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This thesis presents a series of studies about general medical practitioners’ patient management decisions in depression and the role of the clinical guideline within these.  The goal of the research was to identify the factors that influence their prescribing and to investigate how guideline use could be increased so as to promote clinical effectiveness.  A lens model study found that GPs tend to over prescribe compared with the guidelines and place much more emphasis on patients’ reports of thoughts of suicide and sleep disturbance than the guideline. Although GPs’ judgement data were well described by regression models, a simple fast and frugal model of decision-making explained the judgement data equally well.  A cluster analysis was carried out on the resulting GPs’ decision policies and 3 clusters emerged which could be differentiated by the size of practice they worked in.  GPs in the larger practices had decision policies, which were more like those of guideline recommendations.  GPs were found to have good self-insight in to their decision-making when a policy recognition task was used.  A further analysis found that GPs in one area in England prescribed at a greater rate than those in the Grampian region of Scotland and decision policies showed that patient treatment preference had less influence on the English GPs’ decisions. The results from these quantitative studies were explored further by using in-depth interviews with GPs.  A number of factors which help to explain why the GPs are sometimes prevented from following guideline recommendations and fulfilling patient treatment wishes and why changing behaviour in order for it to be more compliant with guideline recommendations it so difficult.

The United Arab Emirates does not currently possess an adequate number of well trained Family Practitioners and only a small proportion of the medical work force are employed in Primary Care. Continuing medical education is important in Family Medicine and, to date, there has been no study in this subject carried out in the United Arab Emirates. It was decided to evaluate and assess the current situation within Family Medicine and the amount of continuing medical education received by medical practitioners in Abu-Dhabi. Accordingly, 3 studies were carried out to provide this information. Initially, a perspective, descriptive study was carried out, involving all Primary Care Practitioners. There was an 80% response, yielding 86 completed questionnaires. The study revealed a perceived low prestige for Family Medicine among Family Practitioners, over half of whom (58%), felt that they did not have the confidence of the public. Only 3% of Family Practitioners were Emirati Nationals. 23% had received training in Family Medicine but only 3% had formal qualifications. It is unlikely that the Government will spend large sums of money on the training of expatriate doctors through a residency programme but there should be a practical alternative. There is a clear need to increase the numbers of Emirati National doctors. It was seen as important to determine how medical students and Interns graduating from the United Arab Emirates University, made their career choices. A second, cross-sectional, descriptive study, was set up. A questionnaire was administered to all final year students in the Faculty of Medicine and Interns in the University hospital. There was an 80% return yielding 48 questionnaire for analysis. The leading reason for selecting a speciality was personal interest 85% and half of the respondents were of the opinion that there was no organised career structure in Family Medicine in the United Arab Emirates. 52% did not wish to enter Family Medicine although 85% appreciated the importance of this speciality. There was also a general feeling that Family Medicine was poorly organised within the Emirates (90%). Continuing medical education is a systematic attempt to facilitate change in doctors' practice. Differences observed over time in patients' health and in doctors' performance and their knowledge and skills, are the types of change that have been the focus of research in continuing medical education. Medical education is successful when it results in improved outcomes for patients, but there may not be much connection between traditional didactic instruction and improvement in clinical practice. Evidence suggests that continuing medical education activities that are learner focused, take place in small groups and adhere to the principles of adult learning, are beneficial to practising physicians and their patients. It was decided to carry out a study designed to ensure the effect of a practiced based, small group, continuing medical education programme on the knowledge and clinical practice of primary health care doctors in the management of hypertension. A randomised, controlled trial was carried out in four Primary Health Care Centres in Abu-Dhabi, two of which were designated as the intervention centres and the other two, the control centres. The first part of the study was the establishment of the intervention, which was a small-group, practice-based, continuing medical education programme (6 hours) in the care of hypertensive patients, relevant to primary care practice. The second part was a study of the effectiveness of the programme, obtained by an evaluation of knowledge and practice, three months before and three months after the intervention. There was no change in the knowledge of care of hypertensive patients between the control and intervention groups but there was evidence that the continuing education programme had changed some aspects of the clinical practice and the performance of primary health care doctors, in the management of hypertension. The results suggested that this form of medical education could be effective.

A longitudinal study followed a cohort of students through the Bachelor of Education (Honours) degree course, the main route to primary teaching at the University of Strathclyde. The main purpose was to determine the extent to which the school experience element met the expressed aims of the course, in particular, the aim of developing reflective practitioners, which is the model of the teacher that underpins the four-year course. In the first year of the study, baseline data was gathered from students in all four years of the course, their faculty tutors, supervising teachers and those members of staff in school holding the remit for students. First year students formed the basis of the longitudinal study, with data gathered through questionnaires and interviews over the subsequent three years. This data was supplemented by an analysis of students' self-evaluation reports and 'good practice' interviews with a sub-sample of supervising teachers. The findings indicate that the major ity of students experienced a primarily apprenticeship form of preparation for the teaching profession, rather than a reflective practitioner model. While considerable opportunities were provided within the structure of the course for the acquisition and exercise of skills of reflection and critical analysis, other factors influenced the extent to which these were realised. These included resources, and the ways in which teachers and tutors interpreted their roles and responsibilities as supervisors. Consideration is given as to how these might be addressed in order to provide a professional workforce of reflective practitioners might be realised within the current framework of pre-service primary education. More fundamentally, issues of professionalism, government policy changes and the changing context of professional education generally, support the argument that the Scottish BEd, in its present form, is unlikely to support the development of the reflective primary despite the professed aims of its designers.

Thesis (M.S.)--University of Wyoming, 2006. / Title from PDF title page (viewed on Nov. 13, 2007). Includes bibliographical references (p. 47-50).

Thesis (Ph.D.) -- University of Rhode Island, 2007 / Typescript. Includes bibliographical references (leaves 73-78).