Integrating threshold concepts: exploring innovations in the redesign of a problem-based learning curriculum

YesAn innovative new midwifery programme leading to midwifery registration with the Nursing and Midwifery Council (NMC) developing potential registrants at both BSc and MSc levels commenced in September 2016. The programme is delivered utilising problem-based learning (PBL) as both a content delivery method and a philosophical approach, underpinning student learning at the UK's University of Bradford, School of Midwifery. A requirement for NMC revalidation at a five-year juncture and institutional programme reapproval acted as a catalyst for change. The programme team embraced a new curriculum framework which emphasised a move to reviewing stage and programme outcomes rather than concentrating on the minutiae of module outcomes. This new approach suited the holistic nature of PBL ensuring an intellectually challenging and inclusive method of teaching and learning for midwifery practice. A further progression for the programme team was to develop an understanding of, and to integrate, ‘threshold concepts’ or ‘troublesome knowledge’. These are defined as knowledge, principles or components which students find difficult to understand and therefore to utilise to improve practice and deliver high-quality care. This article explores the integration of threshold concepts into a problem-based midwifery curriculum

An exploration of young people’s narratives of hope following experience of psychosis

Aims: To expand understandings of how young people with psychosis experience hope. This included to which factors young people attributed changes in their hopefulness and the role played by professionals and others with lived experience. Method: Ten young people recovering from an experience of psychosis were interviewed using narrative methodology. Results: The experience of hope as an overarching strand throughout the narratives had three common elements: sense of belonging, which included social inclusion, the importance of information and the significance of planning and occupation. Professionals played an important role in facilitating small steps forwards. Conclusions: The findings suggest the importance to young people of a sense of belonging and achieving small goals to facilitate hopeful thinking and, for clinicians, the value of supporting new peer relationships and meaningful occupation

The impact of an enhanced assessment tool on students’ experience of being assessed in clinical practice: a focus group study

YesAs part of a CETL funded project (ALPS 2006) 29 student midwives and their link lecturers were given an electronic version of a clinical portfolio on hand held computers (PDAs). These devices were used during an eight week clinical practice placement to record tripartite assessment interviews and to facilitate grading of the placement. Three focus groups conducted at the end of the placement explored the concept of clinical practice assessment and the impact of the electronic portfolio on the students’ experience of clinical practice and its assessment. Data was analysed from an activity theory perspective in that the electronic assessment tool was viewed as an artefact mediating situated knowing about student assessment in a particular socio-historical context. Findings suggest that students perceive clinical assessment as contested with different assessors having different understandings of it. However the electronic devise facilitated changes to the assessment tool. These changes promoted a shared understanding of the assessment process which was pragmatic and acceptable to students and clinicians. The significance of this study is that it highlights the role of assessment tools in creating a shared understanding of the assessment process rather than simply articulating that understanding

Statistical inference in mixture models with random effects

There is currently no existing asymptotic theory for statistical inference on the maximum likelihood estimators of the parameters in a mixture of linear mixed models (MLMMs). Despite this many researchers assume the estimators are asymptotically normally distributed with covariance matrix given by the inverse of the information matrix. Mixture models create new identifability problems that are not inherited from the underlying linear mixed model (LMM), and this subject has not been investigated for these models. Since identifability is a prerequisite for the existence of a consistent estimator of the model parameters, then this is an important area of research that has been neglected. MLMMs are mixture models with random effects, and they are typically used in medical and genetics settings where random heterogeneity in repeated measures data are observed between measurement units (people, genes), but where it is assumed the units belong to one and only one of a finite number of sub-populations or components. This is expressed probabalistically by using a sub-population specific probability distribution function which are often called the component distribution functions. This thesis is motivated by the belief that the use of MLMMs in applied settings such as these is being held back by the lack of development of the statistical inference framework. Specifically this thesis has the following primary objectives; i To investigate the quality of statistical inference provided by different information matrix based methods of confidence interval construction. ii To investigate the impact of component distribution function separation on the quality of statistical inference, and to propose a new method to quantify this separation. iii To determine sufficient conditions for identifiability of MLMMs

Investigating Assessment in Higher Education: Demystifying Marking and Grading to Reveal Expert Practices. A phenomenological analysis of marking and grading practices of novice and experienced health academics

This thesis is focused on exploring marking and grading in higher education. Using a phenomenological approach 26 interviews were undertaken with a heterogeneous sample of health academics at four universities. The sample included novice lecturers with two years or less experience in the academy to those with academic careers spanning more than 20 years. Two interview methods were utilised, Protocol Analysis (PA) and Cognitive Interviewing (CI). Protocol Analysis enables close contact with the marking and grading, in the moment, whilst Cognitive Interviewing is a novel method for exploring lecturer practices in higher education. Analysis was completed by applying a modified framework analysis to both data sets, facilitating synthesis of the two series of research findings. A wealth of rich data was gathered which resulted in close exploration of marking and grading practices, with the production of corroboratory evidence for issues previously identified on these phenomena. Close connection as an insider practitioner researcher has enabled close exploration and the gaining of new insights into practice, resulting in the identification of previously unexplored areas. My original contributions to knowledge in this area are: identifying the messiness of marking and grading and troublesome knowledge, the ‘rubric paradox’, importance of communities of practice, dual identity of health academics, working environments, experience recast as expertise, and using current interview techniques (PA and CI) for supporting continuing professional development. This thesis develops these themes suggesting ways in which they could impact upon contemporary marking and grading practice

Physician assessments of medication adherence and decisions to intensify medications for patients with uncontrolled blood pressure: still no better than a coin toss

Abstract Background Many patients have uncontrolled blood pressure (BP) because they are not taking medications as prescribed. Providers may have difficulty accurately assessing adherence. Providers need to assess medication adherence to decide whether to address uncontrolled BP by improving adherence to the current prescribed regimen or by intensifying the BP treatment regimen by increasing doses or adding more medications. Methods We examined how provider assessments of adherence with antihypertensive medications compared with refill records, and how providers’ assessments were associated with decisions to intensify medications for uncontrolled BP. We studied a cross-sectional cohort of 1169 veterans with diabetes presenting with BP ≥140/90 to 92 primary care providers at 9 Veterans Affairs (VA) facilities from February 2005 to March 2006. Using VA pharmacy records, we utilized a continuous multiple-interval measure of medication gaps (CMG) to assess the proportion of time in prior year that patient did not possess the prescribed medications; CMG ≥20% is considered clinically significant non-adherence. Providers answered post-visit Likert-scale questions regarding their assessment of patient adherence to BP medications. The BP regimen was considered intensified if medication was added or increased without stopping or decreasing another medication. Results 1064 patients were receiving antihypertensive medication regularly from the VA; the mean CMG was 11.3%. Adherence assessments by providers correlated poorly with refill history. 211 (20%) patients did not have BP medication available for ≥ 20% of days; providers characterized 79 (37%) of these 211 patients as having significant non-adherence, and intensified medications for 97 (46%). Providers intensified BP medications for 451 (42%) patients, similarly whether assessed by provider as having significant non-adherence (44%) or not (43%). Conclusions Providers recognized non-adherence for less than half of patients whose pharmacy records indicated significant refill gaps, and often intensified BP medications even when suspected serious non-adherence. Making an objective measure of adherence such as the CMG available during visits may help providers recognize non-adherence to inform prescribing decisions.http://deepblue.lib.umich.edu/bitstream/2027.42/112850/1/12913_2012_Article_2450.pd

The Hospital: Still the Doctors’ Workplace(s)—A Cautionary Note for Approaches to Safety and Value Improvement

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142954/1/hesr12780.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142954/2/hesr12780-sup-0001-AppendixSA1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142954/3/hesr12780_am.pd