A study of the relational aspects of the culture of academic medicine

PURPOSE: The impact of medical school culture on medical students has been well studied, but little documentation exists regarding how medical faculty experience the culture in which they work. In an ongoing project, the National Initiative on Gender, Culture and Leadership in Medicine, the authors are investigating how the existing culture of academic medical institutions supports all faculty members' ability to function at their highest potential. METHOD: The authors conducted a qualitative study of faculty in five disparate U.S. medical schools. Faculty in different career stages and diverse specialties were interviewed regarding their perceptions and experiences in academic medicine. Analysis was inductive and data driven. RESULTS: Relational aspects of the culture emerged as a central theme for both genders across all career categories. Positive relationships were most evident with patients and learners. Negative relational attributes among faculty and leadership included disconnection, competitive individualism, undervaluing of humanistic qualities, deprecation, disrespect, and the erosion of trust. CONCLUSIONS: The data suggest that serious problems exist in the relational culture and that such problems may affect medical faculty vitality, professionalism, and general productivity and are linked to retention. Efforts to create and support trusting relationships in medical schools might enhance all faculty members' efforts to optimally contribute to the clinical, education, and research missions of academic medicine. Future work will document the outcomes of a five-school collaboration to facilitate change in the culture to support the productivity of all medical faculty. © 2009 Association of American Medical Colleges.

Contingency Learning and Reactivity in Preterm and Full-Term Infants at 3 Months

Learning difficulties in preterm infants are thought to reflect impairment in arousal regulation. We examined relationships among gestational age, learning speed, and behavioral and physiological reactivity in 55 preterm and 49 full-term infants during baseline, contingency, and nonreinforcement phases of a conjugate mobile paradigm at 3 months corrected age. For all infants, negative affect, looking duration, and heart rate levels increased during contingency and nonreinforcement phases, whereas respiratory sinus arrhythmia (RSA, an index of parasympathetic activity) decreased and cortisol did not change. Learners showed greater RSA suppression and less negative affect than nonlearners. This pattern was particularly evident in the preterm group. Overall, preterm infants showed less learning, spent less time looking at the mobile, and had lower cortisol levels than full-term infants. Preterm infants also showed greater heart rate responses to contingency and dampened heart rate responses to nonreinforcement compared to full-term infants. Findings underscore differences in basal and reactivity measures in preterm compared to full-term infants and suggest that the capacity to regulate parasympathetic activity during a challenge enhances learning in preterm infants.

Efficacy of a powered wheelchair simulator for school aged children: A randomised controlled trial.

Purpose: To determine the efficacy of a custom made wheelchair simulation in training children to use a powered wheelchair (PWC). Design: Randomised controlled trial employing the 4C/ID-model of learning. Twenty-eight typically developing children (13M, 15F; mean age 6 years, SD 6 months) were assessed on their operation of a PWC using a functional evaluation rating scale. Participants were randomly assigned to intervention (8x 30minute training sessions using a joystick operated wheelchair simulation) or control conditions (no task), and were re-assessed on their PWC use following the intervention phase. Additional data from the simulation on completion times, errors and total scores were recorded for the intervention group. Results: Analysis of variance showed a main effect of time, with planned comparisons revealing a statistically significant change in PWC use for the intervention (p = 0.022) but not the control condition. Whilst the intervention group showed greater improvement than the controls this did not reach statistical significance. Multiple regression analyses showed that gender was predictive of pre-test (p = 0.005) functional ability. Implications: A simulated wheelchair task appears to be effective in helping children learn to operate a PWC. Greater attention should be given to female learners who underperformed when compared to their male counterparts. This low cost intervention could be easily employed at home to reduce PWC training times in children with motor disorders.

Assessing the need for and potential role of a day hospice:A qualitative study

We conducted a qualitative case study as part of a needs assessment for a day hospice in a small Ontario city. Data were gathered from semi-structured interviews with 28 stakeholders: nine health care administrators, 11 health care providers, and eight lay people (terminally ill adults and informal caregivers). Respondents described support, counselling, social activities, and respite as key day hospice services. They also described several barriers to accessing services, including location, transportation, admission criteria, referrals, and fees. For most respondents, the ideal staff mix includes both volunteers and paid professionals in either a free-standing organization or institutionally linked hospice. Although the vast majority of participants were reluctant to impose admission criteria or other limitations on hospice clientele, they expressed the need to ensure equitable access to this scarce resource. Opinions varied greatly across stakeholder groups, highlighting the need to collect information from ail relevant stakeholder groups when planning hospices.

A New Irish? Problems of communication in modern Irish media and new speakers.

While the Gaeltacht (Irish speaking) areas of Ireland are geographically isolated from each other and relatively small in area, it is expected that the number of second language Irish speakers throughout the country should ensure the future of the language. Nevertheless, while the official standard grammar has been established for many decades, there is still a tendency in the spoken language to give precedence to regional dialectal variants in schools and the broadcast media which often raises barriers between native speakers themselves and between learners and native speakers.
All pupils in school in the Republic and many in Northern Ireland learn Irish and there has been a great increase in the number of pupils attending immersion Irish language Gaelscoileanna. But concern has been expressed about the phonetic and structural accuracy achieved in schools, all of which contributes to communication breakdown.
This paper discusses how a greater awareness of the link between phoneme and grapheme in Irish and the proposals for the Lárchanúint (Central Dialect) in the 1980s and current discussions on Caighdeán Leathan agus Caighdeán Cúng (Broad and Narrow Standard) would mitigate these concerns.

Language Teacher Education in Ireland, North and South

The European Union considers modern languages among the basic skills or key competencies required by all its citizens and is concerned to promote excellence in the teaching and learning of languages as well as greater diversity in the range of languages available to learners in the Member States, as witnessed by the recent European Commission Action Plan, Promoting Language Learning and Linguistic Diversity: An Action Plan 2004-2006. This consideration, the changing socio-cultural demography of Ireland, the need for more joined-up thinking in the context of language teaching in schools, and in the context of language teacher education in particular, form the back-drop to the paper. Among the challenges facing modern/world languages’ education in Ireland identified in the paper are, lack of a languages’ policy, lack of a languages’ strategy, and lack of an integrated language curriculum and by implication, a whole school approach to language teaching and learning. The paper refers to positive signs that are occurring in this context as well, e.g. official recognition to Irish as a working language in the European Union and in the Official Languages Act in Ireland (2003). The paper reports on the recent first ever all Ireland cross-border conference in the context of language teacher education. It outlines the background, aims, and content of the conference that includes findings from a study about the impact of autonomous language teaching and learning supported by the European Language Portfolio in the context of post-primary language teacher education in Ireland. The paper shows data from the first ever survey on language teacher education provision, policy and practice across colleges in Ireland, North and South. Initial teacher education is on the cusp of change. This paper highlights several key issues facing language teacher education. This paper has implications for Irish as well as international readers, and is aimed at supporting all those who want to bring about improvement in this important area.

Learner-Teacher Interaction (LTI): engaging and supporting students in achieving self-regulated learning

This report represents the second stage of a study which was part of a wide-ranging research programme conducted by the Centre for Excellence of Interprofessional Education, Queen’s University Belfast. The study was an investigation into learner-teacher interaction in the education of undergraduate medical and other healthcare students in order to inform how teachers might facilitate learning in a healthcare setting. It focused in particular on clinical and ward-based tutorials and seminars.

In order to give meaning to this second stage of the study, the report will contextualise the learner-teacher interaction study, will describe the research methods and methods of analysis developed and used to explore learner-teacher interaction. It will then focus on this second stage of the research and the results of the analysis of video sessions of clinical and ward-based tutorials and seminars. In particular it will identify examples of good practice and missed opportunities for the engagement of the learners.

Finding Your Feet in the Field: Critical Reflections of Early Career Researchers on Field Research in Transitional Societies

Fieldwork that takes place in conflict or transitional regions is becoming increasingly popular amongst early-career and more seasoned researchers, but is an area that retains an air of mystery and remains an exotic form of knowledge gathering. There exists a paucity of personal reflection on the challenges associated with conducting fieldwork in conflicted or transitional regions and a limited amount of insight into the practical steps taken in advance of and when immersed in the field. Such reticence to share honest fieldwork experiences, particularly the more challenging research that takes place in conflict or transitional settings aids in creating a culture of silence. This paper attempts to counteract this silence by drawing on the challenges experienced by two early career researchers conducting fieldwork in Uganda and Palestine, focusing on the practical steps taken in advance of entering the field, and the challenges faced whilst engaged in fieldwork. Specific challenges are highlighted throughout, including: physical access to areas in conflict; engaging with reluctant research participants; the emotional impact of fieldwork on the researcher; maintaining confidentiality; researching with vulnerable victims; and ensuring appropriate knowledge exchange between researchers and participants. The paper concludes by emphasising the requirement for greater reflection on the inherently personal challenges associated with conducting fieldwork in conflicted or transitional settings and highlights the view that fieldwork is a privileged position that carries great responsibilities which must be upheld to ensure the sustainability of future research. This paper hopes to contribute to the wider debate on conducting fieldwork and the challenges associated with working in conflicted or transitional regions.

Mature students – participation in maths support and progression

Maths support at the Learning Development Service takes the form of drop-in contact, one-to-one appointments and workshops. Analysis over three years from 2010/11 to 2012/13 shows that 45% of one-to-one appointments involved a mature student, defined at Queen’s University Belfast (QUB) as one who has had a break in full-time study (normally a minimum of two years). This is a very high proportion given that 4% of students at QUB are mature. Considering engineering undergraduates only, the fraction of one-to-one appointments involving mature students was also 45%. This study can report a wide variation in terms of progression of mature students in engineering and aims to consider how more traditional undergraduate learners could be persuaded to adopt the attitudes of mature students in partaking of maths support.

Educational gaming in the health sciences: systematic review

Educational gaming in the health sciences: systematic review. Aim. This paper is a report of a review to investigate the use of games to support classroom learning in the health sciences. Background. One aim of education in the health sciences is to enable learners to develop professional competence. Students have a range of learning styles and innovative teaching strategies assist in creating a dynamic learning environment. New attitudes towards experiential learning methods have contributed to the expansion of gaming as a strategy. Data sources. A search for studies published between January 1980 and June 2008 was undertaken, using appropriate search terms. The databases searched were: British Education Index, British Nursing Index, The Cochrane Library, CINAHLPlus, Medline, PubMed, ERIC, PsychInfo and Australian Education Index. Methods. All publications and theses identified through the search were assessed for relevance. Sixteen papers reporting empirical studies or reviews that involved comparison of gaming with didactic methods were included. Results. The limited research available indicates that, while both traditional didactic methods and gaming have been successful in increasing student knowledge, neither method is clearly more helpful to students. The use of games generally enhances student enjoyment and may improve long-term retention of information. Conclusion. While the use of games can be viewed as a viable teaching strategy, care should be exercised in the use of specific games that have not been assessed objectively. Further research on the use of gaming is needed to enable educators to gaming techniques appropriately for the benefit of students and, ultimately, patients.

The Evidence Debate for Behavioural Interventions for Autism

For more than fifty years evidence has been accrued regarding the efficacy of applied behaviour analysis-based interventions for individuals with autism spectrum disorders. Despite this history of empirical evidence, some researchers and ASD experts still are reluctant to accept behavioral interventions as best practice for ASD. In this paper, we consider both random control trials and single subject experimental designs as forms of evidenced-based practice (EBP). Specific application of these methods to ASD research is considered. In an effort to provide scientifically based evidence for interventions for ASD, EBP standards have been debated without a consensus being achieved. Service users of ASD interventions need access to sound empirical evidence to choose appropriate programmes for those they care for with ASD rather than putting their hopes in therapies backed by pseudoscience and celebrity endorsements.

Developing mathematics support for first-year engineering students with non-traditional mathematics backgrounds

A maths support system for first-year engineering students with non-traditional entry qualifications has involved students working through practice questions structured to correspond with the maths module which runs in parallel. The setting was informal and there was significant one-to-one assistance. The non-traditional students (who are known to be less well prepared mathematically) were explicitly contacted in the first week of their university studies regarding the maths support and they generally seemed keen to participate. However, attendance at support classes was relatively low, on average, but varied greatly between students. Students appreciated the personal help and having time to ask questions. It seemed that having a small group of friends within the class promoted attendance – perhaps the mutual support or comfort that they all had similar mathematical difficulties was a factor. The classes helped develop confidence. Attendance was hindered by the class being timetabled too soon after the relevant lecture and students were reluctant to come with no work done beforehand. Although students at risk due to their mathematical unpreparedness can easily be identified at an early stage of their university career, encouraging them to partake of the maths support is an ongoing, major problem.

Teachers’ Perspectives on Moving Image as a digital literacy tool in Creative Classrooms

Eight Creative Classroom (CCR) elements are used as a framework for analysing teachers’ current attitudes towards the use of moving images as a tool for teaching digital literacy to pupils aged 11-18 years in the context of ‘Creative Classrooms’. This paper reports on the challenges being faced by innovative teachers willing to adopt moving image (as a new ICT) into their teaching, and highlights the gaps currently present in the systemic support structures in schools which need to be addressed for innovative pedagogical practices to occur in these Creative Classrooms. By ensuring educators learn from their experiences of poor ICT uptake in the past and utilise these lessons for future innovations in classrooms, it is hoped that the transition to moving image, and its associated digital literacy skills, will be smooth and beneficial to the learners.

Uniformity and diversity in religious education in Northern Ireland

This paper considers the tension that can exist in the aims of religious education between the desire to encourage open-minded, critical thinking through exposure to diverse traditions, ideas and cultures and the encouragement, overt or otherwise, into uniformity whereby learners take on the values of a particular tradition, culture or ideology (say of a religion, family or school). The particular situation of teaching religious education to post-primary school pupils in Northern Ireland is considered, and evidence cited to suggest that the Northern Ireland Core Syllabus in Religious Education has tried to impose a particular non-denominational Christian uniformity on pupils and teachers through its use of religious language. This has contributed to a culture of 'avoidance' in relation to the teaching of broad Christian diversity. The article concludes that there is a need for an ongoing and meaningful dialogue to discover what kind of balance between uniformity and diversity is best in teaching religious education in Northern Ireland, and notes that this also requires the reassessment of fundamental issues such as the aims of education and the relationship between secular and religious values in publicly funded schools. © 2004 Christian Education.

Helping the most vulnerable out of the poverty trap and reducing inequality: Policies, strategies, and services for individuals with Autism Spectrum Disorder, including intellectual and neurodevelopmental disabilities: Benchmarking Autism Services Efficacy: BASE Project (Volume 3) Secondary Data analysis

1) Executive Summary
Legislation (Autism Act NI, 2011), a cross-departmental strategy (Autism Strategy 2013-2020) and a first action plan (2013-2016) have been developed in Northern Ireland in order to support individuals and families affected by Autism Spectrum Disorder (ASD) without a prior thorough baseline assessment of need. At the same time, there are large existing data sets about the population in NI that had never been subjected to a secondary data analysis with regards to data on ASD. This report covers the first comprehensive secondary data analysis and thereby aims to inform future policy and practice.
Following a search of all existing, large-scale, regional or national data sets that were relevant to the lives of individuals and families affected by Autism Spectrum Disorder (ASD) in Northern Ireland, extensive secondary data analyses were carried out. The focus of these secondary data analyses was to distill any ASD related data from larger generic data sets. The findings are reported for each data set and follow a lifespan perspective, i.e., data related to children is reported first before data related to adults.
Key findings:
Autism Prevalence:
Of children born in 2000 in the UK,
• 0.9% (1:109) were reported to have ASD, when they were 5-year old in 2005;
• 1.8% (1:55) were reported to have ASD, when they were 7-years old in 2007;
• 3.5% (1:29) were reported to have ASD, when they were 11-year old in 2011.
In mainstream schools in Northern Ireland
• 1.2% of the children were reported to have ASD in 2006/07;
• 1.8% of the children were reported to have ASD in 2012/13.

Economic Deprivation:
• Families of children with autism (CWA) were 9%-18% worse off per week than families of children not on the autism spectrum (COA).
• Between 2006-2013 deprivation of CWA compared to COA nearly doubled as measured by eligibility for free school meals (from near 20 % to 37%)
• In 2006, CWA and COA experienced similar levels of deprivation (approx. 20%), by 2013, a considerable deprivation gap had developed, with CWA experienced 6% more deprivation than COA.
• Nearly 1/3 of primary school CWA lived in the most deprived areas in Northern Ireland.
• Nearly ½ of children with Asperger’s Syndrome who attended special school lived in the most deprived areas.

Unemployment:
• Mothers of CWA were 6% less likely to be employed than mothers of COA.
• Mothers of CWA earned 35%-56% less than mothers of COA.
• CWA were 9% less likely to live in two income families than COA.

Health:
• Pre-diagnosis, CWA were more likely than COA to have physical health problems, including walking on level ground, speech and language, hearing, eyesight, and asthma.
• Aged 3 years of age CWA experienced poorer emotional and social health than COA, this difference increased significantly by the time they were 7 years of age.
• Mothers of young CWA had lower levels of life satisfaction and poorer mental health than mothers of young COA.
Education:
• In mainstream education, children with ASD aged 11-16 years reported less satisfaction with their social relationships than COA.
• Younger children with ASD (aged 5 and 7 years) were less likely to enjoy school, were bullied more, and were more reluctant to attend school than COA.
• CWA attended school 2-3 weeks less than COA .
• Children with Asperger’s Syndrome in special schools missed the equivalent of 8-13 school days more than children with Asperger’s Syndrome in mainstream schools.
• Children with ASD attending mainstream schooling were less likely to gain 5+ GCSEs A*-C or subsequently attend university.



Further and Higher Education:
• Enrolment rates for students with ASD have risen in Further Education (FE), from 0% to 0.7%.
• Enrolment rates for students with ASD have risen in Higher Education (HE), from 0.28% to 0.45%.
• Students with ASD chose to study different subjects than students without ASD, although other factors, e.g., gender, age etc. may have played a part in subject selection.
• Students with ASD from NI were more likely than students without ASD to choose Northern Irish HE Institutions rather than study outside NI.

Participation in adult life and employment:
• A small number of adults with ASD (n=99) have benefitted from DES employment provision over the past 12 years.
• It is unknown how many adults with ASD have received employment support elsewhere (e.g. Steps to Work).
•
Awareness and Attitudes in the General Population:
• In both the 2003 and 2012 NI Life and Times Survey (NILTS), NI public reported positive attitudes towards the inclusion of children with ASD in mainstream education (see also BASE Project Vol. 2).

Gap Analysis Recommendations:
This was the first comprehensive secondary analysis with regards to ASD of existing large-scale data sets in Northern Ireland. Data gaps were identified and further replications would benefit from the following data inclusion:
• ASD should be recorded routinely in the following datasets:
o Census;
o Northern Ireland Survey of Activity Limitation (NISALD);
o Training for Success/Steps to work; Steps to Success;
o Travel survey;
o Hate crime; and
o Labour Force Survey.
• Data should be collected on the destinations/qualifications of special school leavers.
• NILT Survey autism module should be repeated in 5 years time (2017) (see full report of 1st NILT Survey autism module 2012 in BASE Project Report Volume 2).
• General public attitudes and awareness should be assessed for children and young people, using the Young Life and Times Survey (YLT) and the Kids Life and Times Survey (KLT); (this work is underway, Dillenburger, McKerr, Schubolz, & Lloyd, 2014-2015).