Medical students' personal experience of high-stakes failure:case studies using interpretative phenomenological analysis

Abstract (provisional): Background Failing a high-stakes assessment at medical school is a major event for those who go through the experience. Students who fail at medical school may be more likely to struggle in professional practice, therefore helping individuals overcome problems and respond appropriately is important. There is little understanding about what factors influence how individuals experience failure or make sense of the failing experience in remediation. The aim of this study was to investigate the complexity surrounding the failure experience from the student’s perspective using interpretative phenomenological analysis (IPA). Methods The accounts of 3 medical students who had failed final re-sit exams, were subjected to in-depth analysis using IPA methodology. IPA was used to analyse each transcript case-by-case allowing the researcher to make sense of the participant’s subjective world. The analysis process allowed the complexity surrounding the failure to be highlighted, alongside a narrative describing how students made sense of the experience. Results The circumstances surrounding students as they approached assessment and experienced failure at finals were a complex interaction between academic problems, personal problems (specifically finance and relationships), strained relationships with friends, family or faculty, and various mental health problems. Each student experienced multi-dimensional issues, each with their own individual combination of problems, but experienced remediation as a one-dimensional intervention with focus only on improving performance in written exams. What these students needed to be included was help with clinical skills, plus social and emotional support. Fear of termination of the their course was a barrier to open communication with staff. Conclusions These students’ experience of failure was complex. The experience of remediation is influenced by the way in which students make sense of failing. Generic remediation programmes may fail to meet the needs of students for whom personal, social and mental health issues are a part of the picture.

Perceptions and experiences of the implementation, management, use and optimisation of electronic prescribing systems in hospital settings:protocol for a systematic review of qualitative studies

Introduction: There is increasing evidence that electronic prescribing (ePrescribing) or computerised provider/physician order entry (CPOE) systems can improve the quality and safety of healthcare services. However, it has also become clear that their implementation is not straightforward and may create unintended or undesired consequences once in use. In this context, qualitative approaches have been particularly useful and their interpretative synthesis could make an important and timely contribution to the field. This review will aim to identify, appraise and synthesise qualitative studies on ePrescribing/CPOE in hospital settings, with or without clinical decision support. Methods and analysis: Data sources will include the following bibliographic databases: MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, Social Policy and Practice via Ovid, CINAHL via EBSCO, The Cochrane Library (CDSR, DARE and CENTRAL databases), Nursing and Allied Health Sources, Applied Social Sciences Index and Abstracts via ProQuest and SCOPUS. In addition, other sources will be searched for ongoing studies (ClinicalTrials.gov) and grey literature: Healthcare Management Information Consortium, Conference Proceedings Citation Index (Web of Science) and Sociological abstracts. Studies will be independently screened for eligibility by 2 reviewers. Qualitative studies, either standalone or in the context of mixed-methods designs, reporting the perspectives of any actors involved in the implementation, management and use of ePrescribing/CPOE systems in hospital-based care settings will be included. Data extraction will be conducted by 2 reviewers using a piloted form. Quality appraisal will be based on criteria from the Critical Appraisal Skills Programme checklist and Standards for Reporting Qualitative Research. Studies will not be excluded based on quality assessment. A postsynthesis sensitivity analysis will be undertaken. Data analysis will follow the thematic synthesis method. Ethics and dissemination: The study does not require ethical approval as primary data will not be collected. The results of the study will be published in a peer-reviewed journal and presented at relevant conferences.

Costs and Benefits of Stem Cell Research and Treatment: Media Presentation and Audience Understanding in Hungary

This study examined the press coverage and audience understanding of the costs and benefits of stem cell research/treatment in Hungary. A content analysis of five newspapers and a focus group study was conducted. The way participants talked about the costs and benefits in many aspects echoed the dominant framing of the issue in the press (medical benefits = main benefit, high expense of treatment = dominant negative aspect). Even though participants applied analogical reasoning to formulate some risks that were missing from the reporting on stem cells, many gaps of the media coverage were echoed in gaps in lay discussions.

An evaluation of child welfare inservice training: The relative effectiveness of substance abuse content in improving worker knowledge and attitudes

Given the seriousness of substance abuse as a child welfare problem, the purpose of this study was to examine the relative effectiveness of an inservice training curriculum for child welfare workers. The training was designed to improve worker knowledge and attitudes in working with substance abusing families. Seventy (70) child welfare workers from public and private agencies in two south Florida counties participated in a pretest/posttest control group design that also trained and retested the control group. The literature review supports that the general preparedness of child welfare workers for the issues presented by substance abusing families is in question. Confounding this problem is a lack of understanding of substance abuse dynamics, worker biases, and predispositions. The two research hypotheses focused on whether inservice training could increase worker knowledge and improve worker attitudes in working with this population. Training delivery was in the form of a five-day inservice focusing on an array of substance abuse knowledge and attitudinal topics. Separate knowledge and attitude instruments were developed for the research and were administered, before and after training, to a purposive sample of participants that were randomly assigned to the experimental and control groups. The data analysis supported the research hypotheses but raised a question. Specifically, the experimental group demonstrated significant improvement in posttest scores on both instruments after receiving the training; whereas the control group, with training withheld, also demonstrated a significant improvement at posttest, but only on the knowledge instrument. Although the question was unanswered, when examined at a more critical significance level, only the experimental group remained significant. The hypotheses were reconfirmed when, after training and retesting, the control group also displayed significant improvement on both instruments. The findings support the conclusion that this substance abuse inservice was effective in improving worker knowledge and attitudes regarding working with substance abusing families. As an implication for social work practice, it suggests that similar inservice training can be a viable training resource when formal substance abuse training is unavailable. Additional research is suggested regarding to what degree increased substance abuse knowledge and improved worker attitudes correlate with improved practice.

Without women: Masculinities, gay male sexual culture and sexual behaviors in Miami, Florida

Recent studies have reported alarmingly high rates of HIV infection and risky sexual behaviors among gay men in Miami, Florida. Previous research has suggested that the risky sexual behaviors of many gay men reflect the pursuit of intimacy and love, and that barriers to intimate relationships among gay men may stem from traditional masculinity norms. This dissertation examines the meanings which gay men ascribe to their sexual behaviors, as well as the intersections of those meanings with both traditional masculinity constructions and Miami's gay male sexual culture. ^ The study is based upon participant observation, print media content analysis, surveys and ethnographic interviews of a purposive snowball sample of 30 Cuban American, Puerto Rican, African American and Anglo gay men who reside in Miami-Dade County, Florida. Analysis of research questions was accomplished through grounded theory methods and descriptive and non-parametric statistics, including Pearson chi-square, Fisher's Exact and Mann-Whitney U tests. ^ The study shows that culturally-specified masculinity norms vary in the relative importance ascribed to heterosexual prowess, economic providership and competitiveness. These cultural differences appear important not only to the timing of sexual awareness and to the strength of homosexual stereotyping as effeminacy, but also to men's strategies in coming out as gay. The meanings men attributed to their sexual behaviors were, however, constructed in response to both inherited masculinity norms and the hypermasculine structure of Miami's gay male sexual culture. In addition to providing an ethnographic account of this subculture, the study elaborates men's issues relative to casual sex and committed relationships. Unprotected anal intercourse with casual partners during the previous twelve months was associated with growing up without one's father in the home, having been teased for effeminacy during childhood, being defensive about one's masculinity, not trusting men, having been cheated on by boyfriends, and believing that long-term gay male relationships are problematic. ^ It is concluded that the continuing epidemic of HIV infections among local gay men, as well as the hypermasculine form of the gay sexual subculture itself, are nihilistic symptoms embedded in the masculinist gender structure of the larger society. ^

An assessment of computer usage within the Bahamian public school system and recommended guidelines towards the development of a strategic national computer plan

Computers have dramatically changed the way we live, conduct business, and deliver education. They have infiltrated the Bahamian public school system to the extent that many educators now feel the need for a national plan. The development of such a plan is a challenging undertaking, especially in developing countries where physical, financial, and human resources are scarce. This study assessed the situation with regard to computers within the Bahamian public school system, and provided recommended guidelines to the Bahamian government based on the results of a survey, the body of knowledge about trends in computer usage in schools, and the country's needs. ^ This was a descriptive study for which an extensive review of literature in areas of computer hardware, software, teacher training, research, curriculum, support services and local context variables was undertaken. One objective of the study was to establish what should or could be relative to the state-of-the-art in educational computing. A survey was conducted involving 201 teachers and 51 school administrators from 60 randomly selected Bahamian public schools. A random stratified cluster sampling technique was used. ^ This study used both quantitative and qualitative research methodologies. Quantitative methods were used to summarize the data about numbers and types of computers, categories of software available, peripheral equipment, and related topics through the use of forced-choice questions in a survey instrument. Results of these were displayed in tables and charts. Qualitative methods, data synthesis and content analysis, were used to analyze the non-numeric data obtained from open-ended questions on teachers' and school administrators' questionnaires, such as those regarding teachers' perceptions and attitudes about computers and their use in classrooms. Also, interpretative methodologies were used to analyze the qualitative results of several interviews conducted with senior public school system's officials. Content analysis was used to gather data from the literature on topics pertaining to the study. ^ Based on the literature review and the data gathered for this study a number of recommendations are presented. These recommendations may be used by the government of the Commonwealth of The Bahamas to establish policies with regard to the use of computers within the public school system. ^

A qualitative study of the clinical practice of graduates of a problem-based physical therapy program

The purpose of this study was to examine the perspectives of three graduates of a problem-based leaning (PBL) physical therapy (PT) program about their clinical practice. The study used the qualitative methods of observations, interviews, and journaling to gather the data. Three sessions of audiotaped interviews and two observation sessions were conducted with three exemplars from Nova Southeastern University PBL PT program. Each participant also maintained a reflective journal. The data were analyzed using content analysis. A systematic filing system was used by employing a mechanical means of maintaining and indexing coded data and sorting data into coded classifications of subtopics or themes. All interview transcripts, field notes from observations, and journal accounts were read, and index sheets were appropriately annotated. From the findings of the study, it was noted that, from the participants' perspectives, they were practicing at typically expected levels as clinicians. The attributes that governed the perspectives of the participants about their physical therapy clinical practice included flexibility, reflection, analysis, decision-making, self-reliance, problem-solving, independent thinking, and critical thinking. Further, the findings indicated that the factors that influenced those attributes included the PBL process, parents' value system, self-reliant personality, innate personality traits, and deliberate choice. Finally, the findings indicated that the participants' perspectives, for the most part, appeared to support the espoused efficacy of the PBL educational approach. In conclusion, there is evidence that the physical therapy clinical practice of the participants were positively impacted by the PBL curriculum. Among the many attributes they noted which governed these perspectives, problem-solving, as postulated by Barrows, was one of the most frequently mentioned benefits gained from their PBL PT training. With more schools adopting the PBL approach, this research will hopefully add to the knowledge base regarding the efficacy of embracing a problem-based learning instructional approach in physical therapy programs. ^

Tennessee trabajadores: Global wage arbitrage comes home to roost

In the 1980s, the American meat industry began restructuring both its domestic production methods and the distribution of its processing facilities. Many meat and poultry processing facilities have since been relocated into small rural communities. The red meat industry was once highly-paid and unionized, but now work in both meat and poultry processing is a dangerous, low-paid manufacturing job, heavily reliant on immigrant workers who must turn to local social services to supplement their wages and benefits. In an attempt to discover the manner in which the social relations of a specific locale may be enmeshed with global production, this research explored perceptions of social power and alliances after a rural community became host to a foreign workforce employed by the local poultry processing plant. On-site semi-structured interviews were conducted with sixteen local residents, and a content analysis of the community newspaper was undertaken. ^ The research found that as new production relations were inserted into the community, the society continued to reproduce and social relations remained relatively unchanged. The community's cultural standards and social infrastructure dictate that residents are respectful of authority, extend Christian charity to those less fortunate, and are generally accepting of a community known for low wages, low taxation, and low standards of education. Hegemonic ideologies seem to dictate the goals and beneficiaries of social power, and residents are unable to name any power vectors even in the face of sustained community support of, for example, the company that introduced the immigrant labor into the community. While there are indications of displeasure with the influx of immigrants appearing in the newspaper and the interviews, there are tangible examples that the community was proactive in welcoming the immigrants into their community. Thus, given that the last time elements of the community united around an issue was in the mid-1970s and no other issue has evoked any type of tangible struggle since then, there is no indication that any social alliances will be formed in reaction to changes in the community wrought by the globalization of its economy. ^

Re-imagining Yerevan in the post-Soviet era: Urban symbolism and narratives of the nation in the landscape of Armenia's capital

The urban landscape of Yerevan has experienced tremendous changes since the collapse of the Soviet Union and Armenia’s independence in 1991. Domestic and foreign investments have poured into Yerevan’s building sector, converting many downtown neighborhoods into sleek modern districts that now cater to foreign investors, tourists, and the newly rich Armenian nationals. Large portions of the city’s green parks and other public spaces have been commercialized for private and exclusive use, creating zones that are accessible only to the affluent. In this dissertation I explore the rapidly transforming landscape of Yerevan and its connections to the development of contemporary Armenian national identity. This research was guided by principles of ethnographic inquiry, and I employed diverse methods, including document and archival research, structured and semi-structured interviews and content analysis of news media. I also used geographic information systems (GIS) and satellite images to represent and visualize the stark transformations of spaces in Yerevan. Informed by and contributing to three literatures—on the relationship between landscape and identity formation, on the construction of national identity, and on Soviet and post-Soviet cities—this dissertation investigates how messages about contemporary Armenian national identity are being expressed via the transforming landscape of Armenia’s national capital. In it I describe the ways in which abrupt transformations have resulted in the physical and symbolic eviction of residents, introducing fierce public debates about belonging and exclusion within the changing urban context. I demonstrate that the new additions to Yerevan’s landscape and the symbolic messages that they carry are hotly contested by many long-time residents, who struggle for inclusion of their opinions and interests in the process of re-imagining their national capital. This dissertation illustrates many of the trends that are apparent in post-Soviet and post-Socialist space, while at the same time exposing some unique characteristics of the Armenian case.

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.

Early career special education teachers' perceptions of school site induction support

Research highlights teacher attrition as one of the biggest challenges facing public schools and their attempts to provide a quality teacher for every student (Ingersoll & Smith, 2003). The teacher shortage is particularly daunting in special education where teachers are over twice as likely to leave the field. The first few years of teaching are the most critical in determining whether or not a beginning teacher will stay in the teaching profession (Whitaker, 2000). ^ A mixed-methods sequential explanatory design was utilized to examine research questions focused on the components of induction support that early career teachers received at their school site, including what they considered most valuable to their long-term retention in the classroom and their development as a quality teacher. Eighty seven early career special education teachers were surveyed during the first phase of the study and six participants were interviewed during the second phase. ^ Data analysis of the Likert-scale survey used in the study revealed that the majority of the respondents received at least 21 of the 25 listed induction components. Moreover, early career special education teachers indicated that they valued all 25 induction components. In addition, findings revealed that over two thirds of the respondents indicated a desire to remain a special education teacher. Overall, early career special education teachers felt confident in their abilities to teach students with disabilities; however, nearly half of the respondents did not feel satisfied with the induction they received. Independent t-tests showed a statistically significant difference between teachers who indicated a desire to remain in special education and those that did not on the level of satisfaction with their induction experience. ^ The six interviews provided elaboration and clarification of the survey responses. The participants expressed their passion for the art of teaching, their dedication to students with disabilities, and their frustration with being a beginning teacher. Furthermore, it was reported that the overall school culture was not very supportive. Participants offered relevant ideas for additional or alternate induction components that would be more effective.^

A Q-Methodology approach to investigating the relationship between level of reflection and typologies among prospective teachers in the physics learning assistant program at Florida International University

The purpose of this mixed methods study was to understand physics Learning Assistants' (LAs) views on reflective teaching, expertise in teaching, and LA program teaching experience and to determine if views predicted level of reflection evident in writing. Interviews were conducted in Phase One, Q methodology was used in Phase Two, and level of reflection in participants' writing was assessed using a rubric based on Hatton and Smith's (1995) "Criteria for the Recognition of Evidence for Different Types of Reflective Writing" in Phase Three. Interview analysis revealed varying perspectives on content knowledge, pedagogical knowledge, and experience in relation to expertise in teaching. Participants revealed that they engaged in reflection on their teaching, believed reflection helps teachers improve, and found peer reflection beneficial. Participants believed teaching experience in the LA program provided preparation for teaching, but that more preparation was needed to teach. Three typologies emerged in Phase Two. Type One LAs found participation in the LA program rewarding and believed expertise in teaching does not require expertise in content or pedagogy, but it develops over time from reflection. Type Two LAs valued reflection, but not writing reflections, felt the LA program teaching experience helped them decide on non-teaching careers and helped them confront gaps in their physics knowledge. Type Three LAs valued reflection, believed expertise in content and pedagogy are necessary for expert teaching, and felt LA program teaching experience increased their likelihood of becoming teachers, but did not prepare them for teaching. Writing assignments submitted in Phase Three were categorized as 19% descriptive writing, 60% descriptive reflections, and 21% dialogic reflections. No assignments were categorized as critical reflection. Using ordinal logistic regression, typologies that emerged in Phase Two were not found to be predictors for the level of reflection evident in the writing assignments. In conclusion, viewpoints of physics LAs were revealed, typologies among them were discovered, and their writing gave evidence of their ability to reflect on teaching. These findings may benefit faculty and staff in the LA program by helping them better understand the views of physics LAs and how to assess their various forms of reflection.

Socio-ecological vulnerability to climate change in South Florida

Awareness of extreme high tide flooding in coastal communities has been increasing in recent years, reflecting growing concern over accelerated sea level rise. As a low-lying, urban coastal community with high value real estate, Miami often tops the rankings of cities worldwide in terms of vulnerability to sea level rise. Understanding perceptions of these changes and how communities are dealing with the impacts reveals much about vulnerability to climate change and the challenges of adaptation. ^ This empirical study uses an innovative mixed-methods approach that combines ethnographic observations of high tide flooding, qualitative interviews and analysis of tidal data to reveal coping strategies used by residents and businesses as well as perceptions of sea level rise and climate change, and to assess the relationship between measurable sea levels and perceptions of flooding. I conduct a case study of Miami Beach's storm water master planning process which included sea level rise projections, one of the first in the nation to do so, that reveals the different and sometimes competing logics of planners, public officials, activists, residents and business interests with regards to climate change adaptation. By taking a deeply contextual account of hazards and adaptation efforts in a local area I demonstrate how this approach can be effective at shedding light on some of the challenges posed by anthropogenic climate change and accelerated rates of sea level rise. ^ The findings highlight challenges for infrastructure planning in low-lying, urban coastal areas, and for individual risk assessment in the context of rapidly evolving discourse about the threat of sea level rise. Recognition of the trade-offs and limits of incremental adaptation strategies point to transformative approaches, at the same time highlighting equity concerns in adaptation governance and planning. This new impact assessment method contributes to the integration of social and physical science approaches to climate change, resulting in improved understanding of socio-ecological vulnerability to environmental change.^

Access to better education: The school choice experience of families served by low-performing elementary public schools in Miami-Dade County

Public school choice education policy attempts to create an education marketplace. Although school choice research has focused on the parent role in the school choice process, little is known about parents served by low-performing schools. Following market theory, students attending low-performing schools should be the primary students attempting to use school choice policy to access high performing schools rather than moving to a better school. However, students remain in these low-performing schools. This study took place in Miami-Dade County, which offers a wide variety of school choice options through charter schools, magnet schools, and open-choice schools. ^ This dissertation utilized a mixed-methods design to examine the decision-making process and school choice options utilized by the parents of students served by low-performing elementary schools in Miami-Dade County. Twenty-two semi-structured interviews were conducted with the parents of students served by low-performing schools. Binary logistic regression models were fitted to the data to compare the demographic characteristics, academic achievement and distance from alternative schooling options between transfers and non-transfers. Multinomial logistic regression models were fitted to the data to evaluate how demographic characteristics, distance to transfer school, and transfer school grade influenced the type of school a transfer student chose. A geographic analysis was conducted to determine how many miles students lived from alternative schooling options and the miles transfer students lived away from their transfer school. ^ The findings of the interview data illustrated that parents’ perceived needs are not being adequately addressed by state policy and county programs. The statistical analysis found that students from higher socioeconomic social groups were not more likely to transfer than students from lower socioeconomic social groups. Additionally, students who did transfer were not likely to end up at a high achieving school. The findings of the binary logistic regression demonstrated that transfer students were significantly more likely to live near alternative school options.^

A formação da habilidade de explicar no contexto do ensino médio: o que dizem os livros? o que pensam os professores?

The discussion about explanation in knowledge has been made for decades. Through this course, we present different ways of understanding about what is to explain the history: the primitive ethnographic description, the chronicler, the positivist construction of a historical science and historiography of the second half of twentieth century. Nowadays this discussion needs to be continued both in the general framework of scientific practice as within educational institutions as cognitive - linguistic ability. The focus of our research is by the second approach, which is the explanation as cognitive - linguistic ability. The formation of skills, among them, the explaining one, has been studied by the authors as: (NÚÑEZ 2012; JORBA et al, 2000; SANMARTÍ and IZQUIERDO 2000). This research had as general purpose: to study the processes of formation of the ability to explain social revolution in history classes in high school, by teachers opinion and by content as this theme among history books, in order to support the continuing education of history teachers for high school. Th e qualitative based research used instruments of data collection and analysis protocol for the books prepared for this study, and interviews with teachers. For this, the techniques of content analysis and discourse referenced in Bardin and Orlandi , respec tively were used. At first, the instruments for data collection were developed and validated, while in the second, the data were collected, organized and analyzed. From the answers to the questions of the study results shows that: a) in the analyzed books - do not express the work with the definition of Social Revolution, considering the processes for the formation of this definition, the predominant type of explanation has characteristics of multicausality; proposals for teaching are characterized as eclec tic; b) while teachers speech - it is important the students know the definition of Social Revolution, the ability to explain is more linked to didactic explanation in the classroom than the explanation through epistemological sense. These results indicate that the formation of the ability to explain Social Revolution based in Cultural History approach, are not expressed in the analyzed books, but they can serve as an important resource for this purpose. The discourse of teachers has a potential pointing to the possibility of teaching organization and learning process, based on training or upgrading the explanation skill from the theory of stepwise formation of mental actions and concepts by P.Ya. Galperin. For this purpose, the research constitutes a contri bution to support the continued education of history teachers in high school.