Learning clinical skills during bedside teaching encounters in general practice: a video-observational study with insights from activity theory

Purpose – This paper aims to explore how opportunities for learning clinical skills are negotiated within bedside teaching encounters (BTEs). Bedside teaching, within the medical workplace, is considered essential for helping students develop their clinical skills. Design/methodology/approach – An audio and/or video observational study examining seven general practice BTEs was undertaken. Additionally, audio-recorded, semi-structured interviews were conducted with participants. All data were transcribed. Data analysis comprised Framework Analysis informed by Engeström’s Cultural Historical Activity Theory. Findings – BTEs can be seen to offer many learning opportunities for clinical skills. Learning opportunities are negotiated by the participants in each BTE, with patients, doctors and students playing different roles within and across the BTEs. Tensions emerged within and between nodes and across two activity systems. Research limitations/implications – Negotiation of clinical skills learning opportunities involved shifts in the use of artefacts, roles and rules of participation, which were tacit, dynamic and changing. That learning is constituted in the activity implies that students and teachers cannot be fully prepared for BTEs due to their emergent properties. Engaging doctors, students and patients in refecting on tensions experienced and the factors that infuence judgements in BTEs may be a useful frst step in helping them better manage the roles and responsibilities therein. Originality/value – The paper makes an original contribution to the literature by highlighting the tensions inherent in BTEs and how the negotiation of roles and division of labour whilst juggling two interacting activity systems create or inhibit opportunities for clinical skills learning. This has signifcant implications for how BTEs are conceptualised.

What are the perceived learning needs of Australian general practice registrars for quality prescribing?

BACKGROUND: Little is known about the perceived learning needs of Australian general practice (GP) registrars in relation to the quality use of medicines (QUM) or the difficulties experienced when learning to prescribe. This study aimed to address this gap. METHODS: GP registrars' perceived learning needs were investigated through an online national survey, interviews and focus groups. Medical educators' perceptions were canvassed in semi-structured interviews in order to gain a broader perspective of the registrars' needs. Qualitative data analysis was informed by a systematic framework method involving a number of stages. Survey data were analysed descriptively. RESULTS: The two most commonly attended QUM educational activities took place in the workplace and through regional training providers. Outside of these structured educational activities, registrars learned to prescribe mainly through social and situated means. Difficulties encountered by GP registrars included the transition from hospital prescribing to prescribing in the GP context, judging how well they were prescribing and identifying appropriate and efficient sources of information at the point of care. CONCLUSIONS: GP registrars learn to prescribe primarily and opportunistically in the workplace. Despite many resources being expended on the provision of guidelines, decision-support systems and training, GP registrars expressed difficulties related to QUM. Ways of easing the transition into GP and of managing the information 'overload' related to medicines (and prescribing) in an evidence-guided, efficient and timely manner are needed. GP registrars should be provided with explicit feedback about the process and outcomes of prescribing decisions, including the use of audits, in order to improve their ability to judge their own prescribing.

Information learning and the stability of fiat money

We analyze the stability of monetary regimes in a decentralized economy where fiat money is endogenously created, information about its value is imperfect, and agents only learn from their personal trading experiences. We show that in poorly informed economies, monetary stability depends heavily on the government's commitment to the long run value of money, whereas in economies where agents gather information more easily, monetary stability can be an endogenous outcome. We generate a dynamics on the acceptability of fiat money that resembles historical accounts of the rise and eventual colIapse of overissued paper money. Moreover, our results provide an explanation of the fact that, despite its obvious advantages, the widespread use of fiat money is a very recent development.

SUPPORTING LEARNING FOR NAVAJO STUDENTS THROUGH ETHNOMATHEMATICS

The purpose of this research was to address how culturally informed ethnomathematical methods of teaching can be utilized to support the learning of Navajo students in mathematics. The study was conducted over the course of four years on the Navajo Reservations at Tohatchi Middle School in Tohatchi New Mexico. The students involved in the study were all in 8th grade and were enrolled either in Algebra 1 or a Response to Intervention, RTI, class. The data collected came in the form of a student survey, student observation and student assessment. The teacher written survey, a math textbook word problem, and two original math textbook problems along with their rewritten version were the sources of these three studies. The first year of the study consisted of a math attitude survey and how Navajo students perceived math as a subject of interest. The students answered four questions pertaining to their thoughts about mathematics. The students’ responses were positive according to their written answers. The second year of the study involved the observation of how students worked through a math word problem as a group. This method tested how the students culturally interacted in order to solve a math problem. Their questions and reasoning to solve the problem were shared with peers and the teacher. The teacher supported the students in understanding and solving the problem by asking questions that kept the students focused on the goal of solving the problem. The students worked collaboratively and openly in order to complete the activity. During the iv study, the teacher was more able to notice the students’ deficiencies individually or as a group, therefore was able to support them in a more specific manner. The last study was conducted over a period of two different years. This study was used to determine how textbook bias in the form of its sentence structure or word choice affects the performance of students who are not culturally familiar with one or both. It was found that the students performed better and took less time on the rewritten problem than on the original problem. The data suggests that focusing on the culture, language and education of Navajo students can affect how the students learn and understand math.

Learning about Self Far From Home: A Pre-service Teacher’s Intercultural Development During an International Program

Preparing teachers to effectively teach culturally diverse students, teacher educators advocate for the use of cross-cultural field experiences, including international study abroad programs. This paper reports on a qualitative case study of two pre-service teachers’ intercultural development during a semester-long teacher education study abroad program in London, England. Findings indicate that international experiences provide a catalyst to move pre-service teachers forward in their intercultural development. Implications include the need for multicultural teacher educators to take a developmental approach to pre-service teacher education informed by theories of intercultural development and cultural learning developed within intercultural communications.

A pedagogically-supported TEL solution for learning nontechnical minimally invasive surgical skills across Europe

Residents learning nontechnical skills in Europe face two problems: (1) the difficulty to fit learning time in their overloaded schedules; and (2) the lack of standard pedagogical models for all countries. Online video-based repositories such as WeBSurg or WebOP provide ubiquitous access to surgical contents. However, their pedagogical facets have not been fully exploited and they are often seen as quick-reference repositories rather than full e-learning alternatives. We present a new pedagogically-supported Technology Enhanced Learning (TEL) solution, MISTELA, designed by surgeons, pedagogical experts and engineers. MISTELA aims at building a common European pedagogical model supported by ICT technologies and elearning. The solution proposes a pedagogical model based on a framework for pedagogically-informed design of e-learning platforms. It is composed of (1) an authoring tool for editing and augmenting videos; (2) a media asset management system; and (3) a virtual learning environment. Support of the European Association for Endoscopic Surgery (EAES) and validation of the solution, will help to determine its full potential.

Embracing english as a lingua franca : learning from portuguese users of english in higher education

Tese de doutoramento, Linguística (Linguística Aplicada), Universidade de Lisboa, Faculdade de Letras, 2016

Teaching College Writing in a High School Setting: The Impact of Concurrent Enrollment on Teacher Learning and Practice

Thesis (Ph.D.)--University of Washington, 2016-06

RESEARCHING SITUATED LEARNING AS THE DEVELOPMENT OF PRACTICE FOR COLLEGE ACCESS PRACTITIONERS: A CASE STUDY OF THE COLLEGE ASSISTANCE MIGRANT PROGRAM

Thesis (Ph.D.)--University of Washington, 2016-03

Discovering the Parameters of Sound Creation: Physics Informed String Pedagogy

Thesis (D.M.A.)--University of Washington, 2016-06

The engineering link project: Learning about engineering by becoming an engineer

There has been a greater emphasis over the past few years of encouraging high school students to take up engineering as a career. This is due to a greater need for engineers in society, particularly in areas that are suffering a skills shortage. Both the engineering profession and universities across Australia have moved to address this shortage, with a proliferation of engineering outreach activities and programs the result. The Engineering Link Group (TELG) began the Engineering Link Project (ELP) over a decade ago with a focus on helping motivated high school students make an informed choice about engineering as a career. It also aimed at encouraging more high school students to study maths and science at high school. From the start the ELP was designed so that the students became engineers, rather than just hear from or watch engineers. Real working engineers pose problems to groups of students for them solve over the course of a day. In this way, students experience what it is like to be an engineer. It has been found that the project does help high school students make more informed career choices about engineering. The project also gave the students real life and practical reasons for studying sciences and mathematics at high school. © 2005, Australasian Association for Engineering Education

The influence of learning styles, enrolment status and gender on academic performance of optometry undergraduates

Purpose: This cross-sectional study was designed to determine whether the academic performance of optometry undergraduates is influenced by enrolment status, learning style or gender. Methods: Three hundred and sixty undergraduates in all 3 years of the optometry degree course at Aston University during 2008–2009 were asked for their informed consent to participate in this study. Enrolment status was known from admissions records. An Index of Learning Styles (http://www4.nscu.edu/unity/lockers/users/f/felder/public/Learning-Styles.html) determined learning style preference with respect to four different learning style axes; active-reflective, sensing-intuitive, visual-verbal and sequential-global. The influence of these factors on academic performance was investigated. Results: Two hundred and seventy students agreed to take part (75% of the cohort). 63% of the sample was female. There were 213 home non-graduates (entrants from the UK or European Union without a bachelor’s degree or higher), 14 home graduates (entrants from the UK or European Union with a bachelor’s degree or higher), 28 international non-graduates (entrants from outside the UK or European Union without a bachelor’s degree or higher) and 15 international graduates (entrants from outside the UK or European Union with a bachelor’s degree or higher). The majority of students were balanced learners (between 48% and 64% across four learning style axes). Any preferences were towards active, sensing, visual and sequential learning styles. Of the factors investigated in this study, learning styles were influenced by gender; females expressed a disproportionate preference for the reflective and visual learning styles. Academic performance was influenced by enrolment status; international graduates (95% confidence limits: 64–72%) outperformed all other student groups (home non graduates, 60–62%; international non graduates, 55–63%) apart from home graduates (57–69%). Conclusion: Our research has shown that the majority of optometry students have balanced learning styles and, from the factors studied, academic performance is only influenced by enrolment status. Although learning style questionnaires offer suggestions on how to improve learning efficacy, our findings indicate that current teaching methods do not need to be altered to suit varying learning style preferences as balanced learning styles can easily adapt to any teaching style (Learning Styles and Pedagogy in Post-16 Learning: A Systematic and Critical Review. London, UK: Learning and Skills Research Centre, 2004).

"Ignorance was bliss, now I'm ignorant and that is far more difficult":transdisciplinary learning and reflexivity in responsible management education

Purpose – The collapse of world economic systems brought the interconnectedness between business and global events sharply into focus. As Starkey points out: “leading business schools need to overcome their fascination with a particular form of finance and economics […] to broaden their intellectual horizons […] (and to) look at the lessons of history and other disciplines”. The purpose of this paper is to provide evidence from three years of research on the Aston MBA suggesting that an emphasis on developing capabilities within a far broader, connected and reflexive business curriculum is what business students and practitioners now recognise as an essential way forward for responsible management education. Design/methodology/approach – This research paper examines the reflective accounts of 300 MBA students undertaking a transdisciplinary Business Ethics, Responsibility and Sustainability core module. Findings – As Klein argues, transdisciplinarity is simultaneously an attitude and a form of action. The student reflections provide powerful discourses of individual learning and report a range of outcomes from finding “the vocabulary or the confidence” to raise issues to acting as “change agents” in the workplace. Originality/value – As responsibility and sustainability requires learners, researchers and educators to engage with real world complexity, uncertainty and risk, conventional disciplinary study, especially within business, often proves inadequate and partial. This paper demonstrates that creative and exploratory frames need to be developed to facilitate the development of more connected knowledge – informed by multiple stakeholders, able to contribute heterogeneous skills, perspectives and expertise.

Engaging employers as partners in work-based learning assessment:proposal for a quality enhancement framework

This paper seeks to advance research and practice related to the role of employers in all stages of the assessment process of work-based learning (WBL) within a tripartite relationship of higher education institution (HEI), student and employer. It proposes a research-informed quality enhancement framework to develop good practice in engaging employers as partners in assessment. The Enhancement Framework comprises three dimensions, each of which includes elements and questions generated by the experiences of WBL students, HEI staff and employers. The three dimensions of the Enhancement Framework are: 1. ‘premises of assessment’ encompassing issues of learning, inclusion, standards and value; 2. ‘practice’, encompassing stages of assessment made up of course design, assessment task, responsibilities, support, grading and feedback; 3. ‘communication of assessment’ with the emphasis on role clarity, language and pathways. With its prompt questions, the Enhancement Framework may be used as a capacity-building tool for promoting, sustaining, benchmarking and evaluating productive dialogue and critical reflection about assessment between WBL partners. The paper concludes by emphasising the need for professional development as well as policy and research development, so that assessment in WBL can more closely correspond to the potentially transformative nature of the learning experience.

A Phenomenological Study of Learning Processes at Work: Confirming, Extending, and Challenging Holistic Learning Theory

Holistic learning theory (Yang, 2003) identified explicit, implicit, and emancipatory knowledge facets in learning. A phenomenological study of how participants’ experienced interactions between knowledge facets showed the facets expressed, informed, changed, and guided one another. The complexity of learning and the role of spirituality in learning were explored.