The professionalism disconnect: do entering residents identify yet participate in unprofessional behaviors?

BACKGROUND: Professionalism has been an important tenet of medical education, yet defining it is a challenge. Perceptions of professional behavior may vary by individual, medical specialty, demographic group and institution. Understanding these differences should help institutions better clarify professionalism expectations and provide standards with which to evaluate resident behavior. METHODS: Duke University Hospital and Vidant Medical Center/East Carolina University surveyed entering PGY1 residents. Residents were queried on two issues: their perception of the professionalism of 46 specific behaviors related to training and patient care; and their own participation in those specified behaviors. The study reports data analyses for gender and institution based upon survey results in 2009 and 2010. The study received approval by the Institutional Review Boards of both institutions. RESULTS: 76% (375) of 495 PGY1 residents surveyed in 2009 and 2010 responded. A majority of responders rated all 46 specified behaviors as unprofessional, and a majority had either observed or participated in each behavior. For all 46 behaviors, a greater percentage of women rated the behaviors as unprofessional. Men were more likely than women to have participated in behaviors. There were several significant differences in both the perceptions of specified behaviors and in self-reported observation of and/or involvement in those behaviors between institutions.Respondents indicated the most important professionalism issues relevant to medical practice include: respect for colleagues/patients, relationships with pharmaceutical companies, balancing home/work life, and admitting mistakes. They reported that professionalism can best be assessed by peers, patients, observation of non-medical work and timeliness/detail of paperwork. CONCLUSION: Defining professionalism in measurable terms is a challenge yet critical in order for it to be taught and assessed. Recognition of the differences by gender and institution should allow for tailored teaching and assessment of professionalism so that it is most meaningful. A shared understanding of what constitutes professional behavior is an important first step.

The Rational Adolescent: Strategic Information Processing during Decision Making Revealed by Eye Tracking.

Adolescence is often viewed as a time of irrational, risky decision-making - despite adolescents' competence in other cognitive domains. In this study, we examined the strategies used by adolescents (N=30) and young adults (N=47) to resolve complex, multi-outcome economic gambles. Compared to adults, adolescents were more likely to make conservative, loss-minimizing choices consistent with economic models. Eye-tracking data showed that prior to decisions, adolescents acquired more information in a more thorough manner; that is, they engaged in a more analytic processing strategy indicative of trade-offs between decision variables. In contrast, young adults' decisions were more consistent with heuristics that simplified the decision problem, at the expense of analytic precision. Collectively, these results demonstrate a counter-intuitive developmental transition in economic decision making: adolescents' decisions are more consistent with rational-choice models, while young adults more readily engage task-appropriate heuristics.

A framework for revising preservice curriculum for nonphysician clinicians: The mozambique experience.

Mozambique, with approximately 0.4 physicians and 4.1 nurses per 10,000 people, has one of the lowest ratios of health care providers to population in the world. To rapidly scale up health care coverage, the Mozambique Ministry of Health has pushed for greater investment in training nonphysician clinicians, Tιcnicos de Medicina (TM). Based on identified gaps in TM clinical performance, the Ministry of Health requested technical assistance from the International Training and Education Center for Health (I-TECH) to revise the two-and-a-half-year preservice curriculum. A six-step process was used to revise the curriculum: (i) Conducting a task analysis, (ii) defining a new curriculum approach and selecting an integrated model of subject and competency-based education, (iii) revising and restructuring the 30-month course schedule to emphasize clinical skills, (iv) developing a detailed syllabus for each course, (v) developing content for each lesson, and (vi) evaluating implementation and integrating feedback for ongoing improvement. In May 2010, the Mozambique Minister of Health approved the revised curriculum, which is currently being implemented in 10 training institutions around the country. Key lessons learned: (i) Detailed assessment of training institutions' strengths and weaknesses should inform curriculum revision. (ii) Establishing a Technical Working Group with respected and motivated clinicians is key to promoting local buy-in and ownership. (iii) Providing ready-to-use didactic material helps to address some challenges commonly found in resource-limited settings. (iv) Comprehensive curriculum revision is an important first step toward improving the quality of training provided to health care providers in developing countries. Other aspects of implementation at training institutions and health care facilities must also be addressed to ensure that providers are adequately trained and equipped to provide quality health care services. This approach to curriculum revision and implementation teaches several key lessons, which may be applicable to preservice training programs in other less developed countries.

Nations' income inequality predicts ambivalence in stereotype content: How societies mind the gap

Income inequality undermines societies: The more inequality, the more health problems, social tensions, and the lower social mobility, trust, life expectancy. Given people's tendency to legitimate existing social arrangements, the stereotype content model (SCM) argues that ambivalence-perceiving many groups as either warm or competent, but not both-may help maintain socio-economic disparities. The association between stereotype ambivalence and income inequality in 37 cross-national samples from Europe, the Americas, Oceania, Asia, and Africa investigates how groups' overall warmth-competence, status-competence, and competition-warmth correlations vary across societies, and whether these variations associate with income inequality (Gini index). More unequal societies report more ambivalent stereotypes, whereas more equal ones dislike competitive groups and do not necessarily respect them as competent. Unequal societies may need ambivalence for system stability: Income inequality compensates groups with partially positive social images. © 2012 The British Psychological Society.

Aspects of care 5: the continuing educational needs of midwives

This is the fifth in a series of six papers presenting key findings from a national study that was undertaken to investigate the role and responsibilities of midwives and to identify continuing educational need. The background to the study and the titles of the other papers in the series have been outlined in the first paper. This paper focuses on the methods used to identify the continuing educational needs of midwives, and provides an overview of the findings related to midwives' perceived confidence/competence to practice and their continuing educational needs.

Maintenance of a case-base for the retrieval of rotationally symmetric shapes for the design of metal castings

In this paper, we discuss the problem of maintenance of a CBR system for retrieval of rotationally symmetric shapes. The special feature of this system is that similarity is derived primarily from graph matching algorithms. The special problem of such a system is that it does not operate on search indices that may be derived from single cases and then used for visualisation and principle component analyses. Rather, the system is built on a similarity metric defined directly over pairs of cases. The problems of efficiency, consistency, redundancy, completeness and correctness are discussed for such a system. Performance measures for the CBR system are given, and the results for trials of the system are presented. The competence of the current case-base is discussed, with reference to a representation of cases as points in an n-dimensional feature space, and a Gramian visualisation. A refinement of the case base is performed as a result of the competence analysis and the performance of the case-base before and after refinement is compared.

Case-based retrieval of 3-dimensional shapes for the design of metal castings

This paper describes research into retrieval based on 3-dimensional shapes for use in the metal casting industry. The purpose of the system is to advise a casting engineer on the design aspects of a new casting by reference to similar castings which have been prototyped and tested in the past. The key aspects of the system are the orientation of the shape within the mould, the positions of feeders and chills, and particular advice concerning special problems and solutions, and possible redesign. The main focus of this research is the effectiveness of similarity measures based on 3-dimensional shapes. The approach adopted here is to construct similarity measures based on a graphical representation deriving from a shape decomposition used extensively by experienced casting design engineers. The paper explains the graphical representation and discusses similarity measures based on it. Performance measures for the CBR system are given, and the results for trials of the system are presented. The competence of the current case-base is discussed, with reference to a representation of cases as points in an n-dimensional feature space, and its principal components visualization. A refinement of the case base is performed as a result of the competence analysis and the performance of the case-base before and after refinement is compared.

Applying CBR to measure similarity of software design structures

This paper examines different ways for measuring similarity between software design models for the purpose of software reuse. Current approaches to this problem are discussed and a set of suitable similarity metrics are proposed and evaluated. Work on the optimisation of weights to increase the competence of a CBR system is presented. A graph matching algorithm and associated metrics capturing the structural similarity between UML class diagrams is presented and demonstrated through an example case.

Creative leadership & communities of practice

This Second Wave presentation focused on 'Creative Leadership and Communities of Practice', with particular reference to issues of trust affecting young people, unemployment and wider uncertainties in an economic recession when people were facing job cuts and in a social environment characterised by cynicism and a downturn in trust. Young people who join Second Wave are brought into a community of practice (CoP) (Lave and Wenger, 1991; Wenger, 1999) involving a dynamic, fluid process which is distinctive in its transformative power to change people's lives. The philosophy behind this involves Dewey's notion of the 'active self' (Dewey, 1916) and the theories of 'social constructivism' (Vygotsky, 1978). The process fosters trust, confidence and social learning (Bandura, 1977; Vygotsky, 1978) in which young people join in with a dialogue involving participation in the youth-centred creative space. The 'border zone' (Heath, 1994) in that creative space enables young people to connect with each other in the specialist field of youth arts. The youth-centred partnerships involved lead to greater confidence and development in a range of important artistic, social, cognitive and emotional skills and opportunities. Ultimately, the young person may become engaged in multi-agency working with Second Wave's external partners. Throughout all of these processes, young people are encouraged progressively to develop a more 'active self' to engage proactively with many different beneficial opportunities relating to the performing arts. In an era in which there has been a loss of trust in public life this is particularly important. If trust is defined in part as a belief in the honesty, competence and benevolence of others, it tends to act like 'social glue', cushioning difficult situations and enabling actions to take place easily that otherwise would not be permissible. The Edelman Trust Barometer for 2009 has recorded a marked diminution of trust in corporations, businesses and government, as a result of the credit crunch. While the US and parts of Europe were showing recovery from a generalised loss of trust by mid-year 2009, the UK had not. Social attitudes in Britain may be hardening - from being a nation of sceptics we may be becoming a nation of cynics: for example, only 13% of the population surveyed by Edelman trust politicians to tell the truth. In this situation, there is a need to promote positive measures to build trust. The presentation aims described key aspects of Second Wave's approach to identify and disseminate its model of good practice to make this more explicit and accessible to others. It is with awareness of the profoundly challenging circumstances facing young people, particularly but not exclusively in inner city urban areas such as Deptford, and the valuable contribution youth arts work can make to their well-being and development, that the presentation was carried out. In an era of generalised mistrust, the work done at Second Wave is crucial in empowering and supporting young people to find a positive and creative direction as part of the community.

Trust, leadership and economic necessity in post-compulsory education

Trust is a complex concept that has increasingly been debated in academic research (Kramer and Tyler, 1996). Research on 'trust and leadership' (Caldwell and Hayes, 2007) has suggested, unsurprisingly, that leadership behaviours influence 'follower' perceptions of leaders' trustworthiness. The development of 'ethical stewardship' amongst leaders may foster high trust situations (Caldwell, Hayes, Karri and Bernal, 2008), yet studies on the erosion of teacher professionalism in UK post-compulsory education have highlighted the distrust that arguably accompanies 'new managerialism', performativity and surveillance within a climate of economic rationalisation established by recent deterministic skills-focused government agendas for education (Avis, 2003; Codd, 1999, Deem, 2004, DFES, 2006). Given the shift from community to commercialism identified by Collinson and Collinson (2005) in a global economic environment characterised by uncertainty and rapid change, trust is, simultaneously, increasingly important and progressively both more fragile and limited in a post compulsory education sector dominated by skills-based targets and inspection demands. Building on such prior studies, this conference paper reports on the analysis of findings from a 2007-8 funded research study on 'trust and leadership' carried out in post-compulsory education. The research project collected and analysed case study interview and survey data from the lifelong learning sector, including selected tertiary, further and higher education (FE and HE) institutions. We interviewed 18 UK respondents from HE and FE, including principals, middle managers, first line managers, lecturers and researchers, supplementing and cross-checking this with a small number of survey responses (11) on 'trust and leadership' and a larger number (241) of survey responses on more generalised leadership issues in post-compulsory education. A range of facilitators and enablers of trust and their relationship to leadership were identified and investigated. The research analysed the ways in which interviewees defined the concept of 'trust' and the extent to which they identified that trust was a mediating factor affecting leadership and organisational performance. Prior literature indicates that trust involves a psychological state in which, despite dependency, risk and vulnerability, trustors have some degree of confident expectation that trustees will behave in benevolent rather than detrimental ways. The project confirmed the views of prior researchers (Mayer, Davis and Schoorman, 1995) that, since trust inevitably involves potential betrayal, estimations of leadership 'trustworthiness' are based on followers' cognitive and affective perceptions of the reliability, competence, benevolence and reputation of leaders. During the course of the interviews it also became clear that some interviewees were being managed in more or less transaction-focused, performative, audit-dominated cultures in which trust was not regarded as particularly important: while 'cautious trust' existed, collegiality flourished only marginally in small teams. Economic necessity and survival were key factors influencing leadership and employee behaviours, while an increasing distance was reported between senior managers and their staff. The paper reflects on the nature of the public sector leadership and management environment in post-compulsory education reported by interviewees and survey respondents. Leadership behaviours to build trust are recommended, including effective communication, honesty, integrity, authenticity, reliability and openness. It was generally felt that building trust was difficult in an educational environment largely determined by economic necessity and performativity. Yet, despite this, the researchers did identify a number of examples of high trust leadership situations that are worthy of emulation.

What Education Studies is and what it might be

Education Studies at the University of Greenwich is presented as an example of what Education Studies is – at least at one Higher Education Institution. As a field of practice to which a body of knowledge can be applied, Education Studies shares common features with other disciplinary fields of study. It is also unique in that its field – learning, is also what its students do – learn. What Education Studies isn’t is then discussed in relation to studies of schooling, the psychology of learning, sociology of education, traditional education degrees and teacher training. Lastly, what Education Studies could become is presented with reference to Ranson’s (1993) argument for the centrality of education as the common focus of all HE study. It is suggested that the subject could then contribute to expanding critical space in (higher) education through making research/ scholarship and creation an integral part of the Independent Study of all students at all levels of learning. This would be a necessary complement to the wider democratic transformation now demanded for human survival. It would also accord with what Marx called humanity’s “species being” as a “learning animal” (Morris). Such a social theory of learning can discriminate between information and competence at one level of learning and (corresponding terms) knowledge and skill at another more generalised level in relation to new divisions of knowledge and labour. Potentially these levels can be combined to create a new form of polytechnic learning, relating theory to practice, education to training and further to higher education.

Habitat-specific adaptation of immune responses of stickleback (Gasterosteus aculeatus) lake and river ecotypes

Freshwater populations of three-spined sticklebacks (Gasterosteus aculeatus) in northern Germany are found as distinct lake and river ecotypes. Adaptation to habitat-specific parasites might influence immune capabilities of stickleback ecotypes. Here, naive laboratory-bred sticklebacks from lake and river populations were exposed reciprocally to parasite environments in a lake and a river habitat. Sticklebacks exposed to lake conditions were infected with higher numbers of parasite species when compared with the river. River sticklebacks in the lake had higher parasite loads than lake sticklebacks in the same habitat. Respiratory burst, granulocyte counts and lymphocyte proliferation of head kidney leucocytes were increased in river sticklebacks exposed to lake when compared with river conditions. Although river sticklebacks exposed to lake conditions showed elevated activation of their immune system, parasites could not be diminished as effectively as by lake sticklebacks in their native habitat. River sticklebacks seem to have reduced their immune-competence potential due to lower parasite diversity in rivers

Teacher attitudes and best practices with ICT faculty Adult Continuing Education in Andalusia

The present paper reports the results of a study aiming to describe the attitudes of teachers in adult continuous education in the Autonomous Community of Andalusia (Spain) towards the use and integration of information and communication technologies (ITC) in the educational centres they work in, while identifying those factors that favour the development of good practice. It is a mixed methods descriptive research, and information collection techniques include a questionnaire and in-depth interviews. A total number of 172 teachers were surveyed, as well as 18 head teachers and coordinators, in adult education. For questionnaire validation the expert judgment technique was used, as they were selected by the «expert competence coefficient» or «K coefficient» procedure. To improve its psychometric properties, construct validity was determined by means of Varimax factor analysis and maximum likelihood extraction (two factors were extracted). Confidence was set by Cronbach's alpha (0.88). The interview guide was also validated by this group of experts. Results point out, on one hand, that teachers hold positive attitudes towards ICT regarding both ICT's role in professional development and their ease of use and access. On the other hand, among the most important factors for ICT-supported good educational practices lies in ICT's capacity to favour personalized work.

El razonamiento moral como elemento constitutivo de la competencia ética: dilemas reales e hipotéticos en profesores de educación secundaria en México

El objetivo del presente texto es la indagación del razonamiento moral en los profesores de secundaria como un elemento de la competencia ética. Se realizó con dilemas morales hipotéticos (analizados y probados previamente para su validación y cuya fiabilidad se obtuvo a través del alfa de Cronbach) y con dilemas reales. Se aplicó a 264 profesores, miembros de la comunidad académica de la Escuela Normal Superior de Michoacán, México. Se analizó a través del programa estadístico Aquad 6. Entre los descubrimientos se encuentra una presencia mayoritaria de conflictos entre las normas éticas interpersonales con las normas de conformidad social y con las normas institucionales particulares. También que la justicia y la protección contra daños a los alumnos son valores presentes en los dilemas reales y una prevalencia en el razonamiento convencional de los profesores

The influence of experience on the research competencies of university professors

Implementation of EHEA, among others, motivates a transforming process in universities and promotes changes in the professor’s tasks. This events, promote changes to which the university professor has to adapt, meaning this to acquire and to develop new competencies to respond correctly to new professional tasks that are demanded. To design training plans in accordance to the new training needs, and to establish referents in accreditation, selection and promotion protocols appear to be necessary to define the new competences profile professors have to face in order to develop their teaching, research and management tasks suitably, and according to their professional settings and professional development stage. A qualitative research was developed to define the emerging competence profile. Quantitative and qualitative methods were mixed as well as different tools (questionnaires, interviews and focus groups) and sources (faculty, experts and students). This article only shows the results obtained from professors (expert and novice) in the 4 research competencies analyzed (design, development and assessment of projects; organization and management of scientific events; development of scientific material; communication and dissemination of scientific knowledges) and the most significant dates of the 30 competency units that compose them. Results show significant differences of self-perception of current competency domain level between novice faculty and expert faculty. These results help us to establish the priority training areas to the faculty according to their professional development stage.