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REVIEW PROTOCOL TEMPLATE
Recommendation 2
Should governments, funders and accrediting bodies support the implementation of higher education policies for mandatory faculty development programmes that are relevant to the evolving health care needs of their communities?
A systematic review
Review protocol
Organization, City, Country: University of Cambridge, Cambridge, United Kingdom Prepared by: Alison Andrew Date: July 2011 Senior supervisor Francesca Celletti Project lead Rebecca Bailey Research team members Rachel Marie Amiya, Carmen Dolea, Annette Mwansa
Nkowane, Erica Lynette Wheeler, Rodrigo Rodriguez Fernandez.
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Table of Contents
A SYSTEMATIC REVIEW ............................................................................................................................ 1
1.0 Background ......................................................................................................... 3
2.0 Objective ............................................................................................................. 3
3.0 Review Question ................................................................................................. 3
4.0 Evidence gathering and study selection .............................................................. 3
5.0 Assessment of risk of bias and data extraction ................................................. 11
6.0 Data synthesis ................................................................................................... 11
7.0 Dissemination ................................................................................................... 11
8.0 Resource implications ....................................................................................... 11
9.0 References ......................................................................................................... 12
Appendix A: database search strategy .......................................................................... 13
Appendix B: data extraction forms (see attached excel workbook) ............................. 14
Appendix C: Example of databases, websites and journals which could be searched . 15
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1.0 Background
Include definitions, answers to background questions, description of the intervention and how it might work to help better understand the question.
It is a given that faulty and teaching staff are rewarded and recognized for their service delivery function, including research functions. This question addresses the effect of additionally rewarding and recognizing faculty and teaching staff specifically for their teaching efforts on a transformative scale up of health professional education. In any scheme to recognize and reward faculty and teaching staff for their teaching efforts a suitable measure of teaching effort or outcomes is essential. Various measures of evaluating teaching performance have been evaluated in the literature and include student ratings, Relative Value Scales which weights teaching activities according to labor intensity, preparation time, level of responsibility and educational value (Bardes et. al) and peer review (Irby et. al). This literature review does not attempt to evaluate different systems of evaluating teaching although such reviews have been published (Beckman et al). The range of interventions that reward and incentivize teaching that this literature review will study is broad; any form of recognition or reward whether monetary or not will be included in the analysis.
2.0 Objective
To assess the effectiveness of packages of salaries, benefits and recognition for faculty and teaching staff, including current health workers, on the quantity, quality and relevance of health professionals.
3.0 Review Question
For the purposes of this literature review, the population, intervention, comparators and outcomes (PICO) framework to inform the review objectives are presented below.
Population Intervention Comparison Outcome
Faculty and teaching staff
Packages of salaries, benefits and recognition for faculty and teaching staff that incentivize and reward teaching
Packages of salaries, benefits and recognition for faculty and teaching staff that do not incentivize and reward teaching.
Quantity, quality and relevance of health professionals
4.0 Evidence gathering and study selection
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4.1 Evidence gathering
The evidence gathering process will start with a search for existing systematic literature
reviews. Depending on the results of the search for systematic reviews, an additional
literature search will be conducted to expand, fill the gaps, or serve as, the systematic
literature review.
The evidence gathering approach will have four components:
4.1.1 Searching databases
The databases in the table below will be searched with a pre-determined strategy as
detailed in Appendix A. In cases where the search results are small in number, search
terms will be reduced to maximize the search sensitivity.
Topic/Field Database
Health and
Higher
Education,
Systematic
Literature
Reviews
Systematic review database:
JBI
Cochrane Library (CDSR)
DARE
Campbell Library
Biomedicine
and health
sciences
All Evidence Based Medicine Reviews: ACP Journal Club,
Database of Abstracts of Reviews of Effects (DARE), NHS
Economic Evaluation Database
Bandolier
British Nursing Index and Achieve
CINAHL
Cochrane Library (CDSR, CCTR, CMR)
EMBASE
Global Health Library (Global Index Medicus)
Global Health
Health Systems Evidence
MEDLINE/PubMed
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SCOPUS
UK Pubmed Central
Social
sciences
Campbell Library
ISI Web of knowledge
JSTOR
Social Care Online
Social Science Research Network
Education Academic Search Alumni Edition
Academic Search Premise
BEME database: Best Evidence Medical Education
ERIC
PsycINFO
Regional
databases for
biomedicine
and health
sciences
Africa
African Index Medicus http://indexmedicus.afro.who.int
Australia
Australasian Medical Index www.nla.gov.au/ami
China and Taiwan
Chinese Biomedical Literature Database
China Journal Net
Chinese Medical Current Content
EASTVIEW (China) http://online.eastview.com
Hyread
Taiwan Electronic Periodical Services
WanFang Data
Eastern Mediterranean
Index Medicus for Eastern Mediterranean Region
www.emro.who.int/his/vhsl
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India
IndMED www.indmed.nic.in
Japan
J-STAGE www.jstage.go.jp
Korea
KoreaMed www.koreamed.org/searchbasic.php
Latin America and the Caribbean
LILACS www.bases.bireme.br/cgi-
bin/wxislind.exe/iah/online/?IsisScript=iah/iah.xis&base=LILACS&l
ang=i
Russia and Ukraine
EASTVIEW (Russia) http://online.eastview.com
Panteleimon for Russia and Ukraine
www.panteleimon.org/maine.php3
South-East Asia
Index Medicus for the South-East Asia Region (IMSEAR)
www.library.searo.who.int/modules.php?op=modload&name=we
bsis&file=imsear
Western Pacific
Western Pacific Region Index Medicus (WPRIM) www.wprim.org
General
databases
Google scholar
4.1.2 Hand searching
The following journals and websites will be hand-searched for relevant articles:
Resources that will be searched by hand
Journals:
Academic Medicine
American Journal of Health Studies
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Assessment & Evaluation in Higher Education
International Journal for Quality in Health Care
International Journal for Academic Development
International Journal of Pharmacy Education
Journal of Interprofessional Care
Journal of Nursing Care Quality
Journal of Quality in Clinical Practice
Managed Care Quarterly
Medical Teacher
Quality and Safety in Health Care
Quality Assurance Journal
Quality in Health Care
Quality in Primary Care
Quality Management in Health Care
Teaching and Teacher Education
The International Journal of Risk and Safety in Medicine
Grey Literature
Agency for Healthcare Research and Quality
Academic Archive On-line
Biomed http://www.biomedcentral.com/
Controlled clinical trials database
Digital Dissertation Consortium
FADE Library http://www.fade.nhs.uk/
Grey Literature Network Service http://www.greynet.org
HMIC: Health Management Information Consortium
http://library.nhs.uk/help/resource/hmic
International Network for Quality Assurance Agencies in Higher Education
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(INQAAHE) http://www.inqaahe.org/
INTUTE http://www.intute.ac.uk/
Index to Theses (UK and Ireland) http://www.theses.com
Lancashire Care Library and Information Service
MEDNAR http://mednar.com/mednar/search.html
National Library of Medicine Gateway
National Library of Guidelines
New York Academy of Medicine Grey Literature site
http://www.nyam.org/library/online-resources/grey-literature-report/
Netting the Evidence www.nettingtheevidence.org.uk
NHS Evidence
OpenSIGLE System for Information on Grey Literature in Europe www.opengrey.eu
ProQuest Dissertation and Thesis
The Networked Digital Library of Theses and Dissertations
UNESCO Literature Database
http://www.unesco.org/new/en/unesco/resources/online-
materials/publications/unesdoc-database/
Web of Science
WHO's Library Database (WHOLIS)
WHO portal of clinical trials
World Bank http://www.worldbank.org
Websites:
Association of American Medical Colleges
American Academy of Family Physicians
American College of Physicians
Council on Graduate Medical Education
HRH Global Resource Centre
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International Council of Nurses http://www.icn.ch
SAMSS Sub-Saharan African Medical Schools Study http://www.samss.org
The Joint Commission http://www.jointcommission.org
World Federation of Medical Education http://www.wfme.org
4.1.3 Expert network consultations
A network of health professional education experts will be consulted by email to identify
additional grey literature or research that has not been found through the above
processes. The following experts and networks will be contacted.
Experts and networks to be contacted regarding additional articles
UNESCO, Prof Ian Couper, University of Witwatersrand, selected members of the WHO
expert group on Increasing access to health workers in remote and rural areas through
improved retention.
4.1.4 Reference searches Bibliographies of those papers that match the eligibility criteria below will be searched by hand to identify any further, relevant references, which will be subject to the same screening and selection process.
4.2 Eligibility criteria
After gathering the evidence, the following eligibility criteria will be applied to the results and all identified references screened independently by two reviewers (Francesca Celletti and Rebecca Bailey) using a three-stage approach to reviewing the title, abstract and full text.
4.2.1 Types of studies: All types of evaluative study designs are eligible for inclusion, including grey literature. Studies will not be selected on methodological quality.
4.2.2 Types of participants: This is a succinct description of the types of participants that you will include. For example, you might copy the health professionals definition here.
This review will consider all public and private educational institutions and their
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associated clinical practice placement sites of health professionals, including:
Medical Doctors - both Generalist and Specialist Practitioners, including Public Health Doctors (ISCO-08 minor group 221)
Nursing Professionals - both Generalist and Specialist Practitioners, including Nurse Practitioners and Public Health Nurses (ISCO-08 minor group 222, unit 2221)
Midwifery Professionals, including Public Health Midwives (ISCO-08 minor group 222, unit 2222)
Dentists (ISCO-08 minor group 226, unit 2261)
Pharmacists (ISCO-08 minor group 226, unit 2262)
4.2.3 Types of intervention: This is a succinct description of the types of intervention you will include.
Interventions this literature review will include are any interventions that recognize and/or reward teaching. Such interventions can be monetary, in the form of performance related pay schemes or bonuses, can involve fringe benefits, such as access to facilities, or purely non-monetary, such as a letter of recognition.
4.2.4 Types of outcome measures:
The primary outcomes of interest are the quantity, quality and relevance of practicing health professionals. These are defined by a number of measurable outcomes found in the Outcomes Framework document. Other important outcomes include values and preferences, resource use/costs, benefits and harms, as well as all other unintended effects of the intervention. Studies that include other outcomes should not be excluded at this stage in the evidence retrieval. Other secondary outcomes can also be defined, as needed.
4.3 Exclusion criteria
Editorials, newspaper articles and other forms of popular media will be excluded. Failure to meet any one of the above eligibility criteria (section 3.2) will result in exclusion from the review and any apparent discrepancies during the selection process will be resolved by a third, independent reviewer. The number of excluded studies (including reasons for exclusion for those excluded following review of the full text) will be recorded at each stage.
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5.0 Assessment of risk of bias and data extraction
Following the initial selection of literature, the reviewers will consult with the WHO Secretariat regarding the process to be followed for summarizing the studies. Data will be extracted from relevant papers using predefined evidence summary templates attached in Appendix B. Data will be collected regarding the reasons for exclusion, characteristics of included studies, participants, interventions (including comparators) and outcomes. The final decision for inclusion or exclusion will be made by a team consisting of the WHO Secretariat, methodologist and researchers conducting the review. Any potential disagreement will be recorded and resolved by further discussion.
Risk of bias across studies will be assessed using the approach outlined by the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group. Any disagreements will be recorded and resolved by involvement of an additional reviewer.
6.0 Data synthesis
The availability of appropriate data and resources to conduct a meta-analysis will be considered, where feasible.
7.0 Dissemination
A final set of tables including a GRADE Evidence Table and Descriptive Evidence Table will be produced and submitted to the WHO Secretariat as stipulated in the Procedures for the Retrieval of Evidence and Summary of Evidence. In addition, a manuscript will be prepared for submission to a peer-reviewed journal.
8.0 Resource implications
The project lead will work closely with the WHO Secretariat to define the scope and methods of the review and facilitate access to unpublished literature, supporting translation of foreign language literature where necessary. Proposed milestones and timescales are outlined below:
MILESTONES
Identification and retrieval of the evidence
Conduct literature review, hand searching, and contacts with experts and networks
Summarizing evidence in Descriptive
Evidence Tables (Table 1. Summary of systematic literature reviews, Table 2. Summary of relevant literature)
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9.0 References
When citing articles, please use the WHO standard citation format, called the Harvard system. The Harvard citation system shows the author and date in the body of the text. This may be done in one of two ways: Ballance, Ewart & Fitzsimmons (2001) have reported ... It has been reported (Ballance, Ewart & Fitzsimmons, 2001) that ... Some examples of formatting reference lists: Article in a Journal Burt BA, Pai S (2001). Sugar consumption and caries risk: a systematic review. Journal of Dental Education, 65:1017–1023.
Chapter in a book Melton L J III (1995). Epidemiology of fractures. In: Riggs BL, Melton L J III, eds. Osteoporosis: etiology, diagnosis, and management, 2nd ed. Philadelphia, PA, Lippincott-Raven, 225–247.
Corporate author Heart Protection Study Collaborative Group (2002). MRC/BHF Heart Protection Study of antioxidant vitamin supplementation in 20 536 high-risk individuals: a randomised placebo-controlled trial. Lancet, 360:23–33.
WHO Publication with no named author World Health Organization (2003). The international pharmacopoeia, 3rd ed. Vol. 5. Tests and general requirements for dosage forms; quality specifications for pharmaceutical substances and tablets. Geneva, World Health Organization.
More on the WHO-style can be found here: http://www.nlm.nih.gov/bsd/uniform_requirements.html
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Appendix A: database search strategy
Search terms
Search Concept PUBMED Search Strategy ERIC Descriptors Population (Faculty[Mesh] OR Preceptorship[Mesh]
OR Mentors[Mesh] OR Faculty[tw] OR Faculties[tw] OR "Academic physician"[tw] OR "Academic Physicians"[tw] OR teachers[tw] OR teacher[tw] OR mentors[tw] OR mentor[tw] OR preceptor[tw] OR preceptors[tw] OR tutor[tw] OR tutors[tw] OR educator[tw] OR educators[tw] OR "teaching staff"[tw] OR lecturer[tw] OR lecturers[tw] OR instructor[tw] OR instructors[tw] OR professor[tw] OR professors[tw]) OR trainer[tw] OR trainers[tw]
Intervention ((Pay[tw] OR Paying[tw] OR Salary[tw] OR Salaries[tw] OR compensate[tw] OR compensation[tw] OR Remunerate[tw] OR Remuneration[tw] OR Income[tw] OR wage[tw] OR stipend[tw] OR benefit[tw] OR benefits[tw] OR stipend[tw] OR stipends[tw] OR "salaries and fringe benefits"[MeSH]) AND (Performance[tw] OR Excellence[tw] OR Merit[tw] OR Productivity[tw] OR Quality[tw] OR value[tw] OR ability[tw]]))
OR (Recognition[tw] OR Recognise[tw] OR Recognize[tw] OR Recognising[tw] OR Recognizing[tw] OR reward[tw] OR rewards[tw] OR rewarding[tw] OR incentive[tw] OR incentives[tw] OR incentivizing[tw] OR incentivising[tw] OR bonus[tw] OR bonuses[tw] OR Award[tw] OR Awards[tw] OR Awarding[tw] OR "Reimbursement, Incentive"[Mesh] OR "Employee Incentive Plans"[Mesh])
Incentive, Teacher
Salaries; Remuneration); Teacher
Promotion Rewards Retirement Benefits
Merit Pay; Recognition (achievement)
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Other search concepts, as needed
The above MeSH thesaurus headings, keywords and free text terms will be amended as required in accordance with each different database used to maximize sensitivity. The scope of each free text search should include the study title and abstract where possible. Individual MESH and free text terms will be combined with the Boolean operator OR, unless otherwise specified. Each search concept should then be combined with the Boolean operator AND as follows: population AND intervention. An example search outlining the appropriate combination of terms is detailed below, executed using PubMed. Search limits
Limit category Specified limit
Languages English
Publication type None
Date of publication 1990-2011
Study design None
Other limits None
Databases (same as section 3.1.1 above)
Topic/Field Database Ex: Education Ex: ERIC, Campbell, Education Research Complete…
Example search output – PubMed (DATE)
Cut and paste from PubMed here, for example:
No. Search term Hits
1 PATIENTS/ 13675
2 OUTPATIENTS/ 6288
…
139 128 OR 129 OR 130 OR 131 OR 132 OR 133 OR 134 OR
135 OR 136 OR 137 OR 138 213037
140 63 AND 110 AND 127 AND 139 635
141
63 AND 110 AND 127 AND 139 [Limit to: Humans and
(Languages Chinese or English or French or Japanese or
Portuguese or Russian or Spanish)]
584
Appendix B: data extraction forms (see attached excel workbook)
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1) GRADE Evidence Table Template.xls 2) Descriptive Evidence Table.xls
Appendix C: Example of databases, websites and journals which could be searched
Databases
Databases for biomedicine and health sciences:
Pubmed/MEDLINE
CINAHL
Cochrane Library (CDSR)
Health Systems Evidence (PPD/CCNC)
UK Pubmed Central
Global Health Library (Global Index Medicus)
UK Pubmed Central Databases for social sciences:
ISI Web of knowledge
Campbell Library
Social Science Research Network
Databases for education:
ERIC
BEME database
Regional databases for biomedicine and health sciences:
African Index Medicus (www.indexmedicus.afro.who.int)
Australasian Medical Index (www.nla.gov.au/ami)
Index Medicus for Eastern Mediterranean Region (www.emro.who.int/his/vhsl)
Chinese Biomedical Literature Database (CBM) (www.imicams.ac.cn/cbm/index.asp)
IndMED (www.indmed.nic.in)
KoreaMed (www.koreamed.org/searchbasic.php)
LILACS (www.bases.bireme.br/cgi-bin/wxislind.exe/iah/online/?IsisScript=iah/iah.xis&base=LILACS&lang=i)
Index Medicus for the South-East Asia Region (IMSEAR)
(www.library.searo.who.int/modules.php?op=modload&name=websis&file=imsear) Panteleimon for Russia and Ukraine (www.panteleimon.org/maine.php3)
Western Pacific Region Index Medicus (WPRIM) (wprim.wpro.who.int/SearchBasic.php)
PASCAL (www.international.inist.fr/article21.html)
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General databases:
Google Scholar
4.1.2 Hand searching
The following journals and websites will be hand-searched for relevant articles:
Resources that will be searched by hand, for peer-reviewed articles and grey literature
Assessment & Evaluation in Higher Education
American Journal of Health Studies
Teaching and Teacher Education
Academic Medicine
Journal of Interprofessional Care
Academic Medicine
Medical Teacher
International Journal for Academic Development
WHO's Library Database (WHOLIS)
SAMMS
HRH Global Resource Center
World Federation of Medical Education
International Council of Nurses
Association of American Medical Colleges
Council on Graduate Medical Education
American Academy of Family Physicians
American College of Physicians
World Bank
HMIC database
Grey Literature Network Service http://www.greynet.org
OPENSIGLE System for Information on Grey Literature in Europe http://opensigle.inist.fr/
NewYork Academy of Medicine Grey Literature site http://www.nyam.org/library/online-resources/grey-literature-report/
FADE Library http://www.fade.nhs.uk/
HMIC: Health Management Information Consortium http://library.nhs.uk/help/resource/hmic
Biomed http://www.biomedcentral.com/
INTUTE http://www.intute.ac.uk/
a) The effect of packages of salaries, benefits and recognition for faculty and teaching staff, which incentivize and reward teaching, on the quantity, quality and relevance of health professionals.
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(Faculty[Mesh] OR Preceptorship[Mesh] OR Mentors[Mesh]OR Faculty[tw] OR Faculties[tw] OR "Academic physician"[tw] OR "Academic Physicians"[tw] OR teachers[tw] OR teacher[tw] OR mentors[tw] OR mentor[tw] OR preceptor[tw] OR preceptors[tw] OR tutor[tw] OR tutors[tw] OR educator[tw] OR educators[tw] OR "teaching staff"[tw] OR lecturer[tw] OR lecturers[tw] OR instructor[tw] OR instructors[tw] OR trainer[tw] OR trainers[tw]
AND
(((Pay[tw] OR Paying[tw] OR Salary[tw] OR Salaries[tw] OR compensate[tw] OR compensation[tw] OR Remunerate[tw] OR Remuneration[tw] OR Income[tw] OR wage[tw] OR stipend[tw] OR stipends[tw] OR "salaries and fringe benefits"[MeSH]) AND (Performance[tw] OR Excellence[tw] OR Merit[tw] OR Productivity[tw] OR Quality[tw] OR value[tw] OR ability[tw]))
OR (Recognition[tw] OR Recognise[tw] OR Recognize[tw] OR Recognising[tw] OR Recognizing[tw] OR reward[tw] OR rewards[tw] OR rewarding[tw] OR incentive[tw] OR incentives[tw] OR incentivizing[tw] OR incentivising[tw] OR incentivize[tw] OR incentivise[tw] OR incentivizes[tw] OR incentivises[tw] OR bonus[tw] OR bonuses[tw] OR Award[tw] OR Awards[tw] OR Awarding[tw] OR "Reimbursement, Incentive"[Mesh] OR "Employee Incentive Plans"[Mesh]))
Search Most Recent Queries Result
#7 Search (#1 AND #6) Limits: English, Publication Date from 1990 to 2011 4093
#6 Search (#4) OR #5 Limits: English, Publication Date from 1990 to 2011 294661
#5 Search (Recognition[tw] OR Recognise[tw] OR Recognize[tw] OR
Recognising[tw] OR Recognizing[tw] OR reward[tw] OR rewards[tw] OR
rewarding[tw] OR incentive[tw] OR incentives[tw] OR incentivizing[tw]
OR incentivising[tw] OR incentivize[tw] OR incentivise[tw] OR
incentivizes[tw] OR incentivises[tw] OR bonus[tw] OR bonuses[tw] OR
Award[tw] OR Awards[tw] OR Awarding[tw] OR "Reimbursement,
Incentive"[Mesh] OR "Employee Incentive Plans"[Mesh]) Limits: English,
272087
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Publication Date from 1990 to 2011
#4 Search (#2) AND #3 Limits: English, Publication Date from 1990 to 2011 25360
#3 Search (Performance[tw] OR Excellence[tw] OR Merit[tw] OR
Productivity[tw] OR Quality[tw] OR value[tw] OR ability[tw]) Limits:
English, Publication Date from 1990 to 2011
1463677
#2 Search (Pay[tw] OR Paying[tw] OR Salary[tw] OR Salaries[tw] OR
compensate[tw] OR compensation[tw] OR Remunerate[tw] OR
Remuneration[tw] OR Income[tw] OR wage[tw] OR stipend[tw] OR
stipends[tw] OR "salaries and fringe benefits"[MeSH]) Limits: English,
Publication Date from 1990 to 2011
111315
#1 Search (Faculty[Mesh] OR Preceptorship[Mesh] OR Mentors[Mesh]OR
Faculty[tw] OR Faculties[tw] OR "Academic physician"[tw] OR
"Academic Physicians"[tw] OR teachers[tw] OR teacher[tw] OR
mentors[tw] OR mentor[tw] OR preceptor[tw] OR preceptors[tw] OR
tutor[tw] OR tutors[tw] OR educator[tw] OR educators[tw] OR "teaching
staff"[tw] OR lecturer[tw] OR lecturers[tw] OR instructor[tw] OR
instructors[tw] OR trainer[tw] OR trainers[tw]) Limits: English,
Publication Date from 1990 to 2011
62612