Abstract: There has been increasing emphasis on the important role that interprofessional education (IPE) must play in educating and developing present and future healthcare professionals. However, clarity is urgently needed regarding appropriate strategies for its timing, content, delivery and assessment. This study focuses on the development of an undergraduate IPE programme for medical and nursing students. It compares learning opportunities in classroom and clinical areas and identifies suitable pedagogical strategies and subject areas. The programme consisted of 2 weeks of classroom-based learning for all 130 participating students, followed by 6 weeks on shared placement for 35 of the 113 medical and all 17 nursing students. A triangulation of data-collection methods was used to help strengthen reliability and validity and provide a more comprehensive analysis. In both classroom and clinical areas, successful methods of delivery for IPE were those that enabled exchanges of perspectives. Ward-based IPE was regarded as particularly effective in encouraging students to begin to feel part of a clinical team. In contrast, classroom-based learning enabled them to know about teamwork, but not to experience it. Practical issues of shift and timetable incompatibility were the most significant barriers to successful placement-shared learning. Developments in this area will need to focus on those elements of clinical practice which bring students together for collaborative involvement in activities that maximize the benefits resulting from the investment of time and effort involved. We conclude that undergraduate IPE opportunities have an important role to play in enabling students to learn about the roles and responsibilities of others and the impact of this on their own practice. It should be the first step towards developing practitioners who, whilst retaining their own unique professional identity, are able to understand and respect the roles of other healthcare professionals and work collaboratively to improve patient care.

Abstract: Contemporary nurse education places a high value on learning in the clinical environment. Combined with increasing numbers of students there are unprecedented demands on clinical areas and staff. One response to this problem has been the development of the practice placement facilitator (PPF) role. This study aimed to evaluate, over 12 months, the impact of the PPF role on the provision of practice placements, student support during placement and professional development needs of staff as clinical supervisors/assessors. The evaluation focused on three areas: capacity to accommodate students; quality of placements in relation to the role of the PPF; and the evolution of the role of the PPF. Data-collection methods included interviews, focus groups, questionnaires and secondary data analysis. The findings of the study demonstrated that: many different groups of learners are present in clinical environments; students need to have continuity of support; clinical staff derive benefits from an enhanced understanding of the needs of learners through the work of the PPF; and that if the role and function of the PPF post is unclear and/or poorly maintained there will be detrimental effects.

Abstract: The National Health Service (NHS) has called for the 'eradication of demarcation lines between healthcare professionals' in the UK. Educational institutions are therefore striving to achieve this outcome through integrative interprofessional initiatives. This article discusses the effects of an integrative training course for medical and nursing students in 'breaking bad news' to patients. Triangulation of the qualitative methods enabled the researchers to gather student perspectives on this experience. Data analysis revealed that the 34 student volunteers challenged misconceptions of professional roles through this interprofessional programmes. Questionnaire demonstrated that although most students had enrolled on the course to develop communication skills, the interprofessional aspect of the course was one of the main educational benefits. While outcomes were largely positive, some students were anxious about a holistic interprofessional curriculum. Undergraduate healthcare students may need to collaborate earlier, and for longer time-periods, to enhance professional understanding and relationships.

Abstract: Many clinicians are moving away from the traditional expert role towards a more collaborative approach to clinical decision making. Collaboration with patients has implications for the power distribution between clinician and patient, how health is defined, and what counts as evidence in the decision-making process. A critical social science perspective provides the philosophical and theoretical underpinnings for collaborative clinical decision making. Key issues of critical social science are critical self-reflection, questioning taken-for-granted practice, and transforming current practice. The way that clinicians define their role in clinical decision making reflects their beliefs and values about health, power and practice knowledge. Clinicians who adopt a collaborative clinical decision-making approach reject the objective scientific view of evidence-based practice, and embrace cultural and political influences on what counts as evidence. The purpose of collaboration is to increase understanding between the clinician and the patient. A distinction is made in this debate between manipulating and emancipating patients. Including patients in the decision-making process promises to result in more realistic and appropriate treatments, reduced patient concerns and complaints and better, sustainable health outcomes, and increased patient and clinician satisfaction. In this article we re-think practice knowledge and the notion of clinician–patient relationships.

Abstract: This paper reports the findings of a longitudinal study that evaluated changes in the self-esteem of pre-registration student nurses taking a 3 year diploma in nursing programme. Quantitative data were collected at the start (n = 68) and the end (n = 61) of the programme. Self-esteem was measured using the Tennessee Self-concept Scale (Roid & Fitts 1988). Students also participated in unstructured, qualitative interviews at the start (n = 56) and end (n = 39) of the course. Results showed that global self-esteem decreased dramatically between the start and end of the programme. Categories grounded in the qualitative data suggest that self-esteem becomes fragmented and students become powerless to be the type of nurse they wish to be. The implications for nursing practice and education are discussed.

Abstract: A collaborative project between a district hospital and a local university resulted in a senior lecturer being seconded 2 days per week to facilitate the continued improvement in pain management. The rationale for this collaboration was to explore the utilization of innovative teaching methods to deliver education in practice and to develop further research in relation to pain management. An interprofessional pain steering group (IPSG) was established with representation from several services (acute pain, chronic pain, palliative care, physiotherapy, etc.). This group identified several objectives, one of which related to the improvement of pain management through interprofessional education based on the findings from previous audit work. This paper reports on the provision of interprofessional education in pain management and on the evaluation of the impact of this on patient outcomes and practitioner learning. The successes and challenges of this endeavour are discussed.

Abstract: Despite clear policies for handling reported occurrences of plagiarism, and the inclusion of antiplagiarism statements in course syllabi and university calendars, reports of both student and faculty plagiarism in universities has increased dramatically in the past decade. Critics indicate that current approaches to prevent plagiarism in universities are limited by their focus on the individual and by their failure to consider the contextual influences in university settings. Eight faculty members and 10 students in a university school of nursing were interviewed about their understanding of, and response to, plagiarism. The participants viewed plagiarism primarily as a student problem caused by moral breakdown or ignorance. Faculty indicated that they most often overlooked university policy for reporting plagiarism if the offence was deemed as unintentional or caused by personal stress. Students were aware that plagiarism was wrong, but undergraduate students frequently conceptualized it as an ‘academic quirk’. The article concludes with a discussion of the implications of the research findings to university schools of nursing.

Abstract: This paper describes an evaluation of an 18 month pilot scheme for clinical facilitators (CFs) in the acute medical and surgical wards of a consortium's hospital trusts. The CFs were appointed to address two perceived deficits: the deficit in nursing skills showed by newly qualified Project 2000 nurses, and the deficit in supervision for clinical placement following the move of schools of nursing into higher education, the abolition of the clinical tutor and the increased workload on ward staff. The CFs were intended to enhance the competence of pre-registration nursing students on clinical placement. The evaluation used a three-pronged approach covering outcomes, process and multiple stakeholder perspectives. Outcome measures proved the most intractable, reflecting widespread problems in nurse education of specification and assessment. The process of clinical facilitation was investigated using consultative methods with the CFs themselves. On the basis of in-depth interviews with the CFs, a four-level model of clinical facilitation was developed that included, at its first level, the direct supervision of students in the ward. This supervisory role was characterized by six main teaching methods described by the CFs. These methods and the work of the CFs were evaluated through interviews, focus groups and questionnaires with key stakeholders: students; clinical staff, and university staff. Differences were found in the ranking by students, ward staff and university staff of the teaching methods and of the staff involved in practice learning. Within a generally positive evaluation of the work of the CFs, concerns were expressed regarding communication. University staff tended to evaluate the CFs less positively than did students and ward staff. Further research is recommended regarding those involved in the supervision of practice and the outcomes of their activities.

Abstract: This article describes an approach to evaluating a leadership-development programme which considers the impact of the programme on individuals, their organizations and the services they manage. Participants were clinical leaders from the health system in Eire, aiming to further develop their leadership skills, awareness and potential. The programme was used as a vehicle for linking personal development, as a leader, with leading improvements at work. Based on the principles of action learning, the programme was underpinned by the application of learning to practice, and the evaluation process was integral to the design and delivery of the development activities. Perceptions of the participants and key stakeholders were used as a baseline to identify desired changes in culture, structure, behaviour and processes in the services where participants worked. Participants used action learning and the content of programme modules to lead changes in their service areas. Perceptions of services at the beginning of the programme were compared with those at the end by using a visual analogue scale, a process that provided an indication of the extent of service improvement and change achieved in organizations by participants. The quantitative data was complemented by qualitative data which reported the personal development of participants’ leadership skills and awareness. Lessons for future evaluation of leadership-development programmes are suggested. Sufficient time needs to be built into the design and delivery of programmes to embed ongoing evaluation within the development process. Time spent on this at early stages aids an in-depth understanding and high level of ownership of the evaluative process by participants. To gain optimum benefit from stakeholder rating, the choice of stakeholders involved needs to take account of unavoidable stakeholder attrition. Methods for identifying organizational support for change, the relative involvement of chosen stakeholders in the change process, and external sources of data to triangulate the reported outcomes, would also enhance the overall evaluation approach.

Abstract: Mature-aged entry students have been found, in previous research, to experience difficulties not always shared by their younger classmates. The majority of research has used quantitative approaches to explore these differences. The aim of this qualitative study was to explore the experiences of mature-aged medical students in relation to their learning at university. Four students from one Australian medical school were interviewed about their experiences, and the data were analysed qualitatively. Ten themes were identified: perceived differences between mature-aged and younger students; financial difficulties; social support; relationship problems; illness; negative emotions; discrimination; necessary personality traits; supportive relationships; and the emotions experienced on being able to study medicine. These students undergo a number of substantial stressors as a result of their studies. Given the desirable qualities that they possess, medical educators should be developing strategies to encourage such students and minimize the obstacles they face.

Abstract: This article explores perspectives on the idea of ‘the good healthcare practitioner’, through active consideration of virtue theory and how virtue could be embedded and developed in the lives of healthcare practitioners. It draws particularly on exploratory work with a small number of medical students and general practitioners, in which these participants were asked to reflect on what, for them, constituted ‘the good doctor’. Three key themes emerged from this empirical work: the idea of medicine as a ‘lived experience’ and the potential of this to contribute to developing the lives of ‘good doctors’; the importance of relationships with patients in understanding who is a ‘good doctor’; and the essential need to attempt the marrying of technical medical knowledge with humanistic skills and intuitive sympathy in ‘good medical lives’. The article reflects on the implications of these themes for medical education and training in particular, and more generally for the wider healthcare field. Some methodological difficulties in the relationship between theoretical conceptions and these empirical investigations are discussed, as are those connected to using the experience of medicine as an exemplar for how the ‘good lives’ of healthcare practitioners, in general, might be developed.

Abstract: The contemporary relationship between theory and practice in interprofessional learning and development is explored in the context of the United Kingdom (UK) government’s multiple reform policies for ‘modernizing’ health and social care. As part of a 1-year action research programme, four local case studies in London are described. These illustrate the new collaborations being created and point to the importance of understanding, as a priority for future research and organizational developments in primary care, the changing and complex roles of non-statutory stakeholder agencies and process facilitation. Both are emerging as critical factors for effective policy implementation. Overall, the London-wide programme indicates the dysfunctional nature of excessively linear conceptual models, and the need, in practice, to espouse eclectic and dynamic approaches to theories for learning in health and social care.

Abstract: This paper reports an evaluation of a management training course undertaken by local authority social services staff. Most participants felt that the course was successful, and positive impacts on practice were reported in both the quantitative and qualitative phases of the study. Areas of change and potential change in practice were identified. More specifically, the course had significant short-term impacts on the skills of course participants. Course participants were more aware of their training needs than the controls. Course participants stressed that training courses cannot stand alone: support was needed via follow-up and supervision.

Abstract: The aim of this work was to evaluate the impact of training in the use of the Consultation Assessment and Improvement Instrument for Nurses (CAIIN) in the context of expanding roles for primary care nurses. To achieve this, 10 experienced primary care nurses undertook a 3-day workshop in using the CAIIN to evaluate videotaped consultations between nurses and patients, and consultations between course participants and simulated patients. The impact of the workshop was assessed by questionnaire and semistructured interview. All participants found the CAIIN to be an acceptable approach to analyse and improve the consultation performance of themselves and others. They believed that it would further improve their existing skills, and provided a useful framework for learning those aspects of consultation competence in which they had less confidence. Several found role-play with simulated patients stressful. Concerns about the role of nurses in clinical problem-solving were reduced, but remained significant. The CAIIN was considered to have good potential as a learning tool as part of continuing professional development and clinical supervision. In conclusion, the rapidly expanding roles of primary care nurses requires serious consideration to be given to assessing and improving their consultation skills. The CAIIN provides an acceptable method of doing so. However, learning to use the instrument effectively requires expertise amongst teachers and significant protected learning time for nurses who become assessors or mentors of their peers.

Abstract: This article aims to provide an evaluation of the ‘Trailblazers’ programme, and seeks to identify the factors affecting the impact of the programme. ‘Trailblazers’ is a learner-centred ‘Teaching the Teachers’ programme in primary care mental health. In the first programme to be run in the West Midlands, seven pairs of participants attended three residential modules and developed an action plan that was cascaded to local colleagues. A primarily qualitative investigation, exploring the experiences of the first cohort of 14 Trailblazers in the West Midlands, demonstrated that the modules were well received and over 200 other professionals benefited from education sessions delivered by the participants. Most delegates were keen to be involved in future programmes and regional policy-making. The Trailblazers programme demonstrated short-term effectiveness in terms of participant reaction, knowledge and changes in professional practice.

Abstract: This study set out to identify the important aspects of training placements as perceived by specialist registrars (SpRs) in accident and emergency medicine (A&EM). These data were to be used to gain greater insight into the collective wishes of this group in order to inform the development of quality assurance systems. A self-administered questionnaire was developed from repertory grid data and was used to identify what were the 'essential', 'useful' and 'not needed' aspects of A&EM training placements. The questionnaire covered 'the job', 'the department', 'clinical experiences', 'support for learning' and 'training'. SpRs were also asked how frequently they wished certain activities to take place. The questionnaire was completed by 16 of the 17 A&EM SpRs (94%) training in the Northern Deanery. Of the 82 statements submitted to the SpRs, 40% (33) were marked as 'essential' by 75% or more of the registrars. Aspects classed as 'essential' by the highest number of SpRs were concerned with the recognition of their role as learners within a service environment and with how their learning was supported. SpRs felt it was essential to be integrated into the work team with a clear role that was understood to combine 'education' and service provision. Although there was consensus, the findings also showed the SpRs' individuality in terms of their learning and support needs. The study illustrates the complexity of defining quality indicators for evaluating training processes in work placements and suggests that quality lies not just in the components of a system for managing education but also in the flexibility of its application and in aspects of the 'learning culture'.

Abstract: Self-harm has become one of the great taboos of our time. In men it is even less acknowledged, accepted and understood than it is in women. This report looks at the almost invisible population of men who self-harm. Using interviews with men who self-harm, it explores their experiences and their perspectives on the support and services to which they have access. It draws on these perspectives to identify what professionals, service providers and commissioners can learn from men who self-harm and proposes ways forward to better meet their needs.

Abstract: The integration of health and social care services, and the move towards a professionalized social care workforce, has stimulated interest in evidence-based social care. A literature review reveals a workforce, poorly equipped by professional education, relying heavily on personal communication and ‘gut instinct’ to deliver packages of care. A workplace culture of action, not reflection, and the absence of information resources and skills, make social care practitioners less likely to consult research to improve their practice. This study aimed to discover whether training in information and research skills training, as currently delivered in healthcare, is of interest to social care practitioners. A postal questionnaire was sent to 595 social care practitioners in the Trent region to determine their attitudes to evidence-based practice, access to information and their training requirements. Twenty-seven practitioners were subsequently interviewed to gain further insight into these issues. Seventy-one per cent of questionnaire respondents had taken a qualification during their career, and less than 50% of the respondents had received training in using research findings or the Internet. Even fewer had been taught to interpret research findings. Around 75% had had no instruction on searching literature databases. Just over 50% of respondents favoured evidence-based practice within social care, but many had reservations regarding its success. Three of the five most popular topics for professional development had an existing health equivalent. Interest decreased as topics moved from practical skills towards methodologies and research skills. The study concludes that training should be pitched at a pragmatic rather than an academic level, should support existing work activities, and be targeted at a diploma-equivalent educational level. Provision should also be made for those without a professional qualification.

Abstract: The concept of organizational learning has continued to capture the interests of scholars and practitioners. At the core of this notion is the belief that organizational learning provides a number of advantages. Some of these advantages include improved team performance, enhanced service quality, better quality-of-work life and, ultimately, competitive advantage. Hence, not surprisingly, there is a sustained upsurge in the interest of organizational learning. Moreover, there is widespread acceptance that learning could occur at the individual, team and organizational levels. Understanding of learning orientations at these three levels has the capacity to advance the current knowledge and practice of organizational learning. In spite of an outpouring of literature on learning, empirical research on organizational learning is still scarce. Thus, the three linkages addressed in this current study include: individual learning and organizational learning; team learning and organizational learning; and individual learning and team learning. These linkages were examined in a field study of an Australian hospital, where 189 respondents participated in an organization-wide survey. Interestingly, individual learning was not significantly related to organizational learning. However, individual learning was a significant predictor of team learning. Team learning was significantly related to organizational learning. The implications of the research findings are discussed.