Implications of aligning full registration of doctors with medical school graduation:a qualitative study of stakeholder perspectives

OBJECTIVES: The Shape of Training report recommended that full registration is aligned with medical school graduation. As part of a General Medical Council-funded study about the preparedness for practice of UK medical graduates, we explored UK stakeholders' views about this proposal using qualitative interviews (30 group and 87 individual interviews) and Framework Analysis.

SETTING: Four UK study sites, one in each country.Save

PARTICIPANTS: 185 individuals from eight stakeholder groups: (1) foundation year 1 (F1) doctors (n=34); (2) fully registered trainee doctors (n=33); (3) clinical educators (n=32); (4) undergraduate/postgraduate Deans, and Foundation Programme Directors (n=30); (5) other healthcare professionals (n=13); (6) employers (n=7); (7) policy and government (n=11); (8) patient and public representatives (n=25).

RESULTS: We identified four main themes: (1) The F1 year as a safety net: patients were protected by close trainee supervision and 'sign off' to prevent errors; trainees were provided with a safe environment for learning on the job; (2) Implications for undergraduate medical education: if the proposal was accepted, a 'radical review' of undergraduate curricula would be needed; undergraduate education might need to be longer; (3) Implications for F1 work practice: steps to protect healthcare team integration and ensure that F1 doctors stay within competency limits would be required; (4) Financial, structural and political implications: there would be cost implications for trainees; clarification of responsibilities between undergraduate and postgraduate medical education would be needed. Typically, each theme comprised arguments for and against the proposal.

CONCLUSIONS: A policy change to align the timing of full registration with graduation would require considerable planning and preliminary work. These findings will inform policymakers' decision-making. Regardless of the decision, medical students should take on greater responsibility for patient care as undergraduates, assessment methods in clinical practice and professionalism domains need development, and good practice in postgraduate supervision and support must be shared.

Cartographies of Differences:Interdisciplinary Perspectives

The co-edited collection investigates the processes of learning how to live with individual and groups differences in the 21century and examines the ambivalences of contemporary cosmopolitanism. The contributions focus on visual, normative and cultural embodiments of differences, examining conflicts at local sites that are connected by the processes of Europeanization and globalization.

Embracing an integromic approach to tissue biomarker research in cancer: Perspectives and lessons learned

Modern approaches to biomedical research and diagnostics targeted towards precision medicine are generating ‘big data’ across a range of high-throughput experimental and analytical platforms. Integrative analysis of this rich clinical, pathological, molecular and imaging data represents one of the greatest bottlenecks in biomarker discovery research in cancer and other diseases. Following on from the publication of our successful framework for multimodal data amalgamation and integrative analysis, Pathology Integromics in Cancer (PICan), this article will explore the essential elements of assembling an integromics framework from a more detailed perspective. PICan, built around a relational database storing curated multimodal data, is the research tool sitting at the heart of our interdisciplinary efforts to streamline biomarker discovery and validation. While recognizing that every institution has a unique set of priorities and challenges, we will use our experiences with PICan as a case study and starting point, rationalizing the design choices we made within the context of our local infrastructure and specific needs, but also highlighting alternative approaches that may better suit other programmes of research and discovery. Along the way, we stress that integromics is not just a set of tools, but rather a cohesive paradigm for how modern bioinformatics can be enhanced. Successful implementation of an integromics framework is a collaborative team effort that is built with an eye to the future and greatly accelerates the processes of biomarker discovery, validation and translation into clinical practice.

The OpenPMU Project: Challenges and perspectives:Challenges and Perspectives

The OpenPMU project is a platform for the development of Synchrophasor measurement technology, Phasor Measurement Units (PMU), in an open source manner. The project has now been operating for a number of years and has seen increased adoption at Universities and interest from electrical utilities. The OpenPMU device has recently been tested against the IEEE C37.118 standard and shown to operate within the specification. This paper discusses the OpenPMU project from the perspective of the past two years of experience and evaluates successes and opportunities for improvements in both the OpenPMU device and the philosophy of the design.

Occurrence of the pinewood nematode, Bursaphelenchus xylophilus in Portugal and perspectives of the disease spread in Europe.

In 1999, the pinewood nematode (PWN) , Bursaphelenchus xylophilus was found and identified for the first time in Portugal and in Europe. Following detection, Portuguese authorities initiated the implementation of eradication measures during 1999 and 2000, following an alert provided to European Community officials; as a result, the nematode was confirmed to be confined in the Setúbal region, near Lisbon. A task force from the follow-up group (GANP) created by the Secretary of State for the Rural Development established a national eradication programme (PROLUNP) to (1) Contain PWN within the initial geographic limits; (2) Implement eradication measures; and (3) Monitor PWN at a national level. Research is presently being conducted both at universities as well as research institutes, focusing on the characterization ofBursaphelenchus species associated with maritime pine, as well as on the insect vector, Monochamus galloprovincialis. Recent reports indicate that the nematode may be present in Siberia (Russia), which would present a threat to Eastern European forestry. Efforts are presently being developed by several European countries to establish a research consortium to detect and study the possible presence of PWN, for a new PRAs. A recent workshop held in Portugal, in 2001, has been an oportunity for sharing experiences and techniques on detection and control. There is clearly a greater awareness of this issue in Europe.

Personal statement in PhD applications: Gatekeepers' evaluative perspectives

This paper explores academic readers’ views of the doctoral Personal Statements (PSs) written by student applicants across institutional contexts. The analysis was based on in-depth semi-structured interviews with 19 faculty members involved in evaluating the PhD applications within Education at one UK-based and one US-based university. Data were coded by NVivo software and then analysed using methods drawn from critical discourse analysis and conversation analysis to unravel participant intended meaning. Results suggest that the situated knowledge of institutional settings where these academics are based will affect the ways in which they act and think in relation to particular forms of discourse. Specifically, the UK and US academics’ interpretations of PSs and its associated evaluation practices are related to their conceptual understanding of the culture of doctoral level study and the structure of the admissions process in their own particular academic community. The paper concludes with some pedagogical implications and a discussion of potential areas for further study to investigate the ‘academic’ and ‘rhetorical’ aspects of the PS and to understand the different and often implicit features of the PS across different disciplines, programmes, and institutional contexts.

L'étude du cheminement de l'enfant de première année du primaire en regard de la conceptualisation des systèmes d'écritures alphabétique et musicale : perspectives parallèles

Considérant les difficultés que les jeunes éprouvent à entrer dans l'écrit et les nombreux bienfaits que la musique apporte à l'être humain, nous avons voulu explorer ce qu'ont en commun l'entrée dans l'écrit et l'apprentissage de la musique. Les deux modèles théoriques qui ont été retenus (Ferreiro, 2000; Upitis, 1992) nous permettent de comprendre que les enfants conceptualisent chacun des systèmes d'écriture en traversant quatre principaux niveaux. Pour connaître le niveau de conceptualisation des systèmes d'écritures alphabétique et musicale (SEA et SEM) et leur évolution en cours d'année scolaire, 32 sujets provenaient de classes régulières et 20 de classes spéciales (difficultés langagières), tous de premier cycle du primaire, ont passé un test à trois reprises (octobre, février et avril). Les résultats démontrent entre autres que les élèves qui sont plus avancés dans leur conceptualisation du SEA le sont également dans celle du SEM en début d'année scolaire.