No description available.

This case study explores the support of pre-registration house officers (PRHOs) through the crucial transition from student to doctor, enhancing understanding of other transition phases in a doctor's career and to the nature of transition generally in professional development. The views of Mersey Deanery PRHOs and their Educational Supervisors were gathered using both quantitative and qualitative methods between August 2000 and 2001.

Effective and efficient clinical teaching is essential with dwindling training hours and growing numbers of trainees and students, however, standards are variable across the UK and USA. Formative evaluation of clinical teaching performance can lead to standardisation and improvement. Current evaluation tools were assessed and found wanting in their development of appropriate formative criteria to evaluate. I employed a grounded theory exploration of ward round teaching to identify factors associated with effective or ineffective learning outcomes to inform the development of a new formative evaluation tool. The thesis was in two phases.

Selecting medical students is a challenge for UK universities: there are more applicants than places, limited selection tools upon which to base decisions, and concerns over fair access. In attempt to alleviate such problems, the United Kingdom Clinical Aptitude Test (UKCAT) was introduced in 2006 to 26 medical schools. This study employed mixed methods to explore issues of fairness and student performance using a sequential explanatory design, Regression analyses were performed first, leading to further research questions addressed through the interpretation of semi-structured interviews with students. The regression analyses served two main purposes: first, to explore the relationship between background factors and admissions scores (including UKCAT), and second, to determine whether background factors and admissions scores were predictive of first and second year medical school examination performance. Privately educated students had significantly higher personal statement scores than state educated students, although personal statements were not predictive of examination performance. Interview scores were unaffected by previous school type and did not predict examination performance. UKCAT scores were not predicted by school type; however, UKCAT was consistently a significant predictor of examination performance. Despite the predictive ability of the UKCAT, much of the variance in examination scores remained unexplained. Interviews investigated admissions performance differences and factors affecting examination performance. When compared to state educated students, privately educated students described higher levels of economic, social and cultural capital, which facilitated the medical school application process. Factors affecting examination performance were unique to individual students; highlighting the difficulties inherent in predicting performance. While medical schools endeavour to create fair and transparent admissions policies, students who have access to economic, social and cultural capital are unintentionally favoured by traditional selection methods. The results of this study indicate that the UKCAT is the least biased and most useful selection tool used at Newcastle University.

Rapidly changing technology, the knowledge explosion and socio-economic transformations owing to globalisation have made it necessary for most people to learn throughout life. The terms such as `lifelong learning' and `continuous professional development' have become part of the educational lexicon as never before. Yet the formal education system alone cannot provide lifelong education for career development and there is research interest in promoting individual responsibility for becoming a self-directed autonomous learner. However, this idea is inconsistent with the prevailing teaching and assessment practices, namely, didactic teaching methods and norm-referenced summative assessment, where students are excluded from the process of deciding targets for learning, setting criteria and standards for assessment, designing assessment schemes and implementing them. Methods and techniques which are claimed to transfer the control of the educational and assessment process form teacher to student such as `Problem-Based Learning' and `Portfolio- Based Assessment', have been seen by researchers in the field of assessment as suitable alternatives to foster autonomy and intrinsic motivation in students. Although medical education in the UK has taken the lead in adopting `Problem Based Learning', teacher education is considerably ahead in the case of `Portfolio-Based Assessment'. Recently, medical education has also started to introduce `Portfolio-Based Assessment' in some colleges. However, its effectiveness in the context of medical education is yet to be established. This study, therefore, attempts to understand the process of `Portfolio-Based Assessment' with reference to the learning attitudes of postgraduate medical students (SpRs) in the context of the Queen's School of Anaesthesia situated in the north of England. The basic aim of this study was to evaluate the effectiveness of PBA in transforming the attitudes of the SpRs. The study revealed that it was very difficult to measure any change in attitude. Moreover, it was realised that in comparison to measuring change in attitudes it was more important to understand the process of intervention of the PBA in order to evolve remedial measures to make it more effective. This early finding considerably changed the focus of the study, research questions and methods. I also realised that the relationship between the effectiveness of the portfolio and the attitudes of SpRs was symbiotic, and so it was also important to understand these attitudes in order to understand the dynamics of portfolio use. The final aim was to understand the process of PBA, rather than to prove any particular theory or measure change in attitudes. Hence, the methodology adopted was more qualitative and naturalistic in nature than quantitative, with the aim of studying the process of PBA through a flexible methodology, and without any pre-conceived theories about the portfolio. However, findings concerning the process of PBA are situated in my understanding of theories of learning and current approaches to assessment within a particular context. The fieldwork combined two separate questionnaires distributed to all 90 SpRs, of whom about 50% responded. In order to understand their perceptions regarding the portfolio, nondirective interviews were carried out with 24 SpRs. Content analysis of the 24 portfolios was carried out to explore the extent to which the SpRs had developed the portfolios and the amount and type of reflection in which they engaged. Non-directed interviews and the content analysis of the portfolios raised questions about the SpRs' professionalism and their attitudes towards self-directed learning. To obtain a better understanding of these issues, focused interviews of 16 SpRs, based on the content analysis of the portfolios, were conducted. The understanding developed from this study and the findings and suggestions that have emerged from it are applicable mainly to postgraduate medical education. However, three propositions emerged from this study which may be relevant to the use of the portfolio for professional development in other educational contexts: (i) The term `Portfolio-Based Assessment' is a misnomer, since a portfolio does not become so central to the assessment process that it can be used to assess all types of ability. It may be concluded that a portfolio only supports the existing assessment system. (ii) The process of portfolio preparation itself leads to learning, while in the case of most of the other assessment processes the learning loop is completed after assessors have provided feedback. The portfolio should therefore be treated as a tool for both assessment and learning, and the term `Portfolio-Supported Assessment and Learning (PSLA)' is more appropriate. (iii) Other assessment methods may be used simultaneously for summative as well as for formative assessment without affecting the quality of formative assessment to a great degree. However, the use of portfolio for both purposes of assessment simultaneously creates a conflict and to a large extent reduces its potential for encouraging the trainees to engage in self-assessment and reflection, thus defeating the basic purpose for which it was introduced. It may be concluded that the same portfolio should not be used for both purposes of assessment. The emergence of the above propositions from the study may be considered as an original contribution to knowledge in this field. Further debate and studies are required in order to develop theories based on these propositions.

No description available.

This thesis develops the concept of apprenticeship to capture and explore how the learning of student doctors takes place in hospital ward rounds, with the aim of developing pedagogical approaches that enable and improve learning. The research pays particular attention to the shifting complexities of the hospital and ward-round environment and the ambiguous status of student-doctors as participants. Using action research the study sets up a collaborative inquiry with eleven student-doctors who use audio-diaries and reflective learning sessions to harness learning from ward-round experiences, explore the nature of their participation and facilitate critical reflection both on and through the workplace. Exploration enables the student-doctors to see that learning needs to be understood not simply as an intellectual activity but as participation in social practice and that this necessitates focusing upon development of their agency and professional identity. Changes were identified at three levels: in the student-doctors' practice, in their understandings of practice and in the conditions under which they practised. Nine of the students were enabled to learn through active participation on the ward round. Eight studentdoctors came to understand they were learning about becoming a doctor. By changing their own understandings of forms of knowledge, of their role and opportunities for learning they influenced the way other clinicians responded to them and were offered more opportunities to participate. The thesis as a whole represents an original and distinct contribution to the growing sociocultural literature in medical education and specifically points to the need for changes in the way learning in the workplace is conceptualised. It challenges medical educators and policy makers to think not just about the individual, but also the culture and power relationships which shape select and legitimise what learning affordances the student-doctors attend to; that is the relational interdependence between personal and social agency.

Medical education aims to train students to become safe and effective clinical practitioners. This includes the ability to make safe and effective clinical judgements and decisions (GMC 2009). It is assumed that trainee doctors acquire these skills through the hidden curriculum. This is not necessarily the case. There is reason to believe that medical education should include some explicit training for doctors to improve their clinical judgements and decisions. This is known as training in clinical reasoning. This thesis explored how to enhance doctors' clinical reasoning through effective training. The aims were to develop and evaluate an intervention informed by decision theory to Improve doctors' reasoning about clinical judgements and decisions. A series of empirical studies were conducted to achieve these aims. A systematic review and questionnaire study were conducted to evaluate existing interventions that aimed to enhance doctors' clinical reasoning skills. There was little agreement between medical educators on how to effectively enhance doctors' clinical reasoning through training. However, the minority of interventions that aimed to improve doctors' awareness about their own reasoning processes were effective. Little is known about how to improve the processes doctors use to make clinical judgements and decisions in practice. A qualitative interview study was conducted to explore doctors' views and experiences of how to make effective clinical judgements and decisions. Doctors had limited explicit insight into their own reasoning processes, such as the methods that lead to good decisions and factors that bias their reasoning. A quasi-experimental. study was developed to evaluate the feasibility of an intervention to enhance doctors' understanding about their own reasoning processes. A brief tutorial was shown that explained the basic science underpinning human judgement and decision making. Doctors were receptive to learning about this information. They found it relevant to their clinical practice and gained knowledge about decision sciences concepts. Findings from this thesis suggest that, potentially, doctors can improve their clinical judgements and decisions through training to understand how they think about clinical problems.

Clinical reasoning research has concluded that experts use less, but more selective, knowledge in a more efficient way, based on the construction of schema, scripts and other representations of the relation between signs, symptoms and diagnoses, derived from their experience. However, this conclusion does not help Medical Schools to decide which pedagogical strategies should be adopted to foster clinical reasoning in undergraduates. This study aims to investigate how medical students, approach clinical cases and the impact of three types of curriculum upon their clinical reasoning. Two studies were carried out. The first analysed 60 hours of Problem-Based Learning sessions using electronic content analysis and corpus analysis. A second used a cross-sectional approach assessing and comparing students’ clinical reasoning in three different medical schools (Derby, Nottingham and Coimbra)based on a Clinical Reasoning Test (CRT) developed and validated for the purposes of this research. The clinical reasoning test prove to be a valid and reliable tool to assess clinical reasoning. The analysis of the PBL sessions indicated that early contact with clinical cases might favour students’ encapsulation of knowledge. First year students use more words, are more descriptive and make significantly more use of explanations. Second year students are more focused using less words, focusing more on the biomedical sciences aspect of the cases and engaging more in questions. The comparisons between different medical curricula show some differences between groups, at the entry to practice level in favour of the PBL and the integrated curricula. However, at the graduation level only small differences remain between the groups. Clinical exposure has a significant impact in improving students’ clinical reasoning, with differences in exposure time between curricula possibly accounting for such results. Additionally, differences in the strategies used to approach the cases were noted. Students from the traditional curriculum seem to be waiting until all information is displayed to make a decision, while their peers from other curricula seem to be more willing to make decisions based on initial patient’s information. No significant correlations with knowledge about the cases, or confidence on the diagnosis were found; possible reasons for these results will be discussed and implications for curriculum development and future research highlighted.

No description available.