The training experience of primary care pharmacists

Objectives — To map the tasks, activities and training provision for primary care pharmacists (PCPs) and to identify perceived future training needs. Methods — Survey undertaken in 1998/1999 using a pre-piloted, postal, self-completion questionnaire to two samples of PCPs. Setting — PCPs in (a) the West Midlands and (b) England (outside West Midlands). Key findings — The response rate was 66 per cent. A majority (68 per cent) had worked in the role for less than two years. Eighty per cent had some form of continuing education or training for the role although only 50 per cent had a formal qualification. Over two-thirds had contributed to the funding of their training, with one-third providing all funding. Seventy-four per cent of PCPs agreed that pharmacists should go through a procedure to ensure competence (accreditation) before being allowed to work for a general medical practice or primary care group. Views on the need for formal education/training prior to work differed: 82 per cent of those with formal qualifications, but only 46 per cent of those without, considered that this should be a requirement. There was general agreement that training/education had met training needs. Views on future training closely reflected previous training experiences, with a focus upon pharmaceutical roles rather than upon generic skill development and the acquisition of management skills. Conclusions — The study provides a snapshot in time of the experience of pioneer PCPs and the training available to them. PCPs will need further training or updating if they are to provide the wider roles required by the developing needs of the National Health Service. Consideration should be given to formal recognition of the training of PCPs in order to assure competence. The expectation that pharmacists should fund their own training is likely to be a barrier to uptake of training and uncertainties over funding will militate against consistency of training.

An evaluation of pharmacy education and pre-registration training

This thesis covers two major aspects of pharmacy education; undergraduate education and pre-registration training. A cohort of pharmacy graduates were surveyed over a period of four years, on issues related to undergraduate education, pre-registration training and continuing education. These graduates were the first-ever to sit the pre-registration examination. In addition, the opinions of pre-registration tutors were obtained on pre-registration training, during the year that competence-based assessment was introduced. It was concluded that although the undergraduate course provided a broad base of knowledge suitable for graduates in all branches of pharmacy, several issues were identified which would require attention in future developments of the course. These were: 1. the strong support for the expansion of clinical, social and practice-based teaching. 2. the strong support to retain the scientific content to the same extent as in the three-year course. 3. a greater use of problem-based learning methods. The graduates supported the provision of a pre-registration continuing education course to help prepare for the examination and in areas inadequately covered in the undergraduate course. There was also support for the introduction of some form of split branch training. There was no strong evidence to suggest that the training had been an application of undergraduate education. In general, competence-based training was well regarded by tutors as an appropriate and effective method of skill assessment. However, community tutors felt it was difficult to carry out effectively due to day-to-day time constraints. The assistant tutors in hospital pharmacy were found to have a very important role in provision of training, and should be adequately trained and supported. The study recommends the introduction of uniform training and a quality assurance mechanism for all tutors and assistants undertaking this role.

Enhancing delivery of health behaviour change interventions in primary care: a meta-synthesis of views and experiences of primary care nurses

Objective To systematically find and synthesise qualitative studies that elicited views and experiences of nurses involved in the delivery of health behaviour change (HBC) interventions in primary care, with a focus on how this can inform enhanced delivery and adherence to a structured approach for HBC interventions. Methods Systematic search of five electronic databases and additional strategies to maximise identification of studies, appraisal of studies and use of meta-synthesis to develop an inductive and interpretative form of knowledge synthesis. Results Nine studies met the inclusion criteria. Synthesis resulted in the development of four inter-linking themes; (a) actively engaging nurses in the process of delivering HBC interventions, (b) clarifying roles and responsibilities of those involved, (c) engaging practice colleagues, (d) communication of aims and potential outcomes of the intervention. Conclusion The synthesis of qualitative evidence resulted in the development of a conceptual framework that remained true to the findings of primary studies. This framework describes factors that should be actively promoted to enhance delivery of and adherence to HBC interventions by nurses working in primary care. Practice implications The findings can be used to inform strategies for researchers, policymakers and healthcare providers to enhance fidelity and support delivery of HBC interventions.

Differences in perceptions of teachers' and students' values of physical education programs in private universities in Taipei City, Taiwan

After the New University Code was issued in 1994, the university physical education program was at a crossroad in Taiwan. Physical education teachers are facing changes in the curriculum. The purpose of this study is to find a direction for the future in physical education by using a revised Value Orientation Inventory to investigate the teachers' and students' value orientations. Based on these findings, results could identify a value-based philosophy for physical education curriculum innovation at the private university in Taiwan. ^ The subjects of this study included forty-two physical education teachers and ninety-four current students in five private universities in Taipei City, Taiwan. Value Orientation Inventory were developed by Ennis and Chen (1993), was used to assess subjects on five items five value orientations. VOI data were collected and analyzed by using T-test, ANOVA, and a set of special contrasts. ^ The findings of this study indicated that ninety-four percent of the private university students and physical education teachers made consistent curricular decisions within one or more of the value orientations. Teachers perceived Disciplinary Mastery (DM) and Learning Process (LP) value orientations as the most important values. Students perceived Ecological Integration (EI) and Disciplinary Mastery as the most important values. Both teachers and students placed Social Reconstruction value orientation as the lowest value. There were significant differences between teachers' and students' value orientations. Differences were found in DM, LP, and SA (Self-Actualization). There also were significant differences between teachers' and students' value orientation based on students' gender and year at university. These findings lead to the conclusion that private university students' values are incongruent with the physical education teachers' values. The finding suggests that unless physical education teachers address students' values on EI and SA, conflict may occur. ^

GRE as a predictor of graduate student success at a Hispanic serving institution of higher education

Accurately predicting the success of graduate students is an important aspect of determining which students should be admitted into graduate programs. The GRE is a pivotal factor to examine since it is one of the most widely used criteria for graduate school admission. Even though the GRE is advertised as an accurate tool for predicting first year graduate GPA, there is a lack of research on long term success factors such as time to degree and graduate rate (Luthy, 1996; Powers, 2004). Furthermore, since most studies have low minority sample sizes, the validity of the GRE may not be the same across all groups (ETS, 2008b; Kuncel, Hezlett, & Ones, 2001). Another gap in GRE studies is that few researchers analyze student characteristics, which may alter or moderate the prediction validity of the GRE. Thus, student characteristics such as degree of academic involvement, mentorship interactions, and other academic and social experiences have not been widely examined in this context. These gaps in the analysis of GRE validity are especially relevant given the high attrition rates within of some graduate programs (e.g., an estimated 68% of doctoral student never complete their programs in urban universities; Lovitts, 2001). A sequential mixed methods design was used to answer the research questions in two phases. The quantitative phase used student data files to analyze the relationship of two success variables (graduation rate and graduate GPA) to the GRE scores as well as other academic and demographic graduate student characteristics. The qualitative phase served to complement the first phase by describing a wider range of characteristics from the 11 graduate students who were interviewed. Both proximal and distal moderators influence student behaviors and success in graduate school. In the first phase of the study, the GRE was the distal facilitator under analysis. Findings suggested that both the GRE Quantitative and the GRE Verbal were predictors of success for master’s students, but the GRE Quantitative was not predictive of success for doctoral students. Other student characteristics such as demographic variables and disciplinary area were also predictors of success for the population of students studied. In the second phase of the study, it was inconclusive whether the GRE was predictive of graduate student success; though it did influence access to graduate programs. Furthermore, proximal moderators such as student involvement, faculty/peer interactions, motivational factors, and program structure were perceived to be facilitators and/or detractors for success.

A hermeneutic phenomenology of graduate education students' understandings of instructor power in a higher education classroom

Higher education is a distribution center of knowledge and economic, social, and cultural power (Cervero & Wilson, 2001). A critical approach to understanding a higher education classroom begins with recognizing the instructor's position of power and authority (Tisdell, Hanley, & Taylor, 2000). The power instructors wield exists mostly unquestioned, allowing for teaching practices that reproduce the existing societal patterns of inequity in the classroom (Brookfield, 2000). ^ The purpose of this hermeneutic phenomenological study was to explore students' experiences with the power of their instructors in a higher education classroom. A hermeneutic phenomenological study intertwines the interpretations of both the participants and the researcher about a lived experience to uncover layers of meaning because the meanings of lived experiences are usually not readily apparent (van Manen, 1990). Fifteen participants were selected using criterion, convenience, and snowball sampling. The primary data gathering method were semi-structured interviews guided by an interview protocol (Creswell, 2003). Data were interpreted using thematic reflection (van Manen, 1990). ^ Three themes emerged from data interpretation: (a) structuring of instructor-student relationships, (b) connecting power to instructor personality, and (c) learning to navigate the terrains of higher education. How interpersonal relationships were structured in a higher education classroom shaped how students perceived power in that higher education classroom. Positive relationships were described using the metaphor of family and a perceived ethic of caring and nurturing by the instructor. As participants were consistently exposed to exercises of instructor power in a higher education classroom, they attributed those exercises of power to particular instructor traits rather than systemic exercises of power. As participants progressed from undergraduate to graduate studies, they perceived the benefits of expertise in content or knowledge development as secondary to expertise in successfully navigating the social, cultural, political, and interpersonal terrains of higher education. Ultimately, participants expressed that higher education is not about what you know; it is about learning how to play the game. Implications for teaching in higher education and considerations for future research conclude the study.^

Globalization and the public provision of higher education: Empirical evidence from selected countries

This research study was designed to examine the relationship between globalization as measured by the KOF index, its related forces (economic, political, cultural and technological) and the public provision of higher education. This study is important since globalization is increasingly being associated with changes in critical aspects of higher education. The public provision of education was measured by government expenditure and educational outcomes; that is participation, gender equity and attainment. The study utilized a non-experimental quantitative research design. Data collected from secondary sources for 139 selected countries was analyzed. The countries were geographically distributed and included both developed and developing countries. The choice of countries for inclusion in the study was based on data availability. The data, which was sourced from international organizations such as the United Nations and the World Bank, were examined for different time periods using five year averages. The period covered was 1970 to 2009.^ The relationship between globalization and the higher education variables was examined using cross sectional regression analysis while controlling for economic, political and demographic factors. The major findings of the study are as follows. For the two spending models, only one revealed a significant relationship between globalization and education with the R 2 s ranging from .222 to .448 over the period. This relationship was however negative indicating that as globalization increased, spending on higher education declined. However, for the education outcomes models, this relationship was not significant. For the sub-indices of globalization, only the political dimension showed significance as shown in the spending model. Political globalization was significant for six periods with R2 s ranging from .31 to .52.^ The study concluded that the results are mixed for both the spending and outcome models. It also found no robust effects of globalization on government education provision. This finding is not surprising given the existing literature which sees mixed results on the social impact of globalization.^

The contribution of higher education to economic *development in a globalized environment

Amidst concerns about achieving high levels of technology to remain competitive in the global market without compromising economic development, national economies are experiencing a high demand for human capital. As higher education is assumed to be the main source of human capital, this analysis focused on a more specific and less explored area of the generally accepted idea that higher education contributes to economic growth. The purpose of this study, therefore, was to find whether higher education also contributes to economic development, and whether that contribution is more substantial in a globalized context. ^ Consequently, a multiple linear regression analysis was conducted to support with statistical significance the answer to the research question: Does higher education contributes to economic development in the context of globalization? The information analyzed was obtained from historical data of 91 selected countries, and the period of time of the study was 10 years (1990–2000). Some variables, however, were lagged back 5, 10 or 15 years along a 15-year timeframe (1975–1990). The resulting comparative static model was based on the Cobb-Douglas production function and the Solow model to specify economic growth as a function of physical capital, labor, technology, and productivity. Then, formal education, economic development, and globalization were added to the equation. ^ The findings of this study supported the assumption that the independent contribution of the changes in higher education completion and globalization to changes in economic growth is more substantial than the contribution of their interaction. The results also suggested that changes in higher and secondary education completion contribute much more to changes in economic growth in less developed countries than in their more developed counterparts. ^ As a conclusion, based on the results of this study, I proposed the implementation of public policy in less developed countries to promote and expand adequate secondary and higher education systems with the purpose of helping in the achievement of economic development. I also recommended further research efforts on this topic to emphasize the contribution of education to the economy, mainly in less developed countries. ^

The Effects of Civic Education on Political Knowledge

Traditionally political knowledge was regarded as an important potential outcome for civic education efforts. Most of the currently available research, however, tends to focus on non-cognitive goals, despite the fact that studies repeatedly have shown that political knowledge is an important resource for enlightened and engaged citizenship. In this article, we investigate whether civic education contributes to political knowledge levels. The analysis is based on the Belgian Political Panel Survey, a two year panel study among 2,988 Belgian late adolescents. The analysis shows that experiences with group projects at school contribute significantly to political knowledge levels two years later on. Furthermore, we can observe an interaction effect as those who are already most knowledgeable about politics, gain most from these group projects. Classes about politics, on the other hand, did not have an effect on knowledge levels. In the discussion, it is argued that civic education can have strong cognitive effects, but that these effects are not always related to classical civic education efforts.

Laboratory focussed learning of core electronic engineering concepts in the first year of an honours degree programme

In common with most universities teaching electronic engineering in the UK, Aston University has seen a shift in the profile of its incoming students in recent years. The educational background of students has moved away from traditional Alevel maths and science and if anything this variation is set to increase with the introduction of engineering diplomas. Another major change to the circumstances of undergraduate students relates to the introduction of tuition fees in 1998 which has resulted in an increased likelihood of them working during term time. This may have resulted in students tending to concentrate on elements of the course that directly provide marks contributing to the degree classification. In the light of these factors a root and branch rethink of the electronic engineering degree programme structures at Aston was required. The factors taken into account during the course revision were:. Changes to the qualifications of incoming students. Changes to the background and experience of incoming students. Increase in overseas students, some with very limited practical experience. Student focus on work directly leading to marks. Modular compartmentalisation of knowledge. The need for provision of continuous feedback on performance We discuss these issues with specific reference to a 40 credit first year electronic engineering course and detail the new course structure and evaluate the effectiveness of the changes. The new approach appears to have been successful both educationally and with regards to student satisfaction. The first cohort of students from the new course will graduate in 2010 and results from student surveys relating particularly to project and design work will be presented at the conference. © 2009 K Sugden, D J Webb and R P Reeves.

Essays on the Economics of Higher Education

At least since the seminal works of Jacob Mincer, labor economists have sought to understand how students make higher education investment decisions. Mincer’s original work seeks to understand how students decide how much education to accrue; subsequent work by various authors seeks to understand how students choose where to attend college, what field to major in, and whether to drop out of college.

Broadly speaking, this rich sub-field of literature contributes to society in two ways: First, it provides a better understanding of important social behaviors. Second, it helps policymakers anticipate the responses of students when evaluating various policy reforms.

While research on the higher education investment decisions of students has had an enormous impact on our understanding of society and has shaped countless education policies, students are only one interested party in the higher education landscape. In the jargon of economists, students represent only the `demand side’ of higher education---customers who are choosing options from a set of available alternatives. Opposite students are instructors and administrators who represent the `supply side’ of higher education---those who decide which options are available to students.

For similar reasons, it is also important to understand how individuals on the supply side of education make decisions: First, this provides a deeper understanding of the behaviors of important social institutions. Second, it helps policymakers anticipate the responses of instructors and administrators when evaluating various reforms. However, while there is substantial literature understanding decisions made on the demand side of education, there is far less attention paid to decisions on the supply side of education.

This dissertation uses empirical evidence to better understand how instructors and administrators make decisions and the implications of these decisions for students.

In the first chapter, I use data from Duke University and a Bayesian model of correlated learning to measure the signal quality of grades across academic fields. The correlated feature of the model allows grades in one academic field to signal ability in all other fields allowing me to measure both ‘own category' signal quality and ‘spillover' signal quality. Estimates reveal a clear division between information rich Science, Engineering, and Economics grades and less informative Humanities and Social Science grades. In many specifications, information spillovers are so powerful that precise Science, Engineering, and Economics grades are more informative about Humanities and Social Science abilities than Humanities and Social Science grades. This suggests students who take engineering courses during their Freshman year make more informed specialization decisions later in college.

In the second chapter, I use data from the University of Central Arkansas to understand how universities decide which courses to offer and how much to spend on instructors for these courses. Course offerings and instructor characteristics directly affect the courses students choose and the value they receive from these choices. This chapter reveals the university preferences over these student outcomes which best explain observed course offerings and instructors. This allows me to assess whether university incentives are aligned with students, to determine what alternative university choices would be preferred by students, and to illustrate how a revenue neutral tax/subsidy policy can induce a university to make these student-best decisions.

In the third chapter, co-authored with Thomas Ahn, Peter Arcidiacono, and Amy Hopson, we use data from the University of Kentucky to understand how instructors choose grading policies. In this chapter, we estimate an equilibrium model in which instructors choose grading policies and students choose courses and study effort given grading policies. In this model, instructors set both a grading intercept and a return on ability and effort. This builds a rich link between the grading policy decisions of instructors and the course choices of students. We use estimates of this model to infer what preference parameters best explain why instructors chose estimated grading policies. To illustrate the importance of these supply side decisions, we show changing grading policies can substantially reduce the gender gap in STEM enrollment.

Assessment in primary education in Ireland

This doctoral study examines assessment in primary education in the Republic of Ireland. The nature and purpose of assessment offer an insight into the values which are prioritised by an education system. In 2011, in the Republic of Ireland, the Department of Education and Skills (DES) published a strategy aiming to improve standards of literacy and numeracy. The document, entitled, Literacy and numeracy for learning and life: the national strategy to improve literacy and numeracy for children and young people 2011-2020, contains improvement targets as measured by standardised tests. It also mandates the increased use of standardised tests in primary education, and directs that aggregated scores should be reported to both Boards of Management and the DES. The study is framed by the theoretical perspectives of Michel Foucault and Pierre Bourdieu. Both of these commentators examine social policy and practice in an effort to provide insight into the history and operation of social institutions. This study is especially influenced by Foucault’s archaeology and genealogy of knowledge, and his notion of governmentality. It is also particularly cognisant of Bourdieu’s thoughts on habitus, doxa and capital. The study contains reviews of literature in the areas of assessment, assessment policy, and assessment policy in Ireland. These reviews highlight current debate in each of these areas while also grounding this debate in an historical context. The dissertation contains four empirical sections. 1) It analyses policy documents prepared in the development of the published strategy as well as investigating the strategy itself. In so doing it is aware of the burgeoning influence of pan-national bodies on policy development. 2) A number of high profile policy makers were interviewed as part of the study and their views are interpreted in light of the findings of the literature reviews. 3) The perspective of teachers was sought through a questionnaire survey. This gathered data on these teachers’ views on the purpose of assessment as well as their actual practice. 4) Finally, children were also included as participants in this study. They were interviewed in focus groups and encouraged to contribute drawings as well on their views of assessment in primary school. Literacy and numeracy for learning and life is seen as a seminal document in Irish education. This study is significant in its analysis of original data from high profile policy makers, including two Ministers for Education and Skills. It is also significant in its inclusion of the perspectives of primary school pupils. Finally, the study considers the nature and role of assessment in a holistic manner by including the views of policy makers, teachers and pupils. The study notes that policy development in Ireland underwent a change in the preparation of Literacy and numeracy for learning and life and that international influences, while present, are also mediated to suit the local context. It also highlights a lack of clarity in the definition of assessment in primary education and argues that there is a lack of balance in the approaches that are prioritised. The study demonstrates that teachers are impacted by the strategy but that they also change it by focusing on their own concerns while using assessment tools. The children provide compelling evidence of the impact of assessment on the learner. The study shows how assessment tools (and school subjects) are valued with differing levels of importance by a variety of stakeholders.

Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial

Background
Primary angle-closure glaucoma is a leading cause of irreversible blindness worldwide. In early-stage disease, intraocular pressure is raised without visual loss. Because the crystalline lens has a major mechanistic role, lens extraction might be a useful initial treatment.

Methods
From Jan 8, 2009, to Dec 28, 2011, we enrolled patients from 30 hospital eye services in five countries. Randomisation was done by a web-based application. Patients were assigned to undergo clear-lens extraction or receive standard care with laser peripheral iridotomy and topical medical treatment. Eligible patients were aged 50 years or older, did not have cataracts, and had newly diagnosed primary angle closure with intraocular pressure 30 mm Hg or greater or primary angle-closure glaucoma. The co-primary endpoints were patient-reported health status, intraocular pressure, and incremental cost-effectiveness ratio per quality-adjusted life-year gained 36 months after treatment. Analysis was by intention to treat. This study is registered, number ISRCTN44464607.

Findings
Of 419 participants enrolled, 155 had primary angle closure and 263 primary angle-closure glaucoma. 208 were assigned to clear-lens extraction and 211 to standard care, of whom 351 (84%) had complete data on health status and 366 (87%) on intraocular pressure. The mean health status score (0·87 [SD 0·12]), assessed with the European Quality of Life-5 Dimensions questionnaire, was 0·052 higher (95% CI 0·015–0·088, p=0·005) and mean intraocular pressure (16·6 [SD 3·5] mm Hg) 1·18 mm Hg lower (95% CI –1·99 to –0·38, p=0·004) after clear-lens extraction than after standard care. The incremental cost-effectiveness ratio was £14 284 for initial lens extraction versus standard care. Irreversible loss of vision occurred in one participant who underwent clear-lens extraction and three who received standard care. No patients had serious adverse events.

Interpretation
Clear-lens extraction showed greater efficacy and was more cost-effective than laser peripheral iridotomy, and should be considered as an option for first-line treatment.

Factors affecting transition to second year of an engineering degree

Much research has focused on students’ transition from secondary school to university. Less is known about the transition from first to second year of a university degree programme. Given the difficulties that many students face at this stage of their education, research into the relevant factors is required. Through questionnaires and focus groups, views of second- and third-year aerospace and mechanical engineering students in our university have been gathered. A large majority believed that both the volume and difficulty of work increased in second year. Many stated that first year was slightly too trivial and could have been made more challenging to prepare them better for second year. Different teaching and assessment styles in second year were considered to affect attendance and performance. The survey revealed that students were generally very well settled into university life by the end of first year and were happy with their choice of course and only 23% reported that financial responsibilities have had a negative effect on their academic performance. Differences were observed between male and female students. Male students believed that transition was helped by having regular assessments and by worked examples in lectures. Females found the teaching staff were the most helpful factor for a successful transition. The results indicate that males require more structure and guidance whereas females are more independent and settle in better.