Claire MacRae, PhD student, University of Edinburgh Supervisors: Dr - - PowerPoint PPT Presentation

Claire MacRae, PhD student, University of Edinburgh

Supervisors: Dr Derek Jones, University of Edinburgh Dr Terese Stenfors, Karolinska Institutet

Wider social, cultural & political context

MACRO: Institutional & regulatory context

MICRO: employees MESO: Organisation

“The problem”

Wider social, cultural & political context

Institutional & regulatory context

‘What teachers think / say /do’ ‘What medical schools do’ ‘What medical schools say’

Phenomenon

• f interest

CASE STUDY: AGENTIAL ANALYSIS CRITICAL DISCOURSE ANALYSIS CASE STUDY: CONFIGURATIONAL ANALYSIS CASE STUDY: FIELD ANALYSIS

Wider social, cultural & political context

Institutional & regulatory context

‘What teachers think / say /do’ ‘What medical schools do’ ‘What medical schools say’

Value of clinical teaching

www.smerc.co.uk

Extensive use of ‘implied contracts’ “New Management Ideology”

Teachers do not feel recognised or valued Healthcare valued more highly than education ‘Public Service Values’ “New management ideology” “Consumer culture” Increasing regulation of higher education Teaching awards “Austerity” Resource constraints Loss of agency Faculty development Administration Backgrounding teaching Implied contracts Measurable

• utputs

Changing curricula Population demographics Reduced autonomy Prioritization

• f patient care

Increasing regulation of medical profession Increased service pressures Increased accountability Cascading communication

www.smerc.co.uk

Extensive use of ‘implied contracts’ “New Management Ideology”

‘Public Service Values’ “New management ideology” Increasing regulation of medical profession “Consumer culture” Increasing regulation of higher education Increased accountability Teaching awards Increased service pressures Cascading communication “deagentialisation” Faculty development Population demographics Administration Backgrounding teaching Imperatives Implied contracts Measurable

• utputs

Changing curricula Increased healthcare funding “Austerity” Healthcare valued more highly than education Decreased education funding Teachers do not feel recognised or valued

www.smerc.co.uk

Extensive use of ‘implied contracts’ “New Management Ideology”

‘Public Service Values’ “New management ideology” Increasing regulation of medical profession “Consumer culture” Increasing regulation of higher education Increased accountability Teaching awards Increased service pressures Cascading communication “deagentialisation” Faculty development Population demographics Administration Backgrounding teaching Imperatives Implied contracts Measurable

• utputs

Changing curricula Doctors paid more than teachers Increased healthcare funding “Austerity” Prioritization

• f patient care

Healthcare valued more highly than education Decreased education funding

“Those who can do; those who can’t…”

Prioritization

• f patient care

Teachers do not feel recognised or valued

www.smerc.co.uk

Extensive use of ‘implied contracts’ “New Management Ideology”

Teachers do not feel recognised or valued

Healthcare valued more highly than education

“New management ideology” “Consumer culture” Increasing regulation of higher education Teaching awards

“Austerity”

Faculty development Administration Backgrounding teaching

Changing curricula Population demographics Prioritization of patient care

Increasing regulation of medical profession Increased service pressures Increased accountability

“Those who can do; those who can’t…” Doctors paid more than teachers Increased healthcare funding Decreased education funding Prioritization of patient care

Reduced autonomy Measurable

• utputs

Cascading communication Resource constraints

‘Public Service Values’

Implied contracts Loss of agency

“New Management Ideology”

Teachers do not feel recognised or valued “New management ideology” “Consumer culture” Increasing regulation of higher education

Population demographics

Increasing regulation of medical profession Increased service pressures Increased accountability Resource constraints

“Austerity” Changing curricula

www.smerc.co.uk

Extensive use of ‘implied contracts’ “New Management Ideology”

Teachers do not feel recognised or valued

Healthcare valued more highly than education

“New management ideology” “Consumer culture” Increasing regulation of higher education Teaching awards

“Austerity”

Faculty development Administration Backgrounding teaching

Changing curricula Population demographics Prioritization of patient care

Increasing regulation of medical profession Increased service pressures Increased accountability

“Those who can do; those who can’t…” Doctors paid more than teachers Increased healthcare funding Decreased education funding Prioritization of patient care

Reduced autonomy Measurable

• utputs

Cascading communication Resource constraints

‘Public Service Values’

Implied contracts Loss of agency

“New Management Ideology”

Teachers do not feel recognised or valued “New management ideology” “Consumer culture” Increasing regulation of higher education

Population demographics

Increasing regulation of medical profession Increased accountability Resource constraints

“Austerity” Changing curricula

Increased service pressures

www.smerc.co.uk

Healthcare valued more highly than education “Those who can do; those who can’t…” Doctors paid more than teachers Increased healthcare funding “Austerity” Decreased education funding

Extensive use of ‘implied contracts’

Teachers do not feel recognised or valued

Faculty development Administration

Backgrounding teaching

Changing curricula Prioritization of patient care

Cascading communication Loss of agency Teachers do not feel recognised or valued

Changing curricula Population demographics “New management ideology” “Consumer culture” Increasing regulation

• f higher education

Increasing regulation

• f medical profession

Increased accountability Resource constraints Increased service pressures Prioritization of patient care

Reduced autonomy Measurable

• utputs

‘Public Service Values’

Implied contracts Teaching awards

Healthcare valued more highly than education “Those who can do; those who can’t…” Doctors paid more than teachers Increased healthcare funding “Austerity” Decreased education funding Changing curricula Prioritization of patient care (individual) Changing curricula Population demographics “New management ideology” “Consumer culture” Increasing regulation

• f medical profession

Increased service pressures Prioritization of patient care (organisation)

Teachers do not feel recognised or valued

Resource constraints Administration

Teachers do not feel recognised or valued

Increasing regulation

• f higher education

Teaching awards

Increased accountability

Measurable

• utputs

www.smerc.co.uk

Healthcare valued more highly than education “Those who can do; those who can’t…” Doctors paid more than teachers Increased healthcare funding “Austerity” Decreased education funding

Extensive use of ‘implied contracts’

Teachers do not feel recognised or valued

Faculty development Administration

Backgrounding teaching

Changing curricula Prioritization of patient care

Loss of agency Teachers do not feel recognised or valued

Changing curricula Population demographics “New management ideology” “Consumer culture” Increasing regulation

• f higher education

Increasing regulation

• f medical profession

Increased accountability Resource constraints Increased service pressures Prioritization of patient care

Reduced autonomy Measurable

• utputs

‘Public Service Values’

Implied contracts Teaching awards

Healthcare valued more highly than education “Those who can do; those who can’t…” Doctors paid more than teachers Increased healthcare funding “Austerity” Decreased education funding Changing curricula Prioritization of patient care (individual) Changing curricula Population demographics “Consumer culture” Increasing regulation

• f medical profession

Increased service pressures Prioritization of patient care (organisation)

Teachers do not feel recognised or valued

Resource constraints Administration

Teachers do not feel recognised or valued

Increasing regulation

• f higher education

Teaching awards

Increased accountability

Measurable

• utputs

“New management ideology”

Cascading communication

Programme director Module lead 1 Clinical teacher Clinical teacher Clinical teacher Module lead2 Module lead 3 Module lead 30 Clinical teacher Clinical teacher Administrative team

www.smerc.co.uk

Healthcare valued more highly than education “Those who can do; those who can’t…” Doctors paid more than teachers Increased healthcare funding “Austerity” Decreased education funding

Extensive use of ‘implied contracts’

Teachers do not feel recognised or valued

Faculty development Administration

Backgrounding teaching

Changing curricula Prioritization of patient care

Loss of agency Teachers do not feel recognised or valued

Changing curricula Population demographics “New management ideology” “Consumer culture” Increasing regulation

• f higher education

Increasing regulation

• f medical profession

Increased accountability Resource constraints Increased service pressures Prioritization of patient care

Reduced autonomy Measurable

• utputs

‘Public Service Values’

Implied contracts Teaching awards

Healthcare valued more highly than education “Those who can do; those who can’t…” Doctors paid more than teachers Increased healthcare funding “Austerity” Decreased education funding Changing curricula Prioritization of patient care (individual) Changing curricula Population demographics “Consumer culture” Increasing regulation

• f medical profession

Increased service pressures Prioritization of patient care (organisation)

Teachers do not feel recognised or valued

Resource constraints Administration

Teachers do not feel recognised or valued

Increasing regulation

• f higher education

Teaching awards

Increased accountability

Measurable

• utputs

“New management ideology”

Cascading communication

www.smerc.co.uk

Healthcare valued more highly than education “Those who can do; those who can’t…” Doctors paid more than teachers Increased healthcare funding “Austerity” Decreased education funding

Extensive use of ‘implied contracts’

Teachers do not feel recognised or valued

Faculty development Administration Changing curricula Prioritization of patient care

Loss of agency Teachers do not feel recognised or valued

Changing curricula Population demographics “New management ideology” “Consumer culture” Increasing regulation

• f higher education

Increasing regulation

• f medical profession

Increased accountability Resource constraints Increased service pressures Prioritization of patient care

Reduced autonomy Measurable

• utputs

‘Public Service Values’

Implied contracts Teaching awards

Healthcare valued more highly than education “Those who can do; those who can’t…” Doctors paid more than teachers Increased healthcare funding “Austerity” Decreased education funding Changing curricula Prioritization of patient care (individual) Changing curricula Population demographics “Consumer culture” Increasing regulation

• f medical profession

Increased service pressures Prioritization of patient care (organisation)

Teachers do not feel recognised or valued

Resource constraints Administration

Teachers do not feel recognised or valued

Increasing regulation

• f higher education

Teaching awards

Increased accountability “New management ideology”

Cascading communication Backgrounding teaching Measurable

• utputs

Top ten words by frequency:

1 learning 14385 2 students 12252 3 year 11410 4 education 10782 5 practice 10571 6 work 10345 7 take 10091 8 pass 8700 9 assessment 8368 10 paper 7990 … … … 16 teaching 7266

www.smerc.co.uk

Healthcare valued more highly than education “Those who can do; those who can’t…” Doctors paid more than teachers Increased healthcare funding “Austerity” Decreased education funding

Extensive use of ‘implied contracts’

Teachers do not feel recognised or valued

Faculty development Administration Changing curricula Prioritization of patient care

Teachers do not feel recognised or valued

Changing curricula Population demographics “New management ideology” “Consumer culture” Increasing regulation

• f higher education

Increasing regulation

• f medical profession

Increased accountability Resource constraints Increased service pressures Prioritization of patient care

Reduced autonomy Measurable

• utputs

‘Public Service Values’

Implied contracts Teaching awards

Healthcare valued more highly than education “Those who can do; those who can’t…” Doctors paid more than teachers Increased healthcare funding “Austerity” Decreased education funding Changing curricula Prioritization of patient care (individual) Changing curricula Population demographics “Consumer culture” Increasing regulation

• f medical profession

Increased service pressures Prioritization of patient care (organisation)

Teachers do not feel recognised or valued

Resource constraints Administration

Teachers do not feel recognised or valued

Increasing regulation

• f higher education

Teaching awards

Increased accountability “New management ideology”

Cascading communication Backgrounding teaching Measurable

• utputs

Loss of agency

Removing agency from teachers

“Proposals for curriculum change may arise … from the modules/ attachments within a Year”

(MBChB governance document, 2007)

“we will ask all modules to be specific about their expectations”

(MoT update, 2008)

“Every module will now be asked to draw up information to guide students’ learning”

(Committee report 2015)

“training materials have yet to be received from the Gastrointestinal module”

(Programme committee minutes 2017)

www.smerc.co.uk

Healthcare valued more highly than education “Those who can do; those who can’t…” Doctors paid more than teachers Increased healthcare funding “Austerity” Decreased education funding

Extensive use of ‘implied contracts’

Teachers do not feel recognised or valued

Faculty development Administration Changing curricula Prioritization of patient care

Teachers do not feel recognised or valued

Changing curricula Population demographics “New management ideology” “Consumer culture” Increasing regulation

• f higher education

Increasing regulation

• f medical profession

Increased accountability Resource constraints Increased service pressures Prioritization of patient care

Measurable

• utputs

‘Public Service Values’

Implied contracts Teaching awards

Healthcare valued more highly than education “Those who can do; those who can’t…” Doctors paid more than teachers Increased healthcare funding “Austerity” Decreased education funding Changing curricula Prioritization of patient care (individual) Changing curricula Population demographics “Consumer culture” Increasing regulation

• f medical profession

Increased service pressures Prioritization of patient care (organisation)

Teachers do not feel recognised or valued

Resource constraints Administration

Teachers do not feel recognised or valued

Increasing regulation

• f higher education

Teaching awards

Increased accountability “New management ideology”

Cascading communication Backgrounding teaching Measurable

• utputs

Loss of agency Reduced autonomy

Autonomy or direction?

“a named member of the staff of each module must be available by telephone during each sitting of the exam” “Sometimes teaching staff […] identify apparent gaps in the existing curriculum and wish to address these with some new teaching sessions, learning resources or even courses. Sometimes these are successful and usefully add to the curriculum.”

www.smerc.co.uk

Extensive use of ‘implied contracts’

Teachers do not feel recognised or valued

Healthcare valued more highly than education “New management ideology” “Consumer culture” Increasing regulation of higher education

Teaching awards

“Austerity”

Faculty development Administration Backgrounding teaching

Changing curricula Population demographics Prioritization of patient care Increasing regulation of medical profession Increased service pressures Increased accountability “Those who can do; those who can’t…” Doctors paid more than teachers Increased healthcare funding Decreased education funding Prioritization of patient care

Reduced autonomy Measurable

• utputs

Cascading communication

Resource constraints ‘Public Service Values’

Loss of agency

Extensive use of ‘implied contracts’

Teachers do not feel recognised or valued

“New management ideology” “Consumer culture” Increasing regulation of higher education

Teaching awards Administration Backgrounding teaching

Changing curricula Population demographics Increasing regulation of medical profession Increased service pressures Increased accountability

Reduced autonomy Measurable

• utputs

Cascading communication

Resource constraints

Loss of agency

Implied contracts

In summary:

The problem is complex and overdetermined Many of the causes are located at the societal level

BUT…

Small nudges in the right places could make a big

difference

5 ‘nudges’ that medical schools could make…

• 1. Reduce emphasis on ‘popularity contest’ awards
• 2. Increase focus on achievement-based recognition, attainable by all
• 3. Improve visibility of teaching and teachers in organisational discourse
• 4. Use more direct language and talk to teachers (or even about them!)
• 5. Put the people back in the picture!