On the education of nurses (in the USA) --and parallels

I know that some readers are in nurse education, so you might be interested in this new report from the Carnegie Foundation for the Advancement of Teaching, in the USA [link from post title]. It parallels in some respects the plan for nursing to become an all-graduate profession in England by 2013. That proposal has been met with some scepticism in the UK.

It does seem that what Etzioni (1969) called the "semi-professions" have been making strenuous efforts in the latter half of the last century to enhance their status. As the citation below shows, he identified teachers, nurses and social workers as the main semi-professions, although since he was writing there are many more candidate occupations. I used to teach social workers, and more recently I have been teaching teachers, among whom have been nurses taking what the Nursing and Midwifery Council terms a "Recordable Teaching Qualification"--so I have a certain amount of knowledge in the area.

When I first taught in a primary school in the early sixties, some of my colleagues had only one year's training, or indeed higher education; they were known as "Emergency Trained" in a scheme developed in the aftermath of WW2 particularly to replace the large numbers of male teachers lost to the occupation. The norm was two years (although there was one teacher on the staff, apart from myself, who was quite untrained). Graduates did not have to be trained.

The first social work course I taught on was just a year long, with no specific entry requirements other than at least six months experience in residential child care. When I moved on from social work education, the Diploma in Social Work was just two years long, but in practice only taken by mature people (in age, at least) with some prior experience. The standard qualification has only been an undergraduate degree for a few years. Strangely at my former institution it is a Bachelor of Science award. Recently, (December 2009) the Social Work Task Force has reported, recommending the equivalent of a probationary year for newly-qualified staff, with extra support and supervision and the estbalishment of a National College for Social Work (presumably to replace the National Institute for Social Work which was closed in 2003...)

And nursing is now either a Diploma or Degree qualified profession, in both cases following a three year course. It moved from being work-based training with study blocks to coming under the auspices of universities in a programme called "Project 2000" from 1992 onwards. This was itself influenced by practice in the USA.

So what?

The first point is that as the fully-qualified staff have moved up the professional scale in each occupation, much of what they used to do has been taken over by lowlier and less-trained people. So much of the routine activity in nursing (and crucially the long-term and continuing patient contact) is now undertaken by Health Care Assistants, whose basic qualification is at National Qualifications Framework (NQF) level 3. Classroom Assistants have become increasingly important in schools, they may have minimal training or be relatively well-qualified with a Foundation Degree; from being primarily concerned to help children with special educational needs, their roles have become broader to the extent that the may be asked to "deliver" lessons using material prepared by a "proper" teacher. And social work has always relied heavily on an army of poorly-paid residential or domiciliary care assistants, nursery nurses and others often with very basic National Vocational Qualifications. So a caste division is established.

Of course, the fully-qualified staff cease to be direct practitioners--they become supervisors and managers. And because of the  institutional anxiety engendered by the fact that direct "user" contact is increasingly undertaken by under-qualified staff, the quality assurance procedures have to be tightened which means that the qualified staff spend even more time in their offices dealing with paperwork... There is also a view which may or may not be legitimate that the new generations of highly-qualified staff are coming to see direct contact, particularly of a routine and even menial kind, as "beneath them".

And... Many commentators have made the point that raising the bar for the final qualification is likely to entail raising entry requirements and thereby excluding  many potential candidates from under-represented groups. I'm not entirely convinced by this argument. Further and higher education institutions are in practice going out of their way to create ladders through sub- and para-professional qualifications to full professional recognition. And--purely on the basis of prejudicial respect for dozens of people I have had the privilege of guiding to that recognition--I need actively to be persuaded that people following this route are not the very best all-round practitioners in their fields. Their commitment, stamina, and practical experience (tempered perhaps by their toleration of being taught by prats like me--putting up with that is not  a commendation)! ...does not merely add--it multiplies their practice wisdom.

But. From a different angle--

What is happening to those left behind?

Policies of social mobility which encourage able people to transcend their origins are great. Up to a point...

• in a norm-referenced world, for everything which goes up, something must go down.
  
  
• Gramsci (1971) (Italian marxist theorist imprisoned by Mussolini) was concerned about the development of "organic intellectuals" among the working class. Roughly, "traditional intellectuals" are people who think of themselves as such; organic intellectuals are people who undertake intellectual work without recognising themselves or being recognised by others. Gramsci argued that organic intllectuals were a by-product creation of the ruling classes, but that they also had counterparts "embedded" as we should now say within the working classes, in voluntary and community groups, in unions, in churches (not sure where he stood on religion) and families. In his view it was vital that they be enlisted to lead the revolutionary struggle.
  
  
• The problem from this perspective is of course that educationally-promoted social mobility may be seen as "creaming off" the working-class organic intellectuals, thereby leaving working-class communities leaderless and even more disenfranchised than before; hence, it may be argued, "sink estates" and so-called "broken Britain" (and perhaps vulnerability to right-wing demagoguery), as opposed to Hoggart's account of pre-WW2 working-class life in "The Uses of Literacy" (1957).
  
  
• The rise of the semi-professions fits into this argument because of their accessibility to aspirants.

Push the argument further (perhaps too far?) and it suggests that raising the bar for the semi-professions does not enhance but undermines not only the quality of the service they offer, but also the quality of life of a large proportion of the population...

Discuss!

Etzioni, A. (1969) The Semi-professions and their Organisation: Teachers, Nurses and Social Workers, New York: Free Press


Hoggart, R (1957) The Uses of Literacy; Aspects of Working Class Life London; Chatto and Windus

On the evolution of dumbing-down

There is a political/commercial side of the alleged process of dumbing-down--the pressure for greater "achievement" rates, etc. But there is also a logistical side, a trivial equivalent of the "banality of evil" demonstrated in the Eichmann trial... Just how does it work?

When I started to create my site on learning, I explicitly set out to address "An introduction to theories of learning for college, adult and professional education" I found that in order to discuss key ideas of assimilation and accommodation, I needed to mention Piaget. But he was primarily a developmental psychologist.

So he was interested in the unfolding potential of the child. I was concerned with its product in the adult, but I needed to sketch in a simplified account of his view of the developmental process, on another page, and just for completeness...

This has become the most viewed page on the site, much to my annoyance!

What happened? There is no agreed way to tag for academic level, on the web... Searchers have latched onto a much-distilled account of an idea, and reproduced it because it has been the most immediately comprehensible account. That was fine for my target audience for whom it was a side-show, but not to be presented as a definitive account.

And web-searchers do tend to stop at, and believe, the first few instances of the search result. But what has now begun to happen is that I am being approached by authors and publishers with requests to reproduce part of the page in text-books they are working on. So for some readers, this diluted version of Piaget's developmental sequence is acquiring an authority it certainly does not deserve, and I perhaps a reputation for over-simplification.

In my present revision I am inserting a caveat on the page, and I have also taken to declining some of the requests; I hope that helps.

On less being more at Master's level

I have been on a validation panel today, grappling with the problem of how to specify modules at Master's level. It was very instructive.

The team developing the programme had understandably assumed that outcomes for a Master's level module would have to be more tightly specified than for a lower level course, in order to ensure that the learning and the assessment would be at greater “depth” than for an undergraduate module.

First, though, it is quite easy to specify “learning outcomes” for low-level courses. When people are learning the basics of any subject or skill, what any one person learns will have to be the same as any other learner. It's easy to assess, and “correct” knowledge or performance is clear-cut. It's not so easy at higher levels. Knowledge and “understanding” (not to mention, for those who care, the higher regions of Bloom, or Krathwohl and Anderson) may be contestable, and indeed one person's understanding or “take” on the subject may quite legitimately be different from their neightbour's. So when you get to Master's level it may be reasonable to specify that the outcomes will include so-and-so, but it may well be patronising and simply counter-productive to presume to set them out completely and exhaustively.

Even so, how do you incorporate the academic level requirements into the outcomes? It's traditional to use all those recommended “Bloom verbs” to produce “SMART” objectives. (What's the difference between an objective and an outcome, in this context? Strictly between ourselves, I no longer have to pretend that I know, and I don't care.) So the first-year students “list” or “describe”, the second-years “analyse” and the third-years “evaluate”... So Master's students? They “critically evaluate”, it seems. (That means in practice that they evaluate on the basis of one or more over-arching frameworks, showing that there are no simple answers.)

That is fair enough but it does risk becoming formulaic, and also implying that there is a correct procedure for doing it. The more specific the directions, the more restricted the outcomes, and the less the scope for the exercise of individual initiative and creativity (if that is desirable in your discipline, of course!) Master's students are experts, or at least nearly there. They need to be given their heads rather than constrained. (I am referring mainly to experienced practitioners of their discipline undertaking Master's study part-time, here; I am aware that full-time “second cycle” students who were undergraduates last year may not fit this picture.)

Personally I would rather just set out the aims of the module just so the students know what they are letting themselves in for, and recognise that the outcomes will be different every time it runs, and different for every participant. But that won't wash in the compliance climate where standardisation is all. So what can we get away with?

(Specify the level and assessment criteria at a scheme/programme level so you don't have to do it at a module level)

"On completion of this module, participants will (I prefer “participant” to “student” at this level);

• Come to their own informed conclusions about the significance of...
• Explore ... in the context of ...
• Use ... as the basis of original work on ...

Or have I got it wrong?