Keith Postlethwaite

Simulation in clinical learning

Simulation in clinical learning is becoming increasingly commonplace. The use of simulation spans both the undergraduate and postgraduate domains and has come about as a result of a number of driving forces. Medical education reform has been widespread throughout the world. These reforms recognise the need to prepare undergraduate learners for their roles in the ever changing world of medical practice. Moreover, widespread adoption of the concept of clinical governance has implications for learning in both undergraduate and postgraduate arenas. The purpose of clinical governance is to ensure that the highest quality of care is provided to patients. Areas within the remit of clinical governance upon which simulation may have an impact include risk management, lifelong learning, education, training and continuing personal and professional development, staffing and staff management, continuous quality improvement and the management of poor performance. Technological advances in recent years have seen the development of a variety of models and manikins ranging from simple replications of body parts for task-based learning of some examination skills, to high fidelity patient simulators driven by complex pathophysiological computer models developed to provide a highly valid replication of clinical environments. Anaesthesia has been one speciality where the use of high fidelity simulation has been seen to be of great value in promoting patient safety and in developing competence and on-going training, drawing from the world of aviation and its experience in flight crew training and teamwork. Simulation has extended into other fields, including emergency medicine, and surgical training and assessment, and has crossed into the undergraduate educational arena. In this latter field, opportunities can be created to practise the management of clinical conditions which would otherwise not be possible, safe in knowledge of them taking place in a protected environment. At the same time, there has been criticism of medical education from within the profession of the relative paucity of sound educational research that underpins much of medical education innovation. Medical simulation offers tremendous opportunities for the advancement of our understanding of learning because it is consistent with very different ways of conceptualising learning, and because research in very different paradigms can be accommodated. A more explicit discussion of theories of learning, and of paradigms of research, might therefore helpfully inform future practice and future research on simulation. We begin here to explore something of what this might mean.

Setting up a clinical skills learning facility

Objective  This paper outlines the considerations to be made when establishing a clinical skills learning facility.

Action Research: a strategy for teacher change and school development?

This paper is concerned with the reflections of two lecturers from higher education who worked through several cycles of action research with a group of teachers in a school over a period of eight years trying to improve learning in the school. Very many of the factors identified in the literature as being essential for sustained change were in place, and there were successful outcomes associated with each cycle of action. Nevertheless, our reflections on the whole process highlight some complexities of working with teachers in this way. In this paper we examine the difficulty of attending to contextual factors within the project; we identify links between teacher change and perceptions of risk; we explore a confusion which emerged over the role of such a group within the school. In addition, we argue that the deficit approach which characterises action research is unhelpful to some teachers.

Improving the learning of newly qualified teachers in the induction year

Newly qualified teachers of mathematics and science are a precious resource and it important that they are provided with appropriate support and challenge during their first year in post. This study examines the developing thinking and practice of a group of such teachers in England and the influence of their mentors within the workplace context of the school. We argue that thinking and practice is restricted by the concern to ‘fit in’, by the belief that behaviour management should be addressed before teaching can be developed and by a lack of attention to the development of pedagogical thinking. We conclude that there is a need to change the beliefs and practices of induction mentors and develop their skills in discussing pedagogical ideas. This is most likely to be achieved within a school‐wide culture of continuing professional learning.

An exploration of changes in thinking in the transition from student teacher to newly qualified teacher

For newly qualified teachers (NQTs), the induction period of support is an important phase which has the potential to deepen learning that has already taken place in initial teacher education (ITE) as well as preparing the NQT for future learning. A particularly crucial time in the induction process is the first term of teaching, when NQTs are likely to be facing a ‘reality shock’ in relation to their new responsibilities. Data were collected by questionnaire from a volunteer sample of student teachers of science and mathematics close to the end of their ITE course and then by questionnaire from the same sample towards the end of their first term as NQTs. The questionnaires were virtually identical and both consisted mainly of free response questions. The responses were transcribed and then coded in a grounded fashion. For this paper, five cases are examined within a framework of activity theory and drawing on ideas of identity. We identify three issues relating to the changes in thinking that occur as beginning teachers move from the role of students in ITE to NQTs in schools: concern for classroom management; school support for NQTs; and boundary crossing issues. We argue that the way the role of induction tutor is enacted determines the changes in thinking that take place for NQTs.

Student Teachers' Thinking about Learning to Teach: A Study of Student Teachers of Mathematics and Science at the End of Their Initial Training.

Recent dominant models of student teacher learning include apprenticeship and reflective practice, but these are now being challenged, extended and enriched by broader sociocultural models of learning. These new models direct attention to how learning is shaped by an interplay between the characteristics of the student teachers, their lecturers and their teacher mentors, and the characteristics of the university, schools and societal contexts within which these students, lecturers and mentors work. Sociocultural theories also reveal the importance of how learning is transferred and transformed as the student teacher moves between different contexts (e.g. between university and school, or between one school and another). In the context of teacher education in England, this paper explores the nature of student teachers’ thinking at the end of their initial teacher education (ITE) programme, and questions how the student teachers learnt to think about teaching in these ways – in particular what they felt they learnt in the university and school contexts, and how they dealt with differences between the ideas which were valued in those different contexts. Data were collected by questionnaire from a volunteer sample of student teachers of science and mathematics close to the end of their ITE course. Questions generally called for free response answers which were transcribed, coded and then related to a framework of ideas derived from our synthesis of sociocultural theories of learning. From the insights gained, we develop a theoretical understanding of the emerging aspects of student teachers’ thinking and learning which we summarise under the term ‘progressive filtering’. We discuss the relationship of this idea to the classical literature on socialisation of teachers and on ‘reality shock’, and also relate this idea to activity theory. We illustrate how this theoretical framework offers insights that could enable ITE to address issues which have remained problematic for some time.

Boundary crossings in research: towards a cultural understanding of the research project ‘Transforming Learning Cultures in Further Education’

To achieve its aim of deepening understanding of the complexities of learning in Further Education (FE), the Transforming Learning Cultures in FE (TLC) project developed a model of learning as a cultural activity. The purpose of this paper is to explore the implications of taking a cultural view, not of learning, but of the research itself. The paper provides a description of the TLC project in cultural terms, but is also of general interest in the field of research methodology, with the account of this project serving as an illustration of how research generally might be described in this way. The paper draws heavily on Activity Theory and on the work of Bourdieu, showing how the latter further enriches the former. It concentrates on two examples of cultural analysis of the project: (i) managing large multiple case studies; (ii) integrating qualitative and quantitative methods within a consistent interpretivist approach. In describing the multiple case studies, the paper identifies the key boundary objects that enabled the different teams to collaborate on building a project‐wide understanding of learning cultures in FE thus avoiding the risk that our large project could become little more than a series of loosely connected smaller case studies. In describing the combination of qualitative and quantitative enquiry, it shows how similar boundary objects enabled us to move iteratively across the qualitative/quantitative boundary. In both analyses, the paper shows how the habitus of the members of the project team was influential in allowing these boundary objects to come into full play, and how the details of the field affected our decision‐making about optimal ways of working. We argue that our research decisions were particularly influenced by aspects of habitus and field when these showed an element of synergy, and illustrate the negative impact of a lack of synergy on one aspect of our project.

Recruitment, Access and Retention Some Issues for Secondary Initial Teacher Education in the Current Social Context

The number of entrants to secondary undergraduate and postgraduate courses of initial teacher training in 1996–97 was 15 per cent below the government’s target. In 1998–99 the shortfall increased to 24 per cent when all subjects except History and Physical Education under-recruited. The largest shortfalls occurred in Mathematics (–47 per cent), Design and Technology (–46 per cent) and information Technology (–44 per cent). Of those giving evidence to the select committee of inquiry with a brief to look at the supply and retention of teachers, several perceived teacher recruitment to be in a state of ‘crisis’ and in danger of jeopardising the government’s commitment to raising standards (House of Commons, 1997: para. 58, p. xxi). Problems in guaranteeing a sufficient supply of secondary teachers are not, however, new. A decade earlier, the shortage of applicants to train as secondary teachers of Mathematics, Physics and Technology had led the government to introduce a financial inducement in the form of a nonmeans-tested, tax-free bursary, additional to the student grant (DES, 1986). Evaluation of this scheme showed that its impact was greatest in increasing the number of mature students entering teacher education, particularly those in the 25–9 age group (Bullock et al., 1989). Almost a quarter of the mature students, compared with 12 per cent of the younger students, claimed that without the bursary they would have been unable to train. For the rest the bursary had no effect, or had a minor effect, or was one of several other factors influencing the decision to enter teacher training. Other initiatives to attract more people into teaching have come through the diversification of training routes. One of these, the two-year Articled Teacher scheme, sought to reduce the negative financial impact of training through more generous support, whilst the introduction of part-time routes enabled employment to be combined with study and professional training. The Articled Teacher scheme was not sustained by the government and those on part-time routes have had to juggle the enormous intellectual and physical demands of a teacher training programme with those of employment, sometimes in a totally unrelated field. Whilst there is evidence that these routes have enabled some mature students to train who would not have Recruitment, access and retention

Setting up and running clinical skills learning programmes

C hanges in healthcare education have driven the development of clinical skills (CS) learning. Tomorrow’s Doctors formed a blueprint for medical education reform, calling for a reduction in factual overload and for courses in communication and CS. Poor levels of skills had been noted amongst students. This may result in junior doctors underperforming, which can be stressful for them and is a potential risk for their patients. Yet neither junior doctors nor their supervisors may recognise this. In addition, opportunities for junior doctors to acquire skills in clinical environments are reducing. At the same time the drive of clinical governance is setting the new standards which inevitably affect both undergraduate and postgraduate education.

Assessment of a condition-specific quality-of-life measure for patients with developmentally absent teeth: validity and reliability testing.

OBJECTIVES This article describes the process of validity and reliability testing of a condition-specific quality-of-life measure for patients with hypodontia presenting for orthodontic treatment. The development of the instrument is described in a previous article. SETTING AND SAMPLE POPULATION Royal Devon and Exeter NHS Foundation Trust & Musgrove Park Hospital, Taunton. MATERIALS AND METHODS The child perception questionnaire was used as a standard against which to test criterion validity. The Bland and Altman method was used to check agreement between the two questionnaires. Construct validity was tested using principal component analysis on the four sections of the questionnaire. Test-retest reliability was tested using intraclass correlation coefficient and Bland and Altman method. Cronbachs alpha was used to test internal consistency reliability. RESULTS Overall the questionnaire showed good reliability, criterion and construct validity. This together with previous evidence of good face and content validity suggests that the instrument may prove useful in clinical practice and further research. CONCLUSIONS This study has demonstrated that the newly developed condition-specific quality-of-life questionnaire is both valid and reliable for use in young patients with hypodontia.