782 resultados para Rural Education
Resumo:
Background and context Since the economic reforms of 1978, China has been acclaimed as a remarkable economy, achieving 9% annual growth per head for more than 25 years. However, China's health sector has not fared well. The population health gains slowed down and health disparities increased. In the field of health and health care, significant progress in maternal care has been achieved. However, there still remain important disparities between the urban and rural areas and among the rural areas in terms of economic development. The excess female infant deaths and the rapidly increasing sex ratio at birth in the last decade aroused serious concerns among policy makers and scholars. Decentralization of the government administration and health sector reform impacts maternal care. Many studies using census data have been conducted to explore the determinants of a high sex ratio at birth, but no agreement has been so far reached on the possible contributing factors. No study using family planning system data has been conducted to explore perinatal mortality and sex ratio at birth and only few studies have examined the impact of the decentralization of government and health sector reforms on the provision and organization of maternal care in rural China. Objectives The general objective of this study was to investigate the state of perinatal health and maternal care and their determinants in rural China under the historic context of major socioeconomic reforms and the one child family planning policy. The specific objectives of the study included: 1) to study pregnancy outcomes and perinatal health and their correlates in a rural Chinese county; 2) to examine the issue of sex ratio at birth and its determinants in a rural Chinese county; 3) to explore the patterns of provision, utilization, and content of maternal care in a rural Chinese county; 4) to investigate the changes in the use of maternal care in China from 1991 to 2003. Materials and Methods This study is based on a project for evaluating the prenatal care programme in Dingyuan county in 1999-2003, Anhui province, China and a nationwide household health survey to describe the changes in maternal care utilization. The approaches used included a retrospective cohort study, cross sectional interview surveys, informant interviews, observations and the use of statistical data. The data sources included the following: 1) A cohort of pregnant women followed from pregnancy up to 7 days after birth in 20 townships in the study county, collecting information on pregnancy outcomes using family planning records; 2) A questionnaire interview survey given to women who gave birth between 2001 and 2003; 3) Various statistical and informant surveys data collected from the study county; 4) Three national household health interview survey data sets (1993-2003) were utilized, and reanalyzed to described the changes in maternity care utilization. Relative risks (RR) and their confidence intervals (CI) were calculated for comparison between parity, approval status, infant sex and township groups. The chi-square test was used to analyse the disparity of use of maternal care between and within urban and rural areas and its trend across the years in China. Logistic regression was used to analyse the factors associated with hospital delivery in rural areas. Results There were 3697 pregnancies in the study cohort, resulting in 3092 live births in a total population of 299463 in the 20 study townships during 1999-2000. The average age at pregnancy in the cohort was 25.9 years. Of the women, 61% were childless, 38% already had one child and 0.3% had two children before the current pregnancy. About 90% of approved pregnancies ended in a live birth while 73% of the unapproved ones were aborted. The perinatal mortality rate was 69 per thousand births. If the 30 induced abortions in which the gestational age was more than 28 weeks had been counted as perinatal deaths, the perinatal mortality rate would have been as high as 78 per thousand. The perinatal mortality rate was negatively associated with the wealth of the township. Approximately two thirds of the perinatal deaths occurred in the early neonatal period. Both the still birth rate and the early neonatal death rate increased with parity. The risk of a stillbirth in a second pregnancy was almost four times that for a first pregnancy, while the risk of early neonatal deaths doubled. The early neonatal mortality rate was twice as high for female as for male infants. The sex difference in the early neonatal mortality rate was mainly attributable to mortality in second births. The male early neonatal mortality rate was not affected by parity, while the female early neonatal mortality rate increased dramatically with parity: it was about six times higher for second births than for first births. About 82% early neonatal deaths happened within 24 hours after birth, and during that time, girls were almost three times more likely to die than boys. The death rate of females on the day of birth increased much more sharply with parity than that of males. The total sex ratio at birth of 3697 registered pregnancies was 152 males to 100 females, with 118 and 287 in first and second pregnancies, respectively. Among unapproved pregnancies, there were almost 5 live-born boys for each girl. Most prenatal and delivery care was to be taken care of in township hospitals. At the village level, there were small private clinics. There was no limitation period for the provision of prenatal and postnatal care by private practitioners. They were not permitted to provide delivery care by the county health bureau, but as some 12% of all births occurred either at home or at private clinics; some village health workers might have been involved. The county level hospitals served as the referral centers for the township hospitals in the county. However, there was no formal regulation or guideline on how the referral system should work. Whether or not a woman was referred to a higher level hospital depended on the individual midwife's professional judgment and on the clients' compliance. The county health bureau had little power over township hospitals, because township hospitals had in the decentralization process become directly accountable to the township government. In the township and county hospitals only 10-20% of the recurrent costs were funded by local government (the township hospital was funded by the township government and the county hospital was funded by the county government) and the hospitals collected user fees to balance their budgets. Also the staff salaries depended on fee incomes by the hospital. The hospitals could define the user charges themselves. Prenatal care consultations were however free in most township hospitals. None of the midwives made postnatal home visits, because of low profit of these services. The three national household health survey data showed that the proportion of women receiving their first prenatal visit within 12 weeks increased greatly from the early to middle 1990s in all areas except for large cities. The increase was much larger in the rural areas, reducing the urban-rural difference from more than 4 times to about 1.4 times. The proportion of women that received antenatal care visits meeting the Ministry of Health s standard (at least 5 times) in the rural areas increased sharply from 12% in 1991-1993 to 36% in 2001-2003. In rural areas, the proportion increase was much faster in less developed areas than in developed areas. The hospital delivery rate increased slightly from 90% to 94% in urban areas while the proportion increased from 27% to 69% in rural areas. The fastest change was found to be in type 4 rural areas, where the utilization even quadrupled. The overall difference between rural and urban areas was substantially narrowed over the period. Multiple logistic regression analysis shows that time periods, residency in rural or urban areas, income levels, age group, education levels, delivery history, occupation, health insurance and distance from the nearest health care facilities were significantly associated with hospital delivery rates. Conclusions 1. Perinatal mortality in this study was much higher than that for urban areas as well as any reported rate from specific studies in rural areas of China. Previous studies in which calculations of infant mortality were not based on epidemiological surveys have been shown to underestimate the rates by more than 50%. 2. Routine statistics collected by the Chinese family planning system proved to be a reliable data source for studying perinatal health, including still births, neonatal deaths, sex ratio at birth and among newborns. National Household Health Survey data proved to be a useful and reliable data source for studying population health and health services. Prior to this research there were few studies in these areas available to international audiences. 3.Though perinatal mortality rate was negatively associated with the level of township economic development, the excess female early neonatal mortality rate contributed much more to high perinatal mortality rate than economic factors. This was likely a result of the role of the family planning policy and the traditional preferences for sons, which leads to lethal neglect of female newborns and high perinatal mortality. 4. The selective abortions of female foetuses were likely to contribute most to the high sex ratio at birth. The underreporting of female births seemed to have played a secondary role. The higher early neonatal mortality rate in second-born as compared to first-born children, particularly in females, may indicate that neglect or poorer care of female newborn infants also contributes to the high sex ratio at birth or among newborns. Existing family planning policy proved not to effectively control the steadily increased birth sex ratio. 5. The rural-urban gap in service utilization was on average significantly narrowed in terms of maternal healthcare in China from 1991 to 2003. This demonstrates that significant achievements in reducing inequities can be made through a combination of socio-economic development and targeted investments in improving health services, including infrastructure, staff capacities, and subsidies to reduce the costs of service utilization for the poorest. However, the huge gap which persisted among cities of different size and within different types of rural areas indicated the need for further efforts to support the poorest areas. 6. Hospital delivery care in the study county was better accepted by women because most of women think delivery care was very important while prenatal and postnatal care were not. Hospital delivery care was more systematically provided and promoted than prenatal and postnatal care by township hospital in the study area. The reliance of hospital staff income on user fees gave the hospitals an incentive to put more emphasis on revenue generating activities such as delivery care instead of prenatal and postnatal care, since delivery care generated much profits than prenatal and postnatal care . Recommendations 1. It is essential for the central government to re-assess and modify existing family planning policies. In order to keep national sex balance, the existing practice of one couple one child in urban areas and at-least-one-son a couple in rural areas should be gradually changed to a two-children-a-couple policy throughout the country. The government should establish a favourable social security policy for couples, especially for rural couples who have only daughters, with particular emphasis on their pension and medical care insurance, combined with an educational campaign for equal rights for boys and girls in society. 2. There is currently no routine vital-statistics registration system in rural China. Using the findings of this study, the central government could set up a routine vital-statistics registration system using family planning routine work records, which could be used by policy makers and researchers. 3. It is possible for the central and provincial government to invest more in the less developed and poor rural areas to increase the access of pregnant women in these areas to maternal care services. Central government together with local government should gradually provide free maternal care including prenatal and postnatal as well as delivery care to the women in poor and less developed rural areas. 4. Future research could be done to explore if county and the township level health care sector and the family planning system could be merged to increase the effectiveness and efficiency of maternal and child care. 5. Future research could be done to explore the relative contribution of maternal care, economic development and family planning policy on perinatal and child health using prospective cohort studies and community based randomized trials. Key words: perinatal health, perinatal mortality, stillbirth, neonatal death, sex selective abortion, sex ratio at birth, family planning, son preference, maternal care, prenatal care, postnatal care, equity, China
Resumo:
It is a common knowledge that there exists a wide gap between domestic fish production and demand in Nigeria. Government recognizes this situation and has in recent years encouraged fish production through fishing inputs subsidies, DFRRI assisted fingerlings production among others. Despite these efforts, impact at the grassroots has been low. One of the major reasons for the failure could be attributable to inadequate involvement of rural communities in fish production. This missing link appears to be ignorance of local communities in harnessing this potential to stimulate fish production. There is therefore the need to educate the rural dwellers through effective extension services. Strategies to achieve the required awareness have been discussed
Resumo:
Artisanal Fish Societies constitutes one of the poorest societies in the developing world. Attempts to harness the potentials of the societies have often failed due to the enormity of the problem of poverty. This study was conducted in four major fishing villages namely; Abule titun, Apojola, Imama Odo and Ibaro in order to investigate the occupational practices and the problems of rural artisanal fisherfolks in Oyam's Dam, area of Ogun State. Eighty respondents were randomly selected among the artisanal fisher folks for interview using interview guide. The findings revealed that 43.8% of the fisherfolks are within active range of 31-40 years while 30% are within 21-30 years range. Also 31% had no formal education indicating a relatively high level of illiteracy among the fisherfolks while majority of the respondents practice fishing activities using paddle and canoe. It was similarly discovered from the study that the most pressing problems of the fisherfolks is the lack of basic social amenities like electricity, potable water, access roads, hospitals and markets. It is therefore recommended that basic social infrastructures be provided for the artisanal fishing communities in order to improve their social welfare, standard of living and the capacity to have a sustainable fishing occupation in the interest of food security and poverty alleviation
Resumo:
Este trabalho é um estudo sobre a mistura que se estabelece entre informação meteorológica e entretenimento nos quadros da previsão do tempo de dois telejornais nacionais das Organizações Globo: Jornal Nacional JN (canal aberto Rede Globo) e Rural Notícias RN (canal fechado Canal Rural). A recepção dos programas sobre o tempo é analisada a partir de entrevistas abertas, com 40 espectadores de ambos os noticiários, habitantes da cidade e do campo. Também por meio de entrevistas, são avaliadas as representações da produção, privilegiando as denominadas moças do tempo, Flávia Freire (JN) e Lilian Lima (RN). Auxiliam na identificação do entretenimento, nos espaços da meteorologia, a observação do surgimento do consumidor moderno, a extensão do consumo ao lazer, o divertimento pela televisão, o tempo como assunto para conversa, as representações do corpo na cultura brasileira e traços da educação na transmissão meteorológica no Telejornalismo do país. Assim, são analisados os formatos dos quadros do tempo, suas funções aparentes, formatações, imagem corporal construída de suas apresentadoras e o público-alvo de cada telejornal. Esses principais pontos são relacionados com o pensamento de autores que estudam comunicação, tempo, hedonismo, utilitarismo, consumo, representações sociais, corpo, educação e pedagogia. A previsão da meteorologia aparece com várias funções, sendo dominantes a ênfase no cotidiano, em ambos os jornais; o foco no lazer, sobretudo no Jornal Nacional; e o destaque para o vínculo com a produção rural em sentido amplo, no caso do Rural Notícias.
Resumo:
O objetivo da pesquisa foi explorar os elementos constitutivos dos itinerários formativos desenvolvidos nas experiências de Internato Rural na Amazônia, a partir do contato com a realidade e a cultura locais, observando possíveis contribuições para o aprendizado de valores ético-políticos condizentes com a noção de responsabilidade. Trata-se de pesquisa qualitativa com pressupostos fenomenológicos e análise baseada nas narrativas dos sujeitos entrevistados, basicamente estudantes que passaram recentemente pela experiência de Internato Rural e professores envolvidos com o programa. Por suas peculiaridades, foram escolhidas as experiências da Universidade do Estado do Amazonas e da Universidade Estadual do Pará campus Santarém. Foram também realizados grupos focais com estudantes e observação direta e participante da ação dos estudantes em alguns municípios selecionados. Foram definidas três categorias em que as narrativas se concentraram: Mundo; Saberes e Práticas; e Responsabilidade. Estas foram analisadas na perspectiva das mudanças de paradigma pertinentes a cada uma delas, sendo por isso designadas como fronteiras. Ao iniciar o Internato Rural, os estudantes se sentem em outro mundo, numa realidade que não conheciam, mas que encaram e se deixam surpreender. Essa sensibilização parece criar um sentimento de pertença à região, numa possível reconciliação com o mundo, em manifestações narrativas que evocam o sentimento arendtiano de amor mundi. A partir desse processo de valoração, as reflexões se voltaram inclusive para a possibilidade de viver essa situação como médico, numa possível ida para o interior. E também na reafirmação da esperança que a ideia arendtiana de renovação do mundo nos traz, com o advento da natalidade e com a apresentação do mundo aos novos através da educação. Durante o estágio, os estudantes entram em contato com os saberes e práticas tradicionais da floresta. Nesse encontro percebem a importância das parteiras e dos pegadores, assim como da utilização de plantas medicinais e outras práticas próprias do local. Esse encontro foi visto, na maioria das vezes, de maneira positiva, ressaltando-se o respeito e a abertura para o aprendizado que devem estar presentes nas relações, numa tendência mais conciliadora no diálogo entre a biomedicina e a medicina tradicional. As narrativas sobre esse encontro puderam ser interpretadas como expressão da pluralidade humana, sendo inclusive estimuladas por alguns estudantes. Ao final do Internato Rural, os estudantes o consideram mais que um estágio acadêmico, uma experiência de vida. Reconhecem a importância de se tornarem mais humildes, de aprender a escutar melhor, de ter mais flexibilidade e paciência. Essas são virtudes que parecem ganhar sentido para a medicina no cenário do interior. Houve a construção de um juízo sobre a prática médica, baseado tanto na percepção do significado da presença deles ali para aquela população, quanto nos bons e maus exemplos com que tiveram oportunidade de conviver. Dessa forma emergiu a responsabilidade pessoal, na escolha de com que outro queremos conviver em pensamento. Por pertencerem ao coletivo da universidade pública, ressaltam a importância e a responsabilidade de atuarem no interior, podendo desenvolver um compromisso especial com essa população num senso de responsabilidade coletiva.
Resumo:
É urgente a necessidade da maior inclusão social dos estudantes que articulam a rotina de trabalho diurno e a educação formal noturna, objetivando melhorar as condições de vida através de aumentar oportunidades no mercado de trabalho. Por ser tema de extrema relevância social, a presente pesquisa busca compreender os desafios de alunos matriculados em cursos de Ensino Superior noturno no Instituto Multidisciplinar da Universidade Federal Rural do Rio de Janeiro, destacando o processo de democratização do acesso e a permanência de jovens de camadas populares em quatro cursos de graduação. Descrevemos políticas públicas de acesso e de permanência dos estudantes nos cursos superiores noturnos de Pedagogia, História, Matemática e Administração, tendo em vista contribuir com a discussão da real efetividade destes cursos para a democratização da educação superior. O procedimento metodológico é a investigação qualitativa em estudo de caso. Nesta pesquisa, foram contatadas pessoas chave da universidade, aplicados 361 questionários e entrevistados 39 alunos de quatro cursos escolhidos. Os resultados relacionados aos fatores sociais que impõem o caráter compulsório do trabalho ao estudante universitário confirmaram que o jovem, dos cursos noturnos estudados deste Instituto Multidisciplinar, em geral, tem dificuldades de gerenciar sua vida para contemplar as diversas demandas, isto é, as sociais, familiares, educacionais e laborais. O jovem estudado costuma ter um perfil de vulnerabilidade socioeconômica. Os resultados também mostram em alguns discursos dos entrevistados alguns desafios de conciliar o curso noturno com a vida de trabalho. Assim, os resultados também revelam a necessidade de que mais recursos sejam destinados a programas com alunos com o perfil de vulnerabilidade socioeconômica. Apesar do perfil heterogêneo dos alunos desta pesquisa, os resultados apontam também que muitos aproveitam a oportunidade de continuidade de escolarização conciliando o trabalho diurno com a educação noturna. A opção destes por cursos de licenciaturas, como os de Matemática, História e Pedagogia, é atrativa pela maior facilidade de acesso devido a serem carreiras menos disputadas no ingresso à universidade pública. Embora a profissão docente em nossa sociedade não ofereça elevado prestígio social, ter a formação e o diploma de Ensino Superior ainda é para muitos jovens, uma possível trajetória que pode levar a mobilidade social. Assim, as políticas públicas precisam melhor atender os jovens deste segmento populacional que deseja estudar e trabalhar com educação.
Resumo:
The study was undertaken to understand the rural women's (i) extent of participation in some selected aquaculture practices and (ii) extent of empowerment through participation in aquaculture program. Data were collected from 200 selected rural women of two districts - Sherpur and Kishoreganj. Each of the families where the selected rural women who were involved in aquaculture under the supervision of two partner NGOs of DSAP, namely- Foundation for Human Development (FHD) and Center for Rural and Environmental Development (CRED). Both conventional and participatory methods of data collection were employed where structured questionnaire and Focus Group Discussion (FGD) were used as the tools. The data collection procedure took five-months spanning from September 2004 to January 2005. Appropriate scales were developed and used in order to determine the focus variables of the study, while most analyses regarding women empowerment were done using 'before' and 'after' method. Empowerment of women was measured by five dimensions such as decision making ability, spending ability, social participation, cosmopoliteness, access to assets and resources. The ten selected aquaculture practices were: fish feeding, eradication of aquatic vegetation from fish pond, disease detection, application of fertilizer, liming, harvesting of fry and fish, fish stock management, pond excavation, use of insecticides, and sale of fry and fish. The study also aimed at determining some selected characteristics of rural women and determining relationship between their extent of empowerment and the selected characteristics. The characteristics of rural women included: age, personal education, average family education, family size, family farm size, area under aquaculture, extension media exposure, training exposure, knowledge in aquaculture, and family income. The findings revealed an overall low level of participation by rural women in aquaculture activities. However, significant level of improvement was identified regarding overall status of empowerment during the course of participation in aquaculture program under DSAP.
Resumo:
Yeoman, A., Durbin, J. & Urquhart, C. (2004). Evaluating SWICE-R (South West Information for Clinical Effectiveness - Rural). Final report for South West Workforce Development Confederations, (Knowledge Resources Development Unit). Aberystwyth: Department of Information Studies, University of Wales Aberystwyth. Sponsorship: South West WDCs (NHS)
Resumo:
Dissertação apresentada à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Acção Humanitária, Cooperação e Desenvolvimento
Resumo:
This study examines the relationship between rural livelihoods and livestock keeping in Sidama Zones, southern Ethiopia. The livelihood context, assets and strategies of households are the key features of rural livelihoods considered in the study; while households’ livestock ownership, dependence on livestock and livestock management are the main aspects of livestock keeping examined. The study used the sustainable livelihood approach as a framework for data collection and analysis. Describing the main features of rural livelihoods and livestock keeping, and the general pattern of relationship between them, this study mainly aims at identifying the main livelihood factors that determine livestock keeping in the study area. Descriptive statistics, pair wise correlations, mean comparisons and analysis of variance were used to describe rural livelihoods and livestock keeping as well as the relationship between them. Tobit regressions were used to examine the effect of the various livelihood factors on households’ livestock ownership and dependence; Poisson regressions are used to investigate the factors that influence the intensity of livestock management measured by the use of different technologies and inputs. The findings indicated that a number of livelihood factors - assets, livelihood strategies, livelihood shocks and institutional supports - significantly determine the different aspects of livestock keeping. These include: human assets such as age, education and family size; social assets such as membership to social groups; financial assets such as credit; natural assets such as land, and household physical assets; and livelihood strategies such as diversification into farm and nonfarm activities, and coping mechanisms. In addition the livelihood vulnerability context such as shocks and institutional support are among the main determinants of livestock keeping. The results, by and large, matched the findings of previous studies, and it is concluded that households livestock keeping depends on their livelihoods. Accordingly, it is recommended that policies aiming at livestock asset building and productivity improvement should take the livelihoods of rural households in to consideration. As such the study contribute to scholarly works in the area of rural livelihoods, in general, and livestock keeping, in particular. It also contributes to a better understanding of the problems of livestock keeping within the context of rural livelihoods in the country and to the formulation of appropriate policy for the development of the sector.
Resumo:
Contraceptive prevalence in Haiti remains low despite extensive foreign aid targeted at improving family planning. [1] Earlier studies have found that peer-informed learning have been successful in promoting sexual and reproductive health. [2-5] This pilot project was implemented as a three-month, community-based, educational intervention to assess the impact of peer education in increasing contraceptive knowledge among women in Fondwa, Haiti. Research investigators conducted contraceptive information trainings to pre-identified female leaders of existing women’s groups in Fondwa, who were recruited as peer educators (n=4). Later, these female leaders shared the knowledge from the training with the test participants in the women’s group (n=23) through an information session. Structured surveys measuring knowledge of contraceptives were conducted with all participants before the intervention began, at the end of the intervention, and four weeks after the intervention. The surveys measured general contraceptive knowledge, knowledge about eight selected types of modern contraceptives and contraceptive preferences and attitudes. Only test participants showed significant improvement in their general contraceptive knowledge score (p<0.001), but both test participants and peer educators showed significant improvement in overall knowledge scores for identifying the types and uses of modern contraceptive methods. Assessment for knowledge retention remained significantly higher four weeks after the intervention than prior to the intervention. Therefore, a one-time, three-hour peer-based educational intervention using existing social structures is effective, and might be valuable in a population with minimal access to education and little to no knowledge about contraceptives.
Resumo:
Inheritance systems and practices have a key role in people’s ability to exit poverty, or, conversely, plunging them further into it. As land is the major asset in low-income developing countries, how property is passed on and divided between future generations is a significant factor. This paper looks at inheritance through minimally-structured interviews with several generations of Kenyan families, seeking to explain that the how and why of poverty can be understood in the wider family context. It analyses their fortunes and misfortunes over a given time period in the context of property ownership rights. It also looks at the impact of education and the inheritance of cultural capital. When both fertility and survival are high, traditional patterns of land inheritance can lead to progression sub-division of land with long-term adverse implications for sustainability. While inheritance in Kenya is male dominated, the paper nonetheless examines the position of women in the chain as vectors of male property rights. The application of male-oriented customary law where inheritance is concerned, rather than the use of statutory legislation, was found to be the reality for the overwhelming majority of the participants in the study.
Resumo:
Sectarian violence in the Northern Ireland is often perceived to be mostly confined to cities. The aim of this paper is to explore statistically what factors contribute to segregation preferences among young people living in rural and urban areas, using the 2005–2009 Young Life and Times (YLT) survey – an annual attitudes survey of 16-year-olds. The findings show that religious and national identities are the strongest predictors of segregation preferences among 16-year-olds, regardless of where they live and what background they have. Those living in rural areas of Northern Ireland are more supportive of residential, workplace and educational segregation than those living in more urban areas. This research highlights the need for government policy to take rurality into account. Nevertheless, some variables significantly determine segregation preferences regardless of where respondents live, such as attendance of segregated schools, being female, or strength of national and religious identity. Consequently, policy initiatives should continue to address the effect of segregation, especially in relation to education, and future research exploring social class and gender is recommended. In conclusion, the perception of the violent ‘urban spaces’ and the ‘peaceful countryside’ has to be challenged.
Resumo:
Using the employment and unemployment panel data of the National Sample Survey Organisation (NSSO), this paper attempts to map the spatial and temporal dimension of skills and education profiles of India’s workforce. After an assessment of India’s employment challenge, this study analyses the changing pattern of skill distribution among Indian workers by their gender, location, type, regions and broad sectors of the economy. The paper draws on the emerging literature and presents its empirical data to outline the essential skill and educational characteristics of workers, and its variations across broad sectors of the economy at both the national and sub-national levels.
Resumo:
Purpose: Changes to health care systems andworking hours have fragmentedresidents’ clinical experiences withpotentially negative effects ontheir development as professionals.Investigation of off-site supervision,which has been implemented in isolatedrural practice, could reveal importantbut less overt components of residencyeducation.
Method: Insights from sociocultural learningtheory and work-based learning provideda theoretical framework. In 2011–2012,16 family physicians in Australia andCanada were asked in-depth how theyremotely supervised residents’ workand learning, and for their reflectionson this experience. The verbatiminterview transcripts and researchers’memos formed the data set. Templateanalysis produced a description andinterpretation of remote supervision.
Results: Thirteen Australian family physiciansfrom five states and one territory, andthree Canadians from one province,participated. The main themes werehow remoteness changed the dynamicsof care and supervision; the importanceof ongoing, holistic, nonhierarchical,supportive supervisory relationships; andthat residents learned “clinical courage”through responsibility for patients’ careover time. Distance required supervisorsto articulate and pass on their expertiseto residents but made monitoringdifficult. Supervisory continuityencouraged residents to build on pastexperiences and confront deficiencies.
Conclusions: Remote supervision enabled residents todevelop as clinicians and professionals.This questions the supremacy of co-locationas an organizing principle forresidency education. Future specialists maybenefit from programs that give themongoing and increasing responsibilityfor a group of patients and supportive.