProQuest) and ProQuest Education databases for studies that reported the costs and/or economic benefits of student‐led clinics from inception through August 2023. Studies were screened for eligibility, and data were extracted including study characteristics, student‐led clinic description and economic outcomes. A narrative synthesis was undertaken due to the heterogeneity of studies.Of 349 potentially eligible studies, 24 were included. Nine studies (38%) used an outcome description‐monetised approach; four used partial economic evaluation (17%); four employed cost description (17%); two used cost approximation (8%); two used cost analyses (8%); and one was a full economic analysis (4%). Studies examined costs or benefits, from the perspective of a range of stakeholders, but few examined both. Only six studies (25%) had established the clinical effectiveness of their service. Student clinics generate costs for universities in supplying supervision, capital and consumables. Benefits are shared by patients, students, universities and the broader health system, however, economic evaluations to date have largely ignored or not monetised/valued these benefits.Student‐led clinics involve many different stakeholders, each of whom may incur costs and reap benefits. This complicates how we can go about trying to establish the economic efficiency and viability of student‐led clinics. Measurement of both costs and benefits is needed to understand the efficiency of student‐led clinics in comparison to alternatives. Without the full picture, decision‐makers may make decisions that are ill‐informed and lead to a loss of benefit for society. [ABSTRACT FROM AUTHOR]

Introduction: Cost studies are increasingly popular given resource constraints. While scholars stress the context‐dependent nature of cost, and the importance of theory, cost studies remain context‐blind and atheoretical. However, realist economic evaluation (REE) privileges context and the testing/refinement of economic programme theory. This preliminary REE serves to test and refine economic programme theory for supervision training programmes of different durations to better inform future programme design/implementation. Methods: Our preliminary REE unpacked how short (half‐day) and extended (12 week) supervision training programmes in Victoria, Australia, produced costs and outcomes. We employed mixed methods: qualitative realist and quantitative cost methods. Economically optimised programme models were developed guided by identified cost‐sensitive mechanisms and contexts. Results: As part of identified context‐mechanism‐outcome configurations (CMOCs) for both training programmes, we found a wider diversity of positive outcomes but greater costs for the extended programme (11 outcomes; AU$3069/learner) compared with the short programme (7 outcomes; $385/learner). We identified four shared cost‐sensitive mechanisms for both programmes (training duration, learner protected time, learner engagement, and facilitator competence) and one shared cost‐sensitive context (learners' supervisory experience). We developed two economically optimised programme models: (1) short programme for experienced supervisors facilitated by senior educators ($406/learner); and (2) extended programme for inexperienced supervisors facilitated by junior educators ($2104/learner). Discussion Our initial economic programme theory was somewhat supported, refuted and refined. Results were partly consistent with previous research, but also extended it through unpacking cost‐sensitive mechanisms and contexts. Although our preliminary REE fills a pressing gap in the methodology literature, conducting REE was challenging given our desire to integrate economic and realist analyses fully, and remain faithful to realist principles. Attention to training duration and experience levels of the facilitator–learner dyad may help to balance the cost and outcomes of training programmes. The authors test and refine economic program theory for supervision training programs of different durations to better inform program design and implementation. [ABSTRACT FROM AUTHOR]

Background: Rotator cuff related shoulder pain (RCRSP) knowledge is an important contributor to compliance with clinical practice guidelines and providing best practice care. However, there are no validated instruments for measuring health literacy levels among people with RCRSP. This study aimed to design a valid and reliable instrument to measure RCRSP health literacy and use it to evaluate an education intervention for people with RCRSP. Methods: Development of the patient knowledge questionnaire (PKQ‐RCRSP) included three phases. Phase 1 was developed based on available literature and input from expert clinicians, researchers and patients. Face validity, pilot testing and readability assessment were also undertaken. In Phase 2, internal consistency and predictive validity were assessed in people with RCRSP and other shoulder pain diagnoses. In Phase 3, RCRSP health literacy was assessed. Result: Face validity was acceptable and pilot testing identified minor accuracy issues that were corrected. Literacy level was rated as 'difficult to read' which reflects the medical terminology within the questionnaire. Internal consistency was very good and 81% of questions demonstrated acceptable predictive validity. Health literacy was heterogeneous depending on the question with less than 40% of respondents answering correctly for questions related to the indications, process and the known benefits of RCRSP surgery. Conclusion: The PKQ‐RCRSP demonstrated acceptable face validity, predictive validity and reliability (internal consistency) in assessing RCRSP health literacy. Health literacy among our small sample was poor for questions related to surgery for RCRSP. [ABSTRACT FROM AUTHOR]

Studies of "cost and value" in anatomical sciences education examine not only what works, but at what cost, thus evaluating the inputs and outputs of education. This research provides insights into how to use available resources (e.g., academic time, budgets, infrastructure) as a mechanism to obtaining the maximum outcomes available. The purpose of this viewpoint article is to expand on the application of cost and value concepts to anatomical sciences education, contextualizing these concepts through a deeper dive into the more costly educational approaches of human donor dissection. In doing so, both questions and opportunities are raised for the discipline of anatomical sciences going forward. Educational decisions, inclusive of cost and value appraisals, consider the range of outcomes for which the activity is designed to achieve, and the activity's integration with the philosophy of the educational program it is contributing to; these decisions, thus, evaluate more than just cost alone. Healthcare students' engagement with human donor dissection pedagogy offers an array of reported non‐economic benefits, including non‐traditional discipline‐independent skill (NDIS) development (e.g., professionalism, teamwork skills). These skills are often harder to measure, but are no less important to the final pedagogical decision‐making process. The goal of cost and value research is to create an evidence‐base toward education that delivers maximum value for a given spend. Anatomy educators, researchers, and decision makers who embrace cost and value dialogue, and interpret and apply findings from studies of educational costs, are best positioned to improve the educational value for their learners and provide effective outputs for all stakeholders. [ABSTRACT FROM AUTHOR]

Context: The design of selection methods must balance, amongst a range of factors, the desire to select the best possible future doctors with the reality of our resource‐constrained environment. Examining the cost of selection processes enables us to identify areas in which efficiencies may be gained. Methods: A cost description study was conducted based on selection for 2018 entry into medical school directly from secondary school. The perspectives of applicants, volunteer interviewers and the admitting institution were considered. Costs were modelled based on the Monash University (Australia) selection process, which uses a combination of secondary school matriculation score, aptitude test score (Undergraduate Medicine and Health Sciences Admission Test) and multiple mini‐interview score. A variety of data sources were utilised, including bespoke surveys, audit data and existing literature. All costs are expressed in 2018 Australian dollars (AU$). Applicant behaviours in preparing for selection tests were also evaluated. Results: A total of 381 of 383 applicants returned the survey. Over 70% of applicants had utilised commercial preparation materials. The median total cost to applicants was AU$2586 (interquartile range [IQR] AU$1574‐3999), including costs to both prepare for and attend selection tests. Of 217 volunteer interviewers, 108 returned the survey. These were primarily health professional clinicians at a mid‐career stage. The median total cost to interviewers was AU$452 (IQR AU$252‐715) for participation in a half‐day interview session, largely due to the loss of income. The cost to the admitting institution was AU$269 per applicant, accounted for by the costs of equipment and consumables (52%), personnel (34%) and facilities (14%). Conclusions: The costs of student selection for medical school are substantial. Understanding costs facilitates achievement of the objective of selecting the desired future medical workforce within the constraints of the resources available. Opportunities for change may arise from changes in applicant preparation behaviours, opportunities for economies of scale, and efficiencies driven by technological solutions. What does it take to get into medical school? Money for one thing. The authors demonstrate that, in Australia, students spend AU$2, 586 on preparation, attendance. The universities to which they apply spend AU$269 per applicant, money that is likely to be recouped if selection can avoid student attrition. [ABSTRACT FROM AUTHOR]

Context: High‐quality research into education costs can inform better decision making. Improvements to cost research can be guided by information about the research questions, methods and reporting of studies evaluating costs in health professions education (HPE). Our objective was to appraise the overall state of the field and evaluate temporal trends in the methods and reporting quality of cost evaluations in HPE research. Methods: We searched the MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE, Business Source Complete and ERIC (Education Resources Information Centre) databases on 31 July 2017. To evaluate trends over time, we sampled research reports at 5‐year intervals (2001, 2006, 2011 and 2016). All original research studies in HPE that reported a cost outcome were included. The Medical Education Research Study Quality Instrument (MERSQI) and the BMJ economic checklist were used to appraise methodological and reporting quality, respectively. Trends in quality over time were analysed. Results: A total of 78 studies were included, of which 16 were published in 2001, 15 in 2006, 20 in 2011 and 27 in 2016. The region most commonly represented was the USA (n = 43). The profession most commonly referred to was that of the physician (n = 46). The mean ± standard deviation (SD) MERSQI score was 10.9 ± 2.6 out of 18, with no significant change over time (p = 0.55). The mean ± SD BMJ score was 13.5 ± 7.1 out of 35, with no significant change over time (p = 0.39). A total of 49 (63%) studies stated a cost‐related research question, 23 (29%) stated the type of cost evaluation used, and 31 (40%) described the method of estimating resource quantities and unit costs. A total of 16 studies compared two or more interventions and reported both cost and learning outcomes. Conclusions: The absolute number of cost evaluations in HPE is increasing. However, there are shortcomings in the quality of methodology and reporting, and these are not improving over time. Cost may be most influential yet least studied determinant of practice in health professional education. In this systematic review, Foo et al. explore the state of the literature regarding formal use of cost‐evaluations. [ABSTRACT FROM AUTHOR]

Context Effective communication skills are at the core of good health care. Simulated patients ( SPs) are increasingly engaged as an interactive means of teaching, applying and practising communication skills with immediate feedback. There is a large body of research into the use of manikin-based simulation but a gap exists in the body of research on the effectiveness of SP-based education to teach communication skills that impact patient outcomes. The aim of this systematic review was to critically analyse the existing research, investigating whether SP-based communication skills training improves learner-patient communication, how communication skill improvement is measured, and who measures these improvements. Methods The databases Medline, ProQuest (Health & Medical Complete, Nursing and Allied Health Source) and CINAHL ( EBSCOhost) Education Resources Information Centre ( ERIC) were searched for articles that investigated the effects of SP-based education on the communication skills of medical, nursing and allied health learners. Results There were 60 studies included in the review. Only two studies reported direct patient outcomes, one reporting some negative impact, and no studies included an economic analysis. Many studies reported statistically significant third-party ratings of improved communication effectiveness following SP-based education; however, studies were unable to be pooled for meta-analysis because of the outcome collection methods. There were a small number of studies comparing SP with no training at all and there were no differences between communication skills, contradicting the results from studies reporting benefits. Of the 60 studies included for analysis, 54 (90%) met the minimum quality score of 7/11, with four articles (7%) scoring 11/11. Conclusion SP-based education is widely accepted as a valuable and effective means of teaching communication skills but there is limited evidence of how this translates to patient outcomes and no indication of economic benefit for this type of training over another method. [ABSTRACT FROM AUTHOR]

CONTEXT Failure by students in health professional clinical education intertwines the health and education sectors, with actions in one having potential downstream effects on the other. It is unknown what economic costs are associated with failure, how these costs are distributed, and the impacts these have on students, clinicians and workplace productivity. An understanding of cost drivers and cost boundaries will enable evidence-based targeting of strategic investments into clinical education, including where they should be made and by whom. OBJECTIVES This study was designed to determine the additional economic costs associated with failure by students in health professional clinical education. METHODS A cost analysis study involving cost identification, measurement, valuation and the calculation of total cost was conducted. Costs were considered from the perspective of the student, the education institution, the clinical educator, the health service placement provider organisation and the government. Data were based on a 5-week clinical education programme at Monash University,Australia. Data were collected using quantitative surveys and interviews conducted with health professional students, clinical educators and education institute staff. Reference group representation was also sought at various education institution and health service organisation levels. A transferable model with sensitivity analysis was developed. RESULTS There is a total additional cost of US $9371 per student failing in clinical education from the perspective of all stakeholders considered. Students bear the majority of this burden, incurring 49% of costs, followed by the government (22%), the education institution (18%), the health service organisation (10%) and the clinical educator (1%). CONCLUSIONS Strong economic links for multiple stakeholders as a result of failure by students in clinical education have been identified. The cost burden is skewed in the direction of students. Any generalisation of these results should be made with consideration for the unique clinical education context in which each health professional education programme operates. [ABSTRACT FROM AUTHOR]

Context The principles of evidence-based medicine ( EBM) provide clinicians with the ability to identify, source, appraise and integrate research evidence into medical decision making. Despite the mantra of EBM encouraging the use of evidence to inform practice, there appears little evidence available on how best to teach EBM to medical trainees. A systematic review was performed to identify what type of educational method is most effective at increasing medical trainees' competency in EBM. Methods A systematic review of randomised controlled trials ( RCTs) was performed. Electronic searches were performed across three databases. Two reviewers independently searched, extracted and reviewed the articles. The quality of each study was assessed using the Cochrane Collaboration's risk of bias assessment tool. Results In total, 177 citations were returned, from which 14 studies were RCTs and examined for full text. Nine of the studies met the inclusion criteria and were included in this review. Learner competency in EBM increased post-intervention across all studies. However, no difference in learner outcomes was identified across a variety of educational modes, including lecture versus online, direct versus self-directed, multidisciplinary versus discipline-specific groups, lecture versus active small group facilitated learning. Conclusions The body of evidence available to guide educators on how to teach EBM to medical trainees is small, albeit of a good quality. The major limitation in assessing risk of bias was the inability to blind participants to an educational intervention and lack of clarity regarding certain aspects within studies. Further evidence, and transparency in design, is required to guide the development and implementation of educational strategies in EBM, including modes of teaching and the timing of delivering EBM content within the broader medical curriculum. Further research is required to determine the effects of timing, content and length of EBM courses and teaching methods. [ABSTRACT FROM AUTHOR]

Background: Resource and curriculum constraints within contemporary university programmes limit opportunities for supervision and feedback of student practice. This study investigated the technological challenges, solutions and educational rewards in implementing Web-based student self-video of performance as a method to foster the development of student self-evaluation. Methods: Physiotherapy students ( n = 60) in their final preclinical semester participated in the study. All students received guidelines for constructing and uploading self-videos of performance to a Web-based learning system. Students completed a reflective task on each video submission after receiving online tutor feedback and viewing an exemplar peer performance. Students completed a survey of their learning experiences and challenges in completing the learning tasks. Technical information on submissions was obtained in usage reports from the Web-based learning system. Results: Students were successful in recording and uploading digital videos of performance for remote tutor review. Students and tutors encountered technical problems that could be rectified and potentially avoided through activity design. Students reported that the utility of Web-based self-video for enhancing clinical performance outweighed the additional time and effort required in participation. Conclusions: Web-based student self-video of performance, with remote tutor feedback and guided reflection, is a feasible method for increasing students' capacity for reflection and self-evaluation. Although technical difficulties are inherent in any technology-reliant activity, the students' increasing competence with emerging technologies encourage self-video teaching and learning activities as a resource for facilitating clinical skill development. [ABSTRACT FROM AUTHOR]

Objectives Improving efficiencies in the education sector via the sharing of resources is currently the source of much interest and investment within Australia and throughout the world. Despite the development of multiple educational resource repositories worldwide, educators seldom use repositories to share materials. Interprofessional sharing is similarly scarce. This research was designed to identify staff perceptions about inter-departmental sharing of teaching and learning resources within a university faculty. Methods Representatives were recruited over a 2-week period from four campuses of a university, spanning six departments. Participants took part in two focus groups and six semi-structured interviews. A thematic analysis was undertaken by two independent researchers. Results Five key themes emerged: the benefits of electronic resources for improving student education; perceptions of sharing; perceptions of ownership; the ethical use of resources and digital repositories; the requirements for adoption. Conclusions Our research confirms that educators believe interprofessional resource sharing to be beneficial and appropriate. However, concerns that resources are of insufficient quality or will be incorrectly attributed surfaced as barriers to sharing. Poor understanding and ambiguity surrounding intellectual property rights highlighted the need for repository communities to be sufficiently educated. Developing a commonly agreed metadata and labelling system, and linking with existing infrastructure, will enhance the impact of a learning object repository. Providing avenues for sharing, such as resource repositories, may assist in aligning education with the well-established process of peer review utilised by the research community, improving resource quality through exposure to others' perspectives and feedback. Furthermore, the increased accountability, restriction and familiarity of repositories may prove beneficial in encouraging sharing. [ABSTRACT FROM AUTHOR]

Vascular smooth muscle cells (SMC) may be directly exposed to blood flow after an endothelial-denuding injury. It is not known whether direct exposure of SMC to shear stress reduces SMC turnover and contributes to the low rate of restenosis after most vascular interventions. This study examines if laminar shear stress inhibits SMC proliferation or stimulates apoptosis. Bovine aortic SMC were exposed to arterial magnitudes of laminar shear stress (11 dynes/cm2) for up to 24 h and compared to control SMC (0 dynes/cm2). SMC density was assessed by cell counting, DNA synthesis by 3[H]-thymidine incorporation, and apoptosis by TUNEL staining. Akt, caspase, bax, and bcl-2 phosphorylation were assessed by Western blotting; caspase activity was also measured with an in vitro assay. Analysis of variance was used to compare groups. SMC exposed to laminar shear stress had a 38% decrease in cell number (n = 4, P = 0.03), 54% reduction in 3[H]-thymidine incorporation (n = 3, P = 0.003), and 15-fold increase in TUNEL staining (n = 4, P < 0.0001). Akt phosphorylation was reduced by 67% (n = 3, P < 0.0001), whereas bax/bcl-2 phosphorylation was increased by 1.8-fold (n = 3, P = 0.01). Caspase-3 activity was increased threefold (n = 5, P = 0.03). Pretreatment of cells with ZVAD-fmk or wortmannin resulted in 42% increased cell retention (n = 3, P < 0.01) and a fourfold increase in apoptosis (n = 3, P < 0.04), respectively. Cells transduced with constitutively-active Akt had twofold decreased apoptosis (n = 3, P < 0.002). SMC exposed to laminar shear stress have decreased proliferation and increased apoptosis, mediated by the Akt pathway. These results suggest that augmentation of SMC apoptosis may be an alternative strategy to inhibit restenosis after vascular injury. J. Cell. Physiol. 216: 389–395, 2008. © 2008 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Provides information on a forum discussing issues in the philosophy and application of system dynamics approach as of September 1993. Views on the dynamics of essential tension; Significance of linear and nonlinear systems in engineering, physics and mathematics programs; Reason behind the confused identity of systems dynamics.

Magnesium oxide (MgO) nanoparticles were prepared using sol–gel process. The nanoparticles were then dried using a supercritical drying process. The particles were characterized for surface morphology, crystal structure, and surface functionality. The nanoparticles show a coralline structure with an average particle size of 200–300 nm with a surface area of 257 m2/g. The X-ray diffraction spectra of these materials are also obtained. The MgO particles, when contacted with a model explosive component 2, 4 dinitrotoluene in water at 50°C, showed a concentration reduction of 96%. [ABSTRACT FROM AUTHOR]

The article discusses the relationship between cost and value in the context of medical education. Topics include the reason clinicians, educationalists and researchers are uncomfortable talking about cost and value in health professions education, a key concern when looking at who bears the cost and who receives the value, and opportunity for measuring the cost and value of approaches to education.

Background: In the management of diabetes and high-risk patients, timely treatment with scheduled medicines is critical to prevent severe infections and reduce the risk of lower extremity amputation. However, in Australia, few podiatrists have attained endorsement to prescribe. The aims of this study were to identify the costs associated with developing and implementing a podiatry prescribing mentoring program; and to compare the cost of this program against potential healthcare savings produced. Methods: This was a cost-description analysis, involving the calculation of costs associated with the development and implementation of a mentoring program to train podiatrists to become endorsed prescribers. Costs were calculated using the Ingredients Method and examined from the perspective of a public health service provider, and the individual learner podiatrist. Breakeven analysis compared the cost of training a podiatry prescriber for endorsement against the potential benefit (savings) made by averting complications of an infected foot ulcer. A sensitivity analysis was conducted to allow for uncertainty in the results of an economic evaluation. Results: Total start-up cost for the podiatry prescriber mentoring program was $13, 251. The total cost to train one learner podiatrist was $30, 087, distributed between the hospital $17, 046 and the individual learner $13, 041. In the setting studied, a podiatry prescriber must avert 0.40 major amputations arising from an infected foot ulcer through prescribing to recover the cost of training. If in-kind training costs are included, total cost increases to $50, 654, and the breakeven point shifts to 0.68 major amputations averted. Conclusion: The economic benefits (savings) created by an endorsed prescribing podiatrist over their career in a public health service are likely to outweigh the costs to train a podiatrist to attain endorsement. Further research is required to help understand the effectiveness of podiatry prescribing in reducing diabetic foot related complications and the potential economic impact of podiatry prescribers on this health condition. [ABSTRACT FROM AUTHOR]

Aims Method Results Conclusion To test a model of malnutrition screening and assessment conducted by dietetics students on placement in residential aged care facilities. The secondary aim was to identify possible facilitators and barriers to the implementation of the model.The type 1 hybrid effectiveness‐implementation trial study design and reporting outcomes were developed using the Consolidated Framework for Implementation Research. An innovative placement model was developed, where students on voluntary placement visited three residential aged care facilities to identify residents at risk of malnutrition using currently available screening tools for older people. Students completed malnutrition assessments for all residents using the subjective global assessment tool.Thirty‐two students participated; 31 completed all three sessions, with malnutrition screening completed for 207 residents and malnutrition assessment for 187 residents (July and September 2022). Based on the subjective global assessment, 31% (n = 57) of residents were mildly/moderately malnourished, and 3% (n = 5) were severely malnourished. The Innovation Domain of the Framework was the most important consideration before implementation.Whilst previous research documented student learning opportunities in residential aged care facilities, this study provides the first available evidence of the direct contribution students can make to the health of aged care residents through malnutrition screening and assessment. The model enables students to conduct malnutrition screening and assessment feasibly and efficiently in facilities that do not routinely collate and act on these data. With a limited nursing aged care workforce to undertake this vital task, the potential role of student dietitians to fulfil this role must be considered. [ABSTRACT FROM AUTHOR]

Introduction: Decreased Nogo-B expression is associated with neointimal hyperplasia after intimal injury in young animals. To determine whether age-associated differences in neointimal hyperplasia are associated with similar changes in Nogo-B immunoreactivity, we examined neointimal Nogo-B expression in young adult and aged rats Methods: The carotid artery of Fischer 344 rats (6 or 18 mo) was injured and the external carotid ligated; the common carotid was examined (2 wk) for morphometry and immunohistochemistry Results: Although aged and young adult rats had similar vessel areas after angioplasty (aged: 0.49 ± 0.02mm2; young: 0.4 ± 0.02 mm2; p=.2), aged rats had diminished lumen area and increased neointimal thickening compared to young adults (aged: 0.15 ± 0.04 mm2; young: 0.08 ±0.03 mm2; p=.006). Alpha-actin density was increased in balloon-injured neointima but less in aged rats compared to young p=.002); alpha-actin was diminished, in the media similarly in young and aged rats. Neointimal Nogo-B was increased similarly in both young adult and aged rats (p=.004) [ABSTRACT FROM AUTHOR]