WHAT HELP AND HINDERS DOCTORAL STUDY:VIEWS AND EXPERIENCES OF NON-MEDICAL CONSULTANTS
Dr Chris Inman Programme DirectorMSc in Advanced Practice at BCU
PRESENTATION OF THE MAIN FINDINGS
This session will present some of the findings and related literature from qualitative research exploring the motivations, experiences and practices of students involved with PhD/Doctoral study
The participants research tended to focus on psycho-social care questioning some medical approaches. Their populations included people with dementia; mental health problems long-term conditions; midwifery etc.
THE LITERATURE REVIEW
The literature review explored:
• Careers in the NHS for non-medical practitioners whose roles involve expert clinical practice; research; education; and leadership
• Part time doctoral study – the effect of PT study
• Influences on the progress of study
CAREERS IN THE NHS FOR NON-MEDICAL PRACTITIONERS
CONTEXT•‘’Super-nurse’’ (Making a difference DH 1999) Raising the glass ceiling for non-medical professionals - nurses, midwives and allied health professionals include physio; OT; SLT (600,000 registered nurses in UK)
•Doctors’ hours reduced ( EU Working Time Directive)
•Demographic time bomb and increase in complex conditions, technology and treatments
PART TIME DOCTORAL STUDY
The literature suggests:•Challenges implicit in part time PhD study cause dissonance and influence motivation (Wisker et al 2003)
•Students focus on supervisor’s support to reduce fragmented engagement with the research community
•Supervisors are said to prefer the ‘’ideal type’’ -full time student.
METHODOLOGY – A QUALITATIVE, EXPLORATORY
DESIGNThree research questions were identified:
What motivates senior practitioners to study at Pg level?
What is involved in undertaking and making progress with doctoral research?
What is the experience of family, home, work and university and what are the sources of support?
Method – focus groups of 6-10 senior practitioners and 6 individual interviews with women
MAIN THEMES
• Prove to myself
• Get a buzz
• The organisation
• Support
• Inequality
FINDINGS AND DISCUSSION
THEME ONE Participants proving themselves
‘’it is a personal strive to prove yourself to somebody’’ I don’t know if I haven’t to prove something to myself as well’’ (FG1)
‘’I’m more credible … wanted the challenge’’ (FG2)
Elements of obsessive behaviour have been previously noted by Rugg and Petre (2004)
PROVE TO MYSELF
‘’I’d like to say it’s all art, esoteric really but it can’t be can it because … you want to have the personal achievement …[as well as] the philosophy [But it’s] partly a selfish thing’’
If I’m really honest about this … because I left school with one ‘O’ level … I want to know whether I can work at that level, but I’m also interested in the subject’’
PROVE TO MYSELFThe acknowledgement of a ‘‘partly selfish
thing’’ is resonant of Gilligan’s (1989) feminist ‘‘morality of care and responsibility’’ where ideally women would be able to fulfil family responsibilities without sacrificing their own needs
The data suggests women are not prepared to openly acknowledge feminist inclinations and tend to adopt a covert feminist persona
Kohiberg’s ‘Morality of Justice’
Gilligan’s ‘Morality of care and responsibility’
Feminine carer Feminist carer
Based on western positivistic tradition of reasoning – responding to others
Conflicting responsibilities interpreted as moral dilemmas
Non-medical consultants’ self blame for selfishness in doing study
Non-medical consultants resisting the male dominant trend - adopted autonomous, independent behaviour
Participants relationship to feminine and feminist carers Source Hughes (2002) adapted
PROVE TO MYSELFAnother stated ‘‘I’ve always had issues about
how bright I think I am’’. ’’A rare-ish kind of thing …make me feel I’ve really pushed myself to the limits’’
Leonard (2001:7) suggests women are disadvantaged because ‘’the curriculum and pedagogy’’ are not set by women
To some extent the women are surprised to find themselves studying at this level
Ingliss (1998) writes of women’s gender constraints that result from the gender socialisation process
PROVE TO MYSELF
Research focusing on a stigmatised population
‘’This will make a big difference to the way people will view the client group that’s the big motivator probably 50%, the rest is personal …’’
A synergy between intrinsic and extrinsic motivators can be noted in participants with personal and professional satisfaction which suggests ‘self-actualisation’ and even ‘transcendence’ when insights lead to optimal progress (Maslow and Lowery 1998:6)
GET A BUZZClear indications emerged of immersion in research, being inspired, being consumed, driven, proud, possessive and controversial these can be equated with the research ‘high’
’’Well I’m doing a PhD, I think the reason that I did it, I really enjoyed my master’s, loved doing the research and really get a buzz out of doing the research…’’
GET A BUZZ
One new NMC was on the brink of enrolling ‘’This new post … that’s woken me up … I’m
beginning to get itchy to do something else ‘’
There are numerous ‘’how to survive a thesis’’ type books but few feature enjoyment … this leads towards the most positive finding and suggestion that the most rewarding aspect of non-medical consultants role – that of ‘working on the research’ and ’getting a buzz’’
GET A BUZZOne person later left her job to prioritise her research
’’I want to do this thing … (speciality) was my sort of passion, that and the practice development. I’m inspired to almost try and prove some of the key (medical) research is wrong. It is fascinating … For me, consumed because your doing it’’
Abercrombie (1993) indicates that following initial resistance to change, learning that engages and challenges the student can emancipates them from their previous thinking
GET A BUZZAgain the conviction ‘’There is none over and
above the piece of research I’m doing, that’s one of the buttons that inspire me’’ to improve care
Mezirow’s (1978) ‘transformational influences’ involves being open minded and ‘letting go’ to relinquish some basic values and assumptions used to function previously. It introduces uncertainty which initially can be unwelcome until ‘insights’ occur and it can promote inspiration
GET A BUZZ
‘’Feeling everything else is under control… feeling well… having the place to myself… being able to write or think’’
‘’You can’t switch on and off … but once your on a roll … it’s a pain when you think… I can’t really stop now, you've got to keep at it ’’
‘’Capturing them before you lose them is the thing’’
‘’But there are some days when I sit down thinking I can’t do this today’’
HESA part time study – completions had declined
DOCTORATE QUALIFICATIONS OBTAINED BETWEEN 1995 AND 2006 BY UK RESIDENTS
(HESA)
Source HESA January 2008
Type of student
1994/1995
1999/2000
2000/2001
2005/2006
1 Full time 1,385
2,450 10,515 12,950
2 UK domiciled 800 1,490 6,400 7,215
3 Female 243 680 2,665 3,355
4 Male 557 810 3,735 3,865
5 Part time 6,174
9,100 3,605 3,565
6 UK domiciled 4,169 6,090 2,740 2,650
7 Female 1,399 2,400 1,155 1,215
8 Male 2,770 3,600 1,585 1,435
Data Regarding Doctorate Qualifiers from HESA (2008)
•Full-time doctorate qualifiers men and women of UK domiciled people had increased nine fold with 800 in 1994/5 and 7,215 in 2005/6
•A greater increase is shown for full-time women with a fourteen fold increase from 243 qualifiers in 1994/5 and 3,325 in 2005/6
•Part-time doctorate qualifiers men and women shows a substantial decline with 4,169 in 1994/5 and 2,650 in 2005/6
•However only a small decline has occurred for part-time women with 1,399 in 1994/5 and 1,215 in 2005/6
GET A BUZZ
’’It goes in fits and starts … I’m actually taking my study leave in blocks’’
’’It’s a hard slog … you make sure you pick a subject that you feel really passionate about or you’re not going to survive’’
Gilligan (1989) critiques the feminine model because it is a ‘world apart, separated politically and psychologically from the feminist model which depict a realm of individual autonomy’’. These women’s quotes can be linked with feminism … but they tended to deny this
GET A BUZZThe participants tended to identify with a
feminine code claiming to prioritise all family concerns and close relationships.
Their behaviour however was more reflective of feminism and had the potential to create conflict due to:
• Ruthlessness and single mindedness to progress with their part time thesis
• The need for self-fulfilment and reward
THEME THREE - THE ORGANISATION
A paradox emerged in that managers assumed non-medical consultants needed to study at doctoral level and this provided kudos for the trust so they automatically paid fees BUT made little commitment to protecting study time
• ’’There’s no infrastructure … no tradition, no understanding of what [time] is needed’’
• ’’Just being registered is actually not a lot of good’’ and another said ’’ I’ve had my fees paid’’
• ‘’There’s nothing on trust policy [about time] it only goes to Master’s level’’
Erdman (2005) expressed concern about study time for nurses
THE ORGANISATIONThere was a general assumption the doctoral study would be beneficial both personally and professionally
’’Expectation at work … needed for my own [academic] credibility, status, confidence to facilitate others’’
Jonathan (1997) suggests in education can provide an ’’illusion of freedom’’
If the thesis provided an ‘illusion of freedom’’ it rapidly became apparent that it was an illusion when the reality within the organisation became apparent
THE ORGANISATION Another participant said ’’We’ve got to differentiate … we’re getting more
and more nurses with masters…’’
’’They (doctors) certainly wouldn’t value the fact that you weren’t on the ward and you were swanning off to do a PhD’’
Alvesson(2002) advocates being wary of judging
complex ‘organisations as homogenous on a limited number of values’ arguably for these participants the policy was consistently minimal but homogenous across employing trusts
ORGANISATION
The vast majority of participants were convinced of the merits of education for their work
‘’The highest academic accolade’’
’’Any education the I have done in the past or any sort of development has made me better at what I’m doing’’
This can be challenged from a critical theorist perspective. The recent shift by governments to treat education as a marketable commodity to be distributed and consumed causes concern that ‘knowledge would cease to be an end in itself’ (Lyotard 1994:5)
1st Essential to progress Support from family
Guidance from supervisor
2nd Accessibility highly valued
Other Non-medical consultantsColleagues
3rd Of decreasing importance as the thesis became established
University peers
THEME FOUR SUPPORT Relationships and guidance – importance to students
SUPPORT - FAMILY Family were generally viewed as important for support
’’My partner understood my ideas and that was really important’’
’’Inspirational but not in the sense of a figurehead … if you say that’s a load of [rubbish] somebody is going to get upset’’
Conversely some less welcoming attitudes were also reported from partners
’’You’re not going up there [university] again?’’’’My husband is picky and he’ll criticise … I can
feel myself bristling’’
Valued comfort zone and different types of family support
Over-supportive Interest and positive critique Unwelcomed reader and critic-----------------------------------------------------------------------------------------------------------------Threat to ownership Valued comfort zone Causing ‘bristling’
SUPPORT – FRIEND OR FOE The power balance with supervisors changed
with individuals and over time’’My second supervisor had what I would call a more
traditional viper type supervision approach whereas my first was what I would call a critical friend’’
’’I felt them advocating their particular approaches … and I found that annoying because I knew what they were doing … after a while I said I wanted to change the way we were working… now I actually enjoy the joint supervision’’
The students were astute observers and the process was dynamic but there was an assumption that changing supervisor needed to be avoided
FINALLY INEQUALITY
The participants considered that a hierarchy existed enabling some practitioners in the health service to have greater access to protected study time
At the peak were doctors, next came scientists, AHP and finally nurses and midwives
The inequality was verbalised in various ways one participant’s perception was summarised as:
’’Your only a nurse … not a real PhD’’
Coats (1994) suggests that a backlash is experienced when the position of women is considered to have been advanced
This ties in with Foucault theory of gender and power
GENDER ISSUES FOR NON-MEDICAL CONSULTANTS
FOUCAULT’S (1984) THEORY OF GENDER AND POWER
Predominantly female health care practitioners’ senior roles Advanced and Non-medical consultants slowly becoming established in the from 1993 until the present
Western developed nations with gender centred conflict
Non-medical consultants consider individual are blocking progress with their thesis rather than joining forces to influence change to the national system
Inequality struggles – tend to focus on the immediate local enemy
Non-medical consultants striving for status and credibility with thesis work but concerned it may be deemed ‘only a nursing PhD’
Gender struggles focus on the effect of power associated with privilege
RECOMMENDATIONS INCLUDE
National group action would strengthen support for doctoral study and especially protected study time
Universities prepare new and potential students for the complexity of emotional response from partners, family and colleagues
Alert managers to the contradictions involved in paying fees but not protecting study time
Dissemination through conferences and publication
THANK YOU!
Any Questions?
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