Megan Anakin

Negotiating the challenge of collaborative writing: learning from one writing group's mutiny

With continuing pressure to publish or perish, interventions such as writing groups are increasingly part of the academic landscape. In this paper, we discuss our writing groups experiment with collaborative writing, which came unstuck as simmering concerns led to a mutiny within the group. The mutiny provided insights into tensions that are inevitably present in writing groups and collaborative writing exercises but are seldom written about. We explore these tensions via a collaborative autoethnography, drawing on published literature on writing groups and collaborative writing. The mutiny revealed three key dynamics. Experienced voices can have an important role to play but these voices need to be moderated so that other voices might be recognised and valued. Pleasure and productivity are two necessary components for sustaining writing groups and writing collaborations. Finally, hierarchies in the academic context are inescapable but they can be renegotiated so that more enabling power relations can be generated.

A philosophical framework for pharmacy in the 21st century guided by ethical principles

&NA; Pharmacy has a long history of providing products and services for healthcare. In the last century, these roles have taken a strong focus on clinical care with the provision of medicines review, medicines optimisation, and prescribing services being at the forefront. The profession, however, is diverse. Pharmacists operate across a wide range of healthcare practices that often embrace both historic and contemporary roles simultaneously. The purpose of this article is to provide an overarching philosophical framework for pharmacy that encompasses roles that the modern pharmacist may assume. In doing this, we explore how pharmacy services align with healthcare and how different services require different approaches to clinical decision making.

The contextual nature of university-wide curriculum change

ABSTRACT We explored the relationships between social contexts and factors that promoted and inhibited curriculum change at two universities. Thirty interviews were analysed using a general inductive approach to identify factors and forces in three social contexts (lecturer, departmental, and institutional). Curriculum change was characterised by six forces: ownership, resources, identity, leadership, students, and quality assurance, each composed of factors that differed in their direction (enabling or inhibiting) and/or intensity (strong or weak). Academic developers should find the approach and lessons learned useful for planning interventions and identifying where they may encounter resistance or enablers in the process of change.

Clinical decision-making: An essential skill for 21st century pharmacy practice

Clinical decision-making skills are recognized as a central component of professional competency but are under-developed in pharmacy compared to other health professions. There is an urgent need for a comprehensive understanding of how pharmacists can best develop and use therapeutic decision-making skills in clinical practice. The aims of this commentary are to define clinical decision-making in pharmacy practice, and to present a model for clinical decision-making that aligns with a philosophical framework for pharmacy practice. The model has utility in education programs for pharmacists and provides a framework for understanding patient-facing clinical services in practice.

Understanding the process of clinical judgement for pharmacists when making clinical decisions

Clinical decision-making is arguably the most important and underappreciated skill in pharmacy. It can be described as four discrete steps: information gathering, clinical reasoning and judgement and, the decision process. The information gathering and decision negotiation steps and to some extent clinical reasoning are addressed either implicitly or explicitly by practitioners and educators. Clinical judgement, however, remains a largely unexplored concept for clinical decision-making in healthcare therapeutics. It defines how practitioners arrive at a favourable treatment strategy and, due to the often complicated benefit:risk evaluations, is often linked with concepts relating to ambiguity. In this article, we use game theory to explore the judgement stage of clinical decision-making. Game theory allows us to provide a quantitative evaluation of clinical judgement and explore concepts such as ambiguity and its sources in healthcare. Clarifying the elements involved in the judgement stage of clinical decision-making will enable a better understanding of how pharmacists contribute patient care in healthcare teams.

Identifying developmental features in students’ clinical reasoning to inform teaching*

Abstract Background: There is increasing evidence that students at different levels of training may benefit from different methods of learning clinical reasoning. Two of the common methods of teaching are the “whole – case” format and the “serial cue” approach. There is little empirical evidence to guide teachers as to which method to use and when to introduce them. Methods: We observed 23 students from different stages of training to examine how they were taking a history and how they were thinking whilst doing this. Each student interviewed a simulated patient who presented with a straightforward and a complex presentation. We inferred how students were reasoning from how they took a history and how they described their thinking while doing this. Results: Early in their training students can only take a generic history. Only later in training are they able to take a focused history, remember the information they have gathered, use it to seek further specific information, compare and contrast possibilities and analyze their data as they are collecting it. Conclusions: Early in their training students are unable to analyze data during history taking. When they have started developing illness scripts, they are able to benefit from the “serial cue” approach of teaching clinical reasoning.