The Acute Care Undergraduate TEaching (ACUTE) initiative: consensus development of core competencies in acute care for undergraduates in the United Kingdom

Background: The care of the acutely ill patient in hospital is often sub-optimal. Poor recognition of critical illness combined with a lack of knowledge, failure to appreciate the clinical urgency of a situation, a lack of supervision, failure to seek advice and poor communication have been identified as contributory factors. At present the training of medical students in these important skills is fragmented. The aim of this study was to use consensus techniques to identify the core competencies in the care of acutely ill or arrested adult patients that medical students should possess at the point of graduation. Design: Healthcare professionals were invited to contribute suggestions for competencies to a website as part of a modified Delphi survey. The competency proposals were grouped into themes and rated by a nominal group comprised of physicians, nurses and students from the UK. The nominal group rated the importance of each competency using a 5-point Likert scale. Results: A total of 359 healthcare professionals contributed 2,629 competency suggestions during the Delphi survey. These were reduced to 88 representative themes covering: airway and oxygenation; breathing and ventilation; circulation; confusion and coma; drugs, therapeutics and protocols; clinical examination; monitoring and investigations; team-working, organisation and communication; patient and societal needs; trauma; equipment; pre-hospital care; infection and inflammation. The nominal group identified 71 essential and 16 optional competencies which students should possess at the point of graduation. Conclusions: We propose these competencies form a core set for undergraduate training in resuscitation and acute care.

Developing children and young people’s participation in strategic processes: the experience of the Children’s Fund Initiative

The extent of children’s and young people’s participation activities has increased considerably among statutory, voluntary and community sector organisations across the UK in recent years. The Children’s Fund, a major government initiative launched in 2000, represents a systematic drive towards promoting children and young people’s participation in planning, implementing and evaluating preventative services within all 149 local authority areas in England. Based on research carried out by the National Evaluation of the Children’s Fund, this paper explores the experience of Children’s Fund partnerships of engaging children and young people in strategic processes.

Perspectives on community representation within the Extractive Industries Transparency Initiative: experiences from south-east Madagascar

This article critically examines the nature and quality of governance in community representation and civil society engagement in the context of trans-national large-scale mining, drawing on experiences in the Anosy Region of south-east Madagascar. An exploration of functional relationships between government, mining business and civil society stakeholders reveals an equivocal legitimacy of certain civil society representatives, created by state manipulation, which contributes to community disempowerment. The appointment of local government officials, rather than election, creates a hierarchy of upward dependencies and a culture where the majority of officials express similar views and political alliances. As a consequence, community resistance is suppressed. Voluntary mechanisms such as Corporate Social Responsibility (CSR) and the Extractive Industries Transparency Initiative (EITI) advocate community stakeholder engagement in decision making processes as a measure to achieve public accountability. In many developing countries, where there is a lack of transparency and high levels of corruption, the value of this engagement, however, is debatable. Findings from this study indicate that the power relationships which exist between stakeholders in the highly lucrative mining industry override efforts to achieve "good governance" through voluntary community engagement. The continuing challenge lies in identifying where the responsibility sits in order to address this power struggle to achieve fair representation.

"The Poet of Science": how scientists read their Tennyson

Tennyson’s responses to science have been thoroughly documented and discussed, but how did scientists respond to his poetry? Through examining in detail the work of three scientists who wrote at length about Tennyson--the astronomer Norman Lockyer, the physicist Oliver Lodge, and the American geologist William North Rice--it is possible to see how Tennyson went from being respected by contemporary scientists to being feted as the Poet of Science itself after his death. As a materialist, a Spiritualist, and a Darwinian Methodist respectively, Lockyer, Lodge, and Rice had very different conceptions of how science worked and what it implied about the universe, yet each looked to Tennyson and his poetry to confirm and extend his own judgements and values.