Procedural trained, procedural remain : the first report from 'A census of doctors who have been awarded the Graduate Diploma in Rural General Practice (GDRGP)'

Aims & rationale/Objectives : To document the practice of initial cohorts receiving the Graduate Diploma in Rural General Practice
Methods : With the co-operation of the National Rural Faculty (NRF) of Royal Australian College of General Practitioners (RACGP), a census by questionnaire was conducted on 279 graduates. The response rate was 70%.
Principal findings : The target doctors are young (65% < 40 years old). Under half (42.3%) have completed Advanced Rural Skills terms in >1 discipline. Of the total 272 posts recorded from 174 respondents, the most popular advanced skill is anaesthetics, followed by obstetrics. The ARSP increased confidence in 96.3% of respondents. Two thirds of doctors trained in a procedural skill remain practicing procedural General Practice.
Discussion : The GDRGP was the qualification developed to recognise competency gained as a result of a series of rural training initiatives begun within the RACGP Training Program in 1992. Its delivery has continued under the new GPET Training Program. Outcomes from the range of initiatives leading to the GDRGP are currently emerging in an environment which has seen significant changes within vocational training, and within the context of a rising focus on indemnity. Doctors who undertook this training have mostly retained procedural practice. In addition, RACGP rural initiatives successfully achieved increase confidence prior to rural work in advanced areas of practice, with >95% reporting an increase.
Implications : Changes within vocational training were accelerated without analysis of existing initiatives such as the GDRGP. Funding for the GDRGP was, as a result, withdrawn prematurely. These changes also saw the entrant of a second College with an interest in rural procedural practice. This research show that the GDRGP offers, and offered, a clear vocational pathway that will guide a doctor to a career as a rural doctor, and provide them with the advanced skills they need to practice confidently in the bush. It is important to capitalise on past success before deconstructing professional concepts of practice further.
Presentation type : Paper

The effect of using trained versus untrained adult respondents in simulated practice interviews about child abuse

Objective
A single study tested the hypothesis that simulated practice interviews for investigative interviewers of children are more effective when the role of the child respondent is played by trained actors (i.e., postgraduate psychology students) than untrained fellow participants (i.e., child protection workers).
Method
The interviewers included 50 child protection service workers. Each interviewer received instruction in the use of open-ended questions and then engaged in two simulated practice interviews. The role of the child respondent in the practice interviews was played by either a trained psychology student or an untrained fellow participant. The key outcome measure was the proportion of open-ended questions, which was assessed immediately prior to and after the practice sessions, as well as 12 weeks post-training.
Results
Interviewers who had practiced with trained actors had higher post-training performance (M = .83, SD = .12) compared to those who had practiced with untrained fellow participants (M = .73, SD = .13, p < .05), even at the 12-week follow up (M actors = .66, SD = .25; M untrained actors = .49, SD = .23, p < .05).
Conclusions
Training programs that make better use of practice opportunities (e.g., by using trained respondents) will be more effective in improving the performance of investigative interviewers.
Practice implications
A single study investigated the relative effectiveness of two simulated practice exercises for professionals who interview children about abuse. This research is relevant to professionals who design investigative interviewer training programs because it indicates that practical exercises, which are currently chosen on an ‘ad hoc’ or convenience basis, can vary markedly in their effectiveness in encouraging adherence to open questions.

Development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand

This paper reports the three-stage development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand. In Study 1, clinical indicator statements (n = 99) generated from focus group data, which were considered to be unobservable in the nursing documentation in consumer case notes, were included in a three-round Delphi process. Consensus of ratings occurred for the mental health nurse and academic participants (n = 7) on 83 clinical indicator statements. In Study 2, the clinical indicator statements (n = 67) that met importance and consensus criteria were incorporated into a questionnaire, which was piloted at a New Zealand mental health service. The questionnaire was then modified for use in a national field study. In Study 3, the national field study, registered mental health nurses (n = 422) from 11 New Zealand District Health Board mental health services completed the questionnaire. Five categories of nursing practice were identified: professional and evidence-based practice; consumer focus and reflective practice; professional development and integration; ethically and legally safe practice; and culturally safe practice. Analyses revealed little difference in the perceptions of nurses from different backgrounds regarding the regularity of the nursing practices. Further research is needed to calibrate the scores on each clinical indicator statement with behaviour in clinical practice.

Developing effective learning programs : what extension can learn from the fields of adult education and learning communities

Learning is an investment in capacity building that has and will continue to reap rewards for primary producers and government in terms of increased sustainable production, profitability, exports, jobs and sustainable rural communities. Primary production operates in a context of continual change and requires up to date, complex and varied skills of primary producers and land managers.

A recent national research project funded by the Department of Agriculture, Forestry and Fisheries Australia confirmed that application of best practice from the theory of adult education in designing and developing learning programs in primary industry results in learning activities that provide information that is relevant to farmers’ needs, delivered in an entertaining way, and that draws on examples directly relevant to the participants. As a result, the training often exceeds the expectations of the participants.

The project produced a self-assessment checklist to identify ways of improving the development and delivery of training for extension practitioners and training providers. The key issues include continuous monitoring of client’s needs, and actively seeking opportunities to meet and work with industry organisations, other training providers and funding bodies.

There appear to be two drivers for the development of learning programs. One is problems or opportunities identified by people and organisations that could be termed ‘scanners’ and who tend not to be potential participants, the other is learning needs expressed by individuals or enterprises who want to participate in learning activities (participants). Scanners are typically industry organisations, government agencies and researchers, but may include providers and participants. Extension practitioners are well-placed to act as scanners.

It is very important that farmers and farmer organisations contribute to the development of new learning programs. Without industry input and support, extension practitioners and training providers cannot be expected to ensure they meet client needs. In other words, to develop effective learning programs, there must an industry learning community of producers, industry organisations, extension practitioners and training providers and other stakeholders such as supply chain enterprises, government and researchers.

Dancing the thesis : potential and pitfalls in practice-led research

Practice-led or multi modal these (describing examinable outcomes of postgraduate study which comprise the practice of dancing/choreography with an accompanying exegesis) are an emerging strength of dance scholarship; a form of enquiry that has been gaining momentum over a decade, particularly in Australia and the United Kingdom. It has been strongly argued that, in this form of research, legitimate claims to new knowledge are embodied predominantly within the practice itself (Pakes 2003) and that these findings are emergent, contingent and often interstitial contained within both the material form of the practice and in the symbolic languages surrounding the form.

This paper draws on Dancing between diversity and consistency: Refining assessment in postgraduate studies in dance, a study conducted with funding by the Australian Learning and Teaching Council 2006-2008, to critically examine some of the issues raised by such degrees. The study's structure formed around extensive literature reviews into higher degree dance studies; general examination/assessment discussions at research masters and doctoral levels; and issues arising from the relatively new artistic degrees involving practice components. Focus group discussions and semi-structured interviews with 74 supervisors/examiners, research deans and administrators, and candidates/graduates elicited the views on assessing practice-led dance research of two principal participant groups; the professional dance community represented by Ausdance (The Australian Dance Council) and the staff and student cohort of Australian universities who offered dance or related postgraduate degrees.

Tensions arose through the project specifically in terms of deciding what kinds of articulations of practice-led dance research might be acceptable at the PhD level. Here, we address underlying issues of interdisciplinarity that arise from the current common practice of requiring a written requirement for PhD theses. This leads to a consideration of how differing cultural inflections and practices might be incorporated into our reading and evaluation of theses, how creative approaches to layered documentation can function as durable artifacts of creative research while contributing to the overall 'knowledge generation' of the thesis, and what kinds of language structures, such as metaphor, allusion and symbol, can be co opted to function generative in dialogue with other kinds of texts and discourses.

An evaluation of a self-intiated practice exercise for investigative interviewers of children

The current study extends debate and research on the important role of practice in promoting and sustaining complex skills in investigative interviewing. Specifically, we explored the use of self-initiated practice as one avenue for facilitating ongoing development of professionals who interview children about abuse. A group of 40 investigative interviewers were required to organise and administer their own practice opportunities and to document these sessions in a diary. The professionals were aware of the important role of practice and what constitutes best-practice interview guidelines; however no instruction was given about the desired format, structure and timing of the practice sessions. A combination of quantitative and qualitative analyses revealed poor adherence to self-initiated practice, and the practice (among those who adhered to this model) had negligible impact on performance. Overall, these findings highlight the need for careful monitoring and evaluation of all interviewer practice tasks.

Community development and enterprise culture : prospects and dilemmas

Community Development as a form of practice promotes empowerment and social justice. Its origins lie in people's collective struggle to be heard, recognised and accorded full citizenship in society. It has developed strategies to achieve social change that challenge dominant ways of thinking, policy and resource allocation in society. 'Enterprise culture has its origins in the individualism and competitiveness of capitalism. These essentially neo-liberalist concepts have been remoulded into a radical political program of change sponsored by the state under the guise of new managerialism, competitive tendering and privatization. This research seeks to examine the interface between community development and enterprise culture as a potential site of tension and contestation through an analysis of discourse. The initial task, therefore, was to elaborate the concept of enterprise culture and examine the ways enterprise culture has been manifested in community development. The focus has been on practitioners committed to community development through a qualitative, empirical approach with a view to discerning their views on the relevance and impact of enterprise culture on their work. Community development provides a useful domain for interrogating the infiltration of the concept of the enterprise culture because of its history of opposition and mobilisation. The research seeks to understand the ways in which the forms of enterprise culture as an essentially cultural project are manifested in practice contexts and to analyse the nature of the response to its various manifestations. As a result, it constitutes more than just a critique of any one of these forms, eg, privatisation, tendering out, managerialism, and instead seeks to investigate the degree to which a cultural shift may be occurring towards notions of greater individualism and away from collective notions of responsibility, obligation and citizenship. The research critically analyses the impact of enterprise culture on Australian social policy through the case study of community development practice. The manifestations of enterprise culture are investigated at various levels, with an emphasis on the responses of practitioners. A related aim is to reveal the range of possible responses to the infiltration of the enterprise culture in terms of values, language and practice into community development. Are new forms of practice emerging or is the field being steadily co-opted by government social and educational policy? Finally, the research should enable some future directions to be identified for the field of community development. The findings represent an initial attempt in an Australian context to establish the degree of influence that enterprise culture has had and/or will have on social policy. Chapter 1 examines the concept of enterprise culture and a background to its impact on community development as a domain of practice. The meaning of enterprise culture and its origins will be examined in Chapter 2. Its influence on Australian social policy is then discussed with particular reference to recent changes in Victoria regarding family services. In Chapter 3, the main features of critical discourse analysis are outlined as a framework for subsequent analysis of the links between discourse and hegemony. The work of Fairclough (1992, 1995) is utilised to highlight the relevance of discourse analysis to an examination of the infiltration of ideas associated with enterprise culture into the domain of community development. Chapter 4 provides an overview of the origins and defining characteristics of community development practice. The diverse beginnings and philosophical underpinnings are discussed and the main features of community development outlined in order to establish meanings attached to key concepts such as empowerment and participation. In Chapter 5, the findings of initial interviews with sixteen community development practitioners are discussed in terms of their perceptions of the impact of enterprise culture on their practice and the organisational culture within which they operate. These initial interviews were conducted in November-December 1996. A primary focus of the interviews was to establish the key words in their lexicon of practice and to provide an opportunity for reflection on the relative influence of discourse and practices associated with enterprise culture. A framework for analysing and making sense of the forms of response to enterprise culture is applied to the responses. Four forms of possible response are proposed and discussed in the context of the data. Follow up interviews were conducted in November-December 1997 and the findings of these interviews are discussed in Chapter 6. A particular emphasis in these interviews was on any changes in the lexicon of practice and indications of a change in the impact of discourse and practices associated with enterprise culture. The forms of response suggested in the framework outlined in Chapter 5 are discussed in the light of any movement in the responses of participants in the study. The implications of the findings are discussed in the context of the framework of responses or forms of embrace of enterprise culture analysed in earlier chapters. Finally, in Chapter 7, the potential for community development as a form of practice to transcend or at least accommodate the impact of enterprise culture through strategic forms of embrace is discussed and possible strategies based on the research that may assist in the development of this response are proposed.

Empowerment in early childhood intervention : perspectives of parents of children with disabilities

There have been various changes to the manner in which early intervention services for children with disabilities have been provided in recent decades. One of the most significant paradigm shifts that has accoured pertains to a change in the level of family involvement in early intervention, so that families are now required to be equal partners with professionals in the service provision process. It is now policy in Victoria that early intervention services follow a family-centred model of practice. Services adopting this model aim to empower parents, so that they may have impact on their lives, and the lives of their family members, both during and beyond the years of direct service participation. Much of what is known about empowerment to date is based on theory, author opinion, and research that is largely survey-based. There has been little interview-based research, particulary involving parents of children with disabilities, as well as little Australian research conducted regarding empowerment. To the researcher's knowledge, there has been no interview-based research that specifically asked parents of children with disabilities about their perspectives on empowerment and disempowerment. Parents of children with disabilities are not invited to contribute their opinions in services and research. Empowerment is an individual concept and this research provided parents with an opportunity to express their views on this topic. Parent's perspectives on empowerment are vital for service providers who aim to follow the intervention model required by policy. This research, which was guided by the principles of ecological theory and critical theory, involved to individual semi-structured interviews with 37 Victorian families of children with disabilities. Twenty-one of these families had children currently participating in early intervention services, and 16 families had children of mid-primary school age, who had previously participated in early intervention experiences; the factors that they believe influence empowerment and disempowerment; and helpful and unhelpful experiences with early intervention staff and other people in their lives. Data were analysed primarily inductively, in the context of grounded theory. Responses from the two groups of parents were then compared, as were different emergent themes according to helpfulness and empowerment. The nature of enduring empowerment, one of the key objectives of early childhood intervention, was also considered. From the analysis of data, several themes emerged as influential in the empowerment process for both groups of parents including: information, education and knowledge; meeting and talking with other families of children with disabilities; decision-making and choice; having confidence; participation, involvement and input; meeting or addressing families' practical needs; and having a child with a disability. The results of this research provide valuable information for parents, professionals, agencies, organisations, and the wider community, regarding how families can be supported more effectively and how power can be more equitably balanced.

Knowing practice in English teaching? Research challenges in representing the professional practice of English teachers

This article problematises representations of professional practice. It investigates assumptions behind received accounts of professional practice, including professional standards that purportedly capture what accomplished English teachers “should know and be able to do”, “scientific” studies that construct accounts of classrooms from the standpoint of academic researchers, and narratives written by teachers that claim to explore dimensions of classroom teaching that elude outside observers. Especially significant are attempts by practitioner researchers to develop accounts of their professional practice vis-a-vis constructions of their work from other standpoints. We argue that it is timely for practitioner researchers to reflexively examine the conditions for producing such accounts, and to address the question of the validity of their knowledge claims. Yet this is also – crucially – more than an epistemological issue, but one that requires acknowledging the primacy of practice for engaging with the complexities of classroom settings. This article gives an account of our ongoing efforts to develop forms of representation that might begin to do justice to the complexities of practice in comparison with accepted accounts of what English teachers know and do. We intend it to be read as a position paper which outlines a framework for research on English teaching as a dynamic culture practice.

Understanding the mediatisation of educational policy as practice

The main argument presented in this paper is that the mediatisation of education should be viewed as forms of practice linked to specific practice effects. Drawing on Bourdieu's conceptualisation of practice - as elements of practice, practice games and field effects - the paper argues that viewing mediatisation as practice provides a set of methodological starting points for research involving media interactions with education. Taking the mediatisation of education policy as an empirical case for the argument, the contribution of the paper is to raise questions about how the term is utilised in educational research and to suggest that the practice is more open and complex than some accounts suggest. A secondary argument presented in this paper is that Bourdieu's account of practice provides resources suitable to developing research on mediatisation as an addition to social field theorising of processes.

Practice chains of production and consumption : mediatized practices across social fields

The argument developed in this paper is that a focus on practice provides some resolutions to methodological problems facing Bourdieuian scholarship in education. In order to develop Bourdieu's work on practice to account for the interactions between practices, this paper presents a conceptualization of practice as chains of production and consumption. The first part of the paper reviews the account of practice offered by Bourdieu both embedded in practice games and as field effects. The second part of the paper introduces practice chains of production and consumption as a way to conceptualize practice by drawing on a case involving print journalists' involvement with policy makers over the course of an Australian policy review. The final section presents a discussion of this conceptualization and highlights the potential of the concept for further research in understanding the processes of educational policy development.

Policy, practice and purpose in the field of education : a critical review

This paper provides a critical review of papers in this special issue on Bourdieu and practice. What is different about this collection is that, in analysing policy and practice through a Bourdieusian lens, the thinking tools of field, disposition (collective and individual), logics of practice and doxa have been mobilised with regard to the social practices of educational policy - its production, circulation and reception. First, these papers illustrate how, as a field, education has its own language, boundaries and power relations informed by particular modes of distinction and legitimation around different forms of capital formation, thus providing explanations for both social mobility and social stratification. Second, this collection foregrounds 'policy as practice' in terms of the social practices involved in the production of policy, the practices involved with the articulation and vernacularisation of policy through the processes of its reception, as well as the intent and effects of policy changing practice. Third, in focusing on specific policy problematics in higher education and schools, teacher professional development, leadership and educational reform, these contributions illustrate multiple methodological approaches as to how Bourdieu's thinking tools can be used to theorise educational policy, change, practice and effects. The value of Bourdieu's work lies on getting past the impasses between divisions between material and cultural analyses, between the materialist and linguistic focus, by talking about social practices, what people are doing, how they are thinking and how they are acting.

The TrueBlue study : is practice nurse-led collaborative care effective in the management of depression for patients with heart disease or diabetes?

Background: In the presence of type 2 diabetes (T2DM) or coronary heart disease (CHD), depression is under diagnosed and under treated despite being associated with worse clinical outcomes. Our earlier pilot study demonstrated that it was feasible, acceptable and affordable for practice nurses to extend their role to include screening for and monitoring of depression alongside biological and lifestyle risk factors. The current study will compare the clinical outcomes of our model of practice nurse-led collaborative care with usual care for patients with depression and T2DM or CHD.

Methods: This is a cluster-randomised intervention trial. Eighteen general practices from regional and metropolitan areas agreed to join this study, and were allocated randomly to an intervention or control group. We aim to recruit 50 patients with co-morbid depression and diabetes or heart disease from each of these practices. In the intervention group, practice nurses (PNs) will be trained for their enhanced roles in this nurse-led collaborative care study. Patients will be invited to attend a practice nurse consultation every 3 months prior to seeing their usual general practitioner. The PN will assess psychological, physiological and lifestyle parameters then work with the patient to set management goals. The outcome of this assessment will form the basis of a GP Management Plan document. In the control group, the patients will continue to receive their usual care for the first six months of the study before the PNs undergo the training and switch to the intervention protocol. The primary clinical outcome will be a reduction in the depression score. The study will also measure the impact on physiological measures, quality of life and on patient attitude to health care delivered by practice nurses.

Conclusion: The strength of this programme is that it provides a sustainable model of chronic disease management with monitoring and self-management assistance for physiological, lifestyle and psychological risk factors for high-risk patients with co-morbid depression, diabetes or heart disease. The study will demonstrate whether nurse-led collaborative care achieves better outcomes than usual care.

Describing chronic pain : towards bilingual practice

This paper reports on the findings of a pilot study that collated and categorised a range of Welsh-medium chronic pain descriptors and their conceptually equivalent English translations in order to provide a preliminary basis for chronic pain assessment amongst patients in the bilingual community of North West Wales. The results demonstrate the unique and complex nature of individual pain experiences and the challenges of meaningful interpretation, particularly when patient and practitioner do not share a common preferred language. Detailed analysis of the descriptors provided valuable insight into the patient's world, revealing cultural patterns of beliefs and behaviours as well as the suffering associated with chronic pain. Implications for improving chronic pain assessment amongst bilingual speakers are explored.

An examination of financial counselling discourses in Victoria

This thesis investigates the model of practice invoked by the Victorian financial counselling sector. It analyses why community development is inconsistent with the sector's casework approaches to practice, identifies the emergence of a different model of practice and explains financial counselling within the current theoretical context of risk society.