How should teaching on whole person medicine, including spiritual issues, be delivered in the undergraduate medical curriculum in the United Kingdom?

Background

Although the General Medical Council recommends that United Kingdom medical students are taught ‘whole person medicine’, spiritual care is variably recognised within the curriculum. Data on teaching delivery and attainment of learning outcomes is lacking. This study ascertained views of Faculty and students about spiritual care and how to teach and assess competence in delivering such care.

A questionnaire comprising 28 questions exploring attitudes to whole person medicine, spirituality and illness, and training of healthcare staff in providing spiritual care was designed using a five-point Likert scale. Free text comments were studied by thematic analysis. The questionnaire was distributed to 1300 students and 106 Faculty at Queen’s University Belfast Medical School.

351 responses (54 staff, 287 students; 25 %) were obtained. >90 % agreed that whole person medicine included physical, psychological and social components; 60 % supported inclusion of a spiritual component within the definition. Most supported availability of spiritual interventions for patients, including access to chaplains (71 %), counsellors (62 %), or members of the patient’s faith community (59 %). 90 % felt that personal faith/spirituality was important to some patients and 60 % agreed that this influenced health. However 80 % felt that doctors should never/rarely share their own spiritual beliefs with patients and 67 % felt they should only do so when specifically invited. Most supported including training on provision of spiritual care within the curriculum; 40-50 % felt this should be optional and 40 % mandatory. Small group teaching was the favoured delivery method. 64 % felt that teaching should not be assessed, but among assessment methods, reflective portfolios were most favoured (30 %). Students tended to hold more polarised viewpoints but generally were more favourably disposed towards spiritual care than Faculty. Respecting patients’ values and beliefs and the need for guidance in provision of spiritual care were identified in the free-text comments.

Students and Faculty generally recognise a spiritual dimension to health and support provision of spiritual care to appropriate patients. There is lack of consensus whether this should be delivered by doctors or left to others. Spiritual issues impacting patient management should be included in the curriculum; agreement is lacking about how to deliver and assess.

Patience, Persistence and Pragmatism: Experiences and Lessons Learnt from the Implementation of Clinically Integrated Teaching and Learning of Evidence-Based Health Care - A Qualitative Study

Background

Clinically integrated teaching and learning are regarded as the best options for improving evidence-based healthcare (EBHC) knowledge, skills and attitudes. To inform implementation of such strategies, we assessed experiences and opinions on lessons learnt of those involved in such programmes.

Methods and Findings

We conducted semi-structured interviews with 24 EBHC programme coordinators from around the world, selected through purposive sampling. Following data transcription, a multidisciplinary group of investigators carried out analysis and data interpretation, using thematic content analysis. Successful implementation of clinically integrated teaching and learning of EBHC takes much time. Student learning needs to start in pre-clinical years with consolidation, application and assessment following in clinical years. Learning is supported through partnerships between various types of staff including the core EBHC team, clinical lecturers and clinicians working in the clinical setting. While full integration of EBHC learning into all clinical rotations is considered necessary, this was not always achieved. Critical success factors were pragmatism and readiness to use opportunities for engagement and including EBHC learning in the curriculum; patience; and a critical mass of the right teachers who have EBHC knowledge and skills and are confident in facilitating learning. Role modelling of EBHC within the clinical setting emerged as an important facilitator. The institutional context exerts an important influence; with faculty buy-in, endorsement by institutional leaders, and an EBHC-friendly culture, together with a supportive community of practice, all acting as key enablers. The most common challenges identified were lack of teaching time within the clinical curriculum, misconceptions about EBHC, resistance of staff, lack of confidence of tutors, lack of time, and negative role modelling.

Conclusions

Implementing clinically integrated EBHC curricula requires institutional support, a critical mass of the right teachers and role models in the clinical setting combined with patience, persistence and pragmatism on the part of teachers.

Predictive Value of Depressive Symptoms for All-Cause Mortality: Findings From the PRIME Belfast Study Examining the Role of Inflammation and Cardiovascular Risk Markers

OBJECTIVES: To improve understanding about the potential underlying biological mechanisms in the link between depression and all-cause mortality and to investigate the role that inflammatory and other cardiovascular risk factors may play in the relationship between depressive symptoms and mortality.

METHODS: Depression and blood-based biological markers were assessed in the Belfast PRIME prospective cohort study (N = 2389 men, aged 50-59 years) in which participants were followed up for 18 years. Depression was measured using the 10-item Welsh Pure Depression Inventory. Inflammation markers (C-reactive protein [CRP], neopterin, interleukin [IL]-1 receptor antagonist [IL-1Ra], and IL-18) and cardiovascular-specific risk factors (N-terminal pro-b-type natriuretic peptide, midregion pro-atrial natriuretic peptide, midregion pro-adrenomedullin, C-terminal pro-endothelin-1 [CT-proET]) were obtained at baseline. We used Cox proportional hazards modeling to examine the association between depression and biological measures in relation to all-cause mortality and explore the mediating effects.

RESULTS: During follow-up, 418 participants died. Higher levels of depressive symptoms were associated with higher levels of CRP, IL-1Ra, and CT-proET. After adjustment for socioeconomic and life-style risk factors, depressive symptoms were significantly associated with all-cause mortality (hazard ratio = 1.10 per scale unit, 95% confidence interval = 1.04-1.16). This association was partly explained by CRP (7.3%) suggesting a minimal mediation effect. IL-1Ra, N-terminal pro-b-type natriuretic peptide, midregion pro-atrial natriuretic peptide, midregion pro-adrenomedullin, and CT-proET contributed marginally to the association between depression and subsequent mortality.

CONCLUSIONS: Inflammatory and cardiovascular risk markers are associated with depression and with increased mortality. However, depression and biological measures show additive effects rather than a pattern of meditation of biological factors in the association between depression and mortality.

Substance Use and Misuse : Adolescent Substance Use in the context of the family ; a qualitative study of young people's views on parent child attachments , parenting style and parental substance use

Introduction and Aims. While the role of the family in adolescent substance use has been well documented, few studies have attempted to explore in-depth youth perceptions of how these familial processes/dynamics influence teenage substance use. This paper reports the findings from a study exploring risk and protective factors for teenage substance use within the context of the family as perceived by young people with a view to informing current and future family based prevention and education interventions.
Design and Methods. Data collection took place in nine post-primary schools across Northern Ireland. Nine focus groups using participatory techniques were facilitated with a purposive sample of sixty-two young people (age 13-17 years). Data were transcribed verbatim and analysed using a content/thematic analysis.
Results. Three broad themes/aspects of the family emerged from the data, which may serve to protect or attenuate the risk of substance use among young people. Parent-child attachment was a major theme identified in protecting adolescents from substance use in addition to effective parenting particularly an authoritative style of parenting supplemented by parental monitoring and good parent-child communication to encourage child disclosure. Family substance use was deemed to impact on children’s substance use if exposed at an early age and the harms associated with PSM were discussed in detail.
Discussion and Conclusions. The qualitative approach provides insight into current understanding of youth perceptions of substance use in the context of family dynamics. A number of recommendations are outlined. Family based (preventive) interventions/parenting programmes may benefit from components on effective parenting including authoritative styles, parental monitoring, effective communication, spending time together (building attachments), parent-child conflict, adolescent development and factors which impact on parenting. Parenting programmes tailored to mothers and fathers may be beneficial. School based interventions targeting children/adolescents may be best placed to target children living with parental substance misuse.
Keywords: substance/substance related disorders, focus groups, young people/adolescent,

Developmental Antecedents of Proactive and Reactive Rebelliousness: The Role of Parenting Style, Childhood Adversity, and Attachment

Adolescence is a time of developmental transition that for one in five young people is characterised by feelings of oppositionality, rebellion, and negativism. Despite the prevalent experience of teen turbulence and despite its significance within the phenomenological framework provided by reversal theory (RT), the childhood antecedents of rebelliousness in adolescence and adulthood have not been given extensive empirical attention within RT, although such work has been carried out using other constructs and theories. We examined recalled parenting style, childhood adversity, and attachment style in adulthood as correlates of proactive and reactive rebelliousness in a sample of 80 participants, aged 18 to 50 years. Each participant responded to a questionnaire package containing the revised Adult Attachment Scale, the Parental Bonding Instrument, the Childhood Experience of Care and Abuse Questionnaire, and the Negativism Dominance Scale. We found that paternal abusive parenting, followed by paternal parenting style, paternal neglect, and paternal antipathy were independently predictive of scores on proactive rebelliousness, the sensation-seeking form. Maternal and paternal indifferent parenting styles each were found to equivalently and independently predict scores on reactive rebelliousness, the interpersonal disaffection form. The results of this study suggest these two forms of rebelliousness may have distinctly different antecedents. A longitudinal study is needed to examine the potentially causal pathways that are suggested by the results of this cross-sectional research. We consider reversal theory explanations of these results and contrast them with complementary theoretical frameworks.

English as a lingua Franca : bridging the gap between theory and practice in english language teaching

Tese de doutoramento, Linguística (Linguística Aplicada), Universidade de Lisboa, Faculdade de Letras, 2015

Improving Learners’ Motivation through Feedback in English Language Teaching and Learning at Polytechnic School in Benguela, Angola

Currently, it is widely perceived among the English as a Foreign Language (EFL) teaching professionals, that motivation is a central factor for success in language learning. This work aims to examine and raise teachers’ awareness about the role of assessment and feedback in the process of language teaching and learning at polytechnic school in Benguela to develop and/or enhance their students’ motivation for learning. Hence the paper defines and discusses the key terms and, the techniques and strategies for an effective feedback provision in the context under study. It also collects data through the use of interview and questionnaire methods, and suggests the assessment and feedback types to be implemented at polytechnic school in Benguela

Perceptions of some teachers about the similarities and/or differences in teaching online versus in a classroom environment /

The introduction of computer and communications technology, and particularly the internet, into education has opened up some new possibilities for teaching and learning. Courses designed and delivered in an online environment offer the possibility of highly interactive and individually focussed teaching and learning experiences. However, online courses also present new challenges for both teachers and students. A qualitative study was conducted to explore teachers' perceptions about the similarities and differences in teaching in the online and face-to-face (F2F) environments. Focus group discussions were held with 5 teachers; 2 teachers were interviewed in depth. The participants, 3 female and 2 male, were full-time teachers from a large College of Applied Arts & Technology in southern Ontario. Each of them had over 10 years of F2F teaching experience and each had been involved in the development and teaching of at least one online course. i - -; The study focussed on how teaching in the online environment compares with teaching in the F2F environment, what roles teachers and students adopt in each setting, what learning communities mean online and F2F and how they are developed, and how institutional policies, procedures, and infrastructure affect teaching and learning F2F and online. This study was emic in nature, that is the teachers' words determine the themes identified throughout the study. The factors identified as affecting teaching in an online environment included teacher issues such as course design, motivation to teach online, teaching style, role, characteristics or skills, and strategies. Student issues as perceived by the teachers included learning styles, role, and characteristics or skills. As well, technology issues such as a reliable infrastructure, clear role and responsibilities for maintaining the infrastructure, support, and multimedia capability affected teaching online. Finally, administrative policies and procedures, including teacher selection and training, registration and scheduling procedures, intellectual property and workload policies, and the development and communication of a comprehensive strategic plan were found to impact on teaching online. The teachers shared some of the benefits they perceived about teaching online as well as some of the challenges they had faced and challenges they perceived students had faced online. Overall, the teachers feh that there were more similarities than differences in teaching between the two environments, with the main differences being the change from F2F verbal interactions involving body language to online written interactions without body language cues, and the fundamental reliance on technology in the online environment. These findings support previous research in online teaching and learning, and add teachers' perspectives on the factors that stay the same and the factors that change when moving from a F2F environment to an online environment.

A study on the role of the parent in educational decision making from the perspective of parents and teachers

ADeweyan (1916) democratic theoty ofeducation called for the participation ofall citizens in deliberating important educational issues to improve overall student learning. Thus, the move to include parents in educational decision making can be considered to be rooted in democratic principles. To gain greater insight into the issue ofparent involvement in educational decision making, one elementary school was studied and a triangulization method was employed in an attempt to clarify the important issues surrolUlding the move to include parents in the governance ofschools. The three methods to gain information included surveys, interviews, and documentation ofsignificant school events and related work. All ofthe parents and teachers ofthe school were surveyed, 10 parents and 6teachers were interviewed, and related school events were recorded. The survey design was modeled on the Parent Involvement Questionnaire (PIQ) created and reported on by Chavkin and Williams (1987). The results ofthe surveys were used as a guide for the interview questions. An interview outline was developed based on Seidman's (1991) open-ended approach and Patton's (1980) standardized open-ended interview style in which parents and teachers were asked about their experiences and opinions on anmnber ofparent involvement issues. Parents and teachers in this school indicated agreater interest in becoming more aware ofeducational issues such as school budget and school discipline policies. Although the parents indicated agreater interest in school matters and the teachers indicated awillingness to include parents in school matters, both the parents and teachers in this study perceived the role ofthe parent as advisory, not decision making. It was concluded that to ensure ameaningful and functional role for parellts as tlleir p811icipatioll ill educational matters evolves, SCllools must have a clear vision ofthe primary goal ofall schools, namely, to foster and nourish democratic citizens for ademocratic society (Glickman, 1993). Furthennore, intentional practices such as Purkey's (ad) 5-P Relay approach, based on a democratic theory and practice of education, will have to be employed in order to give parents an authentic voice in educational matters and provide an avenue for parents to acquire the necessary skills and lmowledge needed to do so. As schools, school boards, and the Ministry ofEducation implement parent involvement guidelines and policies, developmental needs ofeach school need to be considered to ensure the employment ofdemocratic practices not authoritarian mandates. Parent interest and involvement, at whatever level, should be an important element in the overall move to make schools part ofthe democratic society they were meant to be.

Teaching Tips from a Recovered Autistic

An article by Grandin sharing tips for teaching and working with autistic children. The focus is on: Structured Environment, Learning to Talk, Rhythm, Sensory Problems, Reducing Arousal, Tactile Stimulation, Fixations, Visual Thinking. The conclusion of the article reads "I cannot over emphasize the important role that good teachers and therapists play in enabling autistics to lead a fuller life. A good autism program needs dedicated people and should use a variety of treatment methods in combination with an intense structured environment".

Work less, teach better and get better feedback: why we tried innovative teaching methods

Speaker: Patrick McSweeney Organiser: Time: 15/10/2014 11:00-11:45 Location: B32/3077 Abstract Having started at Southampton in 2005 I have seen quite a few changes to the way courses are taught and studied. I will reflect on some of the interesting changes I have observed and suggest their causes. As a practical example I will talk about codestrom, a peer feedback tool for learning programming. We have found that this teaching method has improved the student experience and reduced the work load for the module team. Together we will discuss how this and other recent developments can enable other teaching innovations which benefit staff as well as students. Hopefully the new class of PhD students will be able to contribute from the point of view of having recently been undergraduate students here and else where.

Teaching science in primary school : a handbook of lesson plans, knowledge and teaching methods.

Este manual proporciona una guía completa de planificación de lecciones y estrategias para la enseñanza de la ciencia en una escuela primaria. Abarca los conocimientos y los enfoques de la ciencia en esta etapa. Incluye actividades de aprendizaje adecuados. Establece los usos de la información y la tecnología para apoyar la enseñanza y el aprendizaje. Ofrece criterios prácticos y estrategias para la evaluación.

Teaching and learning geometry : issues and methods in mathematical education.

Recurso para la evaluación de la enseñanza y el aprendizaje de la geometría en la enseñanza secundaria desde la perspectiva de los nuevos docentes y de los que tienen más experiencia. Está diseñado para ampliar y profundizar el conocimiento de la materia y ofrecer consejos prácticos e ideas para el aula en el contexto de la práctica y la investigación actual. Hace especial hincapié en: comprender las ideas fundamentales del currículo de geometría; el aprendizaje de la geometría de manera efectiva; la investigación y la práctica actual; las ideas erróneas y los errores; el razonamiento de la geometría; la solución de problemas; el papel de la tecnología en el aprendizaje de la geometría.