An Investigation into the Experiences of Non-Graduates Undertaking Masters’ Courses

1. An Investigation into the Experiences of Non-Graduates Undertaking Masters’ Courses Gail Louw1, Dave Baker2, Carmel Keller1 1Institute of Postgraduate Medicine, Brighton and Sussex Medical School, Brighton, UK 2Institute of Education, London, UK

2. Introduction • Background • Literature Review • Methods used • Findings • Discussion • Conclusions/Recommendations

3. Background • Health professions need CPD • Undergraduate / postgraduate choice • IPGM – 16 courses • 3 programmes: Clinical Specialties, Public Health, Professional Development • Student population: 50% doctors, 25% non graduates

4. Literature Review • Very little evidence • Cohen et al (2005) – paucity of lit on Masters programmes for medical/health professionals • Luke (1998) discussed habitus and identity • Lahiff (2005); practitioners’ journey towards understanding academic practices • Coombs (2005); mentoring, action research, critical thinking sustained practitioner research through reflective practice

5. Conceptual/theoretical framework • Academic practices • confidence with reading, writing, interactions, development of critical thinking • Habitus • participants’ expectations, habits, skills, values, beliefs and other aspects essential to his/her social identity • Pedagogical approaches • styles of assessment, access to resources, institutional support systems, time, personal circumstances, and support in the workplace • Student Diversity and Background Knowledge • valuing the diverse experience participants bring to cross disciplinary programmes

6. Ref • Cohen R, Murnaghan L, Collins J, Pratt D 2005 “An update on master's degrees in medical education” Medical Teacher Volume 27, Number 8 (December 2005) pp: 686 – 692 • Coombs S, Fletcher S 2005 “Mentoring, action research and critical thinking scaffolds: promoting and sustaining practitioner research through reflective practice”. Paper presented at the British Educational Research Association Annual Conference, University of Glamorgan, 14-17 September 2005, pp. 18. • Lahiff A 2005 “Developing academic writing: a case study of post-compulsory practitioners personal and professional development” Journal of Vocational Education and Training, 2005, vol. 57, no. 3, p. 275-292, ISSN: 1363-6820. • Luke H . 1998 “Beginning Research on Junior Doctors Habitus”. Paper to be presented at the British Educational Research Association Annual Research Student Conference, The Queens University of Belfast, August 26th - 27th 1998, pp. 26 .*

7. Methodology • Generic qualitative approach (Caelli 2003) • 8 courses chosen: • Cardiology • Diabetes • Nephrology • Resuscitation Practice • Public Health • Women’s Health • Child Health • Professional Development in Health & Social Care • 24 original sample of which 21 interviews undertaken • 12 – Senior Nurses; 1 Physiotherapist, 1 Occupational Therapist, 1 Midwife, 1 Physiologist, 2 Resuscitation Managers, 1 Paramedic; 1 Clinical Effectiveness, 1 Education

8. Methodology cont. • Inclusion criteria • non graduate • must have submitted at least one assignment • Names identified at random • 2 researchers programme leaders; 1 outside the unit • Interview schedule derived from issues identified in the literature review and experience • 10 Questions: Structured interviews conducted by external researcher • Taped and transcribed • Analysis by individual questions – not thematic analysis

9. Results: Question 1What made you decide you wanted to do a Masters course? What were your aspirations and expectations of the course and your sense of being able to achieve them? • ‘it was proof that you’ve taken it seriously’ • The issue around confidence was important; ‘something deep down inside said yes, I think I’d like to try to see if I could do it’ • Some hadn’t studied in years, if at all, and felt the time had come; ‘I am in a time of my life where I want to try it, and see how it goes’ • Some felt that it would enable them to go much further ‘become more of a specialist in that area’ whilst recognising that ‘these days you need it to stay in your job’ • Many students expressed fear at the prospect of undertaking Masters courses, ‘Initially complete terror’ • Meeting the required level was clearly a concern; ‘I was apprehensive about whether I would be up to that standard’ • Some aspirations were rather modest; ‘I hoped to achieve that I could understand it’ • Another student discussed how the lack of higher education had always been ‘a big regret…it has always been something that I have been aware that I don’t have a first degree’

10. Q2: Why did you decide to do a Masters course rather than a first degree? • It was possible to skip the stage of first degree • ..thinking that I would do a BSc. And then when I saw the opportunity to do a MSc I thought; Well what am I thinking of, I can actually do that.’ • Some felt that there was simply no point in doing a first degree if a Masters was available and appropriate • Realistically I couldn’t see, for myself, that I would be doing a first level degree and doing all that work when I could be doing the same amount of work and come out of it with an MSc’

11. Q3: How did you feel during your interview for the course, before you started and on your first morning? • Several felt apprehensive, daunted and anxious. Some felt they had not studied for a long time. • ’It has been a long time since I have done formal studying .. I was fearful I was overreaching’ • Others felt that they did not know what was expected of them. They were not sure that they could manage the level of work or cope with the subject matter. Some felt daunted or intimidated by the prospect of working with students from other professions with different backgrounds and with academic degrees. • ’I was apprehensive but interviewer put my mind at rest about the course what was expected of me’ • ‘we were all in similar positions. .. There were some people who were very confident but there were a lot of people who felt a little bit apprehensive’.

12. Despite their anxieties they also felt ‘very excited and good about it’. • ‘I felt very excited all the way through’. ‘I found it a privilege actually having that [first] day for myself as a practice and being able to come in here and participate and listen to all those wonderful people who were coming to talk to us about things and use the library and everything else’.

13. Q4: What was your experience (feelings, development/change, change of identity, beliefs, values, skills) of your first module, and subsequent ones? • In general the students felt the course enabled them to grow in confidence and in knowledge • Some of the modules encouraged the students to reflect on their own personal development. Some of the students found this most valuable. One said she felt that this: • ‘changed my whole outlook. I began to realise what sort of person I was’ • Others struggled with the language on some modules • ‘hated it. It was like being in a foreign country and not being able to speak the language’

14. Q5: How did you feel in relation to the staff, to other students, and specifically those students deemed to have a high level of education such as doctors? • Most of the students found the staff supportive, knowledgeable, helpful, approachable, treated them as equals and were sympathetic to their needs. • ‘Very supportive, no problems here at all, met quite a few from consultants to permanent members of staff. They were all really great’. • In relation to other students several mentioned that they remained aware that they did not have a first degree whereas the doctors did • ‘I have not shed the bit that I don’t have a first degree, .. the anxiety about that. • But the same student felt that she had the advantages that came with age and other experiences • ‘I think on that particular course there were the most doctors. And actually in many ways, I have to say, I think age is on my side there in that I am able to see that perhaps I have got some skills that they may not have.’

15. Q6: How would you describe your experience during the classes, in terms of interactions, involvement and ease of contributing in class, between peers and tutors? • Overall class interactions seemed to be linked with age and maturity, gender, confidence, the size of the group and the facilitating nature of the tutor. • Some found it easy to contribute and felt their contributions were valued irrespective of their backgrounds. • ‘I would say it has been a very positive experience, to be honest. I haven’t had difficulty in putting forward my opinion even when my opinion is quite different to other people.

16. Q7: What was your experience doing the assignments and dissertation (If appropriate), specifically your first and then subsequent ones? How did you deal with and feel about searching, reading, writing and accessing resources? How did you cope with the Masters’ requirement for coherence and reasoned argument? How has this developed over time? • The first assignment seemed to be a huge moment for them, either as a stumbling block, a crisis, or the point where confidence became more entrenched. • ‘my anxiety was about doing the essay, the assignment, because it was that part that I really felt I hadn’t done any, producing something like that for a very long time. Subsequently it seemed much better. I now have a sort of system of how I organise myself, how I plan my essay, how I keep all my references together, all those things.’

17. Feedback is recognised as important by students. • ‘I found the feedback very helpful. They shaped it in a different way, organised it in a different way.’ • And the importance of feedback on early drafts; • ‘..helped me so much saying, ‘No, you need to expand this, no, you can’t do that etc etc. I’ve learnt a lot’. • Students are offered support, and encouraged to use it particularly in the early stages of the course. • ‘I should have gone to her before I did….I think I could have made them more easy with the help available’.

18. Q8: How has your learning had an impact on your professional practices (in terms of relationships with peer, managers and clients/patients/users, and reading and writing reports). How has your learning impacted on your critical thinking. • Many students considered that doing the Masters has taught them to be more critical or developed lateral thinking. Challenging conventional wisdom and status quo is recognised by several • ‘I question things much more…the kind of questions I ask now are different and sometimes people can’t give me the answers to them and this really makes me think, ‘gosh, have they really thought through what they’re asking for?’. • The learning to be critical seems to have embedded itself within the students’ practice • I don’t just read an article and think, ‘oh well yes, they said this’. It’s actually, ‘is the way they’ve done the research correct? Have they used the right methodology?.. I am much more questioning’.

19. Q9: For those who have completed the Masters, has gaining a Masters affected your self identity, how you feel you are perceived by others? Has it affected your work relationships, the work you undertake? • Students felt that it has impacted on their self identity • ‘any learning you undertake changes you slightly .…[because] you interact with other people’. • After a confrontation with a senior nurse, PD1M (a paramedic) said; • ‘whereas before I would probably have just rolled over.. I felt strongly enough to take him up on it which I probably wouldn’t have done before..I feel the whole Masters process has changed the way I work’.

20. The recognition of educational achievement in others differs too once a Masters has been attained. One student spoke of a colleague with a PhD and other colleagues’ changed attitude to her. She, however, felt differently; • doing the Masters has made me feel, that’s fine, everyone can do it. You can apply yourself. It is not a scary thing’. • One student summarised what it means to have a Masters; • ‘I suppose with a Masters it will just identify that we..can think at that level, are educated at that level and we are able to be specialist in our area’ • The sense of achievement, recognition by self, comes across in others; ‘ • I can proudly say I have done it plus holding a full time job and looking after a family’

21. Q 10: Would you want to continue studying even further? • The answers to this varied from the very positive through the unsure to the definite no. One student said there were so many things he wanted to study and described it as having ‘the bug’.

22. Discussion • Academic Practices • Initial anxiety • Support • Habitus • Concern of lack of degree • Studying with graduates • Call on own resources • Pedagogical Approaches • Relevant and purposeful • Critical thinking and research methods • Student Diversity and Background Knowledge • Multi-discipline, multi-professional

23. Recommendations • Support and feedback for assignments essential, particularly in early days • Students benefit most when area studied is relevant to them personally and/or in their jobs • Research methods must underpin a different, more critical approach to their professional practice. • Multi-disciplinary, multi-professional learning works well