http://theses.ncl.ac.uk/jspui/handle/10443/221 2026-02-03T15:24:03Z 2026-02-03T15:24:03Z Zarezadeh, Yadolah http://theses.ncl.ac.uk/jspui/handle/10443/3605 2017-09-15T09:02:26Z 2009-01-01T00:00:00Z

Title: The teaching and learning reflective practice in medicine, nursing and physiotherapy: a grounded theory study Authors: Zarezadeh, Yadolah Abstract: The purpose of this study is to develop a comparative understanding of the teaching and learning of reflection in medical and healthcare education in two UK universities. Reflection is claimed to fill the gap between theory and practice (Schon, 1987), encourage a deeper level of learning (Entwistle, 1997), and promote lifelong learning (Moon, 1999). Using symbolic interactionism as an interpretivist theoretical perspective, this study adopted the grounded theory methodology. A hermeneutic approach informed both the theoretical perspective and the methodology of the study. The methods of data collection used in the study included semi-structured interviews (n=38), non-participant observation, students' reflective assignments, and students' reflective diaries. Data were analysed by theoretical coding to identify concepts and categories. A constant comparison method (Glaser, 2004) of data analysis enabled the generation of theory. This was supported by the understanding and insight gained through a movement between the parts and the whole of the data in a hermeneutic circle. This study revealed that teaching and learning reflection in different courses is based on the perceived image of the reflective practitioner and the personal and professional benefits of reflection. Different professions use reflection for different purposes. This is influenced by their socio-political stance, social position, and ambitions of the profession. These, in tum affect methods, strategies, and outcomes of reflection. This research contributes to a growing recognition of the sensitivity of assessing students' reflective works, supports the idea that it is problematic and suggests that there are ethical and delicate educational issues to be considered in terms of assessing students' reflective works. This thesis concludes with an acknowledgement of the complexity of teaching and learning reflection in medical and healthcare education. It calls for considering teaching and learning reflection as a "whole" when dealing with its different features (parts) in order to understand and work with the phenomenon. This study has some implications for lecturers, students, and educationalists. Description: PhD Thesis

2009-01-01T00:00:00Z Alghamdi, Awatif Mohammed S. http://theses.ncl.ac.uk/jspui/handle/10443/1774 2013-08-02T09:02:24Z 2012-01-01T00:00:00Z

Title: Challenges of continuing medical education in Saudi Arabia's hospitals Authors: Alghamdi, Awatif Mohammed S. Abstract: Background Health care professionals are responsible for maintaining their proficiency throughout their careers. Continuing medical education (CME) is an integral part of the medical profession that aims to enhance physicians’ knowledge and skills. Health care services in Saudi Arabia are expanding rapidly. However, the country is struggling to cope with a shortage of competent health professionals. CME in the Kingdom is facing some challenges that are preventing learning programmes from responding appropriately to professionals’ demands and needs, and to the complexity of health care. Research questions The research questions addressed in this thesis are: 1. What is the current status of continuing medical education in Saudi Arabian governmental hospitals? 2. What are the barriers preventing continuing medical education from implementing competitive learning programmes? 3. How might Saudi culture be influencing the health context and how does this impact upon the field of CME? Methodology This study adopted a mixed methods approach supplemented by ethnography. Two forms of individual, semi-structured interviews targeted two groups of respondents; the interviews were followed up by a questionnaire (sent by email) listing all the challenges to CME identified by the interviewees, and asking the participants to rank them in order of importance. In addition, observation was conducted throughout the fieldwork. Sampling Three public hospitals were selected from different geographical areas (N=3). Judgemental approach resulted in the selection of 33 medical education representatives from different medical and paramedical departments (N=33). Purposive sampling resulted in the selection of 11 medical librarians (N=11). Results The major CME challenges were identified and grouped into four themes: 1. Management, including the lack of knowledge on the part of decision makers about the importance of lifelong learning, and their influence over learning programmes. 2. Poor status of medical libraries, in terms of location, space and services provided. 3. Lack of transparency in the CME budget, which leads to a too close relationship between the pharmaceutical industry and physicians. 4. Diversity of staff, including their different training backgrounds, and their resistance to making changes in their performance after training. Discussion and conclusions The study found a strong correlation between health stakeholders’ lack of managerial skills and knowledge of the significance of CME and the learning programme limitations in Saudi Arabia; this factor also received the highest ranking by the participants in the study. 3 Hospital officials lack the necessary knowledge about the importance of CME, and lifelong learning has become complex. Their negative attitude towards learning has resulted in several challenges: some of these have been identified in this study, including a lack of support for the learning process in hospitals, an inability to motivate staff to continue developing their skills, and a lack of transparency when allocating budgets to learning elements, including CME and library services. This ambiguity has resulted in poor libraries and a heavy reliance on pharmaceutical industry sponsorship for CME events and medical professionals’ trips, which can affect the quality of the events and/or cause bias. The study has also clarified the issue of staff diversity. Although the majority of health care professionals are foreigners, the concern is that health care stakeholders are recruiting professionals from developing countries where the quality of health care and training might be low. Despite the varied training and educational backgrounds among the staff, no efforts have been made to design learning programmes that meet their actual and wide-ranging needs. Rather, current activities are based on desires and wishes of chiefs of medical departments. Description: Phd Thesis

2012-01-01T00:00:00Z Macmillan, Angus http://theses.ncl.ac.uk/jspui/handle/10443/649 2010-03-02T09:50:33Z 1984-01-01T00:00:00Z

Title: The effectiveness of behaviour modification procedures in the secondary schools with limited teacher training and consultation time Authors: Macmillan, Angus Abstract: The aim of the study was to examine the effectiveness of behaviour modification procedures in alleviating the problems of maladjusted children in the first year of six secondary schools. Teachers (N=39) acted as mediators of treatment procedures, with a psychologist acting as consultant. Interventions were conducted within the constraints of regular school settings, so teacher training and consultation time were limited. Outcomes for the behaviour modification approach (N-711) were compared with those for untreated maladjusted controls (N=92) and two comparison treatment conditions: parent counselling/teacher consultation (N=83) and group counselling (N=73). Treated children and controls were selected by a multiple criterion screen and were randomly allocated by class to the various conditions. Multiple measures of change were employed, including classroom observations, teacher ratings, sociometry, and measures of personality, attitudes, verbal and non-verbal ability and reading comprehension. Follow-up assessments were conducted at three points in time, the last being three years after the initial screening. Significant differences in favour of behaviour modification were recorded on all change measures, mostly in comparison with maladjusted controls and parent counselling/teacher consultation, and such differences were observed at each of the follow-up points. Group counselling showed a similar pattern of outcome to behaviour modification. In placing the present intervention in context, issues in the conceptualisation and assessment of maladjustment, and in the wider body of child therapy research are considered. The theoretical underpinnings of the behavioural approach are examined, and the relevant research literature in educational settings is reviewed. In discussion of the outcomes of the study, consideration is given to the complexity of the social and organisational context of such an intervention and to criticisms of the behavioural approach. On the basis of these considerations, recommendations for future interventions are offered. Description: PhD Thesis

1984-01-01T00:00:00Z Robson, Stephen Courtenay http://theses.ncl.ac.uk/jspui/handle/10443/459 2009-11-25T13:28:50Z 1992-01-01T00:00:00Z

Title: Haemodynamic changes during human pregnancy Authors: Robson, Stephen Courtenay Abstract: The aim of this work was to investigate the physiological adaptations that occur in the maternal cardiovascular system during singleton and twin pregnancy. The cardiovascular system has been shown to undergo major adaptations during human pregnancy. Most investigators agreed that cardiac output increased during pregnancy however there was no unanimity regarding the extent and timing of this increase nor about the physiological mechanisms underlying it. Even less was known about the haemodynamic readjustments following delivery and about the alterations in multiple pregnancy. Further study has been limited by the lack of an accurate noninvasive technique which is applicable and reproducible during pregnancy. Cross-sectional echocardiography combined with Doppler ultrasound measurement of blood velocity provides a noninvasive method for measuring cardiac output at a number of locations within the heart and great vessels. Preliminary investigations revealed that cardiac outputs determined by this method correlated closely with those measured by the direct Fick technique in non-pregnant subjects. In addition the method was highly reproducible in both pregnant and nonpregnant subjects. M-mode echocardiography allows accurate and noninvasive measurements of cardiac chamber size and ventricular function. These measurements were also found to be highly reproducible in pregnant and non-pregnant subjects. Using these techniques the aims of this thesis were to investigate the extent, timing and mechanisms of the changes in cardiac output during singleton and twin pregnancy. Echocardiographic investigations were performed prior to and during singleton pregnancy, during the first 6 months after singleton pregnancy, and during and 6 months after twin pregnancy. All subjects were studied in the left semi-lateral position. The results suggested that; (1) During singleton pregnancy cardiac output was increased early in the first trimester and continued to rise until 24 weeks gestation when values were 43-49% above pre-pregnant control values. Thereafter there was no further change. Heart rate and left ventricular function increased during the first trimester. Left atrial and left ventricular end-diastolic dimensions increased during the second trimester suggesting an increase in venous return. Cardiac valve cross-sectional areas and left ventricular wall thickness also increased during pregnancy. After delivery cardiac output had fallen to non-pregnant values by 2 weeks. This was associated with reductions in left ventricular performance and left atrial and left ventricular end-diastolic dimensions. The decrease in valve cross-sectional areas and left ventricular wall thickness was not evident until later in the puerperium. (2) During twin pregnancy cardiac output was increased by 20 weeks gestation and thereafter showed no further change. Maximum cardiac output was 59-62% above postnatal control values. This increase was greater than that recorded during singleton pregnancy due to a relatively greater increase in heart rate. Twin pregnancy was also associated with a greater increase in left atrial dimension. The results of these studies shed light on some of the the unanswered questions in the field of maternal haemodynamics. The noninvasive Doppler techniques used allowed accurate and reproducible measurements of cardiac output in pregnant subjects. This work has important implications for the future investigation of cardiac and hypertensive disorders during pregnancy. Description: MD Thesis

1992-01-01T00:00:00Z