Deregulation, competition policy and intra-professional contests in medical education

This paper investigates how government policy directions embracing deregulation and market liberalism, together with significant pre-existing tensions within the Australian medical profession, produced ground breaking change in the funding and delivery of medical education for general practitioners. From an initial view between and within the medical profession, and government, about the goal of improving the standards of general practice education and training, segments of the general practice community, particularly those located in rural and remote settings, displayed increasingly vocal concerns about the approach and solutions proffered by the predominantly urban-influenced Royal Australian College of General Practitioners (RACGP). The extent of dissatisfaction culminated in the establishment of the Australian College of Rural and Remote Medicine (ACRRM) in 1997 and the development of an alternative curriculum for general practice. This paper focuses on two decades of changes in general practice training and how competition policy acted as a justificatory mechanism for putting general practice education out to competitive tender against a background of significant intra-professional conflict. The government's interest in increasing efficiency and deregulating the 'closed shop' practices of professions, as expressed through national competition policy, ultimately exposed the existing antagonisms within the profession to public view and allowed the government some influence on the sacred cow of professional training. Government policy has acted as a mechanism of resolution for long standing grievances of the rural GPs and propelled professional training towards an open competition model. The findings have implications for future research looking at the unanticipated outcomes of competition and internal markets.

Developing interdisciplinary research graduates: educational opportunities and dilemmas

Attempting to solve the complex problems of the 21st century requires research graduates that have developed a sophisticated array of interdisciplinary teamwork and communication skills. Although universities, governments, industry and the professions have emphasised the need to break down disciplinary silos in order to produce graduates, who can respond more effectively to the needs of the knowledge economy, much of this work has centred on undergraduate programs. While there are some research higher degree students who choose to work on interdisciplinary research topics, very little has been done to develop interdisciplinary research education systematically. This paper explores the educational opportunities and dilemmas involved in developing systematic programs of interdisciplinary research activities in two research centres at the University of Queensland. Framed by Bruhn's (2000, p. 58) theoretical discourse about interdisciplinary research as 'a philosophy, an art form, an artifact, and an antidote', this paper emphasises the need for such programs to embed the development of students' interdisciplinary research skills and attitudes within their research projects. The two diverse programs also emphasise experiential, active and interactive learning techniques and are centred upon the development of students' reflective practice skills.

SÍNDROME DE BURNOUT ENTRE OS PASTORES ADVENTISTAS DA CIDADE DE SÃO PAULO: CAUSAS POTENCIAIS E MEDIDAS PREVENTIVAS

A prevalência de stress e burnout tem-se tornado um problema comum nas profissões assistenciais. Os ministros religiosos não são uma exceção. Evidências disponíveis derivadas de reflexões pessoais e pesquisas científicas demonstram que o trabalho pastoral hoje é uma ocupação com elevados índices de burnout; entretanto, pouca atenção tem sido dada a este assunto. O presente estudo tem como objetivo contribuir para o desenvolvimento de pré-condições e recursos individuais de forma a prevenir e controlar os efeitos da síndrome entre os pastores adventistas da cidade de São Paulo. Inicialmente o trabalho apresentará uma análise do burnout, a partir de referências selecionadas, incluindo informações gerais sobre os sintomas, antecedentes, instrumentos de medida; intervenções e métodos preventivos. Os ministros religiosos geralmente são tratados como outros profissionais de ajuda nas pesquisas de burnout, com pouca consideração para com a dimensão espiritual, o que é prioritário ou mesmo vital para o clero. Para este estudo, em particular, o burnout pastoral será considerado como um fator resultante de um relacionamento deficiente com Deus. Somam-se a isso as condições ambientais do trabalho e as características pessoais. Finalmente, o estudo pretende sugerir estratégias para ajudar na redução e na prevenção última da síndrome entre os pastores em foco.(AU)

REPRESENTAÇÕES SOCIAIS DE PROFESSORES DE DIREITO SOBRE O EXERCÍCIO DA DOCÊNCIA

O objetivo desse estudo foi investigar representações sociais de professores de Direito acerca do exercício da docência. Buscou-se compreender quais são os saberes docentes que o professor de Direito julga necessários à sua atuação, já que a legislação vigente não exige que o operador do Direito frequente um curso específico que o capacite para a docência no ensino superior. Em razão disso, geralmente, o professor de Direito se depara com inúmeras dificuldades no início de carreira e constata que, na prática, ser um bom profissional do Direito não lhe basta para a docência, pois necessita de didática e de um método pedagógico pelos quais seus alunos o compreendam. A pesquisa teve como sujeitos professores de Direito que se encontram na docência, no mínimo, há dois anos, no município de São Paulo e região do Grande ABC paulista. Os autores que possibilitaram a fundamentação teórica foram: Serge Moscovici (1978), Denise Jodelet (2005), Marília Claret Geraes Duran (2006), dentre outros estudos significativos. O estudo foi realizado mediante pesquisa quantitativa e qualitativa de dados. Para levantamento dos dados, foi utilizado um questionário que, na sua parte inicial, contava com três palavras indutoras. Em seguida, foram apresentadas quinze questões, sendo três abertas e doze fechadas. A partir das descrições das respostas dadas pelos sujeitos no questionário, foi possível realizar a análise dos dados coletados, por meio da análise de conteúdo (Laurence Bardin, 1977). A pesquisa realizada possibilitou a análise da percepção e a concepção dos sujeitos da pesquisa quanto ao ensino jurídico e à sua própria formação. Demonstrou, ainda, que o professor de Direito deve apropriar-se de saberes docentes específicos para lecionar, ultrapassando a ideia de que lhe basta o conhecimento técnico, já que a docência, assim como as demais profissões, tem especificidades importantes.

Professionals, discretion and public sector reform in the UK:re-visiting Lipsky

Purpose – Seeks to examine how far Michael Lipsky's theory of discretion as it relates to public sector professionals as “street-level bureaucrats” is still applicable in the light of public sector reform and in particular the introduction of increased managerial control over professionals. Design/methodology/approach – The main thesis in Lipsky's work, Street-Level Bureaucracy, that street-level bureaucrats devise their own rules and procedures to deal with the dilemmas of policy implementation is linked to public sector reform over the past 25 years or so. The article differentiates between three forms of discretion, rule, task and value and assesses the extent to which these different forms of discretion have been compromised by reform. Examples are drawn principally from the literature on school teachers and social workers Findings – The findings suggest that the rule-making (hence bureaucratic) capacity of professionals at street-level is much less influential than before although it is questionable whether or not the greater accountability of professionals to management and clarity of the targets and objectives of organisations delivering public policy has liberated them from the dilemmas of street-level bureaucracy. Research limitations/implications – The work has focussed on the UK and in particular on two professions. However, it may be applied to any country which has undergone public sector reform and in particular where “new public management” processes and procedures have been implemented. There is scope for in-depth studies of a range of occupations, professional and otherwise in the UK and elsewhere. Practical implications – Policy makers and managers should consider how far the positive aspects of facilitating discretion in the workplace by reducing the need for “rule-making” to cope with dilemmas have been outweighed by increased levels of bureaucracy and the “de-skilling” of professionals. Originality/value – Lipsky's much cited and influential work is evaluated in the light of public sector reform some 25 years since it was published. The three forms of discretion identified offer the scope for their systematic application to the workplace.

The effect of ward design on the well-being of post-operative patients

Changes in the design of hospital wards have usually been determined by architects and members of the nursing and medical professions; the views and preferences of patients have seldom been sought directly. The Hospital Anxiety and Depression scale and the Disturbance Due to Hospital Noise questionnaire were administered to 64 female patients on bay and Nightingale wards together with a questionnaire designed for this study. Perceptions of social and physical factors of ward design were examined, and their relationship to psychological well-being and sleep patterns. The results show that the bay ward seemed to offer a more favourable environment for patients but some of the disadvantages of bay wards are balanced by better staffing levels and better and more modern facilities. Visibility to nurses was lower on the bay ward. The Nightingale ward was perceived as significantly noisier than the bay ward and noise levels were significantly correlated to anxiety scores. Paradoxically the increase in noise levels appeared to improve the perceived level of privacy on the Nightingale ward. Seventy-five per cent of patients were found to prefer the bay ward design, and since neither design appears to have major disadvantages their continued introduction should be encouraged. However, recommendations are made concerning the optimizing of patients' well-being within the bay ward setting.

Information systems design for the community health services

This system is concerned with the design and implementation of a community health information system which fulfils some of the local needs of fourteen nursing and para-medical professions in a district health authority, whilst satisfying the statutory requirements of the NHS Korner steering group for those professions. A national survey of community health computer applications, documented in the form of an applications register, shows the need for such a system. A series of general requirements for an informations systems design methodology are identified, together with specific requirements for this problem situation. A number of existing methodologies are reviewed, but none of these were appropriate for this application. Some existing approaches, tools and techniques are used to define a more suitable methodology. It is unreasonable to rely on one single general methodology for all types of application development. There is a need for pragmatism, adaptation and flexibility. In this research, participation in the development stages by those who will eventually use the system was thought desirable. This was achieved by forming a representative design group. Results would seem to show a highly favourable response from users to this participation which contributed to the overall success of the system implemented. A prototype was developed for the chiropody and school nursing staff groups of Darlington health authority, and evaluations show that a significant number of the problems and objectives of those groups have been successfully addressed; the value of community health information has been increased; and information has been successfully fed back to staff and better utilised.