UK medical graduates’ preparedness for practice (P4P): A multi-site qualitative study

Introduction Previous research has demonstrated mixed findings in terms of graduates’ P4P in terms of their knowledge and skills, and interpersonal, systemic and technological aspects (Monrouxe et al. 2014). Few studies have included diverse stakeholders from multiple sites and employing longitudinal methods. We therefore aimed to understand the extent to which UK medical graduates are prepared for practice as Foundation doctors. Methods Cross-sectional qualitative narrative interview and longitudinal audio-diary (LAD) studies with participants from England, Scotland, Wales and Northern Ireland. Study 1 comprised 27 group and 84 individual interviews (n=185) with participants representing different stakeholders (F1s, fully registered trainees, clinical educators, undergraduate/postgraduate deans/foundation programme directors, other healthcare professionals, employers, policy makers, government representatives, and patient/public representatives). Study 2 comprised LADs with 26 F1s over 4-months. Results Participants found it hard initially to conceptualise the term ‘preparedness for practice’. We identified 2187 personal incident narratives (i.e. stories of P4P experiences) across our data: 506 (23%) were classed as ‘prepared’, 730 (33%) as ‘unprepared’ and 951 (44%) as ‘unspecified’. We identified factors that facilitated (e.g. supportive supervisors/colleagues, opportunities for shadowing) and hindered (e.g. unsupportive or disrespectful colleagues, poor organization, understaffing) transitions into and through the Foundation programme. The LADs suggested that trainees felt more confident and competent over time, but that such development was not always linear as challenging circumstances (e.g. new rotations) sometimes made trainees feel unprepared for situations where they had previously indicated preparedness. Conclusion Our findings add to the existing evidence on medical graduates’ P4P in the UK (e.g. Goldacre et al. 2008; Illing et al. 2013). Our findings support the role of assistantships and supportive supervisors for smoothing transitions from student to F1. Further longitudinal and action research studies are now needed to follow students through their final-year assistantships and into their F2 year.

Musculoskeletal (MSK) and Sport and Exercise Medicine (SEM) in General Practice (GP): A Novel GP-based MSK and SEM Clinic for Managing Musculoskeletal symptoms in a GP

Musculoskeletal (MSK) complaints are common within primary care (1) (2) (3) but some General Practitioners (GPs)/family physicians do not feel comfortable managing these symptoms (3), preferring to refer onto hospital specialists or Integrated Clinical Assessment and Treatment Services (ICATs). Long waiting times for hospital outpatient reviews are a major cause of patient inconvenience and complaints (4). We therefore aimed to establish a GP-ran MSK and sport and exercise medicine (SEM) clinic based within a Belfast GP surgery that would contribute to a sustainable improvement in managing these common conditions within primary care as well as reducing waiting times for patients with these conditions to see a specialist. This shift from hospital-based to community-based management is in-keeping with recent policy changes within the UK health-system, including Transforming Your Care within Northern Ireland (NI) (5). The GP-ran MSK and SEM clinic was held monthly within a Belfast GP practice, staffed by one GP with a specialist interest in MSK and SEM conditions and its performance was reviewed over a three month period. Parameters audited included cases seen, orthopaedic and x-ray referral rates and secondary care referrals comparing the GP practice’s performance to the same time period in the previous year as well as patient satisfaction questionnaires.

Arts Management and Cultural Policy

This chapter explores the relationship between cultural policy and arts management. A connection between policy and practice is visible through initiatives within specific localities, nations and at an international scale. Yet, there is little scholarship that develops our understanding of how these two areas interact, how ideas are exchanged and implemented, and where the power is located within this relationship. The approach to arts and cultural management in the UK has a history of professionalization that has developed increasing influence internationally. As a result, this chapter takes the UK as a case study and presents new empirical work to examine how educators and individuals practicing in both fields perceive the relationship of policymaking to the work of management.

Differences Between Irish and Australian Psychiatric Nurses' Family Focused Practice in Adult Mental Health Services

Psychiatric nurses’ practice with parents who have mental illness, their children and families is an important issue internationally. This study provides a comparison of Irish and Australian psychiatric nurses’ family focused practices in adult mental health services. Three hundred and forty three nurses across Ireland and 155 from Australia completed the Family Focused Mental Health Practice Questionnaire. Cross-country comparisons revealed significant differences, in terms of family focused skill, knowledge, confidence and practice. Australian psychiatric nurses engaged in higher family focused practice compared to Irish nurses. The comparative differences between countries may be attributable to differences in training, workplace support and policy.

Evidence-based practice: the relevance of systematic reviews.

Aim:
To demonstrate how systematic reviews provide robust evidence to inform clinical decision making in practice.

Background
Systematic reviews collate findings from a number of research studies in order to provide a comprehensive and reliable summary of the best available evidence. The use of systematic reviews to inform practice based decisions has increased as a result of the overwhelming amount of research literature available, poor quality of research evidence and the need to ensure practice is based upon the best available evidence. Systematic reviews are an efficient way of coping with large volumes of data to answer focused research questions. They differ from traditional literature reviews as they adhere to an explicit scientific process. The use of explicit and rigorous methods to identify, appraise and synthesise relevant studies minimises bias and provides a reliable basis for decision making. As a result systematic reviews provide clear evidence on the effectiveness of a healthcare intervention to inform policy and decision making across healthcare systems. An example of how the findings from systematic reviews can provide reliable evidence to inform healthcare decisions will be provided in this presentation1. This will demonstrate how focused clinical questions can be answered by systematic reviews and translated into practice.

Reference:
1. McGaughey J, Alderdice F, Fowler R, Kapila A, Moutray M. (2007) Outreach and Early Warning Systems (EWS) for the prevention of Intensive Care admission admission and death of critically ill adult patients on general hospital wards (REVIEW). The Cochrane Database of Systematic Reviews 3. art no CD005529

Examining Participatory Governance in a Devolving UK: insights from national parks policy development in Northern Ireland

This paper provides a contemporary examination of policy making and participatory practice in the context of devolving governance in the UK. The paper takes Northern Ireland as its focus and is particularly timely considering the context of devolved governance, the ongoing transition from conflict to relative peace and the potential for rejuvenating democracy through participatory
governance. The paper concentrates on one particular policy process, namely the attempted designation of a national park in the Mournes Area of Outstanding Natural Beauty. A thematic analysis of qualitative data is drawn upon to analyse the structural factors that framed the policymaking process, in particular the role of power in determining how consultation processes were 2 initiated, designed and undertaken. Using Lukes’ model) as an analytical framework, power is shown to manifest at multiple levels within the policy-making process to influence policy outcomes. The paper reveals how the persistence of a top-down approach to policy development combined with a highly parochial political outlook undermined attempts to designate a Mourne National Park. The paper concludes that, given the immaturity of recently devolved government in
Northern Ireland, in this instance, the democratising intentions of devolved governance have not been met. This has implications for Northern Ireland’s recent reform of public administration which devolves certain planning powers to local authority level and the management of the internationally significant Mournes landscape.

Linking Family Engagement with a Rights Perspective: Macro Factors Influencing Practice

While child welfare practitioners in many countries are struggling to develop methods of effective family engagement, they operate within different national and cultural contexts which influence, both positively and negatively, the ability to engage with families. Increasingly, international comparisons are necessary to further understanding of the development of social work practice. This is particularly necessary because most countries utilize international frameworks (such as the United National Convention on the Rights of the Child) to provide guidance in the development of policies, programs, and interventions. Each country (and locality) struggles to advance practice to be more effective and humane. Our paper offers a comparative analysis focused on family-oriented and rights-based frameworks of different countries. Based on a review of current national policies and a review of the literature regarding family based practices, we examine similarities and differences among four countries: the United Kingdom, Sweden, the United States, and South Korea. These countries were selected because they have some similarities (advanced industrialized democracies, professional social work, formal child protection systems) but have some differences in their social welfare systems (policies, specific practices, socio-cultural context). These differences can be utilized to advance understanding regarding the promise and potential for family engagement strategies. We then discuss the utility of this comparison for theory-building in the arena of child care practice and conclude by identifying the challenges and limitations of this work.

A critical analysis of Child and Adolescent Mental Health Services policy in England, 2000‐2015

Policy in Child and Adolescent Mental Health (CAMH) in England has undergone radical changes in the last 15 years, with far reaching implications for funding models, access to services and service delivery. Using corpus analysis and critical discourse analysis, we explore how childhood, mental health, and CAMHS are constituted in 15 policy documents, 9 pre‐2010, and 6 post 2010. We trace how these constructions have changed over time, and consider the practice implications of these changes. We identify how children’s distress is individualised, through medicalising discourses and shifting understandings of the relationship between socioeconomic context and mental health. This is evidenced in a shift from seeing children’s mental health challenges as produced by social and economic inequities, to a view that children’s mental health must be addressed early to prevent future socio‐economic burden. We consider the implications CAMHS policies for the relationship between children, families, mental health services and the state. The paper concludes by exploring how concepts of ‘parity of esteem’ and ‘stigma reduction’ may inadvertently exacerbate the individualisation of children’s mental health.

Fear and Urban Planning in Ordinary Cities: From Theory to Practice

The paper complements Abu-Orf's theory about violent settings by setting out a theory of fear in urban planning in ordinary urban contexts around three arguments: spatialization of fear; (modernist) spatialities and the encounter and political economies of urban fear. The three theoretical arguments are used to re-frame the planning history of Chelas, an affordable housing district in Lisbon, Portugal, and debate the way fear shapes, and is shaped in turn by, planning practice. Confirming that (growing) fear in ordinary urban contexts is not just an effect of the contemporary organization of cities, the paper argues for a theorization of fear that combines global (hegemonic) and a local (discursive/contingent) perspectives in the theorization of urban fear, and advocates for the need to put fear, and its capacity to create a crisis in urban policy, at the heart of planners' agendas.

Research into the Impact of School Leadership on Pupil Outcomes: Policy and Research Contexts

This paper extends the introduction to the authors’ study of successful school leadership and how it influences pupil outcomes begun in the Editorial introduction. Critical to an appreciation especially of the external validity of their results is an understanding of the policy context in which the English leaders in their study found themselves; this is a policy context dominated by concerns for external accountability and increases in the academic performance of pupils. In addition to describing this context, the paper summarises the conceptual and methodological framework that guided the early stage of their research and outlines their mixed-methods research design.

Professionalism and skills enhancement in the built environment: the role of higher education in a changing policy context in England

Since the election of the Labour Government in 1997 there have been a series of policy initiatives emphasising the importance of co-ordinated and integrated approaches to the delivery of urban regeneration and in particular Sustainable Communities. This changing policy context has given rise to a shortage of practitioners with both the technical skills to deliver specific programmes, and more especially the generic skills to work in multi-disciplinary teams in conjunction with partnership-based management boards. This paper discusses the origins of the debate about skills shortages and deficiencies and reviews the main government reports which have advocated a new approach to the provision of skills for community regeneration. It focuses particularly on the work of the Planning Network which was funded by the Centre for Education in the Built Environment (CEBE) to examine the contribution of higher education to the wider skills debate. It concludes by arguing that higher education has an important part to play in the provision of a more appropriate skills set for professional practice within a broader and more inclusive strategy involving all key stakeholders. However, employers also have a major responsibility in ensuring that key skills are maintained and enhanced within their own organisations.

Reflections of professional practice: using electronic discourse analysis networks (EDANs) to examine embedded business emails

Emails have become a central genre in business communication, reflecting both how people communicate and how they go about their professional practices. This chapter examines embedded business emails as reflections of the professional practices of the regulatory and policy department of a multinational based in London, UK. It argues that the nature of online communication in international organisations, with its high levels of intertextuality and interdiscursivity, requires multidimensional analytical approaches that are capable of capturing its complexity and dynamics. To this end, the chapter introduces electronic discourse analysis networks (EDANs) as one example of such approaches. It begins with a brief review of the literature that has informed the study reported on here before it discusses EDANs as its analytical framework. Using a group of embedded emails and a number of networked data sets, the chapter shows how EDANs can be used to further our understanding of professional online communication.

Embracing difference and the deferral of self-government: a critical analysis of the framing and practice of contemporary peace building

This thesis analyses how dominant policy approaches to peacebuilding have moved away from a single and universalised understanding of peace to be achieved through a top-down strategy of democratisation and economic liberalisation, prevalent at the beginning of 1990s. Instead, throughout the 2000s, peacebuilders have increasingly adopted a commitment to cultivating a bottom-up and hybrid peace building process that is context-sensitive and intended to be more respectful of the needs and values of post-war societies. The projects of statebuilding in Kosovo and, to a lesser extent, in Bosnia are examined to illustrate the shift. By capturing this shift, I seek to argue that contemporary practitioners of peace are sharing the sensibility of the theoretical critics of liberalism. These critics have long contended that post-war societies cannot be governed from ‘above’ and have advocated the adoption of a bottom-up approach to peacebuilding. Now, both peace practitioners and their critics share the tendency to embrace difference in peacebuilding operations, but this shift has failed to address meaningfully the problems and concerns of post-conflict societies. The conclusion of this research is that, drawing on the assumption that these societies are not capable of undertaking sovereign acts because of their problematic inter-subjective frames, the discourses of peacebuilding (in policy-making and academic critique) have increasingly legitimised an open-ended role of interference by external agencies, which now operate from ‘below’. Peacebuilding has turned into a long-term process, in which international and local actors engage relationally in the search for ever-more emancipatory hybrid outcomes, but in which self-government and self-determination are constantly deferred. Processes of emphasising difference have thus denied the political autonomy of post-war societies and have continuously questioned the political and human equality of these populations in a hierarchically divided world.

Plurality, policy and the local: can hyperlocals fill the gap?

Over the last 15 years, the acceleration in media consolidation has presented a series of policy challenges around diversity of editorial output. While policy debates on national ownership limits and other regulatory interventions are important, developments at the local level are often marginalised. And yet, the direction of travel—towards more consolidation and more deregulation—has arguably been more debilitating for democracy at the local level, where the vast majority of citizens interact with hospitals, schools, transport systems and local councils. The decline of local media—including, in some towns, the wholesale disappearance of local newspapers—leaves citizens starved of information and local institutions less accountable. This article uses an existing conceptual framework for assessing whether and how journalism makes a real-life contribution to democratic life at the local level. Against this normative framework, it then assesses the contribution of hyperlocal media sites to local democracy. We present findings from the most extensive survey of the hyperlocal sector to date, a collaboration with research partners at Cardiff and Birmingham City Universities and Talk About Local, which analysed online questionnaires from over 180 local online media initiatives. Our research offers a unique insight into the funding, operational problems and sustainability of community media sites, and suggests they have the potential to fulfil a vital democratic and civic role. These data inform our conclusions and recommendations for policy initiatives that would invigorate hyperlocal sites and therefore provide a real alternative for otherwise democratically impoverished local communities.