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Curricula often seem to be based on the views of their planners rather than empirical findings and theoretical models. Partly this is due to an incomplete understanding of the mechanisms that link curriculum and learning. This study looks at that relationship within undergraduate medical education, especially to allow an evaluation of problem-based learning and the Southampton programme, which represent current alternatives to the conventional curriculum. It does so by identifying and analysing the causes and effects of medical students' approaches to studying as indicators of their learning, and by accounting for them in educational and psychological terms. Using a mixed methodology involving interviews, a questionnaire and an inventory, three kinds of learning were identified: restricted, adequate and elaborated. Restricted learning reflects a chaotic cognitive structure leading to poor knowledge-retention and -retrieval. Adequate learning is 'deeper', with better retention though long-term retrieval remains poor. Elaborated learning is both deep and abroad, resulting in good retention and the cognitive interconnections doctors need for effective clinical thinking. The conventional medical curriculum and the early years in Southampton only seem able to generate restricted and adequate learning. However, problem-based learning can promote elaborated learning, as can a revision period at the end of Year Three in Southampton when students relate theoretical knowledge to their clinical experiences. Elaborated learning occurs under certain curricular conditions, namely when the learner first has a relevant 'assimilative context' followed by specific information and opportunities for what is called 'oscillation'. On these criteria, none of the three curricula are entirely satisfactory, though problem-based learning seems almost appropriate. A model is proposed, called 'contextual learning', for planning, evaluating and developing curricula in medical education and possibly elsewhere, though its implementation is by no means guaranteed.

This study proposes a new concept of curriculum. The need arises because current notions of ‘curriculum’, as it is used in formal education, distort the nature of practice and education. This is particularly evident in current approaches to education in practical settings, and gives rise to my research question: What is the curricular nature of practice? My answer involves a shift in thinking from seeing curriculum as ‘courses of study’ to ‘courses of action’. In this thesis I move the argument away from that of ‘curriculum for practice’ to ‘curriculum in practice’. In achieving this, my thinking has shifted from ‘curriculum in and as practice’ to ‘curriculum-in-practice’ and then to ‘curriculum-in-( )-practice’, where the hyphens unify notions of curriculum and practice as sides of the same coin, and the empty bracket is filled by the details of practical action and practical reasoning specific to a particular practice domain. The study is in two phases. In Phase 1 I searched social learning and curriculum theories for clues to a curricular understanding of practice. This failed to answer my research question. My way forward was by way of concrete everyday examples of practice and an ethnomethodological understanding of action. In doing this, my understanding of ‘curriculum’ changed from ‘learning planned and guided by some educational institution or programme’ to ‘learning in the here-and-now generated in and as the detail of the practical lived work of particular kinds of action.’ As a contribution to Curriculum Studies, my new concept locates the notion of ‘curriculum’ in practice (of any kind) rather than in schooling (of any form). It avoids adopting a ‘big curricular idea’, emphasises the improvised nature of practical action, focuses on ‘lived work’ rather than ‘lived experience’ and suggests different notions of accountability and rational action. The main implication of this study for curriculum design and development is the suggestion that it should take account of what I call ‘ambient practice’, i.e. the curriculum (the basis for learning) that is generated in any and every action. The main implications for research are to investigate educational experience as lived work, to recover the details of curriculum design and development as practical action, to show how, in particular practice domains, learning in the here-and-now provides the grounds for learning as preparation and to recover the details of ‘ambient practice’ as a basis for curriculum design and development

Judging the quality of reflective portfolios is assuming critical importance with their increasing use in accreditation and revalidation. The experience of this work has shown that despite explicit instructions to compilers, considerable investment in assessor training, and the negotiation, agreement and publication of overt criteria, individual assessments are consistent but show only fair inter-rater reliability and are untrustworthy in high stakes assessment. This study has also shown that reliability is not improved through the process of trying to 'shape' portfolios to introduce structural consistency, although it can be improved by using discussant pairs of assessors, with consequent issues of cost. While this method should be further researched as a means by which portfolios can be judged, consideration of the nature of professional practice and the processes that underpin judgements made by professionals moves the debate towards rejecting the traditional first hurdle of reliability before examining the validity of assessment tools. This thesis describes a methodology that begins the process by justifying the general direction such enquiries might be taking. Based on an exploration of the issues, it offers a model for a system for the assessment of professionals that is both theoretically supported and practically possible.