Implications of aligning full registration of doctors with medical school graduation:a qualitative study of stakeholder perspectives

OBJECTIVES: The Shape of Training report recommended that full registration is aligned with medical school graduation. As part of a General Medical Council-funded study about the preparedness for practice of UK medical graduates, we explored UK stakeholders' views about this proposal using qualitative interviews (30 group and 87 individual interviews) and Framework Analysis.

SETTING: Four UK study sites, one in each country.Save

PARTICIPANTS: 185 individuals from eight stakeholder groups: (1) foundation year 1 (F1) doctors (n=34); (2) fully registered trainee doctors (n=33); (3) clinical educators (n=32); (4) undergraduate/postgraduate Deans, and Foundation Programme Directors (n=30); (5) other healthcare professionals (n=13); (6) employers (n=7); (7) policy and government (n=11); (8) patient and public representatives (n=25).

RESULTS: We identified four main themes: (1) The F1 year as a safety net: patients were protected by close trainee supervision and 'sign off' to prevent errors; trainees were provided with a safe environment for learning on the job; (2) Implications for undergraduate medical education: if the proposal was accepted, a 'radical review' of undergraduate curricula would be needed; undergraduate education might need to be longer; (3) Implications for F1 work practice: steps to protect healthcare team integration and ensure that F1 doctors stay within competency limits would be required; (4) Financial, structural and political implications: there would be cost implications for trainees; clarification of responsibilities between undergraduate and postgraduate medical education would be needed. Typically, each theme comprised arguments for and against the proposal.

CONCLUSIONS: A policy change to align the timing of full registration with graduation would require considerable planning and preliminary work. These findings will inform policymakers' decision-making. Regardless of the decision, medical students should take on greater responsibility for patient care as undergraduates, assessment methods in clinical practice and professionalism domains need development, and good practice in postgraduate supervision and support must be shared.

The Masculine Habitus as 'Distributed Cognition': A Case Study of 5- to 6-Year-Old Boys in an English Inner-City, Multi-Ethnic Primary School

This article provides a case study demonstrating the active role that 5- to 6-year-old boys in an English inner-city, multi-ethnic primary school play in the appropriation and reproduction of their masculine identities. It is argued that the emphasis on physicality, violence and racism found among the boys cannot be understood without reference to the immediate contexts of the local community and the school within which they are located. In making this argument the article draws upon and applies the concept of the habitus and develops this with the notion of 'distributed cognition' as proposed in sociocultural theory. Some of the implications of this analysis for working with boys in early years settings are discussed in the conclusion.

The contested notion of a pluralist School Ethos

Debates around the importance of school ethos have gathered pace in recent years. Whilst it is not clear why this concept has become increasingly important in the educational vernacular the marketisation of education seems to have had some effect. As schools are forced to compete they have become concerned to identify and promote their 'Unique Selling Points' as a means of attracting and maintaining a long term 'customer' base. Defining a school in terms of its particular 'ethos' therefore offers a useful means of identifying and encapsulating the particular strengths of the school. It is thus not uncommon for heads to market their schools on the basis of their endorsing a 'liberal ethos' a 'caring ethos' or a 'sporting ethos' (Gardner, 2003).

The purpose of this chapter is to use empirical evidence to explore the meaning of a 'pluralist ethos' or 'integrated ethos', within the integrated school context in Northern Ireland.

Constructing The Ethos of Tolerance and Respect in an Integrated School: The role of Teachers

This article seeks to explore how teachers develop tolerance and respect within an inclusive school
in Northern Ireland. Drawing on interviews and observation of 18 teachers, it will be shown that
teachers’ own personal values and assumptions exert a defining influence on the school ethos. It will
be argued that if teachers are not accorded the time and space to develop an understanding
of their own values and beliefs then there is the potential for schools to simply reinforce the psychological
barriers which sustain division.

What price harmony? Teachers' methods of delivering an ethos of tolerance and respect for diversity in an integrated school in Northern Ireland

The aim of the paper is to explore teachers’ methods of delivering an ethos of tolerance, respect
and mutual understanding in one integrated secondary school in Northern Ireland. Drawing on
interviews with teachers in the school, it is argued that most teachers make ‘critical choices’
which both reflect and reinforce a ‘culture of avoidance’, whereby politically or religiously contentious
issues are avoided rather than explored. Although teachers are well-intentioned in making
these choices, it is shown that they have the potential to create the conditions that maintain or even
harden psychological boundaries between Catholics and Protestants rather than dilute them.

Teachers and pupils: educational experiences and school based responses to the conflict in Northern Ireland

This article describes a study which examined (a) the impact of the political conflict on teachers' and ppils' experiences of education in Northern Ireland and (b) the impact of curricular-based interventions designed to support the ppils and reduce prejudice. The focus of the second part of the article is on the prejudice reduction initiatives identified. A total of 44 staff and 78 pupils spread across 8 schools participated and both teachers' and ppils' perspectives were identified, the latter being an extremely important dimension which has rarely been addressed in previous studies of this area. The findings, which highlight the complexity of the impact of the political conflict, are considered to have both practical and theoretical implications for prejudice reduction programs.