Medical error:a discussion of the medical construction of error and suggestions for reforms of medical education to decrease error

Introduction: There is a growing public perception that serious medical error is commonplace and largely tolerated by the medical profession. The Government and medical establishment's response to this perceived epidemic of error has included tighter controls over practising doctors and individual stick-and-carrot reforms of medical practice. Discussion: This paper critically reviews the literature on medical error, professional socialization and medical student education, and suggests that common themes such as uncertainty, necessary fallibility, exclusivity of professional judgement and extensive use of medical networks find their genesis, in part, in aspects of medical education and socialization into medicine. The nature and comparative failure of recent reforms of medical practice and the tension between the individualistic nature of the reforms and the collegiate nature of the medical profession are discussed. Conclusion: A more theoretically informed and longitudinal approach to decreasing medical error might be to address the genesis of medical thinking about error through reforms to the aspects of medical education and professional socialization that help to create and perpetuate the existence of avoidable error, and reinforce medical collusion concerning error. Further changes in the curriculum to emphasize team working, communication skills, evidence-based practice and strategies for managing uncertainty are therefore potentially key components in helping tomorrow's doctors to discuss, cope with and commit fewer medical errors.

A representation of representation applied to a discussion of variable binding

States or state sequences in neural network models are made to represent concepts from applications. This paper motivates, introduces and discusses a formalism for denoting such representations; a representation for representations. The formalism is illustrated by using it to discuss the representation of variable binding and inference abstractly, and then to present four specific representations. One of these is an apparently novel hybrid of phasic and tensor-product representations which retains the desirable properties of each.

After ANT:an illustrative discussion of the implications for qualitative accounting case research

The main aim of this article is to shed some light on the way in which actor network theory (ANT) might contribute to case research in accounting. The paper will seek to explain some of the theoretical suppositions which are commonly associated with ANT and which have so far made little impact on the accounting literature. At the same time the accounting literature has shown a particular reluctance to engage with the central concept of ANT which Lee and Hassard characterise as the desire to bring together the "human and non-human, social and technical factors in the same analytical view". The article also features a discussion of a research project which used an approach giving emphasis to both humans and objects in order to understand how ``facts'' have come to be settled as they are. In taking such views into the research it is hoped to provide insight into both the detail of accounting as it is practised within organisations and the manner in which human actors and objects of technology may combine to constitute networks within organisations.

A discussion of ethnographic research methods and their relevance for the translation process

In recent years, technologically advanced methodologies such as Translog have gained a lot of ground in translation process research. However, in this paper it will be argued that quantitative research methods can be supplemented by ethnographic qualitative ones so as to enhance our understanding of what underlies the translation process. Although translation studies scholars have sometimes applied an ethnographic approach to the study of translation, this paper offers a different perspective and considers the potential of ethnographic research methods for tapping cognitive and behavioural aspects of the translation process. A number of ethnographic principles are discussed and it is argued that process researchers aiming to understand translators’ perspectives and intentions, how these shape their behaviours, as well as how translators reflect on the situations they face and how they see themselves, would undoubtedly benefit from adopting an ethnographic framework for their studies on translation processes.

Some obstacles to the establishment of a universal method of education for parenthood by the P.N.E.U

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The internet:a discussion of some new and emerging threats to young people

The Internet poses a number of threats to the safety of young people. Using numerous examples, this article discusses a wide range of such threats, including: cyberstalking; the 'grooming' of potential victims of sexual abuse; a new 'wish list' scene (where teenagers encourage contact with potential abusers); the creation and distribution of child pornography; and the emergence of services that create child pornography to order. It is suggested that the latter has provided individuals with the ability to inflict sexual abuse on young people from a distance, an act the authors have termed virtual sex tourism. The final section of the article suggests that paedophiles and pornographers have been quick to adopt new technology as a means of concealing their activities. The article concludes by warning of the danger of overestimating or underestimating the threats described.

Regulating audit beyond the crisis:a critical discussion of the EU green paper

With the European Commission making global leadership claims in the field of audit regulation, the content of its 2010 Green Paper on ‘Audit Policy: Lessons from the Crisis’ warrants careful scrutiny. Important issues raised in the Green Paper include regulatory oversight, competition in the audit market, the dangers of having very few firms with the capacity to audit global transnational corporations, professional judgement, innovative audit practices and, last but not least, social responsibility. This article analyses the principal perspectives and assumptions underpinning the construction of the Green Paper. The aims are threefold: to enhance understanding of the contemporary regulatory mindset of the European Commission, contribute to policy debate and inspire future research.

Protection issue discussion of DC network development:circuit breaker or fault-tolerant converter

This paper provides a discussion on future direct current (DC) network development in terms of system protection under DC-side fault scenarios. The argument between appropriate DC circuit breaker and new DC fault-tolerant converters is discussed after a review on DC technology development and bottleneck issues that require proper solutions. The overcurrent/cost curve of power-electronic DC circuit breakers (CB) superimposed to voltage-source converter (VSC) systems is derived and compared with other possible fault-tolerant power conversion options. This in-advance planning of protection capability is essential for the future development of DC networks.

Education and self-management for people newly diagnosed with type 2 diabetes: a qualitative study of patients' views.

OObjectives: We explored the perceptions, views and experiences of diabetes education in people with type 2 diabetes who were participating in a UK randomized controlled trial of methods of education. The intervention arm of the trial was based on DESMOND, a structured programme of group education sessions aimed at enabling self-management of diabetes, while the standard arm was usual care from general practices. Methods: Individual semi-structured interviews were conducted with 36 adult patients, of whom 19 had attended DESMOND education sessions and 17 had been randomized to receive usual care. Data analysis was based on the constant comparative method. Results: Four principal orientations towards diabetes and its management were identified: `resisters', `identity resisters, consequence accepters', `identity accepters, consequence resisters' and `accepters'. Participants offered varying accounts of the degree of personal responsibility that needed to be assumed in response to the diagnosis. Preferences for different styles of education were also expressed, with many reporting that they enjoyed and benefited from group education, although some reported ambivalence or disappointment with their experiences of education. It was difficult to identify striking thematic differences between accounts of people on different arms of the trial, although there was some very tentative evidence that those who attended DESMOND were more accepting of a changed identity and its implications for their management of diabetes. Discussion: No one single approach to education is likely to suit all people newly diagnosed with diabetes, although structured group education may suit many. This paper identifies varying orientations and preferences of people with diabetes towards forms of both education and self-management, which should be taken into account when planning approaches to education.

‘Let’s talk about feedback’:an exploration of academic feedback practices in pharmacy education

Feedback is considered one of the most effective mechanisms to aid learning and achievement (Hattie and Timperley, 2007). However, in past UK National Student Surveys, perceptions of academic feedback have been consistently rated lower by final year undergraduate students than other aspects of the student experience (Williams and Kane, 2009). For pharmacy students in particular, Hall and colleagues recently reported that almost a third of students surveyed were dissatisfied with feedback and perceived feedback practice to be inconsistent (Hall et al, 2012). Aims of the Workshop: This workshop has been designed to explore current academic feedback practices in pharmacy education across a variety of settings and cultures as well as to create a toolkit for pharmacy academics to guide their approach to feedback. Learning Objectives: 1. Discuss and characterise academic feedback practices provided by pharmacy academics to pharmacy students in a variety of settings and cultures. 2. Develop academic feedback strategies for a variety of scenarios. 3. Evaluate and categorise feedback strategies with use of a feedback matrix. Description of Workshop Activities: Introduction to workshop and feedback on pre-reading exercise (5 minutes). Activity 1: A short presentation on theoretical models of academic feedback. Evidence of feedback in pharmacy education (10 minutes). Activity 2: Discussion of feedback approaches in participants’ organisations for differing educational modalities. Consideration of the following factors will be undertaken: experiential v. theoretical education, formative v. summative assessment, form of assessment and the effect of culture (20 minutes, large group discussion). Activity 3: Introduction of a feedback matrix (5 minutes). Activity 4: Development of an academic feedback toolkit for pharmacy education. Participants will be divided into 4 groups and will discuss how to provide effective feedback for 2 scenarios. Feedback strategies will be categorised with the feedback matrix. Results will be presented back to the workshop group (20 minutes, small group discussion, 20 minutes, large group presentation). Summary (10 minutes). Additional Information: Pre-reading: Participants will be provided with a list of definitions for academic feedback and will be asked to rank the definitions in order of perceived relevance to pharmacy education. References Archer, J. C. (2010). State of the science in health professional education: effective feedback. Medical education, 44(1), 101-108. Hall, M., Hanna, L. A., & Quinn, S. (2012). Pharmacy Students’ Views of Faculty Feedback on Academic Performance. American journal of pharmaceutical education, 76(1). Hattie, J., & Timperley, H. (2007). The power of feedback. Review of educational research, 77(1), 81-112. Medina, M. S. (2007). Providing feedback to enhance pharmacy students’ performance. American Journal of Health-System Pharmacy, 64(24), 2542-2545.