Recognizing Relational Interactions with Social Institutions in Refugee Children's Experiences of Intertwining Vulnerability and Agency.

In this paper, we examine relational interactions between refugee children and social institutions, building the case for the recognition of the co-occurrence and intertwining of vulnerability and agency in children's experiences in diverse refugee situations. This developmental relational approach offers refinement of a general relational worldview by specifying how vulnerable and agentic experiences are co-constructed by children and adult individuals and institutions. We analyze the conceptual roots of vulnerable and agentic experiences, and use the concept of co-construction to specify the processes and outcomes of interactive relational experiences. Evidence from example studies of the intertwining of vulnerability and agency in specific refugee situations demonstrates how refugee children contribute to power-oriented experiences. Due recognition of the relational co-construction of intertwining vulnerable and agentic experiences provides a basis for refining generalized relational observations, and a fine-grained basis for developing policies and procedures to dispel ambivalence to refugee children and to change inequitable policies and practices.

Perspectives and feelings of refugee children from Syria and Iraq about places and relations as they resettle in Australia.

Refugee children's experiences are situated in specific places where they interact with significant people. They are not usually asked about their perspectives although they are social agents with distinctive perspectives and feelings about relationships and events. We investigated the perspectives of refugee children on their experiences of places and relations as they resettled in Australia after their families fled from violence in Syria and Iraq and transitioned through Middle Eastern countries. One hundred-and-nine children chose to work with a computer program in either English or Arabic. They sorted feelings associated with home, school, and where they lived before and rated being nurtured at home. Hierarchical cluster analysis revealed five subgroups of children with distinctive patterns in their sorting of eight feelings for three places. Three subgroups had patterns of positive feelings about home and school. Two smaller subgroups had mixed, ambivalent feelings about either school or home. One subgroup was strongly positive, and two others were negative about before settlement. Subgroups identified on their sortings of feelings differed in their experiences of being nurtured, with positive feelings of places related to higher ratings of being nurtured at home. The study points to the importance of children's perspectives and feelings in how they interpret experiences with people and places and argues against assuming that refugee children are homogeneous in their experiences or perspectives.

Ambivalence towards the Protection of Refugee Children: A Developmental Relational Approach.

In this paper we analyze the contemporary ambivalence to child migration identified by Jacqueline Bhabha and propose a developmental relational approach that repositions child refugees as active participants and rights-bearers in society. Ambivalence involves tensions between protection of refugee children and protection of national borders, public services and entrenched images. Unresolved ambivalence supports failures to honor the rights of refugee children according to international law and the UN Convention on the Rights of the Child. There is failure to protect and include them in national public services and in international coordination of public health and wellbeing. We identify misrepresentations of childhood and refugeeness that lie behind ambivalence and the equitable organization and delivery of public services for health and wellbeing. With illustrative studies, we propose a developmental relational framework for understanding refugee children's contributions in the sociocultural environment. Contrary to the image of passive victims, refugee children interact with other people and institutions in the co-construction of situated encounters. A developmental relational understanding of children's 'co-actions' in the social environment provides a foundation for addressing misrepresentations of childhood and refugeeness that deny refugee children protection and inclusion as rights-bearers. We point to directions in research and practice to recognize their rights to thrive and contribute to society.

Toward a Psychology of Resistance.

Resistance is all around us in contemporary life. It is an everyday phenomenon of personal and cultural life, as the Chaudhary et al. (2017) volume establishes with theoretical analyses and empirical examples from diverse cultural contexts. Resistance functions in the dynamics of person-by-culture encounters when one party takes an opposing position. With the purpose of working towards a unified approach to resistance, the authors in this volume lay down the foundations for a psychology of resistance as an everyday phenomenon. As a basis for analyzing the role of resistance in the dialectical processes of change, the volume presents resistance as: personal and social, oppositional, intentional and future-oriented, transformational and developmental. We see different positions opening up a debate about whether resistance is a particular, intentional and oppositional phenomenon, or is the basic process of all dialectical transformational change. Further resistance to either position is consistent with moving forward in the development of a psychology of resistance.

Conducting patient assessments as a medical student: frequency, barriers, and facilitators.

BACKGROUND: Opportunities for medical students to engage in deliberate practice through conducting patient assessments may be declining, but data on the numbers of patients assessed by students during training are lacking. PURPOSES: The study described relationships between the frequency of patient assessments, student confidence, belief they had seen sufficient patients, and their perceptions of barriers and facilitators of seeing patients. METHODS: We employed survey methodology to estimate the number of patient assessments conducted across 6 rotations in the 1st year of clinical training, gather ratings of confidence and student belief they had conducted sufficient patient assessments, and barriers and facilitators of seeing patients. RESULTS: Rotations focused on general medicine and surgery provided more opportunities for patient assessments than specialist rotations (all p < .001). Students conducting more than 10 patient assessments rated confidence in conducting patient assessments and belief they had seen enough patients for their clinical learning, higher than students who saw 10 or fewer patients (all p < .001). CONCLUSIONS: Our study demonstrated variation in the frequency of patient assessments, and weak relationships between numbers of assessments, student confidence, and barriers to seeing patients. Further investigation is warranted of the impact of fewer opportunities for deliberate practice of skills for expertise development.

Working with young people: evaluation of an education resource for medical trainees.

AIM: Many health professionals report interest in consulting more effectively with young people but have unmet training needs. We set out to evaluate a teaching resource in adolescent health and medicine that was designed for Australian trainees in specialist medicine. METHODS: Thirty-two paediatric and adult trainees of the Royal Australasian College of Physicians completed a pre-evaluation questionnaire to assess attitudes and confidence in working with young people. They were then provided with a training resource and, 6 weeks later, completed a post-evaluation questionnaire. Repeated-measures anovas were used to assess changes in attitudes, self-reported knowledge and confidence by trainee type. χ(2) -tests were used to compare variation in the use of and opinions about the resource. RESULTS: Trainees' awareness of the health issues that affect young people, confidence in working with young people and confidence in their knowledge greatly improved after using the resource. Beforehand, adult medicine trainees scored lower than paediatric trainees. A relatively higher rate of improvement resulted in similar scores between trainee types after using the resource, which was rated equally highly by the different groups of trainees. CONCLUSIONS: As a result of significant gains in the confidence of specialist medicine trainees after access to the resource, it will now be made available for Australian trainees in specialist medicine.

Clinical assessment performance of graduate- and undergraduate-entry medical students.

BACKGROUND: Recent evidence suggests that graduate-entry medical students may have a marginal academic performance advantage over undergraduate entrants in a pre-clinical curriculum in both bioscience knowledge and clinical skills assessments. It is unclear whether this advantage is maintained in the clinical phase of medical training. AIM: The study aimed to compare graduate and undergraduate entrants undertaking an identical clinical curriculum on assessments undertaken during clinical training in the medical course. METHODS: Clinical assessment results for four cohorts of medical students (n = 713) were compared at the beginning and at the end of clinical training for graduate and undergraduate entrants. RESULTS: Results showed that graduate- and undergraduate-entry medical students performed similarly on clinical assessments. Female students performed consistently better than male students. CONCLUSION: The findings of this study suggest that any academic performance advantage held by graduate-entry medical students is limited to the early years of the medical course, and is not evident during clinical training in the later years of the course.

First-year medical students' willingness to participate in peer physical examination.

BACKGROUND: There is little research on student attitudes toward participating in peer physical examination (PPE). PURPOSE: This study explored first-year medical students' attitudes toward PPE and their willingness to participate in PPE before they had experience with PPE as part of their course. METHODS: First-year medical students (n = 119) rated their willingness to participate in PPE for 15 body regions, with male or female peers, and when examining or being examined by others. Attitudes toward participating in PPE were also assessed. RESULTS: Low-sensitivity examinations (e.g., hands, head) in PPE were generally accepted by male and female students. Significant variation in willingness across different body regions was, however, evident for male and female students depending on the type of examination and their examination partner's gender. Students generally held positive attitudes toward participating in PPE as part of the course. Moreover, students with more positive attitudes provided higher ratings of willingness to participate in PPE for all examination types. CONCLUSIONS: Findings suggest high levels of willingness to participate in PPE for low-sensitivity examinations of the kind employed in university teaching contexts. Nonetheless, gender effects appear more complex than previously described, and for some regions of the body, there are subtle preferences for particular examination types, in particular performing examinations, rather than being examined.

Three approaches to the disjunction between psychological measurement and psychological persons: methodological and ethical considerations.

In this paper, we take forward Schwarz's (2009) disjunction between measurement-apparatus-questionnaire and measurement-apparatus-man to examine how the crisis in contemporary psychology is related to assumptions about two sets of connections in research: connections between research tools, research behaviours, and psychological phenomena; and connections between researchers and researchees. By setting up a research problem with methodological and ethical implications, we describe three approaches that involve different assumptions and research activities in relation to the ways each makes these connections: Disassociated, Conventionally Connected and Persons in Dialogue Approaches. We argue that a Persons in Dialogue Approach is the most appropriate approach for a 21st Century psychology in crisis.

Comparing the academic performance of graduate- and undergraduate-entry medical students.

OBJECTIVE: This study compared the academic performance of graduate- and undergraduate-entry medical students completing the same pre-clinical curriculum and assessment at a large metropolitan university. Arguments have been made for the relative merits of both graduate- and undergraduate-entry medical programmes. However, data on the academic performance of graduate and undergraduate entrants are relatively scarce. METHODS: This retrospective study adopted a quasi-experimental design to compare data from assessments of bioscience knowledge and clinical skills undertaken across 2 years for four cohorts of medical students (who commenced their studies between 2002 and 2005). Percentage final results for four bioscience knowledge subjects and four clinical skills assessments (based on objective structured clinical examination [OSCE] results) were compared for 240 graduates and 464 undergraduates using multivariate analysis of variance (manova). RESULTS: Graduate-entry students performed marginally better than undergraduate-entry students on all four bioscience knowledge assessments (partial eta-squared [n(p)(2)], n(p)(2)=0.04) and also on early clinical skills assessments (n(p)(2)=0.06). CONCLUSIONS: Graduate-entry students had a marginal academic performance advantage during the early years of this medical course. Most graduate-entry students had a first degree in a science discipline; thus their advantage may be explained by prior bioscience knowledge. Their performance advantage in clinical skills is less easily attributed to prior learning. Instead, this result provides some evidence for a possible advantage related to age. The marginal differences in early academic and clinical performance probably suggest that both graduate and undergraduate entry should exist in parallel to preserve multiple points of entry to the medical profession.

Teaching pharmacology to medical students in an integrated problem-based learning curriculum: an Australian perspective.

The world-wide move away from the didactic teaching of single disciples to integrated Problem-based Learning (PBL) curricula in medical education has posed challenges for the basic sciences. In this paper we identify two major challenges. The first challenge is the need to describe a core disciplinary curriculum that can be articulated and mapped onto the new structure. We illustrate how the British Pharmacological Society (BPS) Guidelines are used to evaluate the curriculum coverage in the medical course at The University of Melbourne. The second challenge is to ensure that foundational concepts are given adequate emphasis within the new structure, and in particular, that students have the opportunity to pursue these concepts in their self-directed learning. We illustrate one approach to teaching important pharmacological concepts in an integrated curriculum with a case study from the first year curriculum at The University of Melbourne. Finally, we propose the features of an integrated curriculum that facilitates the learning of basic pharmacology in a situation where PBL and integration sets the curriculum framework.

The transition from knowing to doing: teaching junior doctors how to use insulin in the management of diabetes mellitus.

OBJECTIVE: To develop and evaluate a short education programme to improve the skills and confidence of junior doctors in managing the glycaemic control of inpatients with diabetes mellitus. METHODS: A total of 15 junior doctors completed two 1-hour workshops on the practical skills required to manage the glycaemic control of insulin-treated patients. The workshops were based on simulated case scenarios presented in a workbook format. Pre-workshop performance and levels of confidence were tested, using a set of tasks matched to the learning objectives. Participants were re-tested immediately after the second workshop and again after 3 months. RESULTS: There was a significant overall effect for time of testing for performance and confidence considered together, F(4,11) = 12.67, P = 0.000, power = 1.00. The mean score for performance for the intermediate and 3-month post-tests combined was significantly higher than the mean performance score for the pre-test (11.00 < [17.53 + 15.80]), t(56) = -6.50, P = 0.000 (95% CI -6.15, -3.10). The mean score for confidence for the intermediate and 3 month post-tests combined was higher than the mean for the pre-test (13.20 < [15.33 + 15.20]), t(56) = 2.95, P = 0.011 (95% CI 2.19, 0.46), although this result must be treated with caution. CONCLUSIONS: A brief educational intervention can improve and maintain the performance and confidence of junior doctors in managing patients with insulin-treated diabetes in a simulated environment.