Hywel Thomas

Measuring effectiveness for best evidence medical education: a discussion.

This paper considers how educational interventions should be evaluated for their effectiveness. Five levels of effectiveness are clarified and illustrated: outcomes, behaviour, learning, reaction and participation. These levels are then discussed, within the context of research evidence for education within the medical profession. Methodological and practical research conclusions are then drawn. From an analysis of over 300 abstracts the evidence shows that only limited research on healthcare outcomes has been undertaken, and there is considerable ambiguity over what constitutes an effectiveness measure. The benefits of a consistent set of terms are then considered. Finally, five key messages are distilled from the discussion and summarized.

Teacher Job Satisfaction: Lessons from the TSW Pathfinder Project.

Government policy assumes that modernization and remodelling will be effective as external intervention mechanisms to improve job satisfaction. Based on data collected as part of the evaluation of the ‘Transforming the School Workforce Pathfinder Project’, an argument is presented here which suggests that internal management models may be more effective in improving teacher job satisfaction. By comparing the responses of teachers within primary and special schools with those from secondary schools, internal factors are identified which may be more relevant than externally imposed measures.

A "neglected part of the curriculum" or "of limited use"? Views on genetics training by nongenetics medical trainees and implications for delivery.

Purpose: Although the importance of genetics education for health care professionals is increasingly recognized worldwide, little is known about the needs and views of nongenetics postgraduate medical trainees.Methods: Data on the views of 143 learners from four specialties (family practice, neurology, cardiology, and dermatology) in two regions in England (West Midlands and South Western) were collected using focus groups, questionnaires, and interviews.Results: Low levels of genetics training were reported by both trainee family practitioners and trainee hospital consultant specialists. Responses to attitude statements indicate that the majority of trainee family practitioners believed genetics was important but thought that they were underprepared in this area. Focus groups with specialty trainees revealed general consensus that there was not enough formal postgraduate genetics training, although some cardiologists disagreed and trainees in all three specialties thought that the existing curriculum was overcrowded. Trainees stressed the importance of tailoring genetics education to be directly relevant to their daily practice. Trainee family practitioners prioritized topics related to the identification and referral of patients, and the subsequent implication of results. In contrast, specialty trainees prioritized topics related to the genetics and management of particular diseases.Conclusion: There is still work to be done before trainees in nongenetics specialties recognize how genetics can be relevant to their practice. Involvement of specialty trainers in the development and delivery of genetics education may help to address this issue.

Teachers, time and work: findings from the Evaluation of the Transforming the School Workforce Pathfinder Project

Teachers work and workload have been major factors in the recruitment, retention and revitalization of the profession. In January 2003 the Department for Education and Skills (DfES) launched a major reform known as remodelling, by which the work–life balance would be improved by freeing teachers up to teach, and using other members of the workforce (teaching and learning support assistants, administrators and bursars, technicians and welfare and counselling staff) to take on work that teachers need no longer do. This reform is in progress, and while there is anecdotal evidence of both the benefits and concerns of remodelling, there is no formal research evidence. However, prior to this initiative the DfES trialled these changes in 32 pilot schools, and a team from the University of Birmingham evaluated it. In this paper we examine this data with regard to the possibilities and opportunities afforded by remodelling and we consider how the pilot data generates important questions and illuminates contradictions in the modernization project.

Developing a curriculum statement based on clinical practice: genetics in primary care.

BACKGROUND Advances in medical genetics are increasingly being incorporated into clinical management outside specialist genetic services. This study was therefore undertaken to develop learning outcomes in genetics for general practice specialty training, using methods to ensure the knowledge, skills, and attitudes relevant to genetics in primary care were identified. AIM To identify key knowledge, skills, and attitudes in genetics and to synthesise these into learning outcomes to assist training in genetics for primary care. DESIGN OF STUDY Delphi survey and review by expert group. SETTING Primary care practices and Regional Genetics Centre in the West Midlands region of the UK. METHOD A modified Delphi survey involved GP trainers, programme directors, and geneticists (n = 60). The results, along with results from a survey of GP registrars, were reviewed by an expert group, which included GPs, geneticists, and educationalists. RESULTS Core genetics topics for GPs were identified, prioritised, and developed into competency statements in the style of the curriculum structure of the Royal College of General Practitioners. CONCLUSION The development of the GP curriculum statement Genetics in Primary Care was based on a study of educational needs, incorporating the views of practitioners (GP trainers, programme directors, and registrars) and specialists (clinical geneticists). This inclusive approach has enabled the identification of learning outcomes which directly reflect clinical practice.

Education and Modernization.

A review of the articles on modernization in Australia, England, New Zealand, Scotland and the USA demonstrates and discusses the complexity attached to the concept. This also enables a better understanding of the contention and controversy that surrounds the concept and its application to educational policy and practice. Modernization policies in these five countries are then analysed and interpreted within a conceptual framework that explores the locations of decisions and the motivational principles underlying decisions. The analysis proposes four ‘ideal’ type mechanisms for allocating resources in society. Arguing that a ‘mixed economy’ model is both necessary and right, the discussion concludes by examining the appropriate balance within that ‘mixed economy’ if education is to yield both economic growth and social cohesion.

The Consequences of Drop-outs on the Cost-effectiveness of 16-19 Colleges.

The extent of non-retention on post compulsory full-time education courses mainly undertaken by students in the 16-19 age group has become recognised as relatively large. Not the least of the concerns surrounding this, is the extent of resources devoted to initial enrolments on courses who ultimately do not achieve any level of certified outcome. In this paper we examine the extent of the problem for CGE Advanced Level courses in a number of colleges in the further education funded sector.

Markets, Collectivities and Management

abstract This article examines the mechanisms by which a society decides upon how much education it requires, what is to be provided, who is to provide it and to whom. It proposes a framework which defines four ideal types of allocative mechanisms and most of the article discusses these and their approximations in social life. It is argued that it is the interrelationships of these allocative mechanisms which shape the production and distribution of educational resources in what is a mixed economy. Debates juxtaposing the ‘market’ against some alternatives are seen as over‐simplistic. Instead, what is required is the more complex resolution of the balance (s) to be struck between the variety of means by which education services are produced and allocated in our society.

Using dentistry as a case study to examine continuing education and its impact on practice

Continuing education is a defining characteristic of work in the professions. Yet the approach various professional groups take to continuing professional development (CPD) differs widely in terms of regulatory frameworks and requirements, modes of delivery and funding. Importantly, little is understood about how CPD impacts on practice.This paper compares the regulatory context of different professional groups and devises a two‐dimensional model to explore differences in CPD practice by mapping control over CPD content and mode. The emergent quadrants we label as liberal, regulated, managed and controlled. The paper continues by using empirical data from two studies of continuing education in dentistry and the wider literature to explore factors affecting CPD impact. The paper ends by considering how the regulatory context may affect impact and concludes that changes in the control of CPD have potential to influence the power of education to make a difference to professional practice.

More students, less capacity? An assessment of the competing demands on academic medical staff

Context  Medical student numbers in England have increased by more than 60% over the last decade. The capacity of universities and the National Health Service (NHS) to deliver education and training to these expanded cohorts is not clear.