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It is widely accepted that management concepts such as strategic management, human resource management and management development have a well-defined body of knowledge designed to inform management praxis, however the notion of efficiency has no such body of knowledge to support its application within management praxis. This book proposes the replacement of the generalised term efficiency with the more comprehensive notion of performance efficiency to provide a reliable basis on which to evaluate management behaviour. Given the scope of the investigation, the outcome is not designed to prove the success or failure of the inherent nature of efficiency, but rather to establish a new starting point for yet wider empirical research. At a macro-level, it advances the proposition that the notion of efficiency has become an ideological statement of support for any management intention rather than a practical means to inform or evaluate a range of management actions. © 2009 Guy Callender. All rights reserved.

Background/Objective: As financial arrangements for vocational training (VT) in general practice/family medicine seemed to differ among European countries, the VT committee of EURACT compiled an overview to permit comparison. Methods: A questionnaire with open and closed questions wase-mailed in March 2006 to representatives of the 34 different countries on the EURACT Council. Results: Thirty completed questionnaires were returned (88% response rate). The salary of the GP trainee during clinical training in GP/FM is paid by the state on its own or with others in 19 countries (63%), and is the same during community and hospital rotations in 22 countries (73%). The GP trainer gets extra payment for supervision and teaching in only 14 countries (47%). Structured VT programmes are fully or partly financed by the state in 17 countries (57%), with trainees being paid for working hours spent in seminars/coursework in 19 countries (63%). Funding was cited as the commonest challenge and strength regarding VT programmes (cited 20 and 11 times, respectively). Conclusion: Recommendations made regarding the provision of vocational training across Europe include a structured curriculum supported by adequate funding, the professional recognition of GP trainers, which includes a fair and appropriate salary, and equity of salary for GP trainees.

Background: Portfolios, often described as collections of evidence, are discussed as a means of teaching or assessing the Accreditation Council for Graduate Medical Education competencies. Yet, it is unclear how many residency programs utilize portfolios. The purpose of this article is to (a) review the literature on portfolio use in graduate medical education; (b) examine efficacy of portfolio use, based upon studies in the field; and (c) offer a discussion of considerations for implementing portfolios. Summary: Two searches of PubMed, OVID, JSTOR, SCOPUS, and FirstSearch Wilson Select were conducted between October 2006 and April 2007 to identify studies and articles related to portfolio usage. Thirty-nine articles met criteria and were reviewed. Conclusions: There is wide variation in how portfolios are utilized within U.S. residency programs. The challenge for graduate medical education is to create consensus on the definition and purpose of portfolios, such that best practices in portfolio implementation and assessment can be achieved. Copyright © 2008, Taylor & Francis Group, LLC.

All thought and talk about learning involves the use of metaphors. Whilst metaphors aid our understanding of things by suggesting novel insights, they can also mislead if too much is read into the supposed likenesses. Acquisition and transfer are easily the most popular metaphors used to understand learning. This article argues that these metaphors commonly mislead when we take them to mean that learning is located inside of learners, and, hence, that the individual is the appropriate unit for understanding learning. This article discusses the strengths and limitations of the alternative metaphors invoked in some more recent theories of learning, metaphors including participation, construction/re-construction, and becoming. A consideration of these alternative metaphors reveals the multi-facetted nature of learning. It also highlights important kinds of learning, by groups, teams or communities, learning that are not plausibly located inside of individuals. Any rich account of professional practice needs to encompass the roles of both individual and group learning.

[No abstract available]

PURPOSE OF REVIEW: The present review focuses on the education needs and related pedagogical aspects of education in forensic psychiatry. RECENT FINDINGS: Physicians specializing in other fields generally deal with concepts that are thoroughly addressed in forensic psychiatry, such as the ability of patients to consent to treatment, confidentiality, victimization, and risk factors for auto and hetero-lesive behaviour. Present practices like the advance of e-health and patients? rights call for ethical and responsible attitudes. There are a variety of programs providing specific training for psychiatrists willing to work in the forensic area and renewed pedagogical trends are gradually being incorporated. Many articles point out the need to enforce the teaching of expert communication abilities while others warn of the poor economic incentive of forensic psychiatry as a career. SUMMARY: Forensic psychiatry teaching is undergoing a period of significant evolution and expansion. New didactic trends, specific pedagogical research and an increase in training needs in other fields of medicine are promising. It is important to ensure that the formal training provided in every country is comparable and that those who teach and learn this complex field are acknowledged. © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Background. The quality of child care is of social and economic significance worldwide. The beliefs that child care workers hold about knowing and knowledge (epistemological beliefs) influence the quality of their professional work. However, attention to epistemological beliefs is rarely a focus in vocational education programmes. Aim. The aim of this study was to investigate the nature of child care students' epistemological beliefs. Sample(s). All first- and second-year students completing a Diploma of Children's Services at three separate training institutes in a large metropolitan area in Australia were invited to participate in the study. There were 46 first- and 31 second-year students (77 in total, 71 females). Method. This study used semi-structured interviews based on a child care scenario to enable students to articulate their epistemological beliefs. A descriptive-interpretative approach in which interviews were analysed for patterns of meaning was used in the content analysis. The categories, based on the work of Kuhn and Weinstock (2002), included objectivism, subjectivism, and evaluativism. While this proved to be a useful framework, the authors remained open to new categories emerging. This constituted the interpretive component of the analysis. Therefore, the data were analysed using both data-driven and theory-led approaches to analysis, which still made it possible to take account of many viewpoints before arriving at the categories of beliefs. The categories were audited by a second researcher to establish trustworthiness and credibility. Results. The findings of this study revealed a range of epistemological beliefs; however, a new way of thinking about evaluativistic beliefs called 'basic evaluativism' emerged. This view of knowledge relates to the construction of evidence-based practice rather than knowledge as is typically the case in evaluativistic beliefs. Conclusions. Implications for the need to address epistemological beliefs in vocational education programmes for child care workers are discussed. © 2008 The British Psychological Society.

Background: Several investigations suggest inadequate emphasis of basic clinical procedures during internship training. Many trainees had reported lack of competence, while some expressed confidence to manage conditions although not sufficiently experienced. Aims: This study aimed at ascertaining the perceptions of new medical graduates regarding the performance of core clinical skills during training and confidence of performing them later. It also aimed at determining any gender variability in the confidence in performing selected clinical skills in Obstetrics & Gynaecology. Methods: Interns trained during 2005/06 responded anonymously to a questionnaire that listed 48 core clinical skills. The 124 subjects eligible for the study comprised graduates from Kuwait (64), other Gulf Cooperation Council countries (29), Ireland (27) and Egypt. They indicated whether they felt confident to perform the skills in future, and the number of times they had performed them during training. We received 91 completed questionnaires. Results: The majority felt confident in performing routine skills (basic ECG and X-ray interpretations, insertion of intravenous line, inserting urethral catheter and nasogastric feeding). Approximately two thirds had performed generic skills related to emergency resuscitation, with a half of them confident in performing them in the future. A third felt confident in performing artificial ventilation and endotracheal intubation. The confidence to perform common skills in Obstetrics & Gynaecology varied, with no significant gender variation. Approximately a fifth was confident in performing lumbar puncture, needle aspiration of joints, insertion of thoracic drainage, insertion of central venous catheter, venous cut-down and indirect laryngoscopy. A small proportion reported confidence in performing different clinical procedures although they had not undertaken them during training. Conclusions: Substantial proportions of trainees lacked confidence in performing emergency resuscitative measures and some routine clinical skills. Training needs to be closely monitored and interns who are not competent identified early for taking remedial measures.

OBJECTIVE: To investigate the reasons for family medicine graduates' career choices. DESIGN: Qualitative study using focus groups and one-on-one interviews. SETTING: University of Calgary in Alberta. PARTICIPANTS: Seventeen male and female second-year family medicine residents, representing a range of ages and areas of origin, enrolled in the 2004 urban and rural south streams of the family medicine residency program at the University of Calgary. METHOD: During the final month of training, 2 focus groups were conducted to determine graduating students' career choices and the reasons for them. After focus-group data were analyzed, a questionnaire was constructed and subsequently administered to participants during face-to-face or telephone interviews. MAIN FINDINGS: Most residents initially planned to do urban locums in order to gain experience. In the long term, they planned to open practices in urban areas for lifestyle and family reasons. Many residents from the rural stream had no long-term plans to establish rural practices. Most residents said they felt prepared for practice, but many indicated that an optional third year of paid training, with an emphasis on emergency medicine, obstetrics, and pediatrics, would be desirable. Reasons cited for not practising in rural areas were related to workload, lifestyle issues, family obligations, and perceived lack of medical support in the community. Only 4 female graduates and 1 male graduate intended to practise obstetrics. The main reason residents gave for this was inadequate training in obstetrics during residency. Finances were cited as a secondary reason for many choices, and might in fact be more important than at first apparent. CONCLUSION: Despite its intention to recruit family medicine graduates to rural areas and to obstetrics, the University of Calgary residency training program was not successful in recruiting physicians to these areas. The program likely needs to re-examine the effectiveness of current approaches. If other programs are having similar difficulties recruiting graduates to obstetrics and rural practice, perhaps changes in policies should be considered.

The goal of all dental schools is to develop competent, knowledgeable dentists who have excellent communication skills and a sense of social responsibility. This paper describes the theoretical reasoning behind the design of an innovative dental curriculum constructed from first principles in the UK. The recognised theories of psychologists, educationalists and sociologists of the twentieth century have informed our educational decisions. In practice, this translates to a blended learning environment with problem-based learning (PBL) case scenarios at its heart. The learning of clinical and communication skills, which begins in year 1, week 1, is absolutely integral to the case scenarios, as are ethics and professionalism. PBL is supported by a comprehensive e-learning platform, plenary lectures, workshops, clinical and life science teaching delivered by core academic staff and guest speakers who are the experts in our 'community of practice' in which the students are the novices. We believe that the whole is best described as 'enquiry-based learning'. © 2008 Macmillan Publishers Limited. All rights reserved.