Developing rational prescribing competence in medical school : an investigation of the relation between student perceptions and examination performance.

Prescribing medicines is the primary intervention that most doctors offer to influence their patients’ health; however concerns have been expressed about the extent to which graduates are prepared by medical schools to assume prescribing responsibility. Both students and clinical teachers have identified a gap between workplace prescribing demands placed on newly qualified doctors and their preparation for this complex activity during undergraduate training. This study explored the exit-level prescribing performance of final-year students in the Graduate Entry Medical Programme at the University of the Witwatersrand compared with students’ perceptions of their prescribing competence. The results indicated a disparity between students’ competence and confidence. Examination marks showed that 83.6% of students were competent to prescribe according to the graduating standards of the University; however, questionnaire data revealed that 66% of students did not feel that their training had enabled them to prescribe rationally. This inconsistency was explored by analysis of the examination papers according to Bloom’s Revised and the SOLO Taxonomies. It was concluded that students score well on questions which test recall and application of knowledge, but some do not manage questions involving evaluation. Since prescribing is a complex skill that requires evaluative competence, this may explain why, despite high examination scores, students remain insecure. Exploration of the structure of knowledge through a Bernsteinian lens revealed that curricular components including problem-based learning and horizontal integration constrain epistemic access to the structure of rational prescribing knowledge for some students. It is recommended that rational prescribing skills should be taught as a synchronous strand within the curriculum, rather than in the current integrated mode. Learning could also be improved by innovative pedagogies associated with active learning and improved feedback

Options, quasi options, and the opportunity to develop a resource of environmental value

Faced with the choice between preserving and developing a natural resource in the presence of uncertain environmental externalities, the social return to undertaking development is stochastic. When development is irreversible and the decision-maker can defer commencement, there is value to new information that is revealed over time which reduces the uncertainty about the externalities. The assessment is therefore one of how much to develop and when to begin development. This approach to the problem differs from conventional cost benefit analysis and optimal extraction models. The former asks the question of whether to invest a given amount and the latter asks how much is optimal to invest. In this paper a model is developed which identifies both the level and timing of investment which are socially optimal. The solutions are found using optimal stopping techniques a single stochastic state variable, environmental cost and two control variables, timing and scale of development. Initially, the problem is solved for an omnipotent social planner, who makes the time and scale decisions. This is followed by consideration of cases in which one or both decision variables are controlled by private decision-makers. As expected, it is shown that private optimal level of investment exceeds that which is socially optimal. We find that if the social planner can control only investment timing then for levels, which exceed the social optimum, it will pay to wait for environmental costs to fall below the level corresponding to the social optimum. Conversely, level of investment which are low relative to the social optimum, may never generate sufficient private returns to offset the increment to environmental cost. The antecedents to this work are found in the environmental economics literature on quasi-option value and in the finance literature on options and investment

Bard Observer, Vol. 10, No. 10

https://digitalcommons.bard.edu/observer/1491/thumbnail.jp

Face-to-face language learning at a distance? a study of a video conference try-out

Videoconferencing has been proposed as a technology which has an immediate and beneficial application to language learning, because it enables face-to-face communication at a distance. The costs remain high, however, and course providers need to be sure what additional 'pedagogical overheads' are involved, i.e. in the rethinking of teaching approaches and the preparation of material. This paper reports on a study of a videoconference tutorial carried out as part of the distance learning component of a course in Professional English. The study shows that the interaction between teacher, subject expert and students was characterised by the absence, as well as the presence, of important features of face-to-face communication, and that certain kinds of tutorial activity, such as individual correction, and the management of group discussion, were not especially well supported by the technology used. We discuss the implications of this for the pedagogy of language teaching by videoconference, and draw some lessons for the incorporation of the technology into the mainstream of distance language learning