Rachel Locke

Exploring UK Secondary Teachers' Professional Values: An Overview of the Literature since 2000.

Background: Professional commitment from teachers requires more than contractual compliance as personal and professional values are integral to teaching practice. Secondary school teachers are expected to act as role models and demonstrate positive attributes and attitudes in an evolving educational context. Little is known about how they understand or interpret their own values, or realise the shared values that lie at the heart of a school community. Purpose: The purpose of this review is to summarise the literature relating to values that teachers hold. The review is concerned with theoretical and empirical studies in which such values are considered, and also any tensions identified between the personal values of teachers and organisational values of the schools reflected in professional practice. This scoping exercise is part of two-year funded empirical research carried out by the authors in five secondary schools in England, using data from individuals, groups and schools on the personal values of teachers and head teachers. This research explored whether these values are congruent with the organisational values schools seek to establish. Design and methods: An extensive literature review was undertaken relating to the values held by secondary school professionals. The search was restricted to more recent works (i.e. the year 2000 onwards), and was mainly UK and secondary education focused. The search was conducted using the educational database, Education Indexes on Dialog, and the Electronic Journal Service which is a database covering wider disciplines. To reach harder-to-find research reports, additional strategies were adopted including hand searching of key journals and reference to existing publication lists. The review generated over 1000 published references that were then screened to determine whether publications were based on empirical research conducted in schools, and/or helped a deeper theoretical understanding about the meaning of values. Conclusion: The review highlights the integral part values continue to play in education. This article presents a framework of understanding derived from the literary contexts in which values are discussed. There is little empirical data to support current understanding about the values that secondary teachers hold, and how these fit with the organisational values of the schools in which they work. Studies in the context of values and professionalism stress the need for dialogue and reflection so that ‘implicit’ values that teachers hold become explicit, and refined through practice.

The impact on the workload of the Ward Manager with the introduction of administrative assistants.

AIM To evaluate the impact on the workload of the Ward Manager (WM) with the introduction of administrative assistants into eight trusts in the South of England in a year-long pilot. BACKGROUND Ward Managers are nurse leaders who are responsible for ward management and delivering expert clinical care to patients. They have traditionally been expected to achieve this role without administrative assistance. Meeting the workload demands of multiple roles and overload has meant the leadership and clinical role has suffered, presenting issues of low morale among existing WMs and issues of recruiting the next generation of WMs. METHOD Sixty qualitative interviews were carried out with 16 WMs, 12 Ward Manager Assistants (WMAs), and six senior nurse executives about the impact of the introduction of the WMA post. Quantitative data to measure change in WM workload and ward activity was supplied by 24 wards. RESULTS Ward Managers reported spending reduced time on administrative tasks and having increased time available to spend on the ward with patients and leading staff. With the introduction of WMAs, there was also improvement in key performance measures (the maintenance of quality under service pressures) and increased staff motivation. CONCLUSIONS There was overwhelming support for the introduction of administrative assistants from participating WMs. The WMAs enabled WMs to spend more time with patients and, more widely, to provide greater support to ward teams. The success of the pilot is reflected in wards working hard to be able to extend contracts of WMAs. The extent of the success is reflected in wards that were not participants in the pilot, observing the benefits of the post, having worked to secure funding to recruit their own WMAs. IMPLICATIONS FOR NURSING MANAGEMENT The widespread introduction of administrative assistance could increase ward productivity and provide support for clinical leaders. Continuing professional development for WMs needs to incorporate training about management responsibilities and how to best use administrative support.

Educational professionals’ values: voices from secondary schools in England

Background: Values continue to play an integral part in education across the globe, but the importance of teachers’ personal values is often overlooked (Klein, M.B., New teaching and teacher issues, Nova Science Publishers Inc., 2006; Aspin, D.N., and J.D. Chapman, eds, Values education and lifelong learning: Principles, policies, programmes, Springer, 2007). It has been argued that teachers need explicit opportunities to reflect on their own personal and professional values to enable them to model what they ask of their students with integrity (Palmer, P.J., The courage to teach, Jossey Bass, 1998; Atkinson, T., and G. Claxton, The intuitive practitioner, Open University Press, 2000). Professional development is still often narrowly defined within the bounds of skills and competencies. However, discussion of values could help contribute to professional development by building teacher commitment and resilience. Objective: The purpose of this research was to explore the intrinsic values of secondary school professionals and the publicly espoused values of the educational systems in which they work. This research is the result of a two-year funded empirical study carried out by the authors in secondary schools in England. Research design: Research was undertaken in five schools in a range of educational contexts. In each school, individual conversations were undertaken with six key professionals with different roles to elicit personal constructs or values. These values were discussed within schools and formed a schools ‘values footprint’. An interschool workshop completed the data collection. Data were analysed qualitatively. Main outcomes: Qualitative analysis suggested relationships between the professional roles of the participants and predominant values themes. There were also connections between school types and predominating values. Four key themes emerged from the individual and group conversations: importance of dialogue; recognition of the importance of self-awareness; the priority of learning for life and the influence of professional roles on an individuals values focus. Conclusion: This small-scale study supports the importance of dialogue and self-awareness in professional life and ongoing professional development.

GP workload: time for a rethink of the generalist model of care to promote retention

Much has been written in recent months about the ‘crisis’ in general practice; a crisis that has been linked to difficulties in recruiting to and retaining the workforce, changing working patterns, increasing care demands, and bureaucracy in the system of care. The debate has rippled through the press,1,2 been the subject of discussion at conferences and in the pages of journals,3 as well as prompting a number of reviews.4–6 While rarely out of the headlines or journals, it would seem that there is more ‘heat than light’ in identifying a way forward. This lack of clarity prompted us to seek the experiences of GPs and their views of working in general practice today, and to ask them to look ahead to the future. This article is based on an analysis of data gathered in Wessex by a survey of GPs ( n = 1445) and interview of a purposive ‘key informant’ sample of seven,7 reflecting different ages, career stages, and role types. The latter were recruited by invitation through local GP and practice networks, and those participating consented to undertake semi-structured telephone interviews. Both datasets were thematically analysed, and a fuller description of this work can be found elsewhere.8 A recent article in BJGP by Abbt and Alderson3 argues ‘It’s not workload’ , however the views expressed by our informants would challenge this. They described today’s general practice working environment as being very different to that of some 20 or 30 years ago. The lack of a well-defined career structure, alongside other influences, was seen as being a significant factor in GPs no longer seeking to be partners, especially those in the early stages of a career. This seems to have arisen as a result of the extended responsibilities that come …

Clinicians with dyslexia: a systematic review of effects and strategies

For educators, an awareness of the impact of dyslexia on learners in the clinical workplace is vital: first, to be able to identify whether dyslexia may underlie certain traits and behaviours; and second, to be able to provide appropriate advice and support when dyslexia is identified. We reviewed the primary research evidence concerning the effects of dyslexia on clinicians (in or after training) in the workplace, and adaptive strategies (‘workarounds’) that are presently in use.

Medical appraisal and revalidation: can it improve patient care?

Revalidation for all doctors in England, following the process defined in the Medical Appraisal Guide,1 finally started in December 2012 after ten years’ experience of developmental appraisal in the NHS. There has been significant debate about preserving the formative nature of the appraisal conversation in the context of the recent need for the appraiser to make explicit some of their professional judgements within the appraisal meeting.2 These include judgements which evaluate the portfolio of supporting information and whether it shows that the doctor is ‘on track’ to revalidate; deciding whether there are any emerging patient safety issues or performance concerns; and assessing whether the doctor has engaged appropriately in the appraisal process in reviewing his or her full scope of work.3 Appraisers need to gain ‘a rounded impression’4 of the doctor being appraised in order to agree a personal development plan (PDP) and to judge progress towards revalidation. As Wakeling and Cameron5 recognise, the appraiser and his or her skills ‘will become even more pivotal in “enhanced” appraisal’, or what is now referred to as ‘medical appraisal for revalidation’. Up to now the issues surrounding medical appraisal for revalidation have largely been considered from the perspective of the doctor being appraised, engagement in the process and the evidence presented, with little account being taken of the role of the appraiser, who now has to manage both formative and summative aspects.5 Lyons6 has argued that, in spite of concerns such as those found by Wakeling and Cameron,5 appraisers have not experienced role conflict to the extent predicted by the debates, though there is a lack of research into how appraisers balance these opposing demands. Thus, it may be argued, the spotlight is moving from engagement to practice, illuminating the knowledge and skills required by appraisers to manage the different elements of medical appraisal for revalidation. This next chapter is set within a broader agenda of the quality assurance of appraisal services. Ultimately, under the umbrella of revalidation, practice across health sectors needs to be bench-marked by those delivering it. This is to ensure that all doctors revalidate to the same standards, as it is acknowledged that currently appraisal systems are variable.7 This shifting agenda is already evident and strands of work are emerging which describe the development of advanced appraiser skills;8–12 make explicit the knowledge and skills required for the role13,14 and formally recognise them.15 Other work facilitates bench-marking through the development of quality assurance tools;16–18 and demonstrate cross-sector working, for instance in training appraisers.19 In the light of this shift in focus towards practice and process, we argue that there needs to be a similar shift in research and development activity concerning appraisal. Up to now research concerning the benefits of appraisal is sparse and generally based upon self-reported perceptions of change by doctors being appraised.20 One of the key aims of appraisal for revalidation is the promotion of quality improvements in patient care through the professional development of doctors.1 Although the benefits of appraisal for doctors are recognised, demonstrating that it drives improvements in patient care is difficult. Hitherto the focus of research has been on the individual doctor, with change being defined in the context of the individual’s practice. There is a pressing need to look at the outcomes of appraisal not only from the individual’s perspective, but also in terms of the wider context of a practice, locality and the healthcare system: ‘[W]e owe it to patients and all other stakeholders to demonstrate that a process that impinges on time devoted

The benefits of appraisal: a critical (re)view of the literature

Abstract It has been acknowledged that little is known about the impact of general practice (GP) appraisal on clinical and professional practice, as may be demonstrated by identifiable or ‘hard’ outcomes, and further, that the way in which appraisal informs professional development is unclear. In spite of this acknowledgement and the existence of a substantial number of studies about GP appraisal, to date an overview of the field of enquiry which maps what is known, has been lacking. In this leading article we present the first extensive thematic narrative synthesis of the literature on appraisal. In it we highlight the issues and tensions around research into appraisal, based on what we found (or didn’t find) in our review. Key conclusions concern the focus of existing research – which has tended to report the perceptions of change from individual appraisees, rather than specific examples of change captured from other sources and perspectives – and the scope of research – which has been limited to certain data collection methods. Based upon our review, we draw out implications for research and researchers in the future.

Doctors with dyslexia: strategies and support.

Looking beyond dyslexia as an individual doctors issue requires adjusting a working environment to better serve the needs of doctors with dyslexia. With an increasing number of doctors disclosing dyslexia at medical school, how can educators best provide this support? Our research looks at the impact of dyslexia on clinical practice and the coping strategies used by doctors to minimise the effect.

The experience and professional development of medical appraisers

ABSTRACT This article explores the experiences of General Practitioner (GP) appraisers working in a unfamiliar setting (Jersey) with appraisees new to the process. Findings were interpreted using the learning theory, ‘situated cognition’, to shed light on the experience of appraisers working with new appraisees more generally and contribute to new understandings of workplace learning. Rich qualitative data derived from transcripts of nine in-depth interviews with GP appraisers were analysed thematically in a rigorous and iterative manner process. GP appraisers working in an unfamiliar environment shared a common sense of culture shock and discomfort. Initially, they needed to work much harder than usual to establish rapport and credibility, but by the second round of appraisals, appraisers were reminded of the power of appraisal. The innovative application of ‘situated cognition’ helps to explain why appraisers felt like ‘novices’ in Jersey and how they were required to reconstruct their professional knowledge. This is the first time appraiser development has been considered in this way and appraisers can be helped to develop professionally if they are offered a mix of appraisal-related activities in new places and with new people. Such implications for educational support apply internationally where doctors are involved in a process of peer review as part of on-going professional development.

Maintaining the wellbeing of clinicians

Burnout is a severe form of stress, characterised by emotional exhaustion, depersonalisation and a low sense of personal accomplishment, that is prevalent among frontline care clinicians and trainees. As well as the personal costs, it has implications for the quality of patient care. The papers reviewed here cover the causes and effective ways to intervene (either by preventive or remedial means) to address burnout and build resilience (enhanced capacity to deal with stress) throughout the career trajectory of trainees and experienced health professionals.