A comprehensive description of the competencies required for the performance of an ultrasound-guided axillary brachial plexus blockade

We addressed four research questions, each relating to the training and assessment of the competencies associated with the performance of ultrasound-guided axillary brachial plexus blockade (USgABPB). These were: (i) What are the most important determinants of learning of USgABPB? (ii) What is USgABPB? What are the errors most likely to occur when trainees learn to perform this procedure? (iii) How should end-user input be applied to the development of a novel USgABPB simulator? (iv) Does structured simulation based training influence novice learning of the procedure positively? We demonstrated that the most important determinants of learning USgABPB are: (a) Access to a formal structured training programme. (b) Frequent exposure to clinical learning opportunity in an appropriate setting (c) A clinical learning opporunity requires an appropriate patient, trainee and teacher being present at the same time, in an appropriate environment. We carried out a comprehensive description of the procedure. We performed a formal task analysis of USgABPB, identifying (i) 256 specific tasks associated with the safe and effective performance of the procedure, and (ii) the 20 most critical errors likely to occur in this setting. We described a methodology for this and collected data based on detailed, sequential evaluation of prototypes by trainees in anaesthesia. We carried out a pilot randomised control trial assessing the effectiveness of a USgABPB simulator during its development. Our data did not enable us to draw a reliable conclusion to this question; the trail did provide important new learning (as a pilot) to inform future investigation of this question. We believe that the ultimate goal of designing effective simulation-based training and assessment of ultrasound-guided regional anaesthesia is closer to realisation as a result of this work. It remains to be proven if this approach will have a positive impact on procedural performance, and more importantly improve patient outcomes.

Achieving continuous professional development in higher education

Traditional higher education technology emphasizes knowledge transmission. In contrast, the Community platform presented in this paper follows a social approach that interleaves knowledge delivery with social and professional skills development, engaging with others, and personal growth. In this paper, we apply learning and complex adaptive systems theory to motivate and justify a continuous professional development model that improves higher education outcomes such as placement. The paper follows action design research (ADR) as the research method to propose and evaluate design principles.

Health networks: Actors, professional relationships, and controversies

In recent years international policies have aimed to stimulate the use of information and communication technologies (ICT) in the field of health care. Belgium has also been affected by these developments and, for example, health electronic regional networks ("HNs") are established. Thanks to a qualitative case study we have explored the implementation of such innovations (HN) to better understand how health professionals collaborate through the HN and how the HN affect their relationships. Within the HNs studied a common good unites the actors: the continuity of care for a better quality of care. However behind this objective of continuity of care other individual motivations emerge. Some controversies need also to be resolved in order to achieve cooperative relationships. HNs have notably to take national developments into account. These developments raise the question of the control of medical knowledge and medical practice. Professional issues, and not only practical changes, are involved in these innovations. © 2008 The authors and IOS Press. All rights reserved.

The interprofessional practitioner: changing professional identity in social work

Twenty years ago the first joint training programme in learning disability nursing and social work was established as a collaborative project to develop practitioners able to work holistically with people with learning disabilities. Since then a number of programmes have continued this work and more recently the approach has developed in the mental health specialism. These programmes have changed the nature of singular social work education and created a new region of knowledge (Bernstein, 2000) for those who have experienced them. What began as a radical experiment in interprofessional education has been sustained by a strong commitment to the belief that the practitioners who qualify from such programmes are well equipped to support people with learning disabilities in changing and multi-professional services. As with much interprofessional education, however, there is an ongoing need to build an evidence base linking such education with successful outcomes in practice. This paper presents and explores the outcomes of a doctoral research study aimed at evaluating the impact of joint training in learning disability nursing and social work on the professional identity, skills and working practices of practitioners who undertook it. The research was undertaken with almost fifty jointly trained practitioners and involved a national survey followed by semi-structured interviews. The results suggest that practitioners who experience the dual socialisation inherent in this type of training found both gains and losses in the process. They appear to emerge, however, with a confidence, resilience and breadth of knowledge which were part of the early vision for this transformative approach to professional training. Bernstein B. (2000). Pedagogy, Symbolic Control and Identity. Theory, Research, Critique. Revised Edition. Lanham: Rowman and Littlefield (USA).

Absence makes the professional try harder? Meeting the needs of socially excluded young men who become fathers

Research on socially excluded young fathers has been minimally addressed in the literature (SEU 1999, 2004). Indeed, research on young parents which informs health and social care professionals is often presented ‘through the eyes of the mother’ (Reeves 2006). Young parents in general and young fathers in particular are notoriously difficult to gain access to and engage with (Tyrer et al 2005) particularly if they have had previous negative involvement with the statutory services. Moreover, as Daniel and Taylor (1999, 2001, 2003) point out, professionals working in the health and care services often have an intense ‘maternal’ focus and this often excludes fathers from discussion and decisions about their children. The focus of this paper, drawing on two narrative studies of young fathers aged between 15-24 from the US and USA, is to evaluate the features of professional relationships that young fathers describe as finding helpful. Indeed, the findings discuss moving away from a culture of parenting classes, which all the young men interviewed described as finding problematical and in some cases embarrassing, to a culture of support which actively draws on their strengths and helps them become providers for their new families.

Continuing Professional Development: rhetoric and practice in the NHS

This article explores the experience of Continuing Professional Development (CPD) by supervisory-level clinical staff in the National Health Service. Four main themes are highlighted in the literature, namely the nature and experience of CPD, its relationship with human resource management practices and in particular in career development and planning. These themes are examined utilising sources of (triangulated) empirical data based on a 2500 sample survey conducted across five NHS Trusts. A key finding was that responsibility for learning and development was perceived as belonging to the individual rather than the organisation. Other findings concern a lack of resource-based commitment by the organisation to CPD for clinical staff undertaking supervisory-level roles and evidence of 'credentialism' with its emphasis on seeking certificated qualifications. The findings raise concerns about the potential for clinical staff to become disillusioned and to perceive a potential breach in their psychological contract because of problems in reconciling their own interests with those of their professional body, and that of their employer in relation to CPD.

Breaking New Ground: The First Generation of Women to Work as Professional Authors in English Canada (1880-1920)

In the later decades of the nineteenth century and the early decades of the twentieth, large numbers of Canadian women were stepping out of the shadows of private life and into the public world of work and political action. Among them, both a cause and an effect of these sweeping social changes, was the first generation of Canadian women to work as professional authors. Although these women were not unified by ideology, genre, or date of birth, they are studied here as a generation defined by their time and place in history, by their material circumstances, and by their collective accomplishment. Chapters which focus on E. Pauline Johnson (Tekahionwake), the Eaton sisters (Sui Sin Far and Onoto Watanna), Joanna E. Wood, and Sara Jeannette Duncan explore some of the many commonalities and interrelationships among the members of this generation as a whole. This project combines archival research with analytical bibliography in order to clarify and extend our knowledge of Johnson’s and Duncan’s professional lives and publishing histories, and to recover some of Wood’s “lost” stories. This research offers a preliminary sketch of the long tradition of the platform performance (both Native and non-Native) with which Johnson and others engaged. It explores the uniquely innovative ethnographic writings of Johnson, Duncan, and the Eaton sisters, among others, and it explores thematic concerns which relate directly to the experiences of working women. Whether or not I convince other scholars to treat these authors as a generation, with more in common than has previously been supposed, the strong parallels revealed in these pages will help to clarify and contextualize some of their most interesting work.

Evaluation of extended training for general practice in Northern Ireland: qualitative study.

Objective To evaluate participants' perceptions of the impact on them of an additional six months' training beyond the standard 12 month general practice vocational training scheme. Design Qualitative study using focus groups. Setting General practice vocational training in Northern Ireland. Participants 13 general practitioner registrars, six of whom participated in the additional six months' training, and four trainers involved in the additional six months' training. Main outcome measures: Participants' views about their experiences in 18 month and 12 month courses. Results Participants reported that the 12 month course was generally positive but was too pressurised and focused on examinations, and also that it had a negative impact on self care. The nature of the learning and assessment was reported to have left participants feeling averse to further continuing education and lacking in confidence. In contrast, the extended six month component was reported to have restimulated learning by focusing more on patient care and promoting self directed learning. It developed confidence, promoted teamwork, and gave experience of two practice contexts, and was reported as valuable by both ex-registrars and trainers. However, both the 12 and 18 month courses left participants feeling underprepared for practice management and self care. Conclusions 12 months' training in general practice does not provide doctors with the necessary competencies and confidence to enter independent practice. The extended period was reported to promote greater professional development, critical evaluation skills, and orientation to lifelong learning but does not fill all the gaps.