Actuarial examinations: what can be learnt from the students' perspective?

This thesis presents a detailed analysis of the student experience of qualifying as an actuary,\ud and reflects upon what might be learnt from this. The actuarial profession is small and,\ud outside the financial sector, little known. However, within the financial sector, actuaries are\ud influential. Their professional examinations are seen as very demanding and the qualification\ud is coveted. This exploration of the students' perspective, breaks new ground in research on\ud the profession by: adopting principles of 'illuminative evaluation' (Parlett & Hamilton,\ud 1972) and later developments in qualitative research; and using adult learning theory as the\ud conceptual framework.\ud Themes which emerged from the study coalesce around three dominant concerns: adjusting\ud to the learning milieu, the disjuncture between expectation and experience and, finding and\ud decoding clues. These are elaborated separately, then integrated in a series of case studies\ud which demonstrate the diversity of student experience. Dynamic Concept Analysis\ud (Kontiainen, 1973, 1989) is employed to structure the case studies, and highlight the\ud relational nature of influences upon the learning experience.\ud Kontiainen's model of adult learning (1991) is modified to improve its interpretive power\ud in the context of distance learning, and to incorporate the findings of research into student\ud approaches to learning.\ud Contributions are made to the discourses of actuarial education, professional education,\ud distance education and adult learning. Attention is drawn to the pivotal role of the\ud correspondence course tutor in supporting: adjustment to the learning milieu; and high\ud quality learning. Overload is a recurrent theme, and is associated with perceptions of\ud control and validity. Questioning of the validity of several aspects of the education and\ud assessment processes by members of the profession, is discussed. A possible general model\ud for the student experience of actuarial examinations is presented

Conducting a good ward round: How do leaders do it?

Rationale, Aims and Objectives: Ward rounds (WRs) are complex social processes. Done well, WR discussions and decisions contribute to timely, safe, effective pro-gression of care. However, literature highlights medical dominance; marginalisation or absence of other perspectives, safety risks and suboptimal resource use. This study examined leadership behaviours and what supported good interprofessional WRs, defined as enabling interprofessional collaboration and decision making which progresses patient care in a safe and timely manner. Deepening appreciation of this art should support learning and improvements. Method: Mixed‐method appreciative inquiry (AI) into how WRs go well and could go well more often. Context: daily interprofessional consultant‐led WRs in a large adult critical care unit. Data: ethnographic and structured observations (73 h, 348 patient reviews); AI conversations and interviews (71 participants). Inductive iterative analysis shaped by Activity Theory. Participants: 256 qualified healthcare professionals working in the unit. Results: Leadership of good WRs supported (and minimized contradictions to): making good use of expertise and time, and effective communication. These three key activities required careful and skilled orchestration of contributions to each patient review, which was achieved through four distinct phases (a broadly pre-dictable script), ensuring opportunity to contribute while maintaining focus and a productive pace. This expertise is largely tacit knowledge, learnt informally, which is difficult to analyse and articulate oneself, or explain to others. To make this easier, and thus support learning, we developed the metaphor of a conductor leading musicians. Conclusions: Whilst everyone contributes to the joint effort of delivering a good WR, WR leadership is key. It ensures effective use of time and diverse expertise, and coordinates contributions rather like a conductor working with musicians. Although WR needs and approaches vary across contexts, the key leadership activities we identified are likely to transfer to other settings

Interprofessional ward rounds in an adult intensive care unit: an appreciative inquiry into the central collaboration between the consultant and the bedside nurse

Done well, ward rounds (WRs) promote effective, safe care and collaboration; but WR quality varies. An improvement-focused appreciative inquiry (AI) into a large intensive care unit’s WR practices identified a pivotal axis of collaboration between the most senior medical role (the consultant) and the bedside nurse (BSN). This paper examines that axis of interprofessional collaboration (IPC) to deepen understanding of its implications. Data included ethnographic observations, interviews, and co-constructed AI with groups of staff. Four key concepts emerged from cyclical interpretive analysis: “need,” “presence,” “ability” and “willingness.” BSNs and consultants needed the interprofessional WR to enable their work; WR effectiveness was affected by whether they were both present, then able and willing to participate in IPC. BSN presence was necessary for effective and efficient IPC between these key roles. Indirect contributions, based on prior exchanges with colleagues or through written notes, reduced the joint problem-solving through discussion and negotiation that characterizes IPC to less efficient asynchronous interprofessional coordination. Factors affecting “presence,” “ability” and “willingness” are discussed alongside potential mitigations and acknowledgment of asymmetric power. Appreciative examination of interprofessional WRs identified mechanisms supporting and undermining effective WR IPC and the centrality of consultants’ and BSNs’ collaboration

Protocol study: Sexual and reproductive health knowledge, information-seeking behaviour and attitudes among Saudi women: A questionnaire survey of university students

Copyright © 2014 Farih et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background - Sexual and reproductive health (SRH), a basic right for women worldwide, is infrequently researched in countries in the Middle East and North Africa (MENA). No empirical studies of SRH among Saudi women exist. This protocol describes a study to explore the SRH knowledge, information-seeking behaviour and attitudes of Saudi female university students. Methods/Design - This study will administer a questionnaire survey to female students at 13 universities in Riyadh, Saudi Arabia. The questionnaire was developed following a literature search to identify relevant content, with psychometrically tested tools used when available. The content layout and the wording and order of the questions were designed to minimize the risk of bias. The questionnaire has been translated into Arabic and piloted in preparation for administration to the study sample. Ethical approval for the study has been granted (reference no. QMREC2012/54). After questionnaire administration, the data will be collated, analysed and reported anonymously. The findings will be published in compliance with reporting guidelines for survey research. Discussion - This study will be the first to provide fundamental information concerning Saudi females university students SRH knowledge and information needs.King Abdullah Scholarship Program, Saudi Arabi

Playing the game: service users' management of risk status in a UK medium secure forensic mental health service

In this article we examine how forensic mental health service users actively attempt to manage their risk status through playing the game of containing frustration and demonstrating compliance. The article draws on an observational study (2006 to 2009) which explored the practices of risk assessment and management within one inner city forensic mental health medium secure service in the UK. We used a grounded theory approach to explore service users and providers experiences of risk assessment and management. We interviewed forensic mental health service users and providers. We also collected data using participant and non-participant observation. Since access to forensic mental health services is tightly controlled, there are participant observation studies undertaken in these settings. We found that service users attempted to understand the system of assessment and sought to affect and reduce their risk status by engaging in overt, compliant behaviours. We argue that in doing so service users are active agents in the process of risk management. However, we indicate that there are adverse effects of this approach to risk management as the risk assessment process is subverted by the restriction of the flow of information, and service users are left with frustrations that they must contain and manage

Being Interprofessional

Working interprofessionally is an essential part of successful health and social care provision in the twenty-first century. This engaging and easy-to-follow new text highlights the need for collaboration between practitioners from all branches of health and social care. It offers an indispensable guide to learning and working better together, and shows what being interprofessional really means. The book encourages students to sharpen their understanding of concepts and theories surrounding collaborative practice, with a clear emphasis on theory, policy and practice. Chapter-by-chapter, the book takes readers through the most important and relevant issues in contemporary health and social care, including working in teams, learning from others, policy issues, working with children and adults, and specialist practice. Through student-friendly case studies and thoughtful learning exercises, it also considers ways of applying these ideas to the real world. It covers work across the statutory, voluntary and community sectors, drawing on the insights and experiences of a wide range of service users, carers and a variety of practitioners. Being Interprofessional will be essential reading for students and practitioners in all branches of health and social care, such as nursing, social work, midwifery and youth work. Whatever their background, it will inspire readers to find new ways of working together to meet the needs of patients and clients

SIN-BARRSS – Developing a mnemonic to support nurses’ participation in interprofessional ward rounds in intensive care: An appreciative inquiry for quality improvement

Objectives. To develop and pilot a mnemonic to increase the willingness and ability of bedside nurses to contribute to patient reviews in the daily interprofessional ward round. Research methodology/design. Appreciative inquiry quality improvement study, using ethnographic observations and appreciative inquiry discussions, augmented by quantitative data collection of basic facts. Setting. Large (44 beds) critical care unit in the United Kingdom. Main outcome measures. Interprofessional development and acceptance of mnemonic; successful preparation for pilot; use and usability of mnemonic; improvements in bedside nurses’ contributions to ward round discussions (frequency and focus). Result/findings. Interprofessional development of a usable and useful mnemonic was successful, pilot implementation showed promising levels of take up and acceptance. Compared to before the quality improvement project bedside nurses were more willing and able to participate in ward round discussions, did so more often, and used the mnemonic script with insight and flexibility. Conclusions. The implementation of a mnemonic supported bedside nurses’ contributions to the ward round. This could provide a framework for introducing similar programmes to other intensive care units. Appreciative inquiry methodology could be replicated in other settings to aid the improvement of interprofessional ward rounds, or to address other quality improvement priorities. Implications for clinical practice. A mnemonic can provide a structure which supports bedside nurses’ contributions in ways that make good use of bedside nurses’ professional expertise and most up to date knowledge of patients’ clinical state. Furthermore, a well-designed mnemonic can be used flexibly and provides an outline script that supports less experienced and less confident nurses to make well-focused and well received contributions to rapid interprofessional discussions. In turn, this can increase these nurses’ confidence and capability. More experienced and confident nurses, and ward round leaders, can use the same mnemonic flexibly as an aide memoir that guards against missing information and insights that could affect the quality and safety of patient care

Mechanisms that support the assessment of interpersonal skills

In many health professions, experienced practitioners assess students’ or inexperienced practitioners’ clinical skills but do not formally or explicitly rate their interpersonal skills, even though it is often suggested that failing or struggling students have poor interpersonal skills. The Interpersonal Skills Profile (ISP) has been widely used in UK health care programmes. The tool allows assessors to select five statements from a list, which they feel reflect the student’s achievement. These are usually graded from fail to excellent.Using a Realistic Evaluation approach this study examined how the ISP was used to assess interpersonal skills in a university pre-registration nursing programme. The use of the ISP was investigated through interviews with clinical nursing mentors, practice education facilitators and education champions as well as a documentary analysis of student assessment booklets. The findings led to the development of three middle range theories which may be useful in other contexts. These focus on: 1) overt assessment of interpersonal skills, 2) providing support to mentors and 3) feedback and ‘feeding-forward’ to students