Medical error:a discussion of the medical construction of error and suggestions for reforms of medical education to decrease error

Introduction: There is a growing public perception that serious medical error is commonplace and largely tolerated by the medical profession. The Government and medical establishment's response to this perceived epidemic of error has included tighter controls over practising doctors and individual stick-and-carrot reforms of medical practice. Discussion: This paper critically reviews the literature on medical error, professional socialization and medical student education, and suggests that common themes such as uncertainty, necessary fallibility, exclusivity of professional judgement and extensive use of medical networks find their genesis, in part, in aspects of medical education and socialization into medicine. The nature and comparative failure of recent reforms of medical practice and the tension between the individualistic nature of the reforms and the collegiate nature of the medical profession are discussed. Conclusion: A more theoretically informed and longitudinal approach to decreasing medical error might be to address the genesis of medical thinking about error through reforms to the aspects of medical education and professional socialization that help to create and perpetuate the existence of avoidable error, and reinforce medical collusion concerning error. Further changes in the curriculum to emphasize team working, communication skills, evidence-based practice and strategies for managing uncertainty are therefore potentially key components in helping tomorrow's doctors to discuss, cope with and commit fewer medical errors.

Who is really in charge of contemporary education? People and technologies in, against and beyond the neoliberal university

This article reflects on the position of people in, against and beyond information and communication technologies. Firstly, using Jandrić and Kuzmanić’s work on digital postcolonialism, Raymond Williams's work on residual and emergent cultures, and Deleuze and Guattari's insights into the dynamics between territorialization, de-territorialization and re-territorialization, it develops a theoretical framework for inquiry into the hybrid identity of the contemporary university. Then, through critical discourse analysis (CDA), the article moves on to analyse the ways in which technology discourse resides in the dominating ideology of technological determinism and co-opts with neoliberal agendas by omitting humans from explicit mention in UK policy documents. It shows that true counter-hegemonic practice against dominating social practices is possible only through reinvigorating the central position of human beings in regards to information and communication technologies. Within the developed theoretical framework, it seeks openings to intervene subversively into current relationships between technologies, people, and (higher) education, and to identify opportunities for building a non-determinist identity of the contemporary university that reaches beyond the single-minded logic of techno-scientific development. In the process, it situates Paulo Freire's insights into critical pedagogy in the context of the network society, and places the relationships between human beings, language and information and communication technologies amongst central questions of today's (higher) education and society at large.

The Automation of Adaptive Processes in the System of Distance Education and Knowledge Control

The article reveals a new technological approach to the creation of adaptive systems of distance learning and knowledge control. The use of the given technology helps to automate the learning process with the help of adaptive system. Developed with the help of the quantum approach of knowledge setting, a programming module-controller guarantees the support of students’ attention and the adaptation of the object language, and this helps to provide the effective interaction between learners and the learning system and to reach good results in the intensification of learning process.

Special Features of Musical Education in Distant Learning (Training of Intonation Thinking)

The problem of using modern technologies in distant learning of intonation thinking is described in this article. An importance of intonation learning for musician students and the possibilities, provided by World Wide Web and multimedia technologies are the main point of this article.

Technology enhanced learning in Higher Education

Technology-Enhanced Learning in Higher Education is an anthology produced by the international association, Learning in Higher Education (LiHE). LiHE, whose scope includes the activities of colleges, universities and other institutions of higher education, has been one of the leading organisations supporting a shift in the education process from a transmission-based philosophy to a student-centred, learning-based approach. Traditionally education has been envisaged as a process in which the teacher disseminates knowledge and information to the student, and directs them to perform – instructing, cajoling, encouraging them as appropriate – despite different students’ abilities. Yet higher education is currently experiencing rapid transformation, with the introduction of a broad range of technologies which have the potential to enhance student learning. This anthology draws upon the experiences of those practitioners who have been pioneering new applications of technology in higher education, highlighting not only the technologies themselves but also the impact which they have had on student learning. The anthology illustrates how new technologies – which are increasingly well-known and accepted by today’s ‘digital natives’ undertaking higher education – can be adopted and incorporated. One key conclusion is that learning remains a social process even in technology-enhanced learning contexts. So the technology-based proxies we construct need to retain and reflect the agency of the teacher. Technology-Enhanced Learning in Higher Education showcases some of the latest pedagogical technologies and their most creative, state-of-the-art applications to learning in higher education from around the world. Each of the chapters explores technology-enhanced learning in higher education in terms of either policy or practice. They contain detailed descriptions of approaches taken in very different curriculum areas, and demonstrate clearly that technology may and can enhance learning only if it is designed with the learning process of students at its core. So the use of technology in education is more linked to pedagogy than it is to bits and bytes.

How do engineering students develop practical competencies during a period of industrial placement? - Students' perceptions

This paper explores engineering students' perceptions of developing practical competencies as experienced in their industrial placements. In addition, it discusses the criticisms in the literature on Problem Based Learning, Project Based Learning and Conceive-Design-Implement-Operate in relation to the evaluation of effective learning and teaching during placements. The paper goes on to discuss a study which examines how undergraduate engineering students develop practical competencies during their industrial placements. A phenomenological research approach is adopted using in-depth interviews and document analysis. The research findings from this PhD study will contribute to the knowledge, theory and practice for the students, the industries and the institutions of higher education as students' practical competencies are developed and graduate employability rises. In conclusion, this study explores students' experiences of developing practical competencies during industrial placements. Hence, the study should be able to contribute to a set of evidence-based guidelines for higher education institutions and industry.

A tudományterületi sajátosságok következményei a kutatásban, az oktatásban és a felsőoktatási intézmények vezetésében (The consequences of disciplinary difference on teaching, research and institutional management of higher education)

A szerző tanulmányában vizsgálja a tudományterületek különbségeinek következményeit az oktatásban, a kutatásban és a felsőoktatási intézmények irányításában. A tanulmány első felében a tudományterületek episztemológiai és közösségi különbségeit tárgyalja Becher és Trowler (2001) népszerű kategorizálása alapján. A tanulmány második felében a tudományszerveződésre, a publikációs gyakorlatra, a doktori képzésre, az oktatás céljára és formáira, a diákok tudásképére, valamint a menedzsmentfelfogásra gyakorolt hatást mutatja be. A konklúzióban egyrészt a minőség- és teljesítményértékelési rendszerek differenciált megközelítésének szükségességére hívja fel a figyelmet, másrészt arra, hogy a Bologna-rendszer és az élethosszig tartó tanulás erősödésének következményeként egy-egy mesterszakon nemcsak a hallgatóság háttere, előismerete lesz sokszínű, hanem a tudásról alkotott képe is. Ez újfajta oktatói szerepeket és oktatási megközelítéseket tesz szükségessé. ________ In the article the consequences of disciplinary difference on teaching, research and institutional management is examined. In the first part of the paper the epistemological and sociological differences of scientific disciplines are summarized based on the popular typology of Becher and Trowler (2001). In the second part the influence of differences on organisation of sciences, publication practices, PhD studies, the goal and form of teaching, students’ conception of knowledge as well as on the understanding on management and leadership are discussed. In the conclusions, attention is drawn on the necessity of differentiation in quality and performance management processes. Another conclusion is that new roles for teachers and approaches for teaching is required if students’ conception of knowledge become more heterogeneous which is the result of result of life long learning and Bologna-reform.

Public school administrators' knowledge of special education law

The purpose of this study was to assess the knowledge of public school administrators with respect to special education (ESE) law. The study used a sample of 220 public school administrators. A survey instrument was developed consisting of 19 demographic questions and 20 situational scenarios. The scenarios were based on ESE issues of discipline, due process (including IEP procedures), identification, evaluation, placement, and related services. The participants had to decide whether a violation of the ESE child's rights had occurred by marking: (a) Yes, (b) No, or (c) Undecided. An analysis of the scores and demographic information was done using a two-way analysis of variance, chi-square, and crosstabs after a 77% survey response rate.^ Research questions addressed the administrators' overall level of knowledge. Comparisons were made between principals and assistant principals and differences between the levels of schooling. Exploratory questions were concerned with ESE issues deemed problematic by administrators, effects of demographic variables on survey scores, and the listing of resources utilized by administrators to access ESE information.^ The study revealed: (a) a significant difference was found when comparing the number of ESE courses taken and the score on the survey, (b) the top five resources of ESE information were the region office, school ESE department chairs, ESE teachers, county workshops, and county inservices, (c) problematic areas included discipline, evaluation procedures, placement issues, and IEP due process concerns, (d) administrators as a group did not exhibit a satisfactory knowledge of ESE law with a mean score of 12 correct and 74% of responding administrators scoring in the unsatisfactory level (below 70%), (e) across school levels, elementary administrators scored significantly higher than high school administrators, and (f) a significant implication that assistant principals consistently scored higher than principals on each scenario with a significant difference at the high school level.^ The study reveals a vital need for administrators to receive additional preparation in order to possess a basic understanding of ESE school law and how it impacts their respective schools and school districts so that they might meet professional obligations and protect the rights of all individuals involved. Recommendations for this additional administrative preparation and further research topics were discussed. ^

The Central Agency for Jewish Education: Fifty years of Jewish education in Dade County

The purpose of the study was to provide a historical record of the Bureau of Jewish Education/Central Agency for Jewish Education and its role in Jewish education in Miami since its inception in 1944 as well as to provide a sociological context within which to view the growth and development of the community. During the past 50 years of the Agency's existence, Dade County's Jewish population has undergone many changes including a huge population increase in the 1960s and 1970s and then a decrease in the 1980s and 1990s, and a shift from postwar business class of store owners to turn of the century professional class.^ The methodology used in this study was threefold. First, document analysis of formal and informal documents dating from 1944 to the present was conducted. Second, personal interviews were conducted with the Executive Directors of the B.J.E./C.A.J.E., long-time B.J.E./C.A.J.E. staff, present staff, Greater Miami Jewish Federation leaders, and lay leadership of C.A.J.E. Third, national trends in Jewish education were cited as a basis for the comparison and contrast of the achievements of C.A.J.E.^ The historiography concluded that the Agency had come full circle in its programs. Analysis of the services provided to religious and day schools, early childhood education, the High Schools, teacher services, adult education, and the library indicated that in some areas C.A.J.E. was an innovator, in other areas it followed national trends, and in others it was deficient. Recommendations included a reeducative process for the community with Jewish education made top priority, more visibility and publicity for the work of C.A.J.E. that would enhance its prestige and improve support, and holistic planning of programs for the future. ^

Influence, policy formation, and higher education in Florida: 1989--1994

This study examined the perceptions of state governmental officials and administrators from the state university system, community college system, and independent institutions concerning the ability of various groups to influence state-level higher education policy formation. The study was conducted in Florida for the period 1989-94. Florida has a history of legislative involvement in higher education, a unique system of state universities and community colleges, and a limited number of private institutions of higher education. This study was grounded in the works of Mortimer and McConnell (1978), Millett (1987), Marshall, Mitchell, and Wirt (1989) and Finitfer, Baldwin, and Thelin (1991).^ The study represented the application of an embedded, single-case design. A survey was the primary collection instrument. Respondents were asked questions concerning: (a) personal involvement in higher education, (b) perceptions of the ability of various groups to influence higher education policy, (c) the names of particular individuals considered key players in higher education policy formation, (d) important state-level documents, (e) personal knowledge of key areas of policy formation, and (f) emerging higher education issues in Florida. Quantitative and qualitative methods were used to analyze the different sections of the survey.^ The findings indicated that a power and influence hierarchy exists among the various groups that attempt to influence higher education policy and that this hierarchy is recognized by state government officials and higher education administrators. While an analysis of variance of the various groups revealed a few differences between state government officials and higher education personnel, the high overall agreement was an important finding. Leading members of the legislature, especially the Chair of the Senate Higher Education Committee, and key staff members, especially from the Senate Ways & Means Committee, were considered the most influential. Representatives from higher education institutions and research organizations were considered among the least influential. Emerging issues identified by the respondents included: (a) the political nature of state-level policy formation, (b) the role of legislative staff, (c) the competition for state moneys, (d) legislative concern for state-wide budgetary efficiency, and (e) legislative attempts to define quality and supervise academic program development for higher education. ^

The effect of vocational education on high school students in a large urban multicultural school district

The completion of and graduation from high school is a major problem that must be resolved. A 6% random sample of the students (1,059) who were in the 9th grade in Miami-Dade Public Schools, a large urban school district, September 1992, were selected for this study. The sample was divided into 2 groups, advanced academic and general track students. Each group was then divided into vocational and non-vocational. A causal comparative design was used to evaluate the results for graduate vs. non-graduate. The indicators were the program of study, attendance, standardized test scores, grade point average, ethnicity and gender. It was found that both advanced academic and general track students had significantly higher graduation rates at the .01 level when a vocational education program was part of their studies. All of the other indicators did not show any significant differences. If we arc to improve students educational outcomes and reduce the dropout rate, vocational education should be part of every student's education.^

Differences in perceptions of teachers' and students' values of physical education programs in private universities in Taipei City, Taiwan

After the New University Code was issued in 1994, the university physical education program was at a crossroad in Taiwan. Physical education teachers are facing changes in the curriculum. The purpose of this study is to find a direction for the future in physical education by using a revised Value Orientation Inventory to investigate the teachers' and students' value orientations. Based on these findings, results could identify a value-based philosophy for physical education curriculum innovation at the private university in Taiwan. ^ The subjects of this study included forty-two physical education teachers and ninety-four current students in five private universities in Taipei City, Taiwan. Value Orientation Inventory were developed by Ennis and Chen (1993), was used to assess subjects on five items five value orientations. VOI data were collected and analyzed by using T-test, ANOVA, and a set of special contrasts. ^ The findings of this study indicated that ninety-four percent of the private university students and physical education teachers made consistent curricular decisions within one or more of the value orientations. Teachers perceived Disciplinary Mastery (DM) and Learning Process (LP) value orientations as the most important values. Students perceived Ecological Integration (EI) and Disciplinary Mastery as the most important values. Both teachers and students placed Social Reconstruction value orientation as the lowest value. There were significant differences between teachers' and students' value orientations. Differences were found in DM, LP, and SA (Self-Actualization). There also were significant differences between teachers' and students' value orientation based on students' gender and year at university. These findings lead to the conclusion that private university students' values are incongruent with the physical education teachers' values. The finding suggests that unless physical education teachers address students' values on EI and SA, conflict may occur. ^

The democratization of higher education in Jamaica: The role of the University of the West Indies

The University of the West Indies (UWI), established in the British colony of Jamaica in 1948, was mandated to serve the “brightest and the best” of the British colonies. Unfortunately, the austerity of Jamaica's economy has not helped to augment an “open door” access to higher education, and UWI is often criticized for not implementing policies to sustain the democratization of higher education; it is accused of functioning as an elitist institution. ^ The purpose of this qualitative study was to determine whether UWI functions democratically as an institution to influence the equity of higher education in Jamaica. A review of the literature reveals many interpretations of the democratization of higher education. Three of Spaulding and Kargodorian's four criteria were utilized to analyze this research. They were (1) equality of access to higher education, (2) equality of participation within the institution of higher education, and (3) equality of educational results. Multiple sources of written data augmented by interviews in Jamaica and Miami were utilized. ^ The analysis revealed that UWI functions in a collaborative relationship with Jamaica's Centralized Educational System as well as with the country's political, economic, and social realms to impact the democratization of higher education. Documentation suggests that, although strong traditional influences continue to exist, UWI has deviated from its original mandate and instead, flexible admittance policies and diversification of expanded programs have contributed to greater accessibility. ^ Despite UWI's reports of improvements which have contributed to more access, UNESCO and some interviewees have not been impressed. A World Bank report on enrollment ratio at the university level in English speaking Caribbean countries reflects less than one percent of the age cohort. The Jamaicans interviewed, especially those from the lower class, felt that their democratic right to receive higher education was not met. UNESCO regards UWI's efforts as just putting a “dent” in the problem. ^ Recommendations include continuing efforts towards developing curricula more relevant to the Jamaican society, increasing distance education in order to ease UWI's load, expanding financial partnerships with private sectors, and extending research in collaboration with large local and foreign private companies. ^

Marketing practices and their effectiveness in Taiwan's colleges of technology

The main purpose of this study was to investigate marketing practices in Taiwan's institutions of higher education and their relationship with students' college choice behaviors and attitudes. The study was conducted in 11 Taiwan's colleges of technology. It employed a multistrand conversion mixed model design, consisting of a qualitative and a quantitative strand. Funnel-sequenced interviews were conducted with 19 college administrators and the results were content analyzed using a constant-comparative method. The administrator interview data were also quantitized and used in cluster analysis of the institutions. Questionnaire data were collected from 1474 freshmen students, and analyzed using several univariate and multivariate statistical techniques including factor analysis, MANOVA, and correspondence analysis. ^ Analyses indicated that a weak relationship existed between institutions' marketing intensity and students' college choice. Students did not consider institutions' recruitment activities useful in their college searching process. They also reported little knowledge of their current school when they were deciding to enroll. Data analysis also revealed that students were practically oriented in their college selection. Academic resources, employability after graduation, and tuition were the most important attributes in students' college selection. Parents and students' social network such as friends and high school teachers were significant personal sources in enrollment decisions while institutions' representatives (i.e., recruiters) were considered the least influential. ^ Using cluster analysis, institutions were divided into three groups based on intensity of marketing efforts. Multivariate analysis of variance did not reveal significant differences between the college choice behaviors and attitudes of students who entered these three types of institutions. ^ Content analysis of the administrators' interviews indicated that the majority of them practiced passive marketing. This was primarily as a result of resistance to active marketing, lack of leadership commitment, insufficient financial and human resources, little faculty involvement, and inexperience in marketing. In comparison to public institutions, private institutions showed a more favorable attitude towards marketing concepts. They were well advanced in their recruitment activities while public schools were relatively hesitant to use marketing. Curriculum issues were not well represented in marketing activities and did not seem to be impacted by marketing needs. Based on the analysis of qualitative and quantitative data, it can be concluded that in these colleges, curriculum was more driven by commercial and industrial interest than by students' demands. ^ Theoretical, policy, and methodological implementation of the results were discussed. ^

Teacher efficacy of special education teachers of English language learners with disabilities

This research examined the perceived teacher efficacy of special education teachers of English Language Learners (ELLs) with educational disabilities by surveying 202 elementary special education teachers using the EXCEL Teacher Inventory. EXCEL consists of 20 teacher efficacy items, three open-ended questions, and participant demographic items. ^ Overall participant teacher efficacy scores were high. Of the variables assessed, a statistically significant difference in perceived efficacy was found with self-reported proficiency in the language of the target students. No statistically significant differences in teacher efficacy scores were found for (a) levels of teacher preparation; (b) number of years of teaching experience; or (c) socioeconomic status of the students. A multiple regression analysis indicated that, of the variables listed above, proficiency in the language of the target students accounted for significant variance in predicting the level of teachers' perceived efficacy. ^ Responses to the open-ended questions about what was most helpful when working with ELLs with disabilities yielded two major themes: organizational issues and teacher issues. Participants wrote numerous comments about the value of support from educational professionals and parents. Many participants recommended individuals in preservice programs take ESOL content specific courses. ^ The results demonstrate the positive correlation between proficiency in the language of the target students and teacher efficacy. This suggests that teachers of ELLs with disabilities have proficiency in the ELLs' native language (or have support from others who are language proficient) that allows them to distinguish between language difference and language disability and provide instruction in the native language when needed. Further, results from open-ended questions suggest that special education teacher preparation programs should include courses related specifically to strategies for teaching ELLs with disabilities, not just ELLs. ^