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Objectives: Although there is much evidence to support the use of simulation‐based education (SBE) in undergraduate education of health care professionals, less attention has been paid to how SBE, viewed as a complex intervention, is implemented and becomes embedded and sustained. This paper aims to explore factors that inhibited or promoted SBE becoming normal practice in undergraduate health care professional programmes. Methods: Participants involved in the organisation, design and delivery of SBE in the north of England were recruited purposefully from higher education institutions (HEI) and National Health Service (NHS) Trusts through local networks for qualitative telephone interviews. Transcripts were analysed inductively using a hybrid approach involving simultaneous inductive open coding and deductive coding using normalisation process theory (NPT) as a theoretical lens. Findings: A total of 12 NHS staff from 11 trusts and seven individuals from four HEIs were interviewed. There was considerable variation in the approach taken to implementation across organisations, which resulted in varying degrees of embeddedness. Implementation was challenged or enabled by organisational leadership, professional buy‐in and the development and maturity of the strategic approach. Variation in understanding of the scope and pedagogical aims of SBE led to inequity between professions and organisations in investment and participation, as well as design and delivery of SBE. Conclusions: Given the complexity of SBE, best practice in implementation should be considered fundamental to the successful delivery of SBE. The findings provide an explanation of how contextual factors can support or hinder implementation to maximise potential benefits and learning outcomes; this understanding can be used to better inform development of SBE strategies and highlight potential factors needed to navigate contextual barriers so that learning outcomes can be maximised. Although "validity" is a central concept for educators, this research outlining the conversion of outcome frameworks to assessment practice illustrates that the concept can easily get lost in translation. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background There is inconclusive debate within the literature as to whether the best problem-based learning (PBL) tutors are subject experts or not. The debate hinges on whether knowledgeable tutors are tempted to intervene too often in PBL discussions compared to non-expert tutors, and whether the latter may not be able to sufficiently challenge the students' level of understanding. Purpose To describe approaches used by tutors in PBL tutorials and to identify differences between tutors from medical and non-medical backgrounds. Methods The research reported in this paper was undertaken during the academic session 1999–2000 at the Univeristy of Liverpool Faculty of Medicine. A qualitative exploratory case study method was used and two PBL groups were observed. One of these groups had a medically qualified tutor and the other had a tutor from a humanities background. The focus of the observation was the discourse between tutor and students, which was analysed using a framework drawn from linguistics. Results were fed back to both the tutors and the students to check their perceptions of the interactions. Results Analysis of the tutorial group interaction revealed that tutors from both backgrounds used similar techniques to raise students' awareness, facilitate the group process and direct students' learning. Differences were noted between the two tutors: the medical tutor set out to raise students' awareness by using questioning techniques herself, whereas the non-medical tutor expected students to question each other. The non-medical tutor was observed to facilitate the group process more often than the medical tutor. Conclusions Qualitative analysis of spoken discourse in PBL tutorials provides valuable insights into the processes involved in PBL, thereby generating material which is useful for both training of and giving feedback to PBL tutors. [ABSTRACT FROM AUTHOR]

Introduction This paper describes a study designed to evaluate assessment in postgraduate dental education in England, identifying strengths and weaknesses and focusing specifically on its relevance, consistency and cost-effectiveness. Methods A four-phase qualitative method was used: a mapping of current career paths, assessment policy, and issues (phase 1); more detailed studies of the practice of assessment for a range of courses, and the systemic/management perspective of assessment (i.e. quality assurance) (phases 2 and 3), and analysis and reporting (phase 4). Data were analysed from documents, interviews, group consultations and observations. Results and discussion Five key issues may be distilled from the findings: (i) lack of formal assessment of general professional training; (ii) trainer variation in assessment; (iii) the extent to which assessments are appropriate indicators of later success; (iv) the relationship between assessment and patient care, and (v) data to assess the costs of assessment. Conclusion Current assessment procedures might be improved if consideration is given to: assessment which supports an integrated period of general professional training; training for trainers and inspection procedures to address variation; more authentic assessments, based directly on clinical work and grading cases and posts, and better data on allocation of resources, in particular clinicians’ time given to assessment. [ABSTRACT FROM AUTHOR]

Objectives In the present state of flux affecting UK medical undergraduate education, there is a pressing need for evaluative methods which will identify relevant outcomes both expected and unanticipated. The student perspective is now legitimately accepted to form part of any evaluative exercise but qualitative methods commonly used for this purpose are expensive in time and analytical skills. The nominal group technique (NGT) has been used for various purposes, including course evaluation, and appears well suited to this application. It combines qualitative and quantitative components in a structured interaction, which minimizes the influences of the researcher, and of group dynamics. The sequence and mechanics of the NGT process are described as applied to an end of first year evaluation in a novel undergraduate course. Doubts have been raised as to whether the results of NGT can be generalized to the larger group. In this paper, this problem is overcome by compiling a questionnaire based on the NGT items which was distributed throughout the class. Design Nominal group technique with questionnaire development. Setting The medical school at The University of Liverpool. Subjects Medical students. Results Previous claims made on behalf of the NGT, such as the focus on the student voice, the minimizing of leadership influence and the richness of the data, are upheld in this report. Broad agreement was found with the NGT items but two items (10%) did not display any consensus. Conclusions The questionnaire extension of the NGT provides back-up evidence of the reliability of the data derived from the technique and enables it to be applied to the larger groups typical of undergraduate medicine. [ABSTRACT FROM AUTHOR]

Replies to Barbara Miflin's comments on the authors' paper 'Building confidence for work as house officers: student expertise in the final year of a new problem-based curriculum.' Initiative at the Manchester Medical School, England; Points of agreement and disagreement regarding self-directed learning.

Comments on the paper 'Building confidence for work as house officers: student experience in the final year of a new problem-based curriculum.' by C.R. Whitehouse et al. Educational potential of initiative at Manchester Medical School, England; Limitations associated with the evaluation of educational intervention; Lack of clarity about the meaning of self-directed learning among teachers and students.