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Changing patient demographics raise important challenges for healthcare providers around the world. Medical generalists can help to bridge gaps in existing healthcare provision. Various approaches to medical generalism can be identified, for example, hospitalists in the US and the restructuring of care away from medical disciplines in the Netherlands, which have different implications for training and service provision. Drawing on international debates around the definition and role of generalism, this article explores one manifestation of generalism in the UK to understand how abstract ideas work in practice and some of the benefits and challenges. Broad-based training is a two-year postgraduate training programme for doctors recently piloted in England. The programme provided 6-month placements in four specialties (general practice, core medicine, psychiatry and paediatrics) and aimed to develop broad-based practitioners adept at managing complex and specialty integration. Our longitudinal, mixed methods evaluation of the programme demonstrates that although trainees value becoming more holistic in their medical practice, they also raise concerns about being perceived differently by co-workers, and report feeling isolated. Using identity theory to explore the interplay between generalism and existing boundaries of professionalism in healthcare provision, we argue that professional identity, based on disciplinary structure and maintained by boundary work, troubles identity formation for generalist trainees who transcend normative disciplinary boundaries. We conclude that it is important to address these challenges if generalism in secondary care settings is to realise its potential contribution to meeting increasing health service demands.

Objective Changing patient demographics make it ever more challenging to maintain the quality and safety of care. One approach to addressing this is the development of training for generalist doctors who can take a more holistic approach to care. The purpose of the work we report here is to consider whether a broad-based training programme prepares doctors for a changing health service.\ud \ud Setting and participants We adopted a longitudinal, mixed-methods approach, collecting questionnaire data from trainees on the broad-based training (BBT) programme in England (baseline n=62) and comparator trainees in the same regions (baseline n=90). We held 15 focus groups with BBT trainees and one-to-one telephone interviews with trainees post-BBT (n=21) and their Educational Supervisors (n=9).\ud \ud Results From questionnaire data, compared with comparator groups, BBT trainees were significantly more confident that their training would result in: wider perspectives, understanding specialty complementarity, ability to apply learning across specialties, manage complex patients and provide patient-focused care. Data from interviews and focus groups provided evidence of positive consequences for patient care from BBT trainees’ ability to apply knowledge from other specialties. Specifically, insights from BBT enabled trainees to tailor referrals and consider patients’ psychological as well as physical needs, thus adopting a more holistic approach to care. Unintended consequences were revealed in focus groups where BBT trainees expressed feelings of isolation. However, when we explored this sentiment on questionnaire surveys, we found that at least as many in the comparator groups sometimes felt isolated.\ud \ud Conclusions Practitioners with an understanding of care across specialty boundaries can enhance patient care and reduce risks from poor inter-specialty communication. Internationally, there is growing recognition of the place of generalism in medical practice and the need to take a more person-centred approach. Broad-based approaches to training support the development of generalist doctors, which is well-suited to a changing health service.

The introduction of new online technologies in Higher Education brings many challenges for staff, not only in learning new functionality, but in deciding how to use tools in pedagogically effective ways. This JOUR study describes an initiative at the Open University (UK), which set out to provide professional development in the use of an online synchronous tool. It focuses on the teaching potential in a number of different disciplines. The account describes the development of this resource, together with the perspectives of those engaged in producing it. We have illustrated a systematic approach to activity design inspired by threshold concepts and troublesome knowledge. We found that the demonstrators appreciated both the approach and the peer support available. The approach helped with identification of appropriate areas for intervention as well as in the design of activities and authentic use of tools. We suggest that the protocol adopted here is of great relevance to those adopting a blended approach, when deciding what tutor-student interventions should take place, and when. Practitioner Notes What is already known about this topic A wide range of factors influence the way a discipline is taught., Professional development needs to integrate these factors if it is to be relevant., Teachers need to understand why they should use online tools before they are likely to adopt them., Theories of threshold concepts and troublesome knowledge can help to identify significant or difficult areas of curriculum. This can be helpful in deciding when to intervene and facilitate learning., What this paper adds It highlights the teaching potential of an online synchronous tool using example activities within various disciplines., It illustrates a systematic approach to identifying areas of student need, before planning appropriate times in the course for facilitation using online activities., It highlights the potential for a community approach to online activity development and for sharing activities amongst tutors., Implications for practice and/or policy In blended learning strategies staff need to shift their thinking from presenting content in a lecture to putting content online and devoting their time to facilitation., This paper provides a systematic approach to deciding at what stages staff may need to facilitate understanding of significant concepts or skills in the course. It also helps in identifying the aims of any learning activities., Online activities for synchronous tools are time consuming to develop and benefit from collaborative effort in the development and sharing of resources. [ABSTRACT FROM AUTHOR]

There has been much discussion in this journal of the development of the scholarship of teaching and learning. Indeed the effective enhancement of teaching and learning is more likely to take place when generic lessons are contextualized within the language of the discipline, and adapted to the needs of the students. We describe here a study of the teaching practice of distance tutors on a History course, who were given the opportunity for extended reflection on the demands of the course, and to consider their aims and share their strategies, stimulated by ideas from threshold concepts and troublesome knowledge. In line with common practice in a distance environment, the reflection process took place in a workshop followed by participation in an online group, hosted on a wiki. We illustrate the significant or difficult areas of the course that staff reported, and describe their intentions and some of the strategies that they used for helping students with these critical areas. We propose a new approach to professional development which begins with reflection on the demands of the course itself and its students before considering appropriate facilitation strategies to meet those specific demands.

Academic staff who work away from the university campus have few informal opportunities to keep in touch with their peers, and the provision of appropriate professional development for them can be problematic. At the Open University in Scotland an online forum provides a platform for the development of an informal community of distance tutors. It encourages exchange and reflection on the subject of using online media to support students, and has been running continuously for over three years. This paper presents the findings from research undertaken to establish who uses the forum, how and for what purposes, and draws out issues relevant to others supporting and developing staff at a distance.

In the United Kingdom the medical teacher role is being formalized. One result is that Masters level programmes in medical education are proliferating; however little or no attempt has been made to capture any differences in quality offered by them. A small scale project (Allery et al. 2006) set out to rectify this omission.Drawing on data from that study, this paper considers the variation in standards across programmes. Specifically research methods training provided in MMEd courses and levels of support for researchers is investigated.A secondary analysis of the data generated by the evaluative study and gathered via review of programme web sites, semi structured interviews with MSc course directors and case studies in two sites, identified from purposive sampling.Variations in both taught and research elements were identified. The quality of the research experience was compromised for some students many of whom were poorly prepared to undertake educational research and the question of standards raised in respect of those institutions where the examination process lacked real academic rigour.The variance in research methods training and support raises a number of issues in relation to quality standards. The medical education community needs to engage in open and critical dialogue around the whole constellation of paradigms, methods and activities that pertain in educational research. Unless or until we address these deeper concerns, research into medical education will suffer through a lack of design flair, implementation and rigour.

Endoscopy is an important diagnostic and therapeutic procedure that demands high levels of cognitive and technical skill to perform effectively. Surprisingly little is known about how endoscopy is best taught and training is often inadequate. The aims of this study were to explore the learning experiences of endoscopy trainees to improve our understanding of current training. Following the use of an initial focus group to generate appropriate themes semi-structured interviews were performed on 10 trainees to assess their learning experiences. Many different components of the learning experience were identified; one-to-one supervised performance forms the basis for teaching but is often sub-optimal; endoscopy learners experience anxiety and find re-adopting the role of novice difficult; motivation, clear explanation and feedback are crucial to learning; breaking down endoscopy training into segments is seen as valuable and as learners progress a gradual withdrawal of supervision is appreciated. Several of the issues contributing to a positive learning experience relate closely to published evidence and theory relating to skills teaching from other fields. A model identifying the key elements of endoscopy learning is proposed. Further work to apply and test the findings from this study should lead to improved endoscopy training.

The provision of a professional development programme for distance tutors can be problematic because of the need for flexibility to cater for a variety of working practices, or to overcome the hurdles imposed by geographical remoteness. At the UK Open University, online networks are widely in use for teaching and learning, and we are actively exploring their potential for professional development. This paper describes the Supporting Open Learners in A Changing Environment project, which has piloted a reflective approach to professional development using a log to structure reflection, which is then shared with others in a computer conference. Our evaluation of tutors’ perspectives of the project indicated that all participants found the experience stimulating and helpful for identifying and sharing issues of student support, although some found the process unexpectedly time consuming. We believe there is considerable potential for such an approach to networked reflection among distance tutors, provided the...

We know assessment plays a major formative role in driving student learning appropriately, but what implications does this have for online courses? Is it more important than in a face to face context, or less so? Should we reconceptualize the ways in which we assess students, or are existing methods, tried and tested in conventional teaching and learning situations, appropriate? This paper discusses the practical implications of implementing these online pedagogies and illustrates the powerful formative effects, both intended and unintentional, of assessment on student learning and behaviour. It draws on examples from recent research on two e‐learning courses at UK Open University.

The availability of electronic media challenges our approaches to student learning support in a variety of ways. In spite of much work into online course design and delivery, we have tended to neglect the contribution of other modes and media used in learner support, and there has been a critical lack of overt integration of online use with other good learning support systems. In the SOLACE project, we have been exploring current practices for learner support and the degree to which tutor interventions and interactions with their students map to their use of communication media. The main focus for this study is ‘traditional distance’ tutors at the Open University, and contrasts are drawn with three courses taught within a ‘traditional campus’ setting at the University of Glasgow. Preliminary findings from the first phase of this project reflect present practice in learner support for a range of courses, and describe factors influencing the use of media in a blended solution to learner support.

Networked environments offer new scope for presenting activity based courses, in which activities and reflection form the central backbone of course pedagogy. Such courses promise an enriching approach to study, but there are also challenges for the design of assessment. This paper describes a qualitative study of student and tutor perspectives on the assessment of an innovative undergraduate course at the UK Open University which has employed an activity-based approach. It discusses the relationship between assessment, student participation, and the development of skills, and then outlines the priorities for the design of assessment for such courses.

For a variety of reasons, closed book examinations are still part of life for many higher education courses, yet opinion is divided as to their appropriateness and effectiveness in supporting student learning. This article describes two UK Open University courses, one of which uses a closed book examination and the other a project as an end-of-course assessment. It discusses staff and student perspectives on both types of assessment, and argues that both synopsis and motivation are greatly valued by students, particularly in the early undergraduate years, and so this should receive consideration when designing any end-of-course assessment.

Electronic information resources are increasingly in use for courses at all levels of Higher Education. They may be employed as reference material when researching particular topics for assignments, as part of a conventionally structured course, or alternatively their use may be a central part of resource based course philosophy. Whilst the use of these resources may offer many advantages in terms of developing more independent learners, there are also information handling skills which students must acquire. This paper discusses the relevance of these skills and the factors influencing their acquisition for students on two networked resource based courses at the UK Open University.

A novel tissue imaging system has been developed utilising a cooled scientific grade charge coupled device (CCD) to detect the low energy X-ray emissions and β particle emissions from a variety of isotopes commonly used in tissue autoradiography. Results are presented which illustrate the systems potential for faster and more accurate imaging of tissue samples than is conventionally achieved using film emulsion autoradiography. With position resolution approaching 20 μm and intrinsic sensitivity approaching 100%, the CCD system also surpasses the performance of current digital autoradiography technology. Because of the frame-by-frame composite way in which images are constructed, the system displays excellent linearity over a large dynamic range. Operation of the CCD in the inverted mode at temperatures up to 35°C has been investigated, with promising results.

(2012). Identify learning outcomes for learning agreements. Education for Primary Care: Vol. 23, No. 2, pp. 128-130.

Distance learning is seen as the obvious answer for remote learners, and the use of online media is expected to overcome any access difficulties imposed by geographical distance. However, this belief may be obscuring our understanding of the role that location and individual circumstances have in shaping student experience. This paper explores the variation in experiences of remote rural students who study with the Open University (UK). The researchers found that perceptions of remoteness depended on geography, but were also relative to individual circumstances. With respect to students’ sense of connection with university staff and peers, most mentioned their contact with their personal tutor. Networks with peers were less common, a matter of concern if peer networks are integral to fostering improved retention and progression. In this particular context, distance education may be playing an important and distinctive role for remote students by providing opportunities for connections with like-minded people.

Project 2000 has changed the role of nurse teachers. Thus evaluation of Project 2000 should incorporate a theoretical framework that not only evaluates the individual school/college of nursing curriculum but also enhances the teachers professional development. This paper suggests that teacher professional development would be enhanced by teacher self-evaluation (action research). A collaborative approach between teachers and an evaluation co-ordinator would ensure that the quality of the curriculum is maintained (MacDonald 1991). It is argued that the implementation of monitored innovation would fulfil the criteria for the developing school/college of nursing put forward by Holly et al (1989).

The standardized mortality ratios (SMRs) for various cancers were calculated for allcities, large burghs, small burghs, and landward areas of Scotland for the period 1969–73. SMRs for respiratory cancer were also calculated for 1959–63. The communities with statistically significantly high or low SMRs were ascertained. The geographical positions of communities with significantly high SMRs for respiratory cancer were illustrated on a map. Continuous identification of small as well as large communities with abnormally high SMRs is shown to be essential in the monitoring of public health.

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