Background:
We analysed the learning and professional development narratives of Hospital
Methods:
discussed in the context of Consultant Trainers' personal biographies, organisational culture and
medical education practices. We conducted life story interviews with 20 Hospital Consultants in
six NHS Trusts in Wales in 2005.Qualitative study. Learning and continuing professional development (CPD), were
Results:
have changed the nature of medical education. Loss of continuity of care, reduced clinical exposure
of medical trainees and loss of the popular apprenticeship model were seen as detrimental for the
quality of medical training and patient care. Consultant Trainers' perceptions of medical education
were embedded in a traditional medical education culture, which expected long hours' availability,
personal sacrifices and learning without formal educational support and supervision. Over-reliance
on apprenticeship in combination with lack of organisational support for Consultant Trainers' new
responsibilities, resulting from the introduction of MMC, and lack of interest in pursuing training in
teaching, supervision and assessment represent potentially significant barriers to progress.Consultant Trainers felt that new working patterns resulting from the EWTD and MMC
Conclusion:
MMC within the context of EWTD. Postgraduate Deaneries, NHS Trusts and the new body; NHS:
Medical Education England should deal with the deficiencies of MMC and challenges of ETWD and
aspire to excellence. Further research is needed to investigate the views and educational practices
of Consultant Medical Trainers and medical trainees.This study identifies issues with significant implications for the implementation of
Consultants training junior staff ('Consultant Trainers') in order to identify impediments to
successful postgraduate medical training in the UK, in the context of Modernising Medical Careers
(MMC) and the European Working Time Directive (EWTD).
Maria Tsouroufli*1 and Heather Payne2
Address:
of Postgraduate Medical and Dental Education, Cardiff University, UK
Email: Maria Tsouroufli* - M.Tsouroufli@uea.ac.uk; Heather Payne - payneeh@cf.ac.uk
* Corresponding author1School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, NR4 7TJ, UK and 2Wales College of Medicine, School
Abstract
Background:
Consultants training junior staff ('Consultant Trainers') in order to identify impediments to
successful postgraduate medical training in the UK, in the context of Modernising Medical Careers
(MMC) and the European Working Time Directive (EWTD).We analysed the learning and professional development narratives of Hospital
Methods:
discussed in the context of Consultant Trainers' personal biographies, organisational culture and
medical education practices. We conducted life story interviews with 20 Hospital Consultants in
six NHS Trusts in Wales in 2005.Qualitative study. Learning and continuing professional development (CPD), were
Results:
have changed the nature of medical education. Loss of continuity of care, reduced clinical exposure
of medical trainees and loss of the popular apprenticeship model were seen as detrimental for the
quality of medical training and patient care. Consultant Trainers' perceptions of medical education
were embedded in a traditional medical education culture, which expected long hours' availability,
personal sacrifices and learning without formal educational support and supervision. Over-reliance
on apprenticeship in combination with lack of organisational support for Consultant Trainers' new
responsibilities, resulting from the introduction of MMC, and lack of interest in pursuing training in
teaching, supervision and assessment represent potentially significant barriers to progress.Consultant Trainers felt that new working patterns resulting from the EWTD and MMC
Conclusion:
MMC within the context of EWTD. Postgraduate Deaneries, NHS Trusts and the new body; NHS:
Medical Education England should deal with the deficiencies of MMC and challenges of ETWD and
aspire to excellence. Further research is needed to investigate the views and educational practices
of Consultant Medical Trainers and medical trainees.This study identifies issues with significant implications for the implementation of
Background
Structured training, clearly defined competencies, transparent
assessment, and emphasis on self-directed and lifelong
learning are key features of Modernising Medical
Careers (MMC) [1]. This new scheme replaced the current
medical training grades with a 2-year Foundation Pro-
Published: 20 May 2008
BMC Medical Education
Received: 6 August 2007
Accepted: 20 May 2008
This article is available from: http://www.biomedcentral.com/1472-6920/8/31
© 2008 Tsouroufli and Payne; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.2008, 8:31 doi:10.1186/1472-6920-8-31
BMC Medical Education
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gramme followed by a 3–7 year specialty training programme
[2]. It aimed to provide trainees with generic
skills and experience in a variety of settings and specialities
[3] leading to the award of a Certificate of Completed
Training (CCT), described in the document 'The Next
Steps' [4].
However, the recently published Tooke report (2008) recommended
changes to MMC and in particular the return
to a 1-year house officer training followed by a three-year
broader-based training prior to higher specialist training.
It also identified issues that hampered MMC. Lack of policy
objectives; no guiding principles shared by all stakeholders;
lack of clarity about the role of doctors; erosion
of health-education partnership; lack of involvement of
the medical profession in medical management, leadership
and policy. The Tooke report also addressed the effect
of the current interpretation of EWTD by UK legislation
and the implications on the acquisition of clinical experience,
confidence and the ability to shoulder responsibility
[5].
Well before the publication of the Tooke report (2008)
concerns regarding MMC had been expressed by both
trainers and trainees [6], particularly whether the Foundation
schemes will adequately prepare trainees for specialist
programmes. There was also concern about the impact
of MMC and EWTD on the quality of medical training,
surgical training [7] in particular and the quality of patient
care [8]. Fears had been expressed that the 'apprenticeship
model' will be destroyed [9] and that shorter training will
undermine the authority and status of the medical profession
[10].
However, 'Next Steps' [4] stated that the apprenticeship
model should not be abandoned but rather managed
appropriately within the new training system and the
requirements of the EWTD [11]. Unfortunately, when
MMC was implemented Trainers and Trainees were not
equipped with a clear plan for managing and maintaining
the apprenticeship model in a context of reduced working
hours. Consultant Trainers were also expected to undertake
new responsibilities (assessment and educational
supervision) under the new training system and to be supported
in their new role [2]. Although, training in assessment,
supervision and teaching was offered by
Postgraduate Deaneries, most Consultant Trainers did not
have a suitable job plan with an appropriate workload
and time to develop trainees, nor were supported by an
education team when MMC was implemented.
Recently, Postgraduate Medical Education and Training
Board (PMETB), a further challenge for Consultant Trainers,
have set high standards for Clinical and Educational
Supervisors, giving attention to Trainers' competency and
support in their role [12].
However, Consultant Trainers' views about postgraduate
training, their new roles and their everyday experiences
under the new training system and the constraints of
EWTD have received less attention in research, and subsequently
Continuing Professional Development (CPD)
objectives.
In this paper we explore Consultant Trainers' views on
postgraduate medical education and the implications of
cultural changes, resulting from MMC and EWTD, aiming
to identify impediments in the successful implementation
of MMC, within a context of reduced working hours. In
view of the potential confusion about the exact roles of
the 'Educational' and 'Clinical' Supervisor we will use the
generic term 'Consultant Trainer' throughout this paper.
Methods
This qualitative, interview based study was conducted in
2005 on 20 practising NHS Hospital Consultants with
responsibilities for supervising trainee Doctors, from six
NHS Trusts in Wales. The study was funded by Cardiff
University. This research study was conducted in compliance
with the Helsinki Declaration [13]. It was reviewed
and approved by MREC Wales (Ref. no. 05/MRE09/53).
R&D approval was also granted by six NHS Trusts in
Wales.
Recruitment
Research participants were recruited from attendees at a
short training course organised by the Postgraduate Deanery
at Cardiff University (n = 13). Snowballing was also
used. 7 research participants were recruited through interviewees'
personal contacts and had not attended the training
course. The course which looked at teaching,
assessment and educational supervision under the new
training system (MMC) was delivered at many sites across
Wales and was attended by a total of 60 consultants. The
Principal Investigator was a non-participant observer at
the course delivered at Cardiff. Invitations to participate
in the study were sent to all attendees. Those who returned
their consent forms (20) were followed up by email or
phone.
Sample
The sample size was determined by saturation of data.
This sample of consultants gave diversity of age (35 – 55),
sex (11 female, 9 male), ethnicity (1 Asian, 2 Arab, 1
Greek, 3 English, 2 Irish, 1 Scot and 10 Welsh), and clinical
specialty (general medicine, surgery, radiology, cardiology,
obstetrics and gynaecology, ENT, paediatrics,
emergency care, clinical pathology, anaesthetics, psychiatry).
All research participants were committed educators
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who throughout their careers had been involved in formal
or informal teaching, clinical and educational supervision
and staff appraisal.
Life-story approach and the interview schedule
A life story approach was employed because of its orientation
towards exploring the importance of biography in
interviewees' current views and practices [14]. The narrative
approach gave interviewees the opportunity to discuss
their own knowledge and experience of adult learning and
professional development as complex processes, emerging
from dynamic relationships between learners' personal
biographies, organisational and professional
culture and educational practices. Interviews contained
discussion of MMC and the doctors' own medical teaching
role. They also contained discussion of the interviewees'
lifetime experiences of general and medical
education. The themes discussed in interview were based
upon literature in education [15] medical education
[16,17] and the authors' clinical, educational and research
experience. The interview schedule (table 1) was developed
collaboratively and piloted with volunteers
employed by the Postgraduate Deanery at Cardiff University.
Procedure
Interviews were conducted by the Principal Investigator –
a female social scientist aged 35 – in Consultants' offices,
a seminar room in the hospital or University. Consultants'
unfamiliarity with qualitative research and their busy
schedule were important challenges for the interviewer
and the interviewees who seemed to hesitate to express
opinions or feelings. Interviews lasted around an hour or
more in some cases and were audio recorded, transcribed,
anonymised and imported into the qualitative analysis
package Nvivo 2.0. Field-notes were also written up after
each interview, recording reflections on the interviews and
initial analytical comments.
Analysis
A record of analysis as well as detailed information about
the research process and the participants is available in
Nvivo 2.0. We adopted collaborative analysis and writing
to maximise the confirmability and credibility of our findings
[18]. The authors' different academic backgrounds
(qualitative social scientist-clinician/medical educator)
enriched the analytical process.
The interviews were coded by the PI under the broad
descriptive categories (table 1) of the interview schedule
with the purpose of easy retrieval of data in Nvivo 2.0.
Authors worked independently and met regularly to discuss
their thoughts on literal and interpretive reading of
the data [18] Ideas emerged from these two analytical
stages which were developed further during the last stage
of the analysis; the reflective reading [19]. Authors were
able to access, read and discuss each other's reflective
notes in Nvivo 2.0. Through the process of discussion and
comparison of data [20] and reading of relevant literature,
the change of working practices resulting from EWTD and
MMC; and Consultant Medical Teachers' traditional discourses
of medical education emerged as key issues in our
analysis.
The analysis presented in this paper was guided by three
research questions:
•
medical education?What are Consultant Medical Teachers' perceptions of
•
changes?What are the links between organisational and educational
•
of training (as a junior doctor) and current views?What is the relationship between personal experience
Results
In what follows we explore Consultant Trainers' views
about the cultural changes that have occurred as a result of
MMC and EWTD. We also discuss Consultant Trainers'
views of the effect of these changes on trainees' competency,
Trainers' professional-educational role and Continuing
Professional Development (CPD).
Old 'apprenticeship' and the new EWTD
Either explicitly or implicitly, Consultant Trainers
expressed positive attitudes towards the apprenticeship
model of learning or some aspects of it such as
'
They focused on familiarity with many clinical procedures
and fast learning which occurredstability' (Doctor 3).
'simply by being there, asking questions and learning from mistakes'
(Doctor 11).
Sharing information and discussing decision-making
approaches informally with senior staff throughout the
disease trajectory was seen as conducive to learning. How-
Table 1: Interview schedule topics
Employing organisation
Interviewee's life and career
Experiences of learning
Experiences of teaching
Experiences of supervision
Continuing Professional Development
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ever, similar opportunities have disappeared since the
introduction of EWTD and the disintegration of the firm.
The introduction of shift work has resulted in reduced
availability of trainees, reduced contact between trainers
and trainees and limited opportunities for communication
and learning as the following excerpt illustrates:
Now, if I feel someone could have improved the care they gave
somebody and would like to talk about it, I'd have to try and
make a formal appointment with them which makes it seem
very big, and formal, or I'll say I'll just mention it in passing
when I see them, and then I don't see them weeks could go by
so time for that sort of pointed follow-up of an individual case
care is very, very difficult. ... Continuity is very difficult, and if
you are going to give a hot report on somebody's performance
when you are not there when they are doing it, and then you
don't see them until two weeks afterwards, you can't do that
and I think that makes the learning more difficult. If it is not
hot taking on the message, 'well what did you think about that,
or that might have been another way to do' it doesn't mean very
much if it is two weeks later
The limited availability of trainees has also resulted to
reduced clinical exposure and experience. In the following
excerpt a surgeon expresses concerns about the quality of
surgical training, as reduced working hours have inadvertently
resulted to reduced surgical experience.. (Doctor 12)
Hands on training, right ok I want to do the hands on training,
I said I have 3 theatre sessions a week and so I want my FP2 to
be with me in three theatre sessions so that I can give him the
hands on training, that is my commitment in the bid. But, they
can't be with me because they are on call for that day, they don't
come to the theatre with me. Because they have been taking history
examinations to all this emergency cases and then the next
day they are off, they are not allowed to join me, even if they,
er I mean voluntary, because they have been asked to go home.
So, when my trainee is around I don't have the theatre. How
am I going to give him the hands on training?
New working patterns resulting from the EWTD have
altered the nature of medical communities and had implications
for the quality of medical training.(Doctor 6)
Consultant Trainers' perceptions of MMC trainees
Consultant Trainers felt that cultural changes, resulting
from EWTD and MMC, impinged on trainees' competency.
All interviewees described current trainees as less
confident and less able to work independently in comparison
to themselves, however sound their theoretical
knowledge, and thought that trainees required a lot more
support and direction than themselves when they were
being trained. Consultant Trainers felt that trainees were
struggling with the application of theoretical knowledge
in real life situations, due to their limited clinical exposure.
Consultant Trainers also felt that structured training
(MMC) and reduced working hours is creating a generation
of doctors unable to deal with the pressures and challenges
of the medical profession as the following excerpt
illustrates:
Well they
know the amount of time they spend, particularly when they are
qualified, actually doing their job it's substantially theirs,, so
when they have to, which they're not suppose to, but when they
have to work, out of hours or work very intensively for a short
period of time, I don't think they're really got that sort of experience
that they can necessarily cope and some people, obviously
do, but, I think a lot of them do find it quite stressful when they
have to say look after three very sick patients all at the same
time, you know, well I've heard in silence that they just can't
cope. Whereas, in the old days it would be part and parcel of
you training really and you would cope
The implications of shorter training, in particular the deficiencies
of current trainees, dominated the interviews
with Consultant Trainers, whereas reflection and evaluation
of Consultant Trainers' teaching and supervision
practices was a non-issue, irrespective of interviewees' age,
gender, ethnicity and clinical speciality. The doctor in the
following excerpt was the only interviewee who expressed
concerns about her teaching practices and a need for
adjustment to the new reality of reduced working hours
and shorter medical training.(trainees) go through a very structured process, you. (Doctor 7)
So I think it's been pointed out that the change in working
hours means a need for change in the way of teaching the trouble
is from the experience I've had of teaching, is of that apprenticeship
method, so I find it difficult to think about well how
else do I go about getting this message across, when I can't do
it the way that worked for me and it was a good method for me.
I know it's not a good method for some people but it was a good
method for me. (Doctor 12)
MMC-new roles and responsibilities for Consultant
Trainers
Complaints about time constraints and increased workload,
resulting from Consultant Trainers' involvement in
MMC were common in the interviewees. The majority of
interviewees perceived their new responsibilities, including
educational supervision and assessment as conducive
to trainees' learning and important for the effectiveness of
MMC. However, all Interviewees expressed concerns
about lack of time for performing teaching, supervision
and assessment of trainees, due to clinical commitments
and pressures from NHS employers. The doctor in the following
excerpt expresses concerns about the implications
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of her supervision commitments arising from MMC and
the lack of organisational support.
Yeah, well the FP1's I've, I've put an application to get a FP1,
um, I think it's, it's definitely the way forward but I don't think
it's been particularly well thought through. I mean, I just supervise
1 FP2 at the moment and it takes an awful lot of time and
to go through all the materials and, and to do it properly, I don't
know how we're coping because if you're in speciality with
maybe one or two you can but from next August I'll have 5 and
it takes me about an hour a week to, if I'm doing it properly, to
supervise that particular FP2 and go through all their materials
and assessments with them and I don't know how it's going to
be possible, we've got sort of, 15 of them to do. The level of support
will drop because we just won't have the time to do it.
We're not being given any extra consultant time to, to perform
that role. (Doctor 8)
Consultant Trainers' educational expertise and perceived
training needs
Consultants Trainers felt that changes in working patterns
and medical training had implications for trainees as well
as their employing organisation. However, further training
in teaching, supervision and assessment was not identified
as an appropriate response to the changes brought
about by MMC and the EWTD. There was a general feeling
that competency in these areas was acquired through
experience and informal learning. Interestingly Consultants
Trainers, who had formal training; a formal role in
undergraduate of postgraduate Medical Education; and a
strong role model as a teacher/mentor/supervisor; were
more enthusiastic about addressing professional challenges
resulting from MMC and EWTD.
The doctor in the following excerpt came from a family
who valued good teaching and mentoring. He used to
consult his mother, a teacher, on educational and professional
development issues. After reflection and careful
needs assessment, he decided to do a Bachelor of Education
to address challenges, resulting from his involvement
in the Foundation Program and specialist training.
The FP2s have an appraisal every two months and certainly
every 4 months. The GP trainee will need assessment every six
months before they move on to their next placement, a specialist
registrar will need an appraisal every twelve months before they
move onto their next placement. So I had a need to produce various
educational material and a lot of my personal education
has been around improving my teaching technique so that I can
deliver that better. So it hasn't been about learning old age psychiatry,
it is learning how to teach about old age psychiatry in
a different setting or a better setting or more effective
1)
Consultant Trainers' accounts show limited perceived
benefit of teaching and supervision for their educational
and professional development and variation in perceptions
of their supervisory role. All interviewees described
themselves as facilitators of the trainees' learning but most
thought that their main task as MMC educational supervisors
was to organise learning events, discuss aims and
objectives with the trainee and inform them of the learning
opportunities in their department. Providing regular
feedback on performance and progress through formal or
informal learning events was felt to be desirable by fewer
interviewees (and not always achievable, due to organisational
constraints). Supporting trainees in identifying
learning needs, providing pastoral care and career advice
were the least frequently mentioned activities mentioned
by interviewees.. (Doctor
Consultant Trainers' Personal Experience of Training-The
Sink or Swim Medical Education Culture
Consultant Trainers' preference for apprenticeship and
resistance to training, pertinent to Consultants' new role,
might be associated with their personal experience of
medical training. Long hours' availability, personal sacrifices,
emotional and physical robustness and strength,
self-reliance and independence, were subtle expectations
of medicine when Consultants were junior doctors. Consultant
Trainers felt that current trainees should make similar
sacrifices and accept that medicine is not a 9-5 job as
the following excerpts illustrate:
'to come out of their
thinking as a nine to five clerical assistant'(trainees) way to learn... rather than(doctor 13).
You have to be organised, say for instance today I am not going
to do anything I will keep this time to myself for studying or
after five by boss is having an emergency gastrectomy and I will
go and see that. If you go and see the elective emergency gastrectomy
starting at six you have to sacrifice whatever activities
you have in the evening
As junior doctors, Consultant Trainers had ample opportunity
for informal learning due to different working patterns.
However, in the old days, relationships were not
always easy and some Consultant Trainers commented on
difficulties in raising concerns and getting constructive
criticism from their seniors as the following excerpt
shows:. (Doctor 6)
I would have like to feel able to ask questions and if I wasn't
sure or wanted something explained I thought I would get support
but it was more about you don't do it like that, you should
have done this and then there's like you know, you want to
know why but that was never given, it was just everything you
did was wrong. (Doctor 8)
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Consultant Trainers acknowledged the problems arising
from unstructured postgraduate training with no protected
time for learning, no
and lack of constructive criticism, impinging on their
learning. However, all interviewees felt that their difficult
experiences enabled them to develop into independent
learners and hardworking consultants as the following
excerpt illustrates:formal educational supervision
My 1st job was in the A&E department as a pre-registration
house officer with four of us together who graduated together
from medical school and not a great deal of supervision from
anyone more senior, we could go to people if we did have problems
but we generally tried to resolve the problems as far as we
could amongst ourselves. Lots of experience, it probably
moulded me for the future that every job I did involve hard work
and quite a lot of independent problem solving and taking
responsibility for your own education and learning. (Doctor 4)
Conclusion
Analysis of educational narratives of 20 Consultant Trainers
indicates that the EWTD has led to working practices
which have altered the Trainee-Consultant Trainer relationship.
The introduction of shift duties was perceived by
our interviewees, to have fragmented medical communities,
and significantly reduced contact between trainers
and trainees. Similar findings were reported in McKee's
ethnographic study of senior house officers [21].
New working practices resulting from the EWTD have
implications for medical training. Our qualitative data
shows that limited clinical exposure of trainees, lack of
continuity, and limited Consultant Trainer-Trainee contact
at the workplace, has inadvertently led to the loss of
'apprenticeship' long used and still favoured by both
trainers and trainees. This causes concern to the medical
community and is seen as a threat to the profession. Further
research is needed to explore shared understanding of
'apprenticeship', but there was common reference to 'see
one, do one, teach one'.
The implementation of MMC within the context of EWTD
has created new responsibilities and challenges for Consultant
Trainers. Our study findings show that lack of
organisational support for Consultant Trainers and management
strategies that would balance clinical and administrative
impinged on the quality of medical training and
Consultants' educational role.
Lack of clarity about Consultants' educational role in
combination with their resistance to further training
might have also been a barrier to the successful implementation
of MMC, within a context of reduced working
hours. This qualitative study has identified Consultant
Trainers' predominant assumptions about learning,
embedded in a 'sink or swim' medical education culture
[22]. Having received limited supervision and support as
juniors and little training in teaching and supervision [23]
as Consultants, interviewees seemed to be heavily reliant
on the 'old apprenticeship', focusing mainly on the deficiencies
of their trainees and the constraining environments
in which they work and teach. In our study,
interviewees did not often appear to use more advanced
teaching skills such as seeking to diversify educational
techniques in the face of insuperable obstructions (time
and synchronicity constraints), engagement in shared and
reciprocal learning practices [24], reflection and evaluation
of their own teaching and supervisory practices [25].
This is a matter for concern in a sample explicitly committed
to training. It is also a key issue that needs to be
addressed as Consultant Trainers are now expected to be
involved in creating a learning culture, and provide a level
of supervision appropriate to the competence and experience
of the trainee [12].
Establishing appropriate mechanisms for the selection,
organisational and educational support of Trainers [12]
and fostering strong links between health and theeducation
sector are potentially ways forward [5]. Also promoting
effective involvement of the medical profession in
training policy-making could lead to clear, shared principles
about the implementation and management of postgraduate
training [5]. Further qualitative research is also
needed to investigate the quality of postgraduate training
as perceived and experienced by Trainers and Trainees.
Abbreviations
NHS: National Health Service, MMC: Modernising Medical
Careers, EWTD: European Working Time Directive,
MREC: Multi-site Research Ethics Committee, R&D:
Research and Development and CPD: Continuing Professional
Development.
Competing interests
Maria Tsouroufli has no competing interests.
Heather Payne is employed by a Postgraduate Medical
Deanery.
Authors' contributions
Maria Tsouroufli was principal investigator for the study.
Heather Payne was co-applicant on the study research
proposal and contributed to each stage of the study development,
process, analysis and reporting.
Acknowledgements
We thank the participants for their time, referees Dr Simon Murphy and
Professor Gareth Rees, advisers Dr Alan Dowler and Dr Chris Taylor. We
also thank Professor Derek Gallen, Dr Sally Davies and Dr Michael Shepard
for their comments. Last but not least we are indebted to Professor Sam
Leinster for commenting on drafts.
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References
1.
2.
download_files/What%20is%20changing%20at%20MMC.pdf]
3. The Foundation Programme Committee of the Academy of Medical
Royal Colleges, in co-operation with Modernising Medical Careers in
the Departments of Health:
Education and Training
4. UK Health Departments:
Specialist and General Practice Training Programmes
of Health, London; 2004.
5.
pdf]
6. Kang SN, Sanghrajka A, Amin A, Lee J, Briggs T:
Careers: orthopaedic trainees' perspectives.
Royal College of Surgeons in England
7. Payne SR, Shaw MKB:
have on urological service delivery?
in England
8. Devey L:
surgeon?
9. Anwar M:Modernising Medical Careers [http://www.mmc.nhs.uk]Modernising Medical Careers [http://www.mmc.nhs.uk/Curriculum for the Foundation Years in PostgraduateDepartment of Health, London; 2005.The Next Steps: The Future Shape of the Foundation,DepartmentMMC Inquiry 2008 [http://www.inquiry.org.uk?_Jan_08_MMCall.Modernising MedicalAnnals of2005, 873(Suppl):310-312.What impact will shortened trainingAnnals of Royal College of Surgeons2005, 87(Suppl):373-378.Will modernised medical careers produce a betterBMJ 2005, 331:1346.EWTD has negative impact on training for surgeons.
BMJ
10. Clough CG:2005, 331:1476.New development in medical speciality training.
Clinical Medicine
11.2005, 5:349-353.Department of Health European Time Directive
[http:library.nhs.uk/healthmanagement/ViewRe
source.aspx?reID=51961&tabID-290&CATID=4031]
12.
admin/user/QA/Assessment/
PMETB_Standards_FORTRAINERS_JAN_2008.pdf]
13.
14. Czarniawska B:
15. Osler A:
A Kenyan case study.
Development
16. Allery L, Owen PA, Robbing M:
consultants change their clinical practice: a critical incident
study.
17. Bennett N, Davis AP, Easterling WE, Friedman P, Green JS, Koeppen
BM, Mazmanian P, Waxman HS:PMETB Standards for Trainers [http://www.pmetb/org/uk/fileThe Helsinki Declaration [http://www.wma.net/e/policy/b3.htm]Narrative in Social Science Research London: Sage; 2004.Teachers' biographies and educational development:International Journal of Educational1997, 17:361-371.Why general practitioners andBMJ 1997, 314:870.Continuing Medical Education.
Academic Medicine
18. Miles MB, Huberman MA:2000, 75:1167-1172.Qualitative analysis: an expanded sourcebook
Thousand Oaks, CA: Sage Publications; 1994.
19. Mason J:
20. Weber R:
21. Mc Kee A:
adrift in fragmented communities.
Care
22. Doherty C:
the sink or swim culture.Qualitative Researching London: Sage; 1990.Basic Content Analysis London: Sage; 1990.Working and Learning in hospitals: Junior doctorsLearning in Health and Social2002, 3:158-169.Introducing mentoring to doctors: ChallengingDevelopment and Learning in Organisations
2004,
23. Rogstad K, Talbot M:
of trainee doctors and their mentors, to compulsory educational
supervision in postgraduate medicine.
Tutoring
24. Carrington G:1:6-8.A preliminary study comparing attitudesMentoring and2001, 1:77-83.Supervision as a Reciprocal Learning Process.
Educational Psychology in Practice
25. Dewar BJ, Walker E:2004, 1:31-42.Experiential learning: Issues for supervision.
Journal of Advanced Nursing1999, 6:1459-1467.
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