Entry Courses Research Articles

117 Applying the Competency Index for Clinical Research Professionals (CICRP) for Educational Program Evaluation

OBJECTIVES/GOALS: To demonstrate the value of the Competency Index for Clinical Research Professional (CICRP) as a tool in program evaluation using a pre- and post- design to evaluate student perceived self-efficacy in clinical trial competencies at program entry and at program completion. METHODS/STUDY POPULATION: Using a separate-sample pre-post study design, we administered the CICRP questionnaire to students in the entry and exit courses of the Master of Clinical Research (MCR) Program during the 2021-2022 academic year, using QualtricsTM (Provo, Utah) survey instrument for use on desktop or mobile device. We included the 20 CICRP competency items asking students to rate their self-efficacy in performing each item using a Likert Scale (from 0-10) (0=not at all confident; 10= extremely confident). Links to the survey were included in the courses for the foundational entry course and for the final culminating project course. RESULTS/ANTICIPATED RESULTS: Overall, 54 students took the CICRP during the entry course and 56 during the exit. Cronbach’s alpha for each assessment ranged from 0.93 to 0.98. Both the Welch’s two-sample t-test and Wilcoxon rank-sum test show very significant differences between the group of students entering the program and leaving the program (p value < 0.001). A significant increase in mean CICRP total score is seen at each experience level between program entry and program exit (p<0.001) A linear regression, adjusting for available covariates, individuals taking the exit course have a mean CICRP total score 92.690 (p value < 0.001) higher than individuals taking the entry course. DISCUSSION/SIGNIFICANCE: Competency indices have been used to measure self-efficacy in translational research scientists, thus the use of CICRP to measure self-efficacy can be useful in assessing whether our competency-based program is meeting the JTF Competency needs of students.

Vertically‐Integrated Course‐Based Undergraduate Research Experiences (CUREs) Structure a Biomedical Research Certificate Program that Promotes Inclusivity

Underrepresented mentors are critical for impacting the trajectory of underrepresented students toward research careers. Not only do they share lived experiences but can understand the unique challenges of navigating a predominantly white, ableist university. Undergraduates often view these mentors as role models for successful science careers and these mentors can create supportive microenvironments for underrepresented students. Although first‐ and second‐year classes offer broad access and are often the site of first contact with underrepresented faculty, teaching centered instructors are less likely to have an active research program. Minority‐serving undergraduate research programs can generate social stigma due to competitive norms of science culture and embedded bootstrapping rhetoric. Course‐based Undergraduate Research Experiences (CUREs) are often cited as a particularly promising approach to preparing and motivating undergraduates to pursue graduate study that avoids stigma. However, authentic research projects rarely can be completed in a single semester, and CUREs are not typically designed to prepare students to enter particular research labs. Furthermore, CUREs typically are only available in third and fourth years, have extensive prerequisites, and are restricted to honors students (only 19% of underrepresented students in the five biomedical majors have sufficient GPAs to be eligible for honors at TAMU). One‐semester CUREs are insufficient to prepare underrepresented students for graduate study. The Biomedical Research Certificate (BRC) Program provides vertically integrated CUREs to prepare undergraduates for the next stage of their careers. A research certificate was created to address these considerations. The BRC is a multi‐college program that allows undergraduates to perform research in collaborative teams from the students’ freshman to senior years. Open to any major, it attracts diverse students across the university interested in participating in multi‐semester health‐related research. Because there are no entry requirements (e.g., prerequisites or minimum GPA) and courses count toward degree plans, it is the only program at TAMU in which there are no barriers to participating in research starting in their freshman year. This access has radically expanded research participation of lower‐division undergraduates. Freshmen explore multiple research disciplines and join a particular research track in their sophomore year. Built to expand to meet the ever‐increasing needs of both students and research labs, the BRC has grown to include research tracks in health disparities, computational biology, in vitro experimentation, human subject research, bioinformatics, and neuroscience. These tracks not only engage undergraduates in authentic research projects, but also provide the critical skills needed to take full advantage of opportunities across TAMU in junior and senior years.

Volume Rendering Technique (VRT) for Planning and Learning Cranio-Vertebral Junction (CVJ) Surgeries: Technical Note.

To present the application of volume rendering technique (VRT) of computed tomography (CT) scan in cranio-vertebral junction (CVJ) surgeries. The authors used VRT images of CT scan in patients of congenital CVJ anomalies who were subjected to various surgeries through midline posterior approach. The screw entry points and courses of vertebral arteries were identified in relation to various landmarks on the VRT images, preoperatively and intra-operatively. A total of 15 patients of CVJ anomalies, who underwent surgeries through midline posterior approach, formed the study group. The screw entry points and courses of the vertebral arteries could be effectively identified in the surgical fields. We conclude that VRT images are an inexpensive and user friendly tool to identify the screw insertion points in the surgeries of CVJ anomalies. They also help in identifying the course of the vertebral artery in the surgical field. On the whole, their use makes the surgery in this region, safer.

2012 - The year when BAOMS and its officers prevented closure of all UK shortened medical and dental courses.

In Spring 2011 the Department of Health (DH) received a request to review European Union Directive 2005/36 EU - the directive relating to the recognition of professional qualifications. The Department of Health lawyer raised concerns that the existing shortened dental courses may be in breach of EU law. There were three shortened dental courses in the UK: 4year graduate entry courses in Liverpool/Peninsula and 3-year Dental Programme for Medical Graduates (DPMG) in Kings, London. During the summer the General Dental Council (GDC) was made aware of these concerns. In autumn 2011 the Chief Dental Officer for England with the GDC, told the Dental Deans' Council (DDC) that shortened dental courses were illegal. On 12th Jan 2012 students on the DPMG were told that they would have to complete a full 5-year dental degree. The GDC said that this interpretation of EU law would also impact on shortened medical courses. In view of the potentially enormous impact that this would have on OMFS training, BAOMS engaged all the resources it could and by assembling legal opinions including written contributions from Sir David Edward, whose opinion was being misinterpreted by the GDC and DH, and by sharing these resources with all the stakeholders, BAOMS was able to preserve shortened dental and medical courses. Now that the UK has left the European Union, negotiations around mutual recognition of qualifications may mean this issue will resurface. We should remain vigilant.

Predictors of confidence in anatomy knowledge for work as a junior doctor: a national survey of Australian medical students

BackgroundMajor changes to the teaching of anatomy associated with the integration of basic and clinical sciences in modern medical curricula have coincided with students reporting concern over achievement of learning outcomes in anatomy. Little guidance exists for medical educators designing anatomy courses that account for factors that positively influence medical student confidence in their own anatomy knowledge. We sought to determine what factors are associated with medical students’ self-reported confidence in their anatomy knowledge in preparation for clinical practice.MethodsCross-sectional national survey of Australian medical students distributed using social media. We performed univariate and multivariable ordinal regression to determine the factors in anatomy learning and teaching that influence medical student self-reported confidence to have sufficient anatomy knowledge by the time of graduation, for practice as a junior doctor.ResultsOf 1309 surveyed, 1101 (84%) responded, representing 6.5% of the Australian medical student population. Mean age was 23.9 years (SD 4.8 years), a majority were female (644, 58.5%), and students in all years of both undergraduate (52%, 575) and graduate entry courses (48%, 529) were represented. Items associated with increased self-reported confidence in anatomy knowledge included adequate assessment of anatomy (Odds Ratio 2.17 [95% CI 1.69–2.81]), integration of anatomy with other basic sciences (OR 1.97 [1.52–2.56]) and clinical teaching (OR 1.90 [1.46–2.48]), male gender (OR 1.89 [1.48–2.42]), anatomy education prior to medical school (OR 1.46 [1.14–1.87]) and exposure to dissection (OR 1.39 [1.08–1.78]). Medical students in their clinical years reported lower confidence in their anatomy knowledge (OR 0.6 [0.47–0.77], p < 0.0001). Age and career intention were not significant predictors of confidence.ConclusionsMedical educators can enhance student confidence in their own anatomy knowledge by developing curricula that vertically integrating anatomy learning and teaching, integrate anatomy teaching with other basic sciences, and providing consistent assessment through both the pre-clinical and clinical stages of medical training. Anatomy education should also incorporate dissection as a teaching method, and students could benefit from completion of anatomy education prior to medical school. Consideration should also be given to further investigate the confidence of female students in their anatomy knowledge.

Graduate entry nurses' initial perspectives on nursing: Content analysis of open-ended survey questions

BackgroundGraduate entry nursing courses offer individuals with prior degrees the opportunity to gain nursing qualifications and facilitate career change. While it is known that accelerated graduate entry courses are increasingly popular, the perceptions of nursing held by such individuals and the influence this has on those seeking to enter the profession are less clearly understood. ObjectiveTo explore graduate entry nursing students' perceptions of nursing on entering their pre-registration course. DesignA descriptive design utilising cross-section survey with two open-ended questions: What do you believe the role of the nurse is? What things have influenced that view? were asked. Demographic data were analysed using descriptive frequencies, while the two open-ended questions were analysed using summative content analysis. SettingOne university-based postgraduate graduate entry nursing course in Australia ParticipantsEight cohorts (n=286) commencing students with prior degrees other than nursing. ResultsThe course attracts students from diverse backgrounds. Exposure to nursing and nurses, either as a consumer of health care or other health care role, plays a primary role in influencing career change. However, similar to those found with school leavers, there remains much misinformation about nurses' roles for students in these courses. Most identify the role of caring in nursing. For some, media representations are the only information sources. DiscussionGraduate entry courses offer opportunities to attract new nurses and contribute to addressing workforce shortages. However, there is still a lack of knowledge of nursing roles among students on entry. More work is required by the profession to ensure nursing is accurately and positively represented to the community.

Can Financial Education Extend the Border of Bounded Rationality?

When choosing a particular alternative from a number of financial assets, risk is an important feature. According to the classic Capital Assets Pricing Model (CAPM), we would expect to receive a positive correlation between risk and return of financial assets. However, studies show that investors judge financial assets in terms of “good” or “bad”. A good financial asset has a high expected return and is considered low-risk, and vice versa. This type of thinking is biased, as it is both irrational and contradicts the classical theory of finance. One explanation for this bias is the affect heuristic. According to this heuristic, the investor forms her attitude about the asset in the first stage, and then links all of her subsequent judgments to this attitude. The aim of this study is to examine how this bias is affected by studying the CAPM in Finance entry courses. An experiment was conducted in which each subject made both risk judgments and return judgments in regard to 25 domestic stocks chosen randomly from the Tel Aviv 100 stock index. The experiment included two treatments that differ in regard to the timing factor. Some of the subjects were asked to judge the return and risk ratings before learning about the CAPM in class; the others were asked after studying the CAPM material. Finance education reduced the bias, but did not prevent it. The results show that in the teaching of Economics, there should be a balance between providing a coherent theoretical framework together with behavioral aspects. Moreover, given that finance education did not prevent the bias among students with background in quantitative analysis, it is reasonable to assume that other agents without this background would have more difficulties to apply the principles of investments under uncertainty.

Can Financial Education Extend the Border of Bounded Rationality?

When choosing a particular alternative from a number of financial assets, risk is an important feature. According to the classic Capital Assets Pricing Model (CAPM), we would expect to receive a positive correlation between risk and return of financial assets. However, studies show that investors judge financial assets in terms of or bad. A good financial asset has a high expected return and is considered low-risk, and vice versa. This type of thinking is biased, as it is both irrational and contradicts the classical theory of finance. One explanation for this bias is the affect heuristic. According to this heuristic, the investor forms her attitude about the asset in the first stage, and then links all of her subsequent judgments to this attitude. The aim of this study is to examine how this bias is affected by studying the CAPM in Finance entry courses. An experiment was conducted in which each subject made both risk judgments and return judgments in regard to 25 domestic stocks chosen randomly from the Tel Aviv 100 stock index. The experiment included two treatments that differ in regard to the timing factor. Some of the subjects were asked to judge the return and risk ratings before learning about the CAPM in class; the others were asked after studying the CAPM material. Finance education reduced the bias, but did not prevent it. The results show that in the teaching of Economics, there should be a balance between providing a coherent theoretical framework together with behavioral aspects. Moreover, given that finance education did not prevent the bias among students with background in quantitative analysis, it is reasonable to assume that other agents without this background would have more difficulties to apply the principles of investments under uncertainty.

Predicting academic outcomes in an Australian graduate entry medical programme

BackgroundPredictive validity studies for selection criteria into graduate entry courses in Australia have been inconsistent in their outcomes. One of the reasons for this inconsistency may have been failure to have adequately considered background disciplines of the graduates as well as other potential confounding socio-demographic variables that may influence academic performance.MethodsGraduate entrants into the MBBS at The University of Western Australia between 2005 and 2012 were studied (N = 421). They undertook a 6-month bridging course, before joining the undergraduate-entry students for Years 3 through 6 of the medical course. Students were selected using their undergraduate Grade Point Average (GPA), Graduate Australian Medical School Admissions Test scores (GAMSAT) and a score from a standardised interview. Students could apply from any background discipline and could also be selected through an alternative rural entry pathway again utilising these 3 entry scores. Entry scores, together with age, gender, discipline background, rural entry status and a socioeconomic indicator were entered into linear regression models to determine the relative influence of each predictor on subsequent academic performance in the course.ResultsBackground discipline, age, gender and selection through the rural pathway were variously related to each of the 3 entry criteria. Their subsequent inclusion in linear regression models identified GPA at entry, being from a health/allied health background and total GAMSAT score as consistent independent predictors of stronger academic performance as measured by the weighted average mark for the core units completed throughout the course. The Interview score only weakly predicted performance later in the course and mainly in clinically-based units. The association of total GAMSAT score with academic performance was predominantly dictated by the score in GAMSAT Section 3 (Reasoning in the biological and physical sciences) with Section 1 (Reasoning in the humanities and social sciences) and Section 2 (Written communication) also contributing either later or early in the course respectively. Being from a more disadvantaged socioeconomic background predicted weaker academic performance early in the course. Being an older student at entry or from a humanities background also predicted weaker academic performance.ConclusionsThis study confirms that both GPA at entry and the GAMSAT score together predict outcomes not only in the early stages of a graduate-entry medical programme but throughout the course. It also indicates that a comprehensive evaluation of the predictive validity of GAMSAT scores, interview scores and undergraduate academic performance as valid selection processes for graduate entry into medical school needs to simultaneously consider the potential confounding influence of graduate discipline background and other socio-demographic factors on both the initial selection parameters themselves as well as subsequent academic performance.

Developing professionalism in physiotherapy and dietetics students in professional entry courses

In a context of education focused on skill mastery and graduate-level competence in preparation for professional practice, the notion of professionalism could be reduced to measurable and rules-based concepts, and the values, ethical decision making and professional autonomy that underpin it could be overlooked. Using a blend of hermeneutic phenomenology and discourse analysis, this article explores how professionalism is understood, talked about and experienced by lecturers and students in physiotherapy and dietetics courses at an Australian university. The findings of the study highlight the complex and evolving nature of professionalism. Understandings of professionalism appeared to be influenced by opportunities to think about and discuss values that inform them. Moreover, issues like cultural competence and environmental sustainability were not part of participants' understandings of professionalism, suggesting a need to rethink philosophical approaches and pedagogical strategies to develop a notion of professionalism that adequately prepares students for the demands of contemporary professional practice.

Poor Study Skills and Untapped Resources: A Study of Entry-Level Mathematics Students’ Study Habits

The purpose of this descriptive study was to discover the environment in which students enrolled in entry and lower-level mathematics courses study, how long and when they study, whether they study in a group or alone, how they organize their notes and homework, and what use they make of the textbook and online class notes provided by their instructor. Fifty-eight students were interviewed in their instructors’ offices. Responses were correlated to final grades in each course. Results indicated that students making higher grades studied earlier in the day and kept more organized notebooks than students who made lower grades. The majority of students studied alone and did not use the resources available to them.

Widening access to medical education for under-represented socioeconomic groups: population based cross sectional analysis of UK data, 2002-6

Objective To determine whether new programmes developed to widen access to medicine in the United Kingdom have produced more diverse student populations.Design Population based cross sectional analysis.Setting 31 UK universities...

Race and Nation in Twentieth- and Twenty-First-Century Brazil

Race and Nation in Twentieth- and Twenty-First-Century Brazil Kia Lilly Caldwell (bio) White Negritude: Race, Writing, and Brazilian Cultural Identity. By Alexandra Isfahani-Hammond. New York: Palgrave Macmillan, 2008. Pp. 194. $69.95 cloth. Mama Africa: Reinventing Blackness in Bahia. By Patricia de Santan Pinho. Durham, NC: Duke University Press, 2010. Pp. x + 266. $84.85 cloth. $23.95 paper. Brazil’s New Racial Politics. Edited by Bernd Reiter and Gladys L. Mitchell. Boulder, CO: Lynne Rienner, 2010. Pp. viii + 251. $59.95 cloth. Uneven Encounters: Making Race and Nation in Brazil and the United States. By Micol Seigel. Durham, NC: Duke University Press, 2009. Pp. xxii + 386. $89.95 cloth. $24.95 paper. These four books provide important insights into Brazilian racial dynamics from both traditional and contemporary perspectives. Each contributes to the recent surge in scholarship on race in Brazil and moves this scholarship in interesting and exciting new directions. Together, the books examine the ideologies of racial democracy, racism, and antiracism through various disciplinary and interdisciplinary methods, including literary, cultural, historical, and social-science approaches. They also situate Brazilian racial dynamics in the context of twentieth- and twenty-first-century social and political dynamics, and they raise important questions about the roles of race and racism in Brazilian society. Brazil’s New Racial Politics was inspired by Michael Hanchard’s edited volume Racial Politics in Contemporary Brazil (1999). Edited by political scientists Bernd Reiter and Gladys L. Mitchell, Brazil’s New Racial Politics is an innovative and timely collection of multidisciplinary research by Brazil- and U.S.-based sociologists, anthropologists, political scientists, and scholars in the field of communication studies. Several contributors map the advent of affirmative action policies for Brazilians of African descent in the early 2000s, how governmental discourses and policies related to race have unfolded, and the impact of those changes on social and political dynamics in the country. Seth Racusen, Mónica Treviño González, and Renato Emerson dos Santos examine these policies and university entry (preparatory) courses for black and poor students, illuminating the role of race in access to education and the challenges of creating public policies to combat racial inequalities. Racusen’s masterful analysis of university admissions offers useful suggestions for improving the process of [End Page 201] selecting students of African descent. Treviño provides important background on shifting forms and strategies of black mobilization, particularly among women; this mobilization has moved from ideological resistance to racial prejudice and discrimination to calling for the state to combat racism. Treviño finds that nongovernmental organizations (NGOs) have played an increasingly important role in developing policies such as affirmative action for Afro-Brazilians. At the same time, however, the lack of support from the broader public threatens the sustainability of these new measures. Santos provides additional insights into the politics of race and higher education. His analysis of university entry courses focuses on Pré-Vestibular para Negros e Carentes (PVNC), a network for black and poor students established in Rio’s Baixada Fluminense in the early 1990s. Santos traces such preparatory institutions to 1976 and to the inspiration of the renowned black activist Abdias do Nascimento and the Center of Brazil-Africa Studies. (Indeed, Nascimento and members of the Black Experimental Theatre first proposed affirmative action and other public policies to combat racism in the 1940s.1) This background to recent developments is useful, as it makes clear the long-standing challenges that Afro-Brazilians have faced in the effort to achieve educational equity, particularly at the postsecondary level. Several essays in Brazil’s New Racial Politics look instead at formal politics and political institutions. Mitchell focuses on how black voters perceive black candidates for electoral office. Using survey data from the cities of Salvador and São Paulo, she argues that voters who embrace blackness by identifying themselves as preto (black) or pardo (mixed race and/or brown) tend to vote for black candidates in higher numbers. This analysis challenges most scholarship on race and politics in Brazil by pointing to the existence of an untapped “black vote.” Cloves Luiz Pereira Oliveira examines the 1996 election of Celso Pitta, the first black mayor of S...

Brazil's new racial politics

Foreword - Michael Mitchell. The New Politics of Race in Brazil - the Editors. Black Empowerment and White Privilege. Whiteness as Capital: Constructing Inclusion and Defending Privilege - B. Reiter. Politicizing Blackness: Afro-Brazilian Color Identification and Candidate Preference - G.L. Mitchell. Out of Place: The Experience of the Black Middle-Class - A. Figueiredo. The Political Shock of the Year: The Press and the Election of a Black Mayor in Sao Paulo - C.L.P. Oliveira. Affirmative Action Contested. Affirmative Action and Identity - S. Racusen. Opportunities and Challenges for the Afro-Brazilian Movement - M.T. Gonzalez. The New Politics of Black Power. Racialized History and Urban Politics: Black Women's Wisdom in Grassroots Struggles - K.Y. Perry. Black NGOs and Conscious Rap: New Agents of the Antiracism Struggle in Brazil - S.A. dos Santos. Power and Black Organizing in Brazil - F. Conceicao. New Social Activism: University Entry Courses for the Black and Poor - R.E. dos Santos. Conclusion. After the Racial Democracy - the Editors.

Finding voice: Promoting the right of free speech for mental health nurses

Finding voice: Promoting the right of free speech for mental health nurses

Curriculum structure: principles and strategy

This report provides general guidelines for the structure of a curriculum, followed by specific advice on the principles of learning and teaching, the process of restructuring and change leadership and management. It provides examples of several educational philosophies, including vertical and horizontal integration. It discusses the use of competence, learning outcomes, level of degree and assessment and provides a number of recommendations. It does not seek to be prescriptive of time allocation to disciplines within a curriculum. Although this report has been written primarily for those who will develop an undergraduate curriculum, the information may be sufficiently generic to apply to the recent development in graduate entry ('shortened dental' or 'accelerated') courses and to postgraduate degree planning and higher education certificate or diploma courses for other dental care professionals (auxiliaries). The report may have a European bias as progress is made to converge and enhance educational standards in 29 countries with different educational approaches - a microcosm of global collaboration.

Graduate entry medicine: curriculum considerations

Graduates entering medicine need to achieve the same learning outcomes as school leaver medical students in less time. Time is not the only consideration, and rather than just compress five-year courses into a four-year time-frame, curriculum planners have often taken the opportunity to introduce innovations for small cohorts as schools begin these new programmes. This article considers how the particular needs of graduate entrants can be met by UK medical curricula and reviews accumulating evidence around the design considerations, especially that of problem-based learning. Graduate entry courses have been at the forefront of curriculum planning for new professionalism in doctors.

Blood glucose monitoring: Getting a clear view of your diabetes

Graduate entry nursing courses offer individuals with prior degrees the opportunity to gain nursing qualifications and facilitate career change. While it is known that accelerated graduate entry courses are increasingly popular, the perceptions of nursing held by such individuals and the influence this has on those seeking to enter the profession are less clearly understood.To explore graduate entry nursing students' perceptions of nursing on entering their pre-registration course.A descriptive design utilising cross-section survey with two open-ended questions: What do you believe the role of the nurse is? What things have influenced that view? were asked. Demographic data were analysed using descriptive frequencies, while the two open-ended questions were analysed using summative content analysis.One university-based postgraduate graduate entry nursing course in AustraliaEight cohorts (n = 286) commencing students with prior degrees other than nursing.The course attracts students from diverse backgrounds. Exposure to nursing and nurses, either as a consumer of health care or other health care role, plays a primary role in influencing career change. However, similar to those found with school leavers, there remains much misinformation about nurses' roles for students in these courses. Most identify the role of caring in nursing. For some, media representations are the only information sources.Graduate entry courses offer opportunities to attract new nurses and contribute to addressing workforce shortages. However, there is still a lack of knowledge of nursing roles among students on entry. More work is required by the profession to ensure nursing is accurately and positively represented to the community.

Be prepared to work hard at admission

In answer to the question in Advice Zone, if you really have your mind set on medical school, then be prepared for some hard work and discouragement from others.1 Your situation and desire to train as a doctor are far from unique, and although requiring immense effort, it is still possible to gain admission to medical school. Without an honours degree in nursing you are ineligible for graduate entry courses, and regular five year courses might …

Models for the development of graduate entry medical courses: two case studies

The introduction of graduate entry medical courses requires attention to models of decision-making and change. Much of the educational literature describes change as either centralised or decentralised with the latter claimed to be more effective. Recently Fullan has argued for the importance of an ongoing culture of change. This paper examines the change culture of two medical schools adopting graduate entry courses; Flinders University in South Australia and St George's Hospital Medical School, London. Comparative case study was used. Key informants were interviewed and documents and records analysed. Data were cross-checked and categorised to generate models of change. There were four components of the change culture at Flinders but they were not sufficient on their own to generate change. The process was triggered by a significant external event. The nature of the change was also important. The descriptive model developed suggested a complex interplay of factors rather than attributing the success of the change to the change mechanisms adopted alone. The model was tested for explanatory potential at St George's. The culture there was described as both 'macro-innovative' and 'micro-conservative'. External events were also important but they exerted a positive force. A more centralised approach was adopted. The models developed represent change as 'dynamic, complex and open' rather than a simple centralised or decentralised dichotomy. While some of the elements of a change culture were evident at both schools there were longer term questions of sustainability. This has implications for development of all programmes but particularly for graduate entry schools.