382 research outputs found
ANATOMY AND PROFESSIONALISM IN AN UNDERGRADUATE MEDICAL CURRICULUM
Get PDFName: Gabrielle Maria Finn
Title of thesis: Anatomy and professionalism in an undergraduate medical curriculum
Higher degree for which submitted: Doctor of Philosophy (PhD)
Year of submission: 2010
This thesis describes two themes within the undergraduate medical curriculum; innovations in anatomy teaching, and the assessment of professionalism. Methodologies from both the quantitative and qualitative paradigms were utilised.
The main findings were:
1) The Virtual Human Dissector™ (VHD) was shown to be equally as effective as cadaveric prosections as a tool for learning cross-sectional anatomy.
2) Body painting was demonstrated as being a highly motivating and engaging exercise for students. Students reported that the bold colours and kinaesthetic nature of body painting promotes retention of knowledge and informed their approach to future patients when painting was coupled with simultaneous peer-physical examination (PPE).
3) Contextual learning and simulation were shown to directly impact upon retention of knowledge through the use of clothing in anatomy education. This highlighted how when implementing simulation small and seemingly trivial details, such as clothing, are important.
4) The Conscientiousness Index (CI) has been demonstrated as an objective and scalar measure of one element of professionalism, conscientiousness. The CI identified students at the positive and negative end of the behavioural spectrum, and this correlated with peer and staff judgements on the professionalism exhibited by students at these extremes of behaviour.
5) Students were able to accurately assess the conscientiousness of their peers, however were unable to self-assess conscientiousness. The reliability of such peer assessments was improved when peers assessed only those in their tutor groups, with whom they had the majority of academic contact, compared to when assessing the entire cohort. This demonstrated the importance of assessor familiarity in assessments.
6) Critical incident reporting, of extremes in professionalism, was shown to promote reflection in students. Critical incident reports, as with the Conscientiousness Index, offers faculty a tool by which outlying students can be identified.
7) Students were unclear about the constituent elements of professionalism and the contexts in which professionalism was relevant. Three contexts were identified; the clinical, the academic (University), and the virtual (online) context. The impact of professionalism assessments and the scrutiny on students has led students to struggle with identity negotiation. This was with respect to their personal and professional identities and the expectations of different stake holders, such as faculty, the media and prospective patients
Can the arts and humanities bring the patient’s voice centre stage in medical education?
Get PDF‘Where is the patient’s voice in medical education?’ ask Gabrielle Brand and colleagues in their paper published in this issue of Medical Education (1). The answer to this question depends on the type of patient voice that you are referring to. On the one hand, there is the voice of the patient receiving health care, subject to the hierarchies of power in the patient‐clinician context (2), often unwell and unlikely to be strategically focussed on the educational needs of students
A feminist reading of the mother-daughter relationship in Gabrielle Roy and Francine No?l
No full textTHESIS 8330This thesis proposes a feminist reading of the mother-daughter relationship in the writings of Gabrielle Roy and Francine Noel. The texts discussed have been selected due to their feminist nature and to the importance that they accord to the mother- daughter relationship. In the case of Gabrielle Roy, these texts are Bonheur d?occasion. La petite Poule d?eau, Rue Deschambault, La route d?Altamont, La rivi?re sans repos, De quoi t?ennuies-tu Eveline, La d?tresse et l\u27enchantement and Le temps qui m?a manqu?. Her other texts (noted in the bibliography), while they certainly inform the argument of this thesis, do not constitute part of the main body of this study, due to the fact that they are not considered to focus on the mother-daughter relationship. Gabrielle Roy is also the author of a number of unpublished texts. Again, these do not form part of this thesis, as the material to be gathered from the published texts is already substantial. An examination of Gabrielle Roy?s unpublished work would necessitate a separate study (this is perhaps an idea for further research). In the case of Francine Noel, the texts analysed in this thesis are Maryse, Myriam premi?re. La Conjuration de b?tards - also known as the Maryse trilogy -, Nous avons tous d?couvert I?Am?rique and La femme de ma vie
Outreach, selection, retention: a critical examination of widening participation mechanisms in UK medical education
No full textWhile recent years have seen the gradual diversification of the field, medical education in the United Kingdom (UK) continues to face issues recruiting individuals from low and representative socioeconomic backgrounds. Widening participation (WP) programmes aim to ameliorate this by enacting mechanisms to support matriculation of such students. However, the function of many of these mechanisms in medical education is not well explored in the literature. As such, this doctoral work aimed to fill some of the gaps in WP research by critically examining these mechanisms.Firstly, this work examined outreach as the broadest form of WP, via a grounded theory, qualitative exploration of the phenomena of anatomy outreach, as a specific subfield of medical education outreach. The following portions then examined a more specific form of WP in UK medical education: Gateway to Medicine years. The ‘selection’ component examined how modifications to selection and curricula can impact normal ways of working, using normalisation process theory to understand implementation of a Gateway to Medicine year. This study utilised mixed-methods surveys as data collection. Finally, the ‘retention’ component examined the lived experiences of students who matriculate via Gateway to Medicine years. A Bourdieusian theoretical framework was applied with thematic analysis to explore how field modification interacted with student progression.Findings indicate that outreach has a large WP potential, but is still limited in reach, appraisal, and understanding of scope. As such, ‘safety nets’ of alternative selection routes to medicine, such as Gateway years, are warranted. However, creation of such routes needs to consider the toll these programmes can have on their faculty, staff, and students. Through novel methodological approaches, this work has implications for improving WP practice and policy, as well as theoretical understanding of mechanisms to improve diversity, equity, and inclusion in the field of medical education
Outreach, selection, retention: a critical examination of widening participation mechanisms in UK medical education
Get PDFWhile recent years have seen the gradual diversification of the field, medical education in the United Kingdom (UK) continues to face issues recruiting individuals from low and representative socioeconomic backgrounds. Widening participation (WP) programmes aim to ameliorate this by enacting mechanisms to support matriculation of such students. However, the function of many of these mechanisms in medical education is not well explored in the literature. As such, this doctoral work aimed to fill some of the gaps in WP research by critically examining these mechanisms.Firstly, this work examined outreach as the broadest form of WP, via a grounded theory, qualitative exploration of the phenomena of anatomy outreach, as a specific subfield of medical education outreach. The following portions then examined a more specific form of WP in UK medical education: Gateway to Medicine years. The ‘selection’ component examined how modifications to selection and curricula can impact normal ways of working, using normalisation process theory to understand implementation of a Gateway to Medicine year. This study utilised mixed-methods surveys as data collection. Finally, the ‘retention’ component examined the lived experiences of students who matriculate via Gateway to Medicine years. A Bourdieusian theoretical framework was applied with thematic analysis to explore how field modification interacted with student progression.Findings indicate that outreach has a large WP potential, but is still limited in reach, appraisal, and understanding of scope. As such, ‘safety nets’ of alternative selection routes to medicine, such as Gateway years, are warranted. However, creation of such routes needs to consider the toll these programmes can have on their faculty, staff, and students. Through novel methodological approaches, this work has implications for improving WP practice and policy, as well as theoretical understanding of mechanisms to improve diversity, equity, and inclusion in the field of medical education
Life cycle assessment of biosolids land application and evaluation of the factors impacting human toxicity through plants uptake
Get PDFDue to the increasing environmental concerns in the wastewater treatment sector, the environmental impacts of organic waste disposal procedures require careful evaluation. However, the impacts related to the return of organic matter to agricultural soils are difficult to assess. The aim of this study is to assess the environmental impacts of land application of two types of biosolids (dried and composted, respectively) from the same wastewater treatment plant in France, and to improve the quantification of human toxicity.
A Life Cycle Assessment (LCA) was carried out on a case study based on validated data from an actual wastewater treatment plant. Numerous impacts were included in this analysis, but a particular emphasis was laid on human toxicity via plant ingestion. For six out of the height impact categories included in the analysis, the dried biosolids system was more harmful to the environment than the composting route, especially regarding the consumption of primary energy. Only human toxicity via water, soil and air compartments and ozone depletion impacts were higher with the composted biosolids
An exploratory review on designing and developing core anatomy education programmes for undergraduate nurses
Get PDFBACKGROUND:
For nurses to be deemed safe and competent to practice, they require a working knowledge and understanding of several subspecialties within the life sciences, including anatomy, physiology, genetics, biochemistry, pharmacology, microbiology, pathology and radiography subjects. Yet, a plethora of evidence asserts that nursing biosciences are not at the level anticipated by the profession in the United Kingdom and internationally. Several underlying causes have been posited. First and foremost is the need for more regulatory guidance on the level and depth of bioscientific knowledge required at pre-and post-registration levels. Concurrently, the ambiguity surrounding bioscientific standards in nursing education has created disagreement on what works pedagogically alongside challenges in communicating and highlighting the explicit role of the life sciences across multiple areas of practice, manifesting as a gap between theory and nursing applications. Simultaneously, broader sociohistorical factors implore nurses to preserve uniprofessional power and autonomy, generating disagreement on who should teach biological science to nursing students; a 'medical', 'purist' or 'applied' scientist?
The multifaceted nature of the 'bioscience problem' has led to calls for a wide-scale educational evaluation to gain in-depth insight into the current issues to improve the quality of nurses' bioscience education.
OBJECTIVE:
To explore the enablers and constrainers for designing and delivering quality anatomy education to pre-registration nurses?
Review Questions:
(i) Historically, how have nursing and anatomy programmes evolved, changed, or maintained the status quo?
(ii) What are student nurses, academics and registered nurses’ views on anatomy education and provision within the undergraduate nursing programme?
(iii) Can a national consensus be reached on the level and depth of anatomical knowledge required for undergraduate nurses by formulating specific core learning outcomes?
(iv) What are the current structural arrangements, interactions and dynamics between anatomists and nursing educators?
METHODOLOGY:
A realist approach was adopted. Initially, the literature was analysed using social realist theory (a grand theory) to elucidate initial explanatory middle range and programme theories that informed the intervention, a non-prescription, national anatomy syllabus and subsequent realist evaluation that highlighted various influencing factors within higher education and regulatory organisations, systems and processes that were explained using realist principles.
METHODS:
The realist research that was carried out was an iterative process that utilised mixed methods to refine the underlying theories using multisource evidence that was acquired through systematic searches to synthesise the historical and contemporary literature. Based on the key findings, a Delphi process was subsequently undertaken to reach a national consensus on the level and depth of anatomical required by undergraduate nurses, followed by a questionnaire on interprofessional collaboration and a secondary analysis of the data to explore themes and trends on the facilitators and barriers in quality assuring anatomy education in undergraduate nursing programmes in the United Kingdom.
MAIN RESULTS:
Setting Standards: A consensus >80% was reached on the level and depth of anatomical knowledge. The advisory syllabus produced sixty-four systems-based ‘core’ learning outcomes required at the pre-registration level in nursing throughout the United Kingdom. Provision: Anatomy belies a significant proportion of nurses’ professional standards.
Traditionally anatomy was correlated with technical tasks. However, it is discernibly present in the non-technical and safety-critical components of practice. The linked nature of theory to practice see’s nursing programmes deliver anatomy as an integrated component with pathophysiology. Yet, there is variability in teaching anatomy alongside other integrated components ranging from 0.26% to 13% of the overall time allocated for bioscience theory in the curriculum, suggesting that the biosciences are being marginalised. Anatomy was found to be a ‘name and locate’ topic instead of building a conceptually descriptive three-dimensional map to ensure that pathophysiology was covered in more depth, Facilitators and Barriers: There are tenuous or no collegiate links between anatomists and nursing educators. Both groups deem a collegiate relationship essential for increasing learner (and faculty) knowledge and creating opportunities to enhance research and education tailored to nursing. While anatomists are open to working together, there are differences in the level of expertise and pedagogical approaches alongside a lack of information and resource sharing between schools and colleges. For example, 87% of anatomy departments actively use cadaveric specimens to teach compared to 4% of nursing cohorts suggesting inequality of opportunity. This was attributed to significant staff shortages in anatomy, a medical monopoly on resources, under-funding in nursing biosciences and factionalism in nursing that generates a teacher-centred approach to anatomy provision. Along with administrative and geographic issues were ongoing stereotypes about nursing in scientific circles. Nevertheless, there is a desire to break down silos if education is to align with healthcare needs.
CONCLUSION:
The quality of undergraduate nurse anatomy education is compromised at the university level as the current ideologies, structures, and dynamics are out of step with the needs and interests of students, necessitating the need for an urgent review and interdisciplinary dialogue at an institutional and departmental level throughout the United Kingdom. The issues have been attributed to the design, organisation and delivery of bioscientific curricula in nursing programmes due to a broader underappreciation and devaluation of the sciences in nursing education and research frameworks
Appraising the curricula of UK non-medical prescribing programmes and its role in producing high-level prescribers
Get PDFIn recent years, healthcare systems have sought to decrease workload pressures on doctors by expanding the authority to prescribe medications to other healthcare professionals. This authority is most advanced in the UK, where healthcare professionals including pharmacists, nurses, physiotherapists, optometrists, chiropodists, podiatrists, radiographers and dietitians can prescribe. They are referred to as non-medical prescribers (NMPs). Before NMPs can prescribe, they are required to undertake a specific short prescribing programme to obtain an independent prescribing qualification. With the increasing number of healthcare professionals able to prescribe in practice, there are various prescribing practice guidelines, but no overall consensus on the core qualities of a high-level, safe and rational prescriber, regardless of healthcare background. Additionally, there is a gap in knowledge and understanding around the teaching and educational approaches used by prescribing programmes which non-medical healthcare professionals undertake to obtain their independent prescribing qualification.A programme of research was conducted to define the core categories of a high-level prescriber and then explore and appraise the teaching and educational approaches of UK NMP programmes and how they facilitate the development of students into high-level independent prescribers. The research began with a rapid review exploring innovative teaching approaches introduced to prescribing education worldwide in the last ten years. The review highlighted and compared the myriad of approaches used to teach prescribing, but it also highlighted the gap in literature around the training of NMPs. Study One involved a documentary analysis of national and international prescribing practice guidelines aimed at various healthcare professionals to define a universal set of core categories around high-level prescribing for prescribers of all backgrounds. Study Two used the results of Study One to inform semi-structured interviews with 16 NMP programme leads spread across the UK to obtain an understanding around the taught content, teaching approaches and overall logistical functioning of the NMP programme. Participants were also afforded the opportunity to offer their appraisals pertaining to the teaching approaches of the programme. Programme leads were recruited via email and interviews were conducted virtually using Zoom due to the constraints of the COVID-19 pandemic. Study Three involved recruiting 18 graduates of various NMP programmes spread across the UK. These were recruited through a snowball sampling strategy with the aid of programme leads interviewed in Study Two. Graduates undertook a two-part interview, part one involved a vignette exercise, where participants were presented with prescribing case scenarios for which they would verbalise their prescribing decisions. This was an opportunity for participants to demonstrate the extent to which they displayed the qualities of high-level prescribing defined in Study One. Part Two of the interview involved a traditional semi-structured interview, where participants appraised the teaching approaches of the programme and how they helped or hindered development of their prescribing practice.The core categories of high-level prescribing were defined as being knowledgeable, safe, communicative and contemporary. NMP programmes use a range of teaching approaches to inculcate these core qualities of prescribing into their students and utilise stringent assessment approaches to ensure prescribers qualify from the programme with these core qualities, however, despite certain differences in perspectives, both programme leads and graduates highlighted major areas where the teaching approaches and overall functioning of the NMP programme could be improved. Subsequently, these perspectives were used to inform a set of recommendations aimed at optimising the delivery of teaching on NMP programmes. Increasing innovative educational approaches such as flipped classroom, blended learning and simulation-based education will enhance the learning experiences of students on the programme and subsequently their skill and competency. Enhancing the roles of Practice Supervisors as teachers will increase the prescribing knowledge of students in their own area and fulfil the core category of being a knowledgeable prescriber. A widespread implementation of formative OSCEs would be an effective means for students to review and appraise their own prescribing practice before completing the programme. Finally, increasing continuing professional development post-qualification will ensure prescribers will be able to update and enhance their prescribing skills as they progress in their careers.Future research aimed at comparing prescribing practices of NMPs before and after implementation of these recommended changes would be beneficial and additionally, this programme of study can serve as a starting point for countries looking to expand prescribing authority and subsequently develop a specific curriculum of study for these non-medical healthcare professionals
- …
