The Cannabis and Older Persons Study: Has Science Caught Up With Practice Yet?

Since 2016, the Cannabis and Older Persons Study has examined the increasing use of cannabis among Americans over 60 years old. Our current work dives into particular groups of cannabis users and explores outcomes related to medical conditions and symptoms. This symposium also features a range of methodological approaches from an analysis of the BRFSS caregiving and cannabis modules, a convenience sample of more than 4,000 older cannabis users enrolled in the Illinois Medical Cannabis Program and qualitative interviews conducted with aging veterans. Kanika Arora examines the association between informal caregiving and marijuana use and whether this association varies by age. Julie Bobitt shares findings from 32 interviews with older Veteran cannabis users. Alton Croker examines cannabis use as a complement or alternative to palliative care. HyoJung Kang clusters negative outcomes experienced by older persons who use cannabis. Brian Kaskie compares cannabis use among persons with Multiple Sclerosis (N=135) and persons diagnosed with arthritis (N=582) or cancer (N=622). While we certainly find reason to remain concerned that cannabis use alone and co-occurring use with prescription opioids may contribute to increased rates of substance misuse and other undesirable outcomes among older adults, we find it increasingly difficult to overlook the benefits many persons derive when taking cannabis as a method to manage pain or address other medical conditions. At this point, public policy officials and program administrator should strive to strike a balance between addressing cannabis harms relative to promoting benefits such as opioid reduction and diversion.

Ten ways to get a grip on designing and implementing a competency-based medical education training program

Background: Globally there is a move to adopt competency-based medical education (CBME) at all levels of the medical training system. Implementation of a complex intervention such as CBME represents a marked paradigm shift involving multiple stakeholders. Methods: This article aims to share tips, based on review of the available literature and the authors’ experiences, that may help educators implementing CBME to more easily navigate this major undertaking and avoid “black ice” pitfalls that educators may encounter. Results: Careful planning prior to, during and post implementation will help programs transition successfully to CBME. Involvement of key stakeholders, such as trainees, teaching faculty, residency training committee members, and the program administrator, prior to and throughout implementation of CBME is critical. Careful and selective choice of key design elements including Entrustable Professional Activities, assessments and appropriate use of direct observation will enhance successful uptake of CBME. Pilot testing may help engage faculty and learners and identify logistical issues that may hinder implementation. Academic advisors, use of curriculum maps, and identifying and leveraging local resources may help facilitate implementation. Planned evaluation of CBME is important to ensure choices made during the design and implementation of CBME result in the desired outcomes. Conclusion: Although the transition to CBME is challenging, successful implementation can be facilitated by careful design and strategic planning.

School Librarians as Leaders

With the publication of Empowering Learners: Guidelines for School Library Media Programs in 2009, the American Association of School Librarians articulated a role that school librarians had not been expected to take on before: that of leader. Earlier guidelines documents had embedded a variety of leadership activities within the roles of information specialist, instructional consultant or partner, teacher, and program administrator (American Association of School Librarians, 1988, 1998). Without the expectation of leadership clearly articulated in their guidelines, however, school librarians did not perceive themselves as leaders (Ishizuka, Minkel, & Lifer, 2002; McCracken, 2001; Shannon, 2004, 2008; Vansickle, 2000) and neither did the principals who supervised them (Hartzell, 2002). Since the release of Empowering Learners, some states have begun to require school librarians to demonstrate leadership to obtain or maintain their teacher certification and to retain their positions (Public Schools of North Carolina, 2013). The empirical literature surrounding school library leadership reflects this shift; in the era before the publication of Empowering Learners, few studies were published focusing on leadership in the school library, but since its release, several studies have been published. The literature surrounding school library leadership relies on leadership theories grounded in the concept of shared leadership. It addresses preservice leadership education for school librarians, their ability to implement professional guidelines and standards related to leadership, and their leadership capacity in specific facets of leadership such as collaboration, evidence-based practice, and technology integration.

Exploring Preparation of Pre-Service Teachers’ English Proficiency and Pedagogy: Stories from an EFL Teacher Education Program

Many English teachers today are non-native speakers of English graduating from Pre-service English Teacher Education (PETE) programs in English as a Foreign Language (EFL) context. They undertake their teaching career in a strategic but challenging linguistic and educational situation. This paper reports findings from such a situation based on a qualitative case study of a PETE program at an Indonesian university that aimed to explore the nature of curriculum provision in preparation to develop pre-service teachers’ English proficiency and pedagogy. Data were collected from pre-service teachers, teacher educators, and program administrator using interviews, focus groups, and classroom observations. Results of data analyses revealed a nature of curriculum provision that is inadequately supportive in preparing pre-service teachers’ English proficiency and pedagogy. It is represented in three emerging themes: inadequacy of English proficiency in learning to teach English, lack of balance between theory and practice, and inadequate facilitation for contextual and integrated learning experience.

Residency and Fellowship Program Administrator Burnout: Measuring Its Magnitude

ABSTRACT Background Little is known about the level of burnout among program administrators (PAs) working in graduate medical education. Objective We created a national database with baseline burnout data for PAs from residency and fellowship programs, including intention to leave their current positions. Methods A cross-sectional study was conducted in July 2017 to assess levels of burnout in a national cohort of PAs, who were largely members of online specialty forums. The Copenhagen Burnout Inventory (CBI) was used to measure burnout. Univariate analysis produced descriptive statistics for CBI. We performed a 2-sample t test to measure differences in average burnout scores for those who had thoughts of resigning from their positions and those who had not. Results Of the approximately 10 205 national PAs, we sampled 1126 (11%). Of the 1126 individuals who received the study information, 931 (83%) completed the baseline survey. Total mean scores for all subscales were elevated (personal: 53.7, SD 21.4; work-related: 52.0, SD 22; and client-related: 30.6, SD 20.8; each scale ranged from 0, low, to 100, high). Burnout scores differed between those contemplating leaving their jobs and those who were not, across all subscales of CBI, including personal (64.2 versus 42.4, –24.18 to –19.44 confidence interval [CI]), work-related (63.5 versus 39.7, –26.12 to –21.35 CI), and client-related (36.6 versus 24.2, –14.95 to –9.84 CI; P < .0001 for all). Conclusions In this national survey of PAs, burnout scores measured by the CBI were higher among those who had considered leaving their positions.

Current organization of specialist pulmonary hypertension clinics: results of an international survey

Optimal pulmonary hypertension (PH) management relies on a timely, accurate diagnosis and follow-up in specialized clinics by multidisciplinary teams that have clearly defined responsibilities and protocols. Internationally agreed criteria for expert center staff are lacking, particularly with respect to nurses, who often act as a central component of the team. This survey aimed to evaluate the current organization of PH clinics and the role of nurses. The survey (35 questions) was online February–December 2015 and was advertised at international PH nurse meetings and through international PH organizations to their corresponding clinics. In total, 126 healthcare professionals from 32 countries responded. According to respondents, 54% of clinics managed >200 patients, of whom 49% had a pulmonary arterial hypertension (PAH) diagnosis, on average. In terms of staff, 66% had a dedicated program administrator, 35% had one full-time nurse coordinator/practitioner/specialist, and 57% had a nurse attend outpatient clinic alongside a physician. Crucially, not all centers had a nurse in their team. The role of a nurse coordinator/practitioner/specialist varied with 51% taking patient histories/examinations and 66% managing outpatients. In 34% of clinics, nurses were involved in their own research. Protocols were available for PH therapies (81%), management of heart failure (37%) and pain (26%), and referring patients who did not have PAH/chronic thromboembolic PH back to their specialist (62%). Not all clinics are meeting all of the standards outlined in the latest guidelines with key areas of improvement being level of support from/for nurses, clear protocols, and referral pathways.

The Writing Program Administrator as Interstitial Radical

Drawing upon personal experience as a writing program administrator at a research university, and marshaling a body of critical scholarship that examines how neoliberal ideology in the academy might be opposed, the author discusses interstitial resistance in the form of a curricular alternative--namely, the outsider genre of zines. Because zines typically embody a "worldview dramatically at odds with the [one] cultivated and reinforced by institutions of higher education," zines offer students an alternative point of view not usually found in standard writing curricula.While the author uses zines as a central illustration, the purpose here is to encourage readers to find the "cracks and fissures" in their own institutions so that the insinuations of neoliberal policies might be resisted through teaching and administrative initiatives.