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Context: Graduate medical education is currently facing major educational reforms. There is a lack of empirical evidence in the literature about the learning processes of residents in the clinical workplace. This qualitative study uses a 'grounded theory' approach to continue the development of a theoretical framework of learning in the clinical workplace by adding the perspective of attending doctors. Methods: A total of 21 Dutch attending doctors involved in the training of residents in obstetrics and gynaecology participated in 1 of 3 focus group sessions. They discussed their perceptions of how residents learn and what factors influence residents' learning. A grounded theory approach was used to analyse the transcribed discussions. Results: Three related themes emerged. The first concerned the central role of participation in work-related activities: according to attending doctors, residents learn by tackling the everyday challenges of clinical work. The second involved the ways in which attending doctors influence what residents learn from work-related activities. The final theme focused on attending doctors' views of the essential characteristics of residents and their development during residency. Conclusions: Attending doctors' perspectives complement current insights derived from similar research among residents and from related literature. As part of an ongoing effort to further develop understanding of how residents learn, this study adds several ways in which attending doctors strive to combine guidance in both patient care and resident training. Furthermore, attending doctors' perspectives draw attention to other aspects of learning in the clinical workplace, such as the role of confidence and the balance between supervision and independence. © 2007 Blackwell Publishing Ltd.

This article aims to clarify some of our pre-conceived assumptions when we address issues of learning in practice. It argues that we need to develop an understanding of practice based on its own premises. For this purpose the German philosopher Martin Heidegger's (1889-1976) understanding of practice and learning is introduced. Heidegger emphasises the use of equipment as crucial for a practical understanding. This perspective is contrasted with an intellectualistic approach to learning in practice exemplified by the work of Donald Schön. Heidegger and Schön's perspectives on learning in practice are evaluated and discussed throughout the article. Examples from studies of apprenticeship are used to illustrate Heidegger's comprehension of learning in practice. Especially learning through the use of tools and equipment, learning in context, learning as a consequence of making mistakes and learning as a matter of developing a sense of familiarity are types of learning emphasised in this article.

Introduction: The purpose of this study was to assess the agreement of Emergency Department (ED) attendings, ED residents, and neurology residents compared with stroke neurologists in the assessment of intravenous rt-PA eligibility. Methods: A convenience sample of patients presenting with possible stroke symptoms to the University of Michigan Hospital ED from June 2003 to July 2004 was identified. A physician from each of four groups: ED attending, ED resident, neurology resident, and stroke neurology attending independently evaluated each patient for eligibility for intravenous (IV) rt-PA. Accuracy, sensitivity, and positive predictive value (PPV) with 95% confidence intervals (CI) were calculated by physician type, compared with the stroke neurologist, for eligibility for IV rt-PA. Results: Exactly 36 (49%) out of the 73 evaluated patients were diagnosed with acute ischemic stroke and 11 were deemed eligible for treatment with IV tPA by the stroke neurologist. Agreement with the stroke neurologist for rt-PA eligibility was 93% [95% CI: 84%, 98%] (sensitivity = 82% [48%, 98%], PPV = 82% [48%, 99%]) for the ED attendings, 79% [65%, 90%] (sensitivity = 75% [35%, 97%], PPV = 43% [18% 71%]) for the ED residents, and 84% [73%, 92%] (sensitivity = 100% [74%, 100%], PPV = 52% [31%, 73%]) for the neurology residents. There were two false positive cases identified by ED attendings, eight, by ED residents, and 11 by neurology residents. Conclusions: This study suggests that the agreement between ED attendings and stroke neurologists for determination of rt-PA eligibility is good. There is room for improvement, however, in the determination of acute stroke therapy eligibility in the ED setting especially among trainees. © Humana Press Inc. 2007.

The TLRP project reported on in this article attempts to understand how the Learning and Skills sector functions. It traces how education and training policy percolates down through many levels in the English system and how these levels interact, or fail to interact. The authors first focus upon how policy impacts upon the interests of three groups of learners: unemployed people in adult and community learning centres, adult employees in work-based learning and younger learners on Level 1 and Level 2 courses in further education. They focus next upon how professionals in these three settings struggle to cope with two sets of pressures upon them: those exerted by government and a broader set of professional, institutional and local factors. They describe in particular how managers and tutors mediate national policy and translate it (and sometimes mistranslate it) into local plans and practices. Finally, the authors criticise the new government model of public service reform for failing to harness the knowledge, good will and energy of staff working in the sector, and for ignoring what constitutes the main finding of the research: the central importance of the relationship between tutor and students.

This article addresses the challenges that Garnett suggests face higher education through the lens of Bourdieu. In taking up the challenge set by Garnett for higher education in the knowledge economy and responding to its powerful and primary artefact - intellectual capital - the article reviews and uses the analytical tool of Bourdieu's practice in the context of work-based learning in higher education. The article suggests that the rivalry between the fields of higher education and employment weakens both in their attempt to appropriate values in a social field where intellectual capital is the main form of exchangeable capital. [U]niversity professors are situated rather on the side of the subordinate pole of the field of power and are clearly opposed in this respect to the managers of industry and business. (Bourdieu, 1988, p. 36).

The pre-eminence of knowledge and skills as the sources of wealth creation and economic growth is one of the major issues in business at the beginning of the twenty-first century. As a result, Human Resource Development has been propelled into a central role in management thinking. However, this has not always been reflected in practice since many of the methodologies for monitoring and assessment continue to reflect the previous importance of fixed capital, the industrial society and the quantity of labour employed. The police service like other public services has had to ensure that its staff is skilled to undertake an ever more complex role within society. This has traditionally been delivered through typical organisational training processes. The value of learning as opposed to training is rarely proposed. The 'soft' benefits of education, elements like critical thinking and emotional intelligence as well as learning, are rarely given sufficient emphasis. However, increasingly organisations are realizing the benefits of creating an open environment that allows informal learning to flourish. This article will explore the concepts of traditional training within policing before reviewing as a case study the introduction of a work-based and experiential learning paradigm within police development.

Needlestick/sharp injuries (NSIs/SIs) are a serious threat to medical/nursing students in hospital internships. Education for preventing NSIs/SIs is important for healthcare workers but is rarely conducted and evaluated among vocational school nursing students. We conducted an educational intervention for such students after their internship rotations before graduation. This program consisted of a lecture to the students after the internship training and a self-study brochure for them to study before their graduation. This study used the pre-test questionnaires completed by all students and the post-test questionnaires completed by 107 graduates after work experience as licensed nurses to assess the effectiveness of the intervention. After educational intervention, the incidence of NSIs/SIs decreased significantly from 50.5% pre-test to 25.2% post-test, and the report rate increased from 37.0% to 55.6%, respectively. In conclusion, this intervention significantly reduced the incidence of NSIs/SIs and increased the report rate of such events.

Objectives To ascertain the requirements in restorative dentistry that undergraduate dental students have to fulfil in order to sit the finals examinations in dental schools in the UK and Ireland and to compare those requirements with the competencies stipulated by the GDC in The first five years.Methods Fifteen anonymised questionnaires, of open and closed question design, were sent by post to academics in the university departments of restorative dentistry in each of the undergraduate dental schools in the UK and Ireland. The first section concerned numerical information regarding total numbers of procedures that were required to be completed in undergraduate restorative dentistry. The second section was designed to ascertain information as to how decisions are made with respect to an undergraduate's readiness to sit the finals examination in restorative dentistry (such as continual assessment and/or competency assessments).Results A total of 15 replies were received for analysis, a 100% response rate. Several institutions emphasised that they do not have 'requirements', but provide guidelines as to what should be achieved. Six institutions did not have set numerical requirements for direct placement restorations or bridges. The number of direct placement restorations required at the other nine institutions ranged from 50 to 160. Five institutions did not have numerical requirements for dentures; four institutions did not set numerical targets for crowns, veneers, inlays/onlays or endodontics. In institutions where numerical requirements were not used, forms of competency assessments were completed. The requirements across all institutions for periodontology, integrated treatment planning and completed cases were ill-defined.Conclusions This study shows that there is a wide disparity amongst institutions in the UK and Ireland with regards to finals requirements in restorative dentistry. Ideally, such requirements should be similar between institutions and should be closely mapped to the GDC's required learning outcomes (The first five years) for the UK institutions. © 2007 Nature Publishing Group.

As assessment methods are changing, the way to determine their quality needs to be changed accordingly. This article argues for the use Competence Assessment Programs (CAPs), combinations of traditional tests and new assessment methods which involve both formative and summative assessments. To assist schools in evaluating their CAPs, a self-evaluation procedure was developed, based on 12 quality criteria for CAPs developed in earlier studies. A self-evaluation was chosen as it is increasingly used as an alternative to external evaluation. The CAP self-evaluation is carried out by a group of functionaries from the same school and comprises individual self-evaluations and a group interview. The CAP is rated on the 12 quality criteria and a piece of evidence is asked for to support these ratings. In this study, three functionaries from eight schools (N = 24) evaluated their CAP using the self-evaluation procedure. Results show that the group interview was very important as different perspectives on the CAP are assembled here into an overall picture of the CAP's quality. Schools seem to use mainly personal experiences to support their ratings and need to be supported in the process of carrying out a self-evaluation. © 2006 Elsevier Ltd. All rights reserved.

Culture impedes educational transactions between developed countries, and is often an area of tension when developing countries try to borrow models, or have models imposed upon them. This article uses the German Dual System as a case for examining issues surrounding the adaptation of borrowed models. Since attempts at borrowing models can fail for cultural as well as non-cultural reasons, a contention here is that culture needs to be unpacked and laid bare, to avoid it becoming the too easy answer for failure. Borrowed models have a greater chance of taking hold, if the conditions that forged them are understood, and if conditions of the receiving country are likewise internalized. Limits imposed by culture have to be recognized. Four approaches to cultural borrowing that conceivably can reduce the tensions are proposed namely, partial borrowing, pilot borrowing, customization and conceptual borrowing.