Practice Educators in an Uncertain World: Still Too Much to Ask?

In recent times the complexity and ever-evolving nature of health and social care systems have reshaped professions and rendered the future uncertain. Fast moving social, economic and technological changes have redefined the various roles of practitioners and educators alike. There is a danger that standing on shifting sands may have an adverse effect on the quality and outcomes of learning relationships at all levels of learning and professional development. Nearly two decades ago I suggested that yet another role shift in response to yet another policy change was ‘too much to ask’ of hard pressed practitioners involved in delivering professional education. As the world of health and social care remains uncertain and unpredictable, this paper looks at some of the challenges facing practice-based educators in 2013

Perceptions of the learning environment in higher specialist training of doctors: implications for recruitment and retention.

INTRODUCTION: Career choice, sense of professional identity and career behaviour are influenced, subject to change and capable of development through interaction with the learning environment. In this paper workplace learning discourses are used to frame ongoing concerns associated with higher specialist training. Data from the first stage of a multimethods investigation into recruitment into and retention in specialties in the West Midlands is used to consider some possible effects of the specialist learning environment on recruitment and retention. METHODS: The aim of the study was to identify issues, through interviews with 6 consultants and questionnaires completed by specialist registrars from specialties representing a range of recruitment levels. These would inform subsequent study of attributes and dispositions relevant to specialist practice and recruitment. The data were analysed using NVivo software for qualitative data management. RESULTS: Participants' perceptions are presented as bipolar dimensions, associated with: curriculum structure, learning relationships, assessment of learning, and learning climate. They demonstrate ongoing struggle between different models of workplace learning. CONCLUSION: Changes in the postgraduate education of doctors seem set to continue well into the future. How these are reflected in the balance between workplace learning models, and how they influence doctors' sense of identity as specialists suggests a useful basis for examination of career satisfaction and recruitment to specialties

ReGAE 5: Can we improve the surgical journey for African-Caribbean patients undergoing glaucoma filtration surgery? Some preliminary findings

Vinette Cross, Peter Shah, Martin Glynn, Shivani ChidrawarCentre for Health and Social Care Improvement, University of Wolverhampton, Wolverhampton, United KingdomAim: To explore the experiences of African-Caribbean patients who had undergone filtration surgery for advanced glaucoma.Methods: Semi-structured qualitative interviews were used to collect the data and an interview guide was developed. Participants recounted when they first became aware of a problem with their eyes and their feelings at the time. Subsequently they were probed about their subjective experiences of becoming a glaucoma patient, receiving treatment, the decision to undergo surgery, and its aftermath. The perceptions of three participants from three different generations of African-Caribbean men were selected from the larger study for presentation in this paper. Interview transcripts were subjected to narrative analysis.Results: The concept of patient-partnership was re-framed in terms of mentorship. Surgeon–patient relationships are central to developing effective coping strategies. Support to face the ordeals ahead, challenge to take on new responsibilities, and help to envision a meaningful life with glaucoma are fundamental to fostering trust and maintaining motivation to continue.Conclusions: The use of patient narratives provides a valuable a resource for enhancing communication skills and patient-centered care in the hospital eye service.Keywords: glaucoma, secondary eye-care, African-Caribbean, filtration surgery, trabeculectom

“It Sounds Like a Drama:” Hearing Stories of Chronic Low Back Pain Through Poetic (Re)presentation

A poetic voice develops in different ways and from different sources. In this paper, a poetic voice is brought to the experiences of patients and family members as recounted in the first phase of a UK National Health Service funded Q-methodological study, the key outcomes of which are summarized. Their stories are presented as a single poetic performance text crafted from the analysis of combined transcripts of three focus group discussions. The performance bears witness to the sadness, frustration, and resolve of those living with chronic low back pain, and offers an additional hearing to that provided by the main study

Psychophysical measures of visual function and everyday perceptual experience in a case of congenital stationary night blindness

An appreciation of the relation between laboratory measures of visual deficit and everyday perceptual experience is fundamental to understanding the impact of a visual condition on patients and so to a fuller characterization of the disorder. This study aims to understand better the interpretative processes by which modified sensory information is perceived by a patient with congenital stationary night blindness and the adaptive strategies that are devised to deal with their measurable visual loss. Psychophysical measurements of temporal resolution, spectral sensitivity, and color discrimination were conducted on a 78-year-old male patient with the condition, who was also interviewed at length about the ways in which his diagnosis affected his daily life. Narrative analysis was employed to identify the relation between his subjective perceptual experiences and functional deficits in identifiable components of the visual system. Psychophysical measurements indicated a complete lack of rod perception and substantially reduced cone sensitivity. Two particular effects of this visual loss emerged during interviews: 1) the development of navigational techniques that relied on light reflections and point sources of light and 2) a reluctance to disclose the extent of visual loss and resulting lifelong psychosocial consequences. This study demonstrates the valuable complementary role that rich descriptive patient testimony can play, in conjunction with laboratory and clinical measurements, in more fully characterizing a disorder and in reaching a more complete understanding of the experience of vision loss. It also evidences the particular suitability of filmmaking techniques as a means of accessing and communicating subjective patient experience