Trainee underperformance: a guide to achieving resolution

BACKGROUND: Underperformance and the disharmony it can cause are not commonly faced by trainees. However, when it occurs, a process to recognize and manage the issues compassionately must be put in place. METHOD: A literature review was undertaken to outline processes and themes in addressing and resolving these types of issues. A PubMed search using 'surgical underperformance' and 'remedial teaching' was used as a broad template to find papers that illustrated key concepts. One thousand four hundred and fifteen papers were identified. In papers where the titles were in line with the stated topic, 294 abstracts were reviewed. Key papers were used to develop themes. Additional cross-referenced papers were also included where relevant. RESULTS: There can be a variety of reasons for trainee underperformance. The root cause is not always clear. Disharmony can result in a surgical unit during this time. The involved trainee as well as the members of the clinical unit may experience a variety of stressors. A systematic process of management can be used to evaluate the situation and bring some resolution to difficulties in working relationships. CONCLUSION: Early constructive intervention improves outcomes. There should be a process to systematically and compassionately resolve underlying issues. This paper outlines the disharmony that can result from trainee underperformance and offers guidance for resolution to those involved.

'Of course I didn't work … only when I had to': narratives of women's working lives and what really counted

There was a long-held belief, that, prior to the 1970s, women were no longer involved in paid labour once they were married or began to have children. Official statistics also supported this particular national narrative. This paper argues that this narrative did not accurately reflect the historical situation because the methods used to determine who worked and when did not fully capture all of women's paid labour at the time. This is reflected in a small study of older women and their recollections of paid employment. Some women initially claimed that they did no paid work after marriage, but with low key, in-depth and persistent questioning, it became clear that many women did work in an unofficial capacity (in the black economy) or alongside their husbands in their paid employment. This is a preliminary study that underlines the importance of life-course narratives in the social sciences to delve deeply into women's memories and thus their experiences.

The challenge of reconciling working time demands and life transitions : a policy proposal

Labour markets, like all market institutions, exhibit structural and dynamic characteristics. Both the structural and dynamic characteristics of labour markets inevitably change and evolve over time in response to a host of exogenous and endogenous factors. In the case of the Australian labour market, structural changes are reflected in significant shifts in the industry and occupational composition of employment, the decline of full-time work and the concomitant rise in part-time and atypical forms of employment, demographic changes in the labour force, as well as changes in social and individual preferences. Dynamic shifts can be found in cyclical pattern of employment and wages growth, the growth in labour mobility, and transitions between various labour market states.
The starting point for this paper is that these structural and dynamic changes have given rise to an increase in the likelihood that individuals will experience a transition between various labour market states, and a greater diversity in the range of transitions they may experience over their working life. This acceleration in the rate of transition generates ‘transition costs’ for both employers and employees, as well the likelihood of mismatch between employer and employee working time preferences. As a consequence, existing labour market policy regimes, based on the traditional model of labour market participation over the life course may not provide adequate protection for most workers today.
Gunther Schmid (1998) and others have proposed institutional reforms which promote ‘transitional labour markets’. Transitional labour market institutions are those that allow individuals (and firms) to successfully adjust to critical events. While transitional labour market institutions may consist of traditional ‘active labour market policy’ mechanisms, Schmid and others have proposed a range of innovative policy responses which allow individuals (and firms) to adjust the intensity of their abour market participation over the life cycle. In this paper we use the general approach of advocated by the transitional labour market concept to do three things. First, we investigate the processes by which the nature of labour market transitions has changed over time. Second, we review the range of policy options available to government to smooth labour market dysfunctions associated with labour market transitions, with the objective of ensuring labour markets operate more efficiently and more equitably. Third, we focus on one possible way in which an existing labour market institution, Long Service Leave (LSL), could be reformed to make way for a more comprehensive transitional labour market institution in the form of a ‘working time bank’.

Evaluation of a stress management course in adult education centres in rural Australia

Objective: To investigate whether attending a six-week stress management course in a rural adult education centre is effective in reducing participants' levels of stress, anxiety and depression.

Design: Repeated measures design using self-report measures of stress, anxiety and depression at commencement and completion of a six-week stress management course, and six months post-completion follow up.

Setting and participants: One hundred and thirty-two adults (age range 18–73 years) living in a rural community who self-enrolled in the stress management course at adult education centres.

Intervention: The course consisted of six weekly group sessions. Each two-hour session conducted by mental health professionals, included teaching cognitive behavioural strategies targeted at reducing individual symptoms of stress.

Main outcome measures: Comparative analysis of pre- and post-test and six-month follow up on measures of stress (Stress Symptom Checklist), anxiety and depression (Hospital Anxiety and Depression Scale).

Results: Results indicated a significant reduction in stress symptoms (F(7,90) = 34.92, P < 0.001), anxiety and depression (F(3,95) = 87.92, P < 0.001) from course commencement to course completion. These improvements were sustained six months after course completion for stress symptoms (F(11,65) = 22.40, P < 0.001), anxiety and depression (F(5,73) = 41.78, P < 0.001).

Conclusion: Findings demonstrate the stress management course is an effective community intervention in a rural community. Challenges for future implementation of the program are discussed.

Dietary patterns across the life course, mammographic density and implications for breast cancer : results from a British prospective cohort

Background : Previous epidemiological studies have investigated the relationship between individual nutrients such as vitamin D and vitamin B12 and mammographic density, a strong marker of breast cancer risk [1], with varied results. There has been limited research on overall dietary patterns and most studies have focused on adult dietary patterns [2]. We examine prospective data to determine whether dietary patterns from childhood to adult life affect mammographic density.

Methods : The Medical Research Council National Survey of Health and Development is a national representative sample of 2,815 men and 2,547 women followed since their birth in March 1946 [3]. A wealth of medical and social data has been collected in over 25 follow-ups by home visits, medical examinations and postal questionnaires. Dietary intakes at age 4 years were determined by 24-hour recalls and in adulthood (ages 36, 43 years) by 5-day food records. Copies of the mammograms (two views for each breast) taken when the women were closest to age 50 years were obtained from the relevant NHS centres. A total of 1,319 women were followed up since birth in 1946 for whom a mammogram at age 50 years was retrieved, and the percentage mammographic density was measured using the computer-assisted threshold method for all 1,161 women. Breast cancer incidence for the whole cohort is being ascertained through the National Health Service Central Register.

Statistical analysis : Reduced rank regression analysis, a relatively new approach to dietary pattern analysis, is being used to identify dietary patterns associated with mammographic density [4]. This approach identifies patterns in food intake that are predictive of an intermediate outcome of the disease process, such as mammographic density, and subsequently examines the relationship between the identified dietary patterns and breast cancer risk.

Results : Preliminary analyses so far suggest that variations in dietary patterns in adulthood might explain more than 10% of the variation in percentage mammographic density at age 50 years (age 36 years: 13%; age 43 years: 14%), with variations in patterns in childhood explaining slightly less. Further work is being carried out on the characteristics of these dietary patterns and their effects on percentage mammographic density and its two components (that is, absolute areas of dense and nondense tissues) and on breast cancer risk, after adjusting for socioeconomic status, anthropometric variables and reproductive factors.

Conclusion : The present study will provide for the first time information on the relationship between dietary patterns across the life course and mammographic density, and will help to clarify the pathways through which diet may affect breast cancer risk.

Professional standards for physical education teachers' professional development : technology for performance?

Background: The widespread and diverse models of professional standards for teaching raise questions with respect to the need to provide teachers with a pathway for continuing professional development balanced with the public nature of surveillance and accountability that may accompany standards. Ways of understanding technologies of power in relation to standards for
teaching gives us a new language and, in turn, new questions about the standards agenda in the physical education profession.
Purpose: To analyse how one health and physical education (HPE) teacher worked with Education Queensland’s (EQ) professional standards for teaching within the broader context of teacher professional development and renewal.
Participants and setting: An experienced HPE teacher working in an urban secondary school was the ‘case’ for this article. Tim was the only experienced HPE teacher within the larger pilot study of 220 selected teachers from the volunteer pool across the state.
Data collection: The case-study data comprised two in-depth interviews conducted by the first author, field notes from workshops (first author), teacher diaries and work samples, notes from focus groups of which Tim was a member, and electronic communications with peers by Tim
during the course of the evaluation.
Findings: Tim was supportive of the teaching standards while they did not have a strong evaluative dimension associated with technologies of power. He found the self-regulation associated with his reflective practices professionally rewarding rather than being formalised within a prescribed
professional development framework.
Conclusion: Tim’s positive response to the professional standards for teaching was typical of the broader pilot cohort. The concept of governmentality provided a useful framework to help map how the standards for teaching were received, regardless of teacher specialisation or experience.
We suggest that it is not until the standards regimes are talked about within the discourses of
power (e.g. codification for career progression, certification for professional development imperatives) that we can understand patterns of acceptance and resistance by teachers to policies
that seek to shape their performance.

Why do women like working in building conservation?

There is a perception that Building Conservation as a career is different from the mainstream, and it appears to be more attractive to women - at whatever level - than many other careers in the construction industry. Whilst recruitment and publicity can be targeted, the culture within the construction industry can be a barrier to entry for anyone that is "different." As Clara Greed (1999) discovered in her research "the traits, beliefs and lifestyle peculiar to the construction tribe" can inhibit the entry to the industry of a number of groups outside the traditional pool. The growth of women in the workforce generally (some 50% according to Turrell et al, 2000) is nowhere near being matched within the construction industry as a whole - the Construction Industry Board placed it at around 8.6% in 2000 across all positions. The various UK industry and professional bodies are actively supporting the need to attract women, with the CITB saying they want a 10% year on year increase in participation, the RICS have their own Raising the Ratio working group and the RIBA have carried out research to find out "why women leave architecture."

Of course the whole of the industry is not unfriendly to women - there are a number of us who have been in the industry for many years and recognise it as a fulfilling and exciting career - a number of women work as surveyors working on historic buildings. The initiatives that are working towards change might have something to learn from Building Conservation - while the shortage of skills is just as severe in work with historc buildings - this area of work holds an attraction to women, not found elsewhere. This paper draws on research carried out to explore some of the reasons for this.

The study involved sending a questionnaire to twenty women already working in Building Conservation (the response rate was over 100%) and arranging for questionnaires to be completed by school students (male and female) choosing university courses in one school (60 questionnaires sent out, with 35 returned at a response rate of 58%)

The research showed that the majority women working in Building Conservation did not agree that men heavily dominated their sector of the industry, whereas within other areas of the construction industry men make up approximately 90% of the workforce. The research found that women often perceived the Construction Industry to be 'cut-throat', 'egotistical' and 'financially beneficial', whereas they thought Building Conservation required 'patience', 'care' and 'attention to detail'.

Of the women who took part in the research, 87% were working in Building Conservation because of a personal interest , and the main aspect of that attarction was history and architecture. The study examined attitudes of school students choosing careers and the research shows that when male and female sixth form students were told what Building Conservation was about and what it involved, 43% would consider a career in it and 49% would be interested in talking part in a work experience placement working with historic buildings. The shortage of people working in Building Conservation could be reduced if more people were educated about the profession in a way relevant to their skills and interests. In order to assist this action, the study examined ways to introduce Building Conservation careers to school girls and drew on the initiatives that the university is doing to promote careers in the built environment to schoolgirls.

Digital divas : working to change students' perceptions about ICT courses and careers

Currently, women occupy less than 20% of places in the ICT courses offered by higher education institutions in Victoria and, as of 2007, women held only 16% of ICT jobs in the state (Multimedia Victoria 2008 p 25). At the secondary school level there has in fact been a marked downturn in girls' interest in such courses, reflecting a more general decline in female participation in ICT courses and careers. Given that there has also been a decline in overall student ICT numbers, there is a strong case to develop programs aimed to convince female students that an ICT career or course is an attractive option for their future. The Digital Divas program is one such course.

Effectiveness of a community-based osteoporosis education and self-management course : a wait list controlled trial

Summary : Osteoporosis is an increasing burden on individuals and health resources. The Osteoporosis Prevention and Self-Management Course (OPSMC) was designed to assist individuals to prevent and manage osteoporosis; however, it had not been evaluated in an Australian setting. This randomised controlled trial showed that the course increased osteoporosis knowledge.
Introduction and hypothesis : Osteoporosis is a major and growing public health concern. An OPSMC was designed to provide individuals with information and skills to prevent or manage osteoporosis, but its effectiveness has not previously been evaluated. This study aimed to determine whether OPSMC attendance improved osteoporosis knowledge, self-efficacy, self-management skills or behaviour.
Materials and methods : Using a wait list randomised controlled trial design, 198 people (92% female) recruited from the community and aged over 40 (mean age = 63) were randomised into control (n = 95) and intervention (n = 103) groups. The OPSMC consists of four weekly sessions which run for 2 h and are led by two facilitators. The primary outcome were osteoporosis knowledge, health-directed behaviour, self-monitoring and insight and self-efficacy.
Results : The groups were comparable at baseline. At 6-week follow-up, the intervention group showed a significant increase in osteoporosis knowledge compared with the control group; mean change 3.5 (p < 0.001) on a measure of 0–20. The intervention group also demonstrated a larger increase in health-directed behaviour, mean change 0.16 (p < 0.05), on a measure of 0–6.
Conclusion : The results indicate that the OPSMC is an effective intervention for improving understanding of osteoporosis and some aspects of behaviour in the short term.

Ethnography of housing : a conclusion

This paper is the final report of a research project spanning three years, exploring three field locations and capturing the stories of forty (plus) housing workers. Using an ethnographic research approach, this paper provides an account of how housing workers use language and stories to understand and make sense of their challenging and changing work. First hand accounts ('stories') about every day housing work frame the data in this paper, explaining how housing workers in Victoria have experienced and made sense of the shift from public housing as 'affordable housing for the working poor' to 'housing of last resort for the most vulnerable and needy members of the community'. Using a number of composite stories, this paper provides the reader with a glimpse into the work of public housing staff, transporting the leader from the relatively static world of policy and procedure to the more colorful world of tenants with 'high and complex' needs, 'wicked' problems, weary staff and the daily reality of organisational change.

A unique feature of this research is the comparison of how different workers use stories to build a range of 'socially constructed realities' around the housing work and its wicked problems. This paper compares and contrasts the socially constructed realities of frontline staff with the corresponding social realities of the managers at head office (and vice versa). This 'same problem, different perspective' approach allows the reader to better understand how the same problem is understood and approached in different ways, depending on the individual's organisational role, responsibly and authority. Using stories about 'working with problem tenants', 'collecting rental arrears from the poor and marginalised', 'maintaining old, neglected properties' and 'coping with organisational change', this paper illustrates how the shifting (and sometimes contradictory) construction of housing problems has meant that the organisation has long struggled to devise and implement sustainable remedies to these problems.

The following pages describe how the problems identified in the Housing Office Review (and experienced in the daily work of the 'modern day' housing worker) are simply a contemporary manifestation of 'age old public housing issues'. This paper describes and explains how housing staff have long used narrative to make sense of their often difficult work and ultimately, how they understand and experience a major process of operational policy change associated with the shift from 'public' housing to 'welfare' housing.

Prevention of a chronic progressive form of experimental autoimmune encephalomyelitis by an antibody against mucosal addressin cell adhesion molecule-1, given early in the course of disease progression.

A role for α4 and β7 integrins in mediating leucocyte entry into the central nervous system in the multiple sclerosis (MS)-like disease experimental autoimmune encephalomyelitis (EAE) has been demonstrated. However, the individual contributions of their respective ligands mucosal addressin cell adhesion molecule-1 (MAdCAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-cadherin expressed on the blood-brain barrier has not been determined. In the present paper, it is shown that an antibody directed against MAdCAM-1, the preferential ligand for α4β7, effectively prevented the development of a progressive, non-remitting, form of EAE, actively induced by injection of myelin oligodendrocyte glycoprotein peptide (MOG(_35-55)) autoantigen. Combinational treatment with both anti-MAdCAM-1, VCAM-1, and intercellular adhesion molecule-1 (ICAM-1) (ligand for integrin lymphocyte function-associated antigen (LFA)-1) mAbs led to more rapid remission than that obtained with anti-MAdCAM-1 antibody alone. However, neither MAdCAM-1 monotherapy, nor combinational antibody blockade was preventative when administered late in the course of disease progression. In conclusion, MAdCAM-1 plays a major contributory role in the progression of chronic EAE and is a potential therapeutic target for the treatment of MS. Critically, antivascular addressin therapy must be given eaA role for alpha4 and beta7 integrins in mediating leucocyte entry into the central nervous system in the multiple sclerosis (MS)-like disease experimental autoimmune encephalomyelitis (EAE) has been demonstrated. However, the individual contributions of their respective ligands mucosal addressin cell adhesion molecule-1 (MAdCAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-cadherin expressed on the blood-brain barrier has not been determined. In the present paper, it is shown that an antibody directed against MAdCAM-1, the preferential ligand for alpha4beta7, effectively prevented the development of a progressive, non-remitting, form of EAE, actively induced by injection of myelin oligodendrocyte glycoprotein peptide (MOG(35-55)) autoantigen. Combinational treatment with both anti-MAdCAM-1, VCAM-1, and intercellular adhesion molecule-1 (ICAM-1) (ligand for integrin lymphocyte function-associated antigen (LFA)-1) mAbs led to more rapid remission than that obtained with anti-MAdCAM-1 antibody alone. However, neither MAdCAM-1 monotherapy, nor combinational antibody blockade was preventative when administered late in the course of disease progression. In conclusion, MAdCAM-1 plays a major contributory role in the progression of chronic EAE and is a potential therapeutic target for the treatment of MS. Critically, antivascular addressin therapy must be given early in the course of disease prior to the establishment of irreversible damage if it is to be effective, as a single treatment modality.

Scope of practice of occupational therapists working in Victorian community health settings

Background/aim: Current health policy places emphasis on community-based health care and it is expected that there will be an increase in the number of people receiving care in community settings. This study aimed to examine the profile and scope of practice of occupational therapists working in Victorian community health settings and the amount and type of health promotion activity incorporated into their role.
Method:  An anonymous postal questionnaire was sent to 205 community-based Victorian occupational therapists. One hundred and one (49.3% response rate) questionnaires were returned, with 72 respondents (35.1%) meeting study inclusion criteria. A descriptive research design was used to address study aims.
Results:  Results indicate that the majority of community health occupational therapists are experienced practitioners, have a varied scope of practice and report a high level of job satisfaction. Compared with previous studies, there is an increase in new graduate occupational therapists starting their career in community health settings, a greater number of part-time workers and a diversification of clinical and non-clinical roles. Barriers to practice that exist include high demand for service, limited funding and time spent on administrative tasks. Although health promotion was regarded as an important role of community health workers, a large number of therapists were not involved in this activity because of limited knowledge and clinical work taking priority.
Conclusion: Study findings have implications for occupational therapy training, and there is a clear need for input at policy level to address the significant resource allocation issues raised.

Embedding academic skills development in course delivery

Innovative approaches need to be adopted to meet the challenge of ensuring that graduates at the end of their course of study are not only strong in their discipline, but also have the required generic skills to give them a good standing within their selected professions. This paper reports on a study that examined how well academic skills are embedded into the undergraduate Environmental Science curriculum at Deakin University in Australia. It reports on students’ self evaluation of their essay writing skills, and a case study that involves a discipline specialist working with an academic skills advisor to enhance student generic skills. It discusses the patchy nature of current implementation of programs for generic skill education.

Working at the nexus between public health policy, practice and research : dynamics of knowledge sharing in the Netherlands

Background
Joining the domains of practice, research and policy is an important aspect of boosting the quality performance required to tackle complex public health problems. “Joining domains” implies a departure from the linear and technocratic knowledge-translation approach. Integrating the practice, research and policy triangle means knowing its elements, appreciating the barriers, identifying possible cooperation strategies and studying strategy effectiveness under specified conditions.
This article examines the dynamic process of developing an Academic Collaborative Centre for Public Health in the Netherlands, with the objective of achieving that the three domains of policy, practice and research become working partners on an equal footing.
Method
An interpretative hermeneutic approach was used to interpret the phenomenon of collaboration at the nexus between the three domains. The project was explicitly grounded in current organizational culture and routines, applied to nexus action. In the process of examination, we used both quantitative (e.g. records) and qualitative data (e.g., interviews and observations). The data were interpreted using the Actor-Network, Institutional Re-Design and Blurring the Boundaries theories.
Results
Results show commitment at strategic level. At the tactical level, however, managers were inclined to prioritize daily routine, while the policy domain remained absent. At the operational level, practitioners learned to do PhD research in real-life practice and researchers became acquainted with problems of practice and policy, resulting in new research initiatives.
Conclusion
We conclude that working at the nexus is an ongoing process of formation and reformation. Strategies based on Institutional Re-Design theories in particular might help to more actively stimulate managers’ involvement to establish mutually supportive networks.

Provision of control measures for exposure of the hands to wet-working conditions in Australian workplaces

Objective: To analyze the occupational and demographic characteristics for workers participating in the Australian National Hazard Exposure Worker Surveillance (NHEWS) Survey, who reported the provision of various types of workplace control measures for exposure of the hands to wet-working conditions, and to identify the barriers for the provision of controls. Methods: Computer-assisted telephone interviews were conducted with 4500 workers in 2008. Workers were asked about the types of control measures provided to them in the workplace for exposure of the hands to liquids. Results: Workplace size was the strongest predictor for the provision of control measures. Compared to workplaces with fewer than five employees, workers in workplaces with 200 or more employees were more likely to report provision of gloves, barrier creams and moisturizers, labeling and warning, and ongoing training and education about skin care. Conclusion: Smaller workplaces have poorer access to control measures to mitigate exposure to wet work.