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By P. Reto. Woodbury University. 2018.
Commentators on medicine from other academic fields order levitra professional 20 mg fast delivery erectile dysfunction best treatment, formerly sympathetic towards doctors, increasingly ‘portrayed the medical profession as a dominating, monopolising, self-interested force’ (Starr, 1982:392). The radical critics of medicine were often fiercely polemical, but like the wider movements of which they were a part, they were optimistic about their capacity to change things and not lacking in alternative programmes. Undoubtedly some of medicine’s critics aspired to overthrow capitalism and patriarchy as well as the power of the medical profession, but many had more specific proposals for reform. Indeed some of these—such as demands for de- institutionalisation of treatment and care for the mentally ill and for the de-medicalisation of many aspects of childbirth—were rapidly assimilated by the mainstream. Pressures for reform of the American health-care system made some headway before becoming stalled in the complexities of the political process and its relations with doctors, insurers and other commercial interests. Parallel pressures for reform of the medical profession itself—notably in the recruitment of women—made steady progress. The proportion of women admitted to medical schools in Britain increased from 22 per cent in 1965–66, to 41 per cent in 1980–81 and reached 52 per cent in 1992–93 (Allen 1994). In the recessionary climate of the mid-1970s the radical upsurge was gradually contained and a conservative backlash gathered momentum. By the end of the decade the new right was in the ascendant with Margaret Thatcher in 10 Downing Street and her ideological ally Ronald Reagan in the White House. The new conservatism did not however mean that doctors would be delivered from their carping critics and freed to return to business as usual. The end of the era of consensus led to a growing scepticism about the scope for ameliorative intervention in society, whether by the state or by professionals, whether in the spheres of education, social services or health. In a trend he dubbed ‘the generalisation of doubt’, Starr commented that the ‘net effectiveness of the medical system as a whole was called into question’ (Starr, 1982:408). Far from being halted, the crisis of medical authority broadened and a more cynical attitude towards doctors became widespread. The author who best exemplifies the nihilistic spirit of the late 1970s is Ivan Illich, a renegade Jesuit priest, who had already denounced the education system with his book Deschooling Society. In 1975 he published Medical Nemesis, the opening sentence of which declared that ‘the medical establishment has become a major threat to health’. Illich incorporated the familiar criticisms (indeed, as we have seen above, self-criticisms) of modern medicine into his thesis that the health problems of society were predominantly those of ‘iatrogenesis’, illness caused by doctors. The result was ‘the expropriation of man’s coping ability by a maintenance service which keeps him geared up at the service of the industrial system’ (Illich 1975:160). The medical profession was a bureaucracy produced by an ‘over- industrialised society’. Illich’s vituperative polemic repudiated all piecemeal solutions: nothing less than the de-industrialisation of society and the de-bureaucratisation of medicine could save the world from medical nemesis: ‘the inevitable punishment of inhuman attempts to be a hero rather than a human being’ (Illich 1975:28). For Illich, medical nemesis was ‘resistant to medical care’ and ‘could be reversed only through a recovery of mutual self-care by the laity’. While few were prepared to go all the way with Illich’s manifesto, it helped to encourage two trends which attracted growing support— the movement for a ‘holistic’ approach to health and the continuing offensive against the medical profession. In his 1976 book The role of medicine, Thomas McKeown, professor of epidemiology at Birmingham, developed the arguments around the ‘epidemiological transition’, to which he had already made a substantial contribution, synthesised in The modern rise of population (McKeown 1976a, 1976b). To his earlier thesis that the contribution of medical science to the declining mortality from infectious disease was marginal compared with the role of improving social conditions and nutritional standards, McKeown now appended the view that the continuing focus of modern medicine on high-technology interventions aimed at curing disease was misplaced. He claimed that this approach had ‘led to indifference to the external influences and personal behaviour which are the predominant determinants of health’ (McKeown 1979:xvi). Though McKeown’s thesis about the negligible medical contribution to the improved health of modern society was contested, it had a major impact: five years later a review of the literature accurately noted that ‘McKeown’s views have been so immensely influential that they have almost become a new orthodoxy’ (Davey et al. McKeown’s contention that modern medicine treated the human body ‘as a machine’ struck a chord at a time when an anti- technological and environmentalist outlook was becoming increasingly popular. Though McKeown was careful to distinguish between the role of medicine as an institution, which he questioned, and clinical practice, of which he broadly approved, his balanced approach was not shared by many of his readers who interpreted his work as a categorical repudiation of scientific medicine. It was striking that in the second edition of The Role of Medicine, he felt obliged to include a preface distancing himself from Illich and from those who had interpreted his book as ‘an attack on clinical medicine’ (McKeown 1979:vii). Notwithstanding McKeown’s mis-givings, there can be little doubt that the popularity of his work reflected the growing influence of an ecological consciousness that upheld a ‘holistic’ alternative to the ‘biomedical’ tradition.
The resources devoted to evaluation should reflect its importance levitra professional 20 mg cheap erectile dysfunction treatment toronto, but excessive data collection should be avoided. A good system should be easy to administer and use information that is readily available. Interviews—Individual interviews with students are useful if the information is sensitive—for example, when a teacher has received poor ratings from students, and the reasons are not clear. Electronic methods for administering questionnaires may improve response rates. The quality of the data, however, is only as good as the questions asked, and the data may not provide the reasons for a poorly rated session. Information from student assessment—Data from assessment are Subjective Objective useful for finding out if students have achieved the learning outcomes of a curriculum. A downward trend in examination Analysis of tasks results over several cohorts of students may indicate a Qualitative Focus groups successfully Interviews completed in an deficiency in the curriculum. Caution is needed when OSCE station interpreting this source of information, as students’ examination performance depends as much on their application, ability, and motivation as on the teaching. Trends in Quantitative Surveys examination scores Completing the evaluation cycle The main purpose of evaluation is to inform curriculum development. If the results of an evaluation show that no further development is OSCE = objective structured clinical examination needed, doubt is cast on the methods of evaluation or the Examples of methods of evaluation interpretation of the results. This does not mean that curriculums should be in a constant state of change, but that the results of evaluation to Key points correct deficiencies are acted on, that methods continue to improve, and that content is updated. Then the process starts all Evaluation should: x Enable strategic development of a curriculum over again. The examination scores for that part of the x More than one source and type of information should be sought objective structured clinical examination (OSCE) carried out at the x The results should be fed back to participants and details of the end of year three show a decline over several years. Three focus resulting action given groups are held with students in year four, and several clinical teachers are interviewed. The results suggest that the decline is due to Learners need: fewer appropriate patients presenting at outpatient sessions where x To be involved in developing an evaluation cranial nerve examination is taught and to a lack of opportunities for x To feel their time is respected practising examination skills. They should also recognise normal signs and know x Repeat the process which common abnormalities to look for. Sessions are timetabled for practising skills learnt during the teaching session. Evaluation A questionnaire is developed for completion by a third of students. It Further reading seeks their views on the teaching process, including the teaching skills x Robson C. London: appropriateness of the teaching material, and opportunities for Routledge, 1994. Outcome measures include comparison x Snell L, Tallett S, Haist S, Hays R, Norcini J, Prince K, et al. A review of examination scores for students in the previous cohort with those of the evaluation of clinical teaching: new perspectives and participating in the teaching session, plus a questionnaire for all challenges. A tenth of students with a interprofessional education:a United Kingdom review of health and social range of scores in the relevant part of the OSCE are interviewed to care. Whatever their reputation, lectures are an efficient means of transferring knowledge and concepts to large groups. They can be used to stimulate interest, explain concepts, provide core knowledge, and direct student learning. However, they should not be regarded as an effective way of teaching skills, changing attitudes, or encouraging higher order thinking. Students receive information but have little opportunity to process or critically appraise the new knowledge offered. How can lectures be used to maximise learning and provide opportunities for student interaction? This article will supply some of the answers and should help you to deliver better, more interactive lectures. Getting your bearings It is important to find out as much as possible about the context A lecturer holds forth.
X A useful way of gaining access is to find a gatekeeper who can introduce you to other members of the com- munity levitra professional 20 mg lowest price erectile dysfunction medications list. X A researcher needs to do much soul-searching before going into the field as the experience can raise many ethical, moral and personal dilemmas. X It is sometimes quicker and more economical to wait for questions to come to the researcher, rather than ask questions of informants in the early stages of a study. X Field notes may record practical details, methodologi- cal issues, personal thoughts, preliminary analyses and working hypotheses. X Data analysis takes place in the field so that hypotheses can be discussed with key informants. X The community should be left on good terms and any written reports should be given back to the people for their interest and personal comments. It could be influenced also by the methodo- logical standpoint of the person who teaches on your re- search methods course. DECIDING WHICH APPROACH TO USE For quantitative data analysis, issues of validity and relia- bility are important. Quantitative researchers endeavour to show that their chosen methods succeed in measuring what they purport to measure. They want to make sure that their measurements are stable and consistent and that there are no errors or bias present, either from the respon- dents or from the researcher. Qualitative researchers, on the other hand, might ac- knowledge that participants are influenced by taking part in the research process. They might also acknowledge that researchers bring their own preferences and experience to the project. Ask two researchers to analyse a transcript and they will probably come up with very different results. This may be because they have studied different subjects, 110 HOW TO ANALYSE YOUR DATA/ 111 or because they come from different political or methodo- logical standpoints. It is for this reason that some re- searchers criticise qualitative methods as ‘unscientific’ or ‘unreliable’. This is often because people who come from quantitative backgrounds try to ascribe their methods and processes to qualitative research. For qualitative data, the researcher might analyse as the re- search progresses, continually refining and reorganising in light of the emerging results. For quantitative data, the analysis can be left until the end of the data collection process, and if it is a large survey, statistical software is the easiest and most efficient method to use. For this type of analysis time has to be put aside for the data input process which can be long and laborious. However, once this has been done the analysis is quick and efficient, with most software packages producing well presented graphs, pie charts and tables which can be used for the final report. QUALITATIVE DATA ANALYSIS To help you with the analysis of qualitative data, it is use- ful to produce an interview summary form or a focus group summary form which you complete as soon as possible after each interview or focus group has taken place. This includes practical details about the time and place, the participants, the duration of the interview or focus group, and details about the content and emerging themes (see Figures 2 and 3). It is useful to complete these forms as 112 / PRACTICAL RESEARCH METHODS soon as possible after the interview and attach them to your transcripts. The forms help to remind you about the contact and are useful when you come to analyse the data. The method you use will depend on your research topic, your personal preferences and the time, equipment and fi- nances available to you. Also, qualitative data analysis is a very personal process, with few rigid rules and procedures. It is for this reason that each type of analysis is best illu- strated through examples (see Examples 8–11 below). Formats for analysis However, to be able to analyse your data you must first of all produce it in a format that can be easily analysed. This might be a transcript from an interview or focus group, a series of written answers on an open-ended questionnaire, or field notes or memos written by the researcher. It is useful to write memos and notes as soon as you begin to collect data as these help to focus your mind and alert you to significant points which may be coming from the data.
Pitfalls to avoid: ° Writing an overlong introduction so that the essay becomes unbalanced discount levitra professional 20mg erectile dysfunction treatment dublin. This is very boring for the marker and not the best way to impress him or her! The main section The main or middle part will come after your introduction and will form the bulk of your essay. It is here that you will demonstrate to the marker your knowledge and understanding of the subject matter. Structure There are different ways to organise the information in your essay. Your choice of structure will depend on the subject matter and the requirements given in the title. Here are some examples: (a) ‘Illustrate what is meant by the “use and protection” of information within the NHS. The main criterion is that you cluster information to help the reader make connections between ideas. The sequence in which you present these clusters must be logical and coherent. Content Use your analysis of the title and your outline to help you judge whether your choice of material is relevant to the question. Think about whether it is a primary point, secondary point or supporting evidence, such as an ex ample or reference to another source. If you can omit some data without 178 WRITING SKILLS IN PRACTICE making a difference to your overall argument or discussion then it is likely that it is redundant. Constantly check back with your original plan to make sure you re main true to the question. For example, has your answer changed from ‘why does x cause z’ to ‘what causes z’? Your tutor will be looking for an expression of your point of view; however, you must support this with evidence from the literature. You will then be able to discuss a range of theories and refer to information from a num ber of sources. Remember to acknowledge these both in the text and by supplying a reference list at the end of the essay. The main part forms approximately 75 to 80 per cent of your essay – so in a 2000 word composition you would plan to use 1500 words for the main part of the essay. Pitfalls to avoid: ° Showing a bias by the type of information you select or the viewpoint you put across. It will contain either a summary of the key points, a statement of the outcome of your discussion or a resolution to your argument. Making a reference back to your intro duction or the original question brings the essay full circle and achieves a satisfactory closure. Some questions that might help you in writing your conclusion are: ° What are the main points of your essay? ESSAYS 179 ° a change in attitude ° a change in knowledge ° a change in how to apply theory to practice ° a change in awareness ° a change in understanding. Like the introduction, the conclusion forms about 12 per cent of your es say – so in a 2000 word composition you would plan to have a conclusion of about 250 words. Writing drafts Views are mixed about whether writing several drafts is a good idea or not. Some advise writing coursework essays under exam conditions as practice for timed examinations. This may help in preparing you for your exams, however it is unlikely to help you in producing your best piece of work. I would recommend that, like any other written task, you take the opportu nity to draft your essay and revise it as necessary before you submit it. Use the checklist in the ‘Action Points’ at the end of this chapter to help edit your draft.
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