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.

The employability skills provision within a construction project management degree programme

This study was geared at assessing the employability skills provision within a construction project management degree programme through a questionnaire survey. Students were required to assess their level of ability in relation to the most common skills and competencies most sought after by construction project management graduate employers. The study identified team-working ability as the most sought after skill by the employers investigated followed by verbal communication, written communication and leadership ability. It was found that students were very confident of their ability in 12 of the 14 identified skills and competencies. But ironically, leadership, an important skill sought by employers is one that majority of the students felt most insecure in their ability. The study concludes that the BSc programme equips students with these employability skills and competencies, but more effort is needed to make the leadership development opportunities in the programme more conspicuous. With recommendations on how to achieve this proffered.

Putting children forward for epilepsy surgery:a qualitative study of UK parents' and health professionals' decision-making experiences

Background Against a backdrop of recommendations for increasing access to and uptake of early surgical intervention for children with medically intractable epilepsy, it is important to understand how parents and professionals decide to put children forward for epilepsy surgery and what their decisional support needs are. Aim The aim of this study was to explore how parents and health professionals make decisions regarding putting children forward for pediatric epilepsy surgery. Methods Individual interviews were conducted with nine parents of children who had undergone pediatric epilepsy surgery at a specialist children's hospital and ten healthcare professionals who made up the children's epilepsy surgery service multidisciplinary healthcare team (MDT). Three MDT meetings were also observed. Data were analyzed thematically. Findings Four themes were generated from analysis of interviews with parents: presentation of surgery as a treatment option, decision-making, looking back, and interventions. Three themes were generated from analysis of interviews/observations with health professionals: triangulating information, team working, and patient and family perspectives. Discussion Parents wanted more information and support in deciding to put their child forward for epilepsy surgery. They attempted to balance the potential benefits of surgery against any risks of harm. For health professionals, a multidisciplinary approach was seen as crucial to the decision-making process. Advocating for the family was perceived to be the responsibility of nonmedical professionals. Conclusion Decision-making can be supported by incorporating families into discussions regarding epilepsy surgery as a potential treatment option earlier in the process and by providing families with additional information and access to other parents with similar experiences.

Water for the Wayuu: Procurement and maximization of a limited resource among indigenous pastoralists on the Guajira Peninsula of northern Colombia

For the Wayuu of the Guajira Peninsula of northern Colombia, water procurement has historically been challenging. The ancestral territory of this indigenous pastoral society is windy and arid, with low rainfall, high temperatures and an absence of perennial rivers or streams. In the past, the Wayuu adapted to these environmental conditions by practicing transhumance during the prolonged dry seasons, digging spring wells and artificial ponds and by following guiding principles for water usage. Since the 1930s, the government has made efforts to build additional wind-powered wells and ponds for a growing native population. Notwithstanding, these water solutions have only partly met the necessities; public water sources are limited or unreliable and few attempts are made to generate safe drinking water. Furthermore, the ubiquitous practice of animal husbandry places added pressure on existing sources; livestock consume more water than the human populations in the areas visited. Rapid assessments in four Wayuu areas on the peninsula were conducted by the author and an interdisciplinary team working for the Cerrejón Foundation for Water in La Guajira from 2010 to 2013. The assessments were part of a larger pilot project to design and implement a sustainability plan for reservoir-based water supply systems in the region. This study brings cultural practices and local knowledge to the forefront as key elements for the success of water works and other development projects carried out in Wayuu territory.

Engineering for employability:a transition into CDIO

This paper draws upon the findings of a three year study which tracks an institutions journey of CDIO. In focusing on the student perspective the findings discuss students’ prior learning experiences and their expectations of university. The study considers students’ early perceptions of CDIO; emergent findings suggest that whilst CDIO is not really what students expect when they first arrive at university, most prefer it to ‘traditional lectures’. Indeed the majority indicate that they believe the approach enhances their employability and provides a more engaging learning experience. The conclusion argues that with its focus on problem-based learning and team-working, CDIO has changed the face of the 1st year experience for mechanical engineering and designed students within the university and that in doing so it has enhanced transition and ultimately promoted student success.

Tackling Ageing Continence through Theory, Tools & Technology (TACT3)

The complexity of issues surrounding continence management, have been investigated by a UK multi-disciplinary research team working under the project title Tackling Ageing Continence through Theory Tools and Technology (TACT3). The team comprising engineers, chemists, health researchers, designers and social anthropologists is funded by the New Dynamics of Ageing Programme, ‘a seven year multidisciplinary research initiative with the ultimate aim of improving quality of life of older people. The programme is a unique collaboration between five UK Research Councils , and is the largest and most ambitious research programme on ageing ever mounted in the UK’ (www.newdynamics.group.shef.ac.uk). The TACT3 project comprises four work packages that are individually managed by members of the research team. One work package focuses solely on knowledge transfer of the research outputs and the management of the overall project. Another work package, entitled ‘Challenging Environmental Barriers’ has focused on the barriers in the built environment that prevent older people with continence concerns from participating in wider social life, namely access to publicly available toilet facilities. We also have a work package entitled ‘Improving Continence Interventions and Services’ which is exploring patient, carer and service providers experiences in receiving and delivering National Health Service (NHS) continence management treatments. The fourth workpackage ‘Developing Assistive Technologies’ has worked with users to develop devices that promote confidence, improve health and therefore may facilitate greater social interaction for older people with continence management concerns.

The changing role of subject librarians in academic libraries

Discusses the roles that subject librarians (or 'subject specialists') play in contemporary UK academic libraries. Argues that subject librarians, who still form a significant grouping of senior staff in most UK academic libraries, continue to have a significant role to play in the delivery of library services and that applies to both traditional and electronic library services. Discusses the traditional role of subject librarians and analyzes the way in which this role is changing. Those areas where the changing responsibilities are extensions of traditional roles into new areas are pinpointed, together with examples of where subject librarians are performing new roles and adopting new ways of working. Areas where the changing role of subject librarians can be specifically identified include: greater emphasis on liaison with users; advocacy of the collections; adopting new roles; dealing with user enquiries in new ways; working with technical staff; selecting electronic library materials; carrying out more information skills training; having a greater involvement in the implementation of educational technology; team working and project working. Presents practical examples based on experiences at Nottingham university and other UK research libraries. The redesign and relaunch of Nottingham University Library Web site is described to illustrate many of these points.

Development Of Interpersonal Relationships in Global Virtual Teams

This study investigates the development of relationships in same global virtual team working on different projects. The purpose is to explore how do interpersonal relationships develop in terms of characteristics of virtuality and if there is any influence of project lifespan on the development of these relationships. Since relationships are dynamic in nature and are influenced by multiple levels of variables including individual, group and organizational level, therefore characteristics of virtuality have been considered from all these aspects so as to study their influence on development of relationships. In this study, relationships have been studied at two different levels. At first, dyadic relationships between two members of a GVT have been analyzed and thereafter, focus has been on the development of relationships among the team, based on these dyads. Characteristics having influence on development of relationships include trust, physical distance, time zone difference, cultural and language differences, level of formalization in the organization and means of communication used by team members. Level of formalization and means of communication are two characteristics which emerged after empirical study and are found to have direct influence on development of relationships. Remaining characteristics have been identified through literature review. In order to conduct the study, qualitative methodology has been applied. Empirical data has been collected based on a single case study while using semi-structured interviews as data gathering technique. Data analysis has been performed by applying thematic analysis along with the utilization of company documents such as work sheets, minutes of meetings and recordings of conferences. Findings of the study indicate that development of relationships, both at dyadic level and team level, is influenced by different events taking place among different members of GVT. These events have either positive or negative influence on the characteristics of virtuality, which leads to development of the relationships. It has been found that, trust, among all factors plays a greater role in development of these relations. Contrary to the belief that most conflicts arise among members of different cultures, they are equally likely to happen among the members from same culture in GVT environment. Study suggests that relationship development is not a smooth process but it fluctuates based on different events in teams. For further research, teams within large firms shall be studied along these lines. This study is an early attempt towards bringing different characteristics of virtuality together which previously, have been studied individually. It is therefore plausible to conduct similar studies so as to generalize the findings of this study which has provided a starting point.

An interprofessional approach to improving paediatric medication safety

Safe drug prescribing and administration are essential elements within undergraduate healthcare curricula, but medication errors, especially in paediatric practice, continue to compromise patient safety. In this area of clinical care, collective responsibility, team working and communication between health professionals have been identified as key elements in safe clinical practice. To date, there is limited research evidence as to how best to deliver teaching and learning of these competencies to practitioners of the future.An interprofessional workshop to facilitate learning of knowledge, core competencies, communication and team working skills in paediatric drug prescribing and administration at undergraduate level was developed and evaluated. The practical, ward-based workshop was delivered to 4th year medical and 3rd year nursing students and evaluated using a pre and post workshop questionnaire with open-ended response questions.Following the workshop, students reported an increase in their knowledge and awareness of paediatric medication safety and the causes of medication errors (p < 0.001), with the greatest increase noted among medical students. Highly significant changes in students' attitudes to shared learning were observed, indicating that safe medication practice is learnt more effectively with students from other healthcare disciplines. Qualitative data revealed that students' participation in the workshop improved communication and teamworking skills, and led to greater awareness of the role of other healthcare professionals.This study has helped bridge the knowledge-skills gap, demonstrating how an interprofessional approach to drug prescribing and administration has the potential to improve quality and safety within healthcare.

Team teaching : working together to promote student learning

This book chapter examines the concept of team teaching from the perspective of the various stakeholders, in order to discuss the advantages and disadvantages of team teaching for students, to consider the positive and negative dimensions of collaborative teaching for teachers, and to review the implications for educational administration. In addition, attention will be paid to the issues associated with team teaching in the context of e-learning. The chapter concludes with a case study which discusses how the implementation of collaborative teaching within the library and information science discipline at an Australian university helped develop the authors’ understanding of socially constructed knowledge.

‘Working with the team’ : an exploratory study of improved type 2 diabetes management in a new model of integrated primary/secondary care

This study aimed to explore how a new model of integrated primary/secondary care for type 2 diabetes management, the Brisbane South Complex Diabetes Service (BSCDS), related to improved diabetes management in a selected group of patients. We used a qualitative research design to obtain detailed accounts from the BSCDS via semi-structured interviews with 10 patients. The interviews were fully transcribed and systematically coded using a form of thematic analysis. Participants’ responses were grouped in relation to: (1) Patient-centred care; (2) Effective multiprofessional teamwork; and (3) Empowering patients. The key features of this integrated primary/secondary care model were accessibility and its delivery within a positive health care environment, clear and supportive interpersonal communication between patients and health care providers, and patients seeing themselves as being part of the team-based care. The BSCDS delivered patient-centred care and achieved patient engagement in ways that may have contributed to improved type 2 diabetes management in these participants.

Working together : the Medicine Branch, the health care team, and you /

Mode of access: Internet.

Building team-based working:a practical guide to organizational transformation

Building Team-based Working is designed for use by managers and consultants who are introducing team-based working into organizations. The book synthesizes knowledge about how to build team-based organizations, focusing particularly on the psychological and social processes that can facilitate or obstruct successful teamwork. Rather than advise managers on how to build effective teams, as most books in this area tend to do, this book instead focuses on how to build organizations structured around teams. The text is divided into six sections describing the six main stages of developing team-based working in an organization. The chapters follow a common structure. Each one opens with a summary of the aims and activities relevant to that stage and concludes with a selection of appropriate support materials and tools. These materials can also be downloaded from the CD accompanying the text. The advice given is based on evidence gathered by the authors over 20 years of practical management experience, research work in organizations, and consultancy across the public, manufacturing and service sectors.