Specialist Research Articles

517 Ethnic Diversity in the English Urology Workforce and BAUS Leadership 2009-2020: A Retrospective Analysis

Abstract Aim Little is known about the ethnic composition of the national urology workforce. To assess the impact of existing strategies to promote equitable progression, with respect to ethnicity, in the English urology workforce and British Association of Urological Surgeons (BAUS) leadership between 2009 and 2020. Method A Freedom of Information (FOI) Act request was made to NHS Digital regarding demographic data of clinicians working in urology in England between 2009 and 2020. Data was collected on urology consultants, specialist registrars, specialty, and associate specialist (SAS) doctors over this period. The ethnicities of British Association of Urological Surgeons (BAUS) Trustees and Council Members were determined over the same period, by review of public profiles. Statistical analysis was performed using the Cochran-Armitage test. Results The proportion of consultant urologists identified as White decreased from 65.5% to 53.6%, p<.0001), while the proportion of Asian/Asian British consultants increased (26.9% to 36.6%, p<.0001). There was a significant increase in Black/Black British trainees (3.0% to 11.0%, p<0.0001) but a decrease in the proportion of Asian/Asian British trainees. There was a non-significant decrease in the proportion of White urologists occupying BAUS leadership positions (80.6% to 67.6%, p = 0.5). Conclusions Trends towards increased ethnic diversity was seen across all groups, especially consultants. More limited change was observed in the urology leadership, suggesting both a time lag and that there is further work to be done in addressing barriers to progression in the highest echelons of urology leadership in the UK.

Scaling up quality-assured psychotherapy: The role of therapist competence on perinatal depression and anxiety outcomes

ObjectivesTo examine: (1) the psychometric properties of two therapist competence measures—multiple choice questionnaire (MCQ) and standardized role-plays; (2) whether therapist competence differed between non-specialist (NSPs) and specialist (SPs) providers; and (3) the relations between therapist competence and patient outcomes among perinatal patients receiving brief psychotherapy. MethodsThis study is embedded within the SUMMIT Trial–a large, ongoing psychotherapy trial for perinatal women with depressive and anxiety symptoms. We assessed the: (1) psychometric properties of therapist competence measures using Cronbach's alpha and inter-class correlation; (2) differences in therapist competence scores between n = 23 NSPs and n = 22 SPs using a two-sample t-test; and (3) relations between therapist competence measures and perinatal patient outcomes through a linear regression model. ResultsInternal consistency for role-play was acceptable (α = 0.71), whereas MCQ was excellent (α = 0.97). Role-play showed good inter-rater reliability (ICC = 0.80) and scores were higher for SPs compared with NSPs (t(2,38) = −2.86, p = 0.0069) and associated with outcomes of anxiety (B = 1.52, SE = 0.60, p = 0.01) and depressive (B = 0.96, SE = 0.55, p = 0.08) symptom scores. ConclusionsOur study highlights the importance of demonstrating psychological treatment skills through standardized role-plays over knowledge-based competence to predict perinatal patient outcomes. Using well-defined evidence-based tools is critical for deploying NSPs to provide high-quality psychotherapy and increase accessibility to psychological treatments for perinatal populations worldwide.

Knowing the People Oriented Character of Department Leaders with the Belbin Method

This study aims to analyze and understand the dominant character of department heads at PT BTU, who so far have appointed departmental leaders who prefer criteria of general technical competence, experience and soft skills such as communication skills, integrity, creativity, etc. According to Belbin, a person's character can be divided into 3 groups, namely the Thinking Oriented group consisting of Plant (PL), Monitor Evaluator (ME) and Specialist (SP). The Action Oriented group consists of Sharper (SH), Implementer (IMP) and Completer Finisher (CF). Finally, the People Oriented group consists of Team Workers (TW), Resource Investigators (RI) and Coordinators (C). From the research results for the 15 Departments at PT BTU, it was found that 73% of the leaders were People Oriented, and 27% were Action Oriented, and no Thinking Oriented dominant leaders. In order for the team in the department to further improve their performance, it is better if the deficiencies or weaknesses in one of the characters or orientations can be filled by staff who stand out in characters that the leader does not have.

Charter for Locally Employed Doctors in the UK Health Service

Locally employed doctors have been described along with their compatriots as 'the lost tribe' compared to their peers who are either in formal training, consultant, or general practitioner posts. Over the lastdecade, considerable progress has been made in improving the recognition, value, and respect given to doctors in Specialty, Staff Grade or Associate Specialist (SAS) roles with harmonised contracts, working conditions and support available. The vast majority of the cohort of over 127,000 doctors in the SAS-LED category as per the UK medical register (GMC 2022 dataset) continue to be lumped with their SAS historicalcounterparts yet have a very different experience. These LEDs are unsung and unheard and remain voiceless in the UK NHS medical staff, yet continue to provide service in delivering high-quality healthcareto the nation.
 This Charter is ambitious in its aspiration and aims to deliver the 'Gold Standard' for all LEDs. It was developed following a prolonged exercise of listening to the experiences of many LEDs within themembership of BAPIO across its affiliated organisations and social networks. It is unique in being developed and written by LEDs and IMGs early in their careers or by those transitioning to more establishedsenior and autonomous roles. So it is grounded in the reality of lived experiences and ambitious in setting the bar at an equal level with other doctors in the UK NHS.
 The LED Charter offers ten practical recommendations for implementation by all NHS employing organisations. Most of the principles of equality and inclusion described in this Charter should be embraced by the medical royal colleges, education and training agencies (i.e. Health Education England) in their committees and processes to provide a voice to this 'lost tribe'.

A UK-wide survey of speciality doctors and associate specialist (SAS) psychiatrists' psychotherapy case experience, barriers and benefits to professional development and clinical capabilities

AimsResearch suggests that seeing psychotherapy cases benefits psychiatric trainees’ professional development and clinical capabilities, however there is lack of such evidence for SAS psychiatrists, who require this experience for Certificate of Eligibility for Specialist Registration (CESR) applications.Having provided frequently requested psychotherapy training support to our Trust's CESR training programme in Birmingham we aimed to study nationwide SAS psychiatrists’ psychotherapy case experience, professional benefits and barriers to access.MethodAn online questionnaire was sent to UK-wide SAS Psychiatry doctors, with the support of the RCPsych Speciality Doctors and Associate Specialist Psychiatrists Committee (SASC), whilst being promoted on social media. It asked about psychotherapy-related experience, barriers and plans.Result122 doctors completed the questionnaire, estimated to constitute approximately 8% (or more if considering all vacancies) of SAS psychiatry posts based on the RCPsych Census (2015), from across all UK nations and regions.23% had gained experience in delivering psychotherapy (57% of whom confirmed CESR or training application plans), seeing cases mainly in CBT (52%) and psychodynamic psychotherapy (41%). Those who had delivered psychotherapy agreed or strongly agreed that it helped them become a better listener (82%), become more empathetic (75%), enjoy work more (71%), understand the unconscious communication better (82%), be more confident about referring for psychotherapy (82%) and overall be a better psychiatrist (86%).44% planned to start a psychotherapy case but had not started, of whom only 22% had identified a supervisor and 15% identified a case. Only 11% felt confident they could get the psychotherapy training experiences they needed. Barriers reported included it not being part of their job plan (70%), time constraints (57%), difficulties in accessing psychotherapy supervision (61%), difficulties in identifying suitable cases (32%) and limited knowledge about psychotherapy (30%).ConclusionDoctors who delivered psychotherapy reported benefits on many levels, making a strong case it develops their clinical capabilities, which may facilitate psychologically-informed care.The results indicate interest in psychotherapy training outstripped available opportunity and support. Whilst some barriers mirrored those previously reported for trainees (difficulties accessing supervision and cases) others identified particularly related to SAS workload (not being part of their job plan and time constraints) and lack of support (with trainees prioritised). This may highlight a potential concern given the SAS Charter covers CESR-related support and advocates appropriate Supporting Professional Activities (SPA) time.Trusts need to consider more actively supporting SAS psychotherapy training and including in job planning for those receiving, delivering and supporting these valued experiences.

Balint in the time of COVID-19: participant and facilitator experience of virtual Balint groups compared with in-person

AimsOur Trust increased Balint group provision, relocating virtually for psychiatry doctors to explore the emotional impact of clinical practice and doctor-patient relationships, during unfamiliar challenges of the pandemic. This unique context allowed comparison of multiple virtual and face-to-face (F2F) Balint-type group experiences for participants and facilitators.MethodIn March 2020, existing core trainee (CT) year 1 and 2, higher trainee (ST) and consultant Balint groups became virtual, with new CT3 and Speciality Doctor and Associate Specialist (SAS) virtual Balint groups established.All 57 participants and 5 facilitators were sent an anonymous electronic survey to retrospectively rate virtual Balint (March-August 2020) and their preceding F2F Balint group (suggesting September 2019-February 2020) experience.ResultThe response rate was 89% for participants (51 respondents) and 100% for facilitators (5 respondents).For group participants, 90% (virtual) and 78% (F2F) agreed or strongly agreed that Balint group provided an opportunity to explore challenging aspects of clinical work. 76% (virtual) and 71% (F2F) agreed or strongly agreed that it made them feel more supported. Almost 50% agreed or strongly agreed that virtual and F2F Balint group helped work feel less stressful. Both ratings and free-text feedback emphasised virtual Balint attendance being easier.Facilitators rated virtual and F2F formats similarly highly with regards to exploring difficult doctor-patient interactions, richness of discussions and their enjoyment. Facilitators felt virtual attendance was easier but more draining, with more difficult adherence to Balint group etiquette and boundaries.82% of participants and 75% of facilitators agreed or strongly agreed that virtual format made them more likely to attend future Balint groups. The rich pool of free-text comments received were predominantly positive, whilst noting challenges during virtual Balint in remaining present, with more distractions (for participants) and additional difficulty accessing group dynamics (for facilitators).ConclusionParticipant and facilitator responses indicate Balint-type groups being professionally and clinically beneficial across different psychiatrist grades, and promoting clinician wellbeing when both F2F and virtual during pandemic-related restrictions. Facilitator ratings (unlike participants) suggested specific virtual process challenges such as feeling more drained, perhaps in part due to technical application issues around this emerging format.Both participants and facilitators reported attendance being easier when virtual. Although some suggested returning to F2F post-COVID, more preferred to continue virtually or utilise a blended format. This was particularly for non-CT groups where geographical challenges (e.g. region-wide ST Balint) or competing clinical demands (e.g. consultant/SAS Balint) made regular commitment and attendance more difficult.

A Feasibility Pilot Study on the Use of Telemedicine for the Examination of the Knee Joint.

In times of a pandemic threat, such as COVID-19, and the need for reduced direct doctor-patient contact, internet-based telemedicine has attracted more and more attention as a surrogate service. Suspending the diagnosis and treatment of non-virus related diseases for longer periods of time is not a viable option since this would only exacerbate problems on the patient and national level. The need for alternative treatment modalities increased rather quickly. So far, telemedical applications have mainly focused on teleradiological diagnosis, follow-up and monitoring of psychiatric and internal diseases, as well as geriatric patient care. As far as these authors are aware, orthopaedic physical examination of the knee joint, including trauma work-up, has not been the subject of any studies to date. This feasibility study explores how video consultation can be designed and implemented in the context of history taking and physical examination in knee joint complaints. 21 patient actors (PA) with simulated complaints of the knee joint were examined individually for each diagnosis, first via video consultation and then directly by a specialist (SP). One PA group has a medical background, the other was made up of laypersons. The time was measured for both types of consultation. The physician documented the detected symptoms, the quality of implementation of the self-examination steps, and the derived diagnosis on an assessment form. After completion of both consultation sessions, the PAs were handed a questionnaire on the respective examination modality. With the video consultation the examination lasted 8.63 (± 2.5) minutes on average and with the regular consultation in person 5.63 (± 1.7) minutes (p < 0.001). For the group with medical background the examination lasted 7.67 (± 1.4) minutes on average, while for the lay group the video consultation took 9.7 (± 3.1) minutes (p = 0.049). With increased age, the video consultation was prolonged (p = 0.032; r = 0.47). The mean value for self-examination of leg axis, gait pattern and degrees of freedom was 9.32 (± 0.4) of 10 points. The following functional tests resulted in lower mean values (points): Payr 7.2 (± 2.3), Merke 5.9 (± 2.8), no-touch Lachmann 6.4 (± 2.7), gravity sign-recurvatum 6.7 (± 2.4). The mean grade by the PAs for the feasibility of self-examination was 2.43 (± 0.98) out of 5 points. The video consultation for musculoskeletal complaints of the knee joint allows exploratory remote examination and helps to minimise the number of patients in hospitals and practices. It takes longer for the physician to perform and does not permit functional testing for ligament injuries of the knee joint. In its present form, telemedical examination is not able to fully replace personal consultation.

Clinical Decision Making and Treatment Patterns in Canine Prolapsed Nictitans and Feline Herpetic Keratitis

&lt;p&gt;No evidence-based treatment guidelines exist for any ophthalmic conditions of dogs and there is limited published evidence supporting treatments of feline herpes viral keratitis (FHVK). The aim of this study was to document current treatment patterns of canine prolapsed nictitans (PN) and FHVK through the use of a vignette-based survey administered to general practitioner (GP) and ophthalmic specialist (SP) veterinarians.&lt;/p&gt;&lt;p&gt;The majority of veterinarians recommended surgical replacement of PN using a pocketing technique but GPs were more likely to trial medical therapy prior to surgery (26.8% GP, 10.4% SP, p=0.006). More GPs suggested excision as a first line therapy (12% GP, 0% SP, p=0.003) and GPs were more likely to suggest excision in case of surgical failure (27.0% GP, 3.0% SP, p&amp;lt;0.001). SPs rarely recommended excision and used periosteal anchoring more frequently in revision procedures.&lt;/p&gt;&lt;p&gt;The majority of veterinarians used topical antibiotics (77.8% GP, 72.7% SP) for FHVK with fusidic acid and chloramphenicol favored by both groups. GPs were less likely to use any antiviral therapy (52.1% GP,83.3% SP, p&amp;lt;0.0001) and more likely to use topical antiviral therapy (predominantly acyclovir). The majority of SPs used systemic famcyclovir (15.6% GP, 63.6% SP, p&amp;lt;0.001) and preferred trifluorothymidine when a topical was suggested. SPs were also more likely to suggest lysine supplementation (25.1% GP, 50.0% SP, p&amp;lt;0.001). The majority repeated their original treatment suggestions in the event of relapse.&lt;/p&gt;&lt;p&gt;Treatment variation was seen both within and between GP and SP groups for both of these conditions. In particular FHVK elicited a wider array of treatment suggestions, suggesting greater clinical uncertainty. Establishing current practice may add to knowledge of current collective opinion but also identify areas of priority for research in veterinary ophthalmology.&lt;/p&gt;&lt;br /&gt; &lt;img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /&gt;

Risk Factors Associated with Incomplete Endoscopic Mucosal Resection of Colonic Polyps

Introduction: Risk factors for incomplete endoscopic mucosal resection (EMR) of large colonic polyps are uncertain. We aimed to characterize the rates and risk factors of incomplete resections (IR) at a single US center. We hypothesize that polyp size > 40mm predicts IR and resections initiated by endoscopists specializing in colonic EMR protect against IR. Methods: Using an electronic endoscopic database, we identified patients who underwent EMR with at least one follow up colonoscopy from 2006-2015 at our institution. Patients with IBD were excluded. The primary outcome (IR) was defined as cases which the provider noted residual polyp at the end of the first resection attempt. Polyp characteristics and the endoscopist first performing EMR (specialist (SE) vs. non-specialist endoscopist) were noted. Univariate and multivariate analysis was used to identify factors associated with IR. Clinical outcomes were recorded. Results: 258 patients with 289 polyps underwent EMR with at least one follow up colonoscopy. 39/258 (15%) had IR. Age, gender, polyp location, and follow up were similar between complete resections (CR) and IR (Table 1). SE as the sole EMR provider achieved CR in fewer colonoscopies than non-SE± subsequent SE referral (mean 2.4 vs. 3, p< 0.0001). On univariate and multivariate logistic regressions, polyp > 40 mm (odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.1-14.9), piecemeal removal (OR = 7.5, CI 1.8-31.9), and difficulty lifting the polyp (OR = 3.1, CI 1.1-8.9) were associated with IR. Resections performed by SE alone were protective against IR (OR 0.31, CI 0.15-0.65). Based on our regression model, the probability of IR in piecemeal resections of polyps>40 mm with and without difficulty lifting (and started by a non-SE) is 88% and 56%,respectively. When SE are the sole EMR provider, the probability of IR drops to 41% and 11%, respectively, (Figure 1). Of the IR patients, 12 (28%) were referred for surgery, 2 of which were for adenocarcinoma and 1 of which were for high grade dysplasia. 16 (41%) achieved CR after a mean of 2 more colonoscopies (range 1-4), 7(18%) are actively undergoing further EMR, and 4 were lost to follow-up.Figure 1Table 1: Demographics, endoscopic findings and pathology of patients with complete and incomplete resections.Conclusion: In this single center US experience, IR of large colon polyps occurred infrequently. Polyps > 40mm, piecemeal resections and difficulty lifting were risk factors for IR. Primary resections by specialist endoscopists reduce the risk of IR and the number of procedures to achieve CR.

Have the New Training Pathways Enhanced Academic Productivity in Plastic Surgery?

OBJECTIVE: To evaluate the effect of different surgical training pathways on the academic performance of plastic surgical (PS) divisions. METHODS: Eighty-two academic parameters for 338 PS, 1737 general (GS), and 1689 specialist (SS) surgeons from the top-50 NIH funded academic departments of surgery were examined using data gathered from websites, SCOPUS, and NIH RePORT. RESULTS: The median size of a PS division was seven faculty. PS faculty had lower median publications/citations than GS and SS (PS: 25/328, GS: 35/607, SS: 40/713, p < 0.05). Publication (P) and citation (C) differences were observed at all ranks: assistant professor (PS: 11/101, GS: 13/169, SS: 19/249), associate professor (PS: 33/342, GS: 40/691, SS: 44/780) and professor (PS: 57/968, GS: 97/2451, SS: 101/2376). PS had a lower percentage of faculty with current/former NIH funding (PS: 13.5%, GS: 22.8%, and SS: 25.1%, p < 0.05). Academic productivity for PS faculty was dramatically improved in integrated residency programs. P/C for PS faculty from divisions with traditional 3-yr fellowships were 19/153, integrated 5-yr residency were 25/329, and both traditional and 5-yr programs were 27/344, p < 0.05. Cranio-facial reconstructive and hand fellowships further increased productivity within the integrated residency-fellowship programs. P/C for programs that also had a cranio-facial reconstructive fellowship were 32/364, and for those that additionally had a hand fellowships were 45/536. PS faculty at divisions with integrated training programs also had a higher frequency of NIH funding (PS% with current/former NIH funding, 2-yr fellowships: 5.8%, integrated 5-yr residency: 7.9%, and both 5-yr/2-yr programs: 18.7%). CONCLUSION: PS divisions vary in degree of academic productivity. Dramatically improved scholarly output is observed with integrated residency training programs and advanced specialty fellowships. Recruiting trainees into earlier in their careers into PS and providing advanced additional training options may represent successful mechanisms to improve research productivity within PS divisions.

Number of senior paediatricians falls

The number of consultant paediatricians and specialty, staff, and associate specialist (SAS) grade paediatricians in the UK fell by 1.4% between 2009 and 2011, the Royal College of Paediatrics and Child Health has reported.1 The college’s latest workforce census shows that the number of SAS grade paediatricians working in the NHS fell “significantly.” And although the total number of consultant paediatricians rose slightly between 2009 and 2011, the rate of growth was slower than in 2007-09. The college said that the slowing growth in the number of consultant posts was a concern given the high number of doctors …

Charter aims to improve careers of staff grade doctors

The Royal College of Physicians of Edinburgh is urging NHS employers to adopt a UK-wide charter that recognises and supports staff, specialty, and associate specialist (SAS) doctors. The college said that Britain’s hospitals were in danger of losing talented doctors who were essential in keeping services running, because of the lack of importance being attached to their role. …

Most organisations in England are ready for revalidation

Most doctors in England have the organisational backup they need to begin revalidation from the end of this year—the scheduled start date—concludes the latest report from the NHS Revalidation Support Team. But the appraisal rate across the country is still patchy, particularly for consultants and for staff, specialty, and associate specialist (SAS) doctors, says the report, which will inform the health secretary Andrew Lansley’s decision on whether to give the go ahead for revalidation. The support team’s second Organisational Readiness Self-Assessment report captures the state of readiness for revalidation of organisations that employ or contract with doctors (designated bodies).1 This year, 654 designated bodies completed the self assessment, equating to a 95% …

Introduction: Special Issue Der Mensch ist was er isst (Feuerbatch) – Texts on Food, the Eating Process and the Philosophy of Recipes

Introduction: Special Issue Der Mensch ist was er isst (Feuerbatch) – Texts on Food, the Eating Process and the Philosophy of Recipes

Psychosocial working conditions and the utilization of health care services

BackgroundWhile there is considerable theoretical and empirical evidence on how job stress affects physical and mental health, few studies have examined the association between job related stress and health care utilization. Using data from the Canadian National Population Health Survey from 2000 to 2008, this paper examines the association between stressful working conditions, as measured by the job strain model, and the utilization of health care services.MethodsA zero inflated negative binomial regression is used to examine the excess health care utilization due to job strain. Separate regressions are estimated for both males and females since studies have shown gender differences in health care utilization.ResultsEstimates for the whole population show that high or medium job strain has a positive and statistically significant association with the number of visits to both a general practitioner (GP) and a specialist (SP). On average, the number of GP visits is up to 26% more (IRR = 1.26, 95% CI = 1.19-1.31) for individuals with high strain jobs compared to those in the low job strain category. Similarly, SP visits are up to 27% more (IRR = 1.27, 95% CI = 1.14-142) for the high strain category. Results are quantitatively similar for males and females, save for medium strain. In general, findings are robust to the inclusion of workplace social support, health status, provincial and occupational-fixed effects.ConclusionJob strain may be positively associated with the utilization of health care services. This suggests that improving psychosocial working conditions and educating workers on stress-coping mechanisms could be beneficial for the physical and mental health of workers.

Leadership training for SAS doctors

Staff grade and associate specialist (SAS) doctors comprise differing proportions of a trust's workforce depending on specialty and are involved in the delivery of service and teaching. SAS surgeons will at times be the lead surgeon in the theatre and as such will need to display leadership qualities as part of the theatre team. For this reason in late 2008 the London Deanery commissioned the Royal College of Surgeons to provide a programme to develop the leadership skills for SAS surgeons within the deanery.

Clinical management course for staff and associate specialist doctors

Keele University’s clinical management course has been specially developed to meet the needs of staff grade (now specialty) doctors and associate specialist (SAS) doctors in the NHS. The course is intended to help prepare these doctors for a move to consultant posts, and it helps to give a deeper insight into NHS management issues for doctors who are considering article 14 application (certificate of eligibility for specialist registration) to join the General Medical Council’s specialist register. It is not specialty specific and is built on Keele University’s experience of providing clinical management courses for specialist registrars. Before the course, which was a three …

Schweizer Literaturgeschichte by Peter Rusterholz, Andreas Solbach

6io Reviews form constitutes a relatively rare exception in a book organized according to theme and authorship. Indeed, demolishing the assumption of a congruence between the twowastes a disproportionate amount of space, and isnot always successful. Para doxically, it also leads to the inclusion, especially but by no means exclusively, in Erin McGlothlin's final essay on 'Writing by Germany's Jewish Minority of a good number of texts that are not fiction and/or not written (or even interested) in the Berlin Republic. And that then raises serious issues of focus and purpose. Equally, the ubiquity of translations suggests that the book is aimed at people not familiarwith the terrain.Yet almost no attempt is made to cater to this constituency. The translations of titlesand concepts are oftenmechanical, inconsistent, ideological, or just plain wrong. (Particularly crass is the translation 'Middle' for '(Berlin) Mitte'; but we also have 'False Hare' for themeatloaf that is 'Falscher Hase', 'Fall of the Berlin Wall' and 'political turn' for 'Wende\ and 'Legacy for 'Mitgift'.) Buzzwords such as 'Frauleinwunder, 'Generation Golf, '78er\ even '68er\ are explained inade quately and inpassing. (Conversely, afterFinlay's magisterial treatment of the topic, further explanations of the 'Literaturstreit' are redundant.) The two chapters with transnational potential, by Ingo Cornils on 'LiteraryReflections on "68"' and Sabine von Dirke on 'Pop Literature in the Berlin Republic', remain resolutely parochial. And for someone who does not know the text, tobe told that 'Hans Ulrich Treichel's Der Verlorene is included in Bill Niven's discussion of Germans as perpetrators ofNazi crimes, but itmight also have appeared inHelmut Schmitz's examination of "German wartime suffering'" (p. 11) isworse than unhelpful. Anyone familiar with Treichel's book, of course, will find the remark equally infuriating. For experts, moreover, the secondary material cited isworryingly narrow. Unfortunately, then, forall its sundry strengths, this isnot the book thatwe needed. Queen Mary University of London Robert Gillett Schweizer Literaturgeschichte. Ed. by Peter Rusterholz and Andreas Solbach. Stuttgart and Weimar: Metzler. 2007. 529 pp. 49.95. ISBN 978-3-476 07136-9. Eight chapters of Schweizer Literaturgeschichte, each written by an established spe cialist, deal in chronological order with the literature ofGerman-speaking Switzer land from its perceived beginnings in theMiddle Ages to the year 2000, and constitute four-fifthsof the book. The remainder contains a chapter of some forty pages on the literature of French-speaking Switzerland from the Reformation to the end of the twentieth century, ten pages on that of Italian-speaking Switzerland, two chapters providing twenty pages on Romansh literature, and three 'Exkurse' by other authors, on 'Exilliteratur, on 'Der neue Schweizer Film', and on women's writing inGerman-speaking Switzerland since 2000. The composition and proportions of Schweizer Literaturgeschichte present one solution to the problems of organization posed by its title,but it is fairlycertain that this titlealso sets in train in themind of a potential reader differentexpectations of a more equitable distribution of constituent elements. The' Vorwort' does not really ac MLR, 104.2, 2009 611 count for theparticular structure of thebook. The editors point to themarginal place accorded to Switzerland in several recent histories of literature inGerman and to the limitation to the twentieth century of the one recent specialized work of note, Klaus Pezold's Schweizer Literaturgeschichte:Die deutschsprachige Literatur im20. Jahrhun dert (Leipzig: Militzke, 2007) (reviewed in MLR, 104 (2009), 291-92), and posit as a consequence the desirability of 'eine Geschichte der Literatur aus der Schweiz' which, going beyond the texts themselves, sets themmore widely 'imKontext der Geschichte der Kulturen, der Geschichte und Politik der Schweiz* (p. ix).The volume also seeks to encourage the reading of 'Literatur aus den Kulturraumen' of Switzer land among awider public since the individual contributors 'mochten [...] Lesende mit unterschiedlichen Voraussetzungen furdiese Literaturen gewinnen' (p. xii). Schweizer Literaturgeschichte contains good examples of contextualization and promotion, namely those chapters in the German section which are sustained by a strong,wide-ranging, and coherent narrative highlighting the characteristics of the period under discussion and the relationship of outstanding figures to it. Remy Charbon on 'Das achtzehnte Jahrhundert (i700-i83o)>, Dominik Miiller on 'Der liberale Bundesstaat (1830-1848-1914)', and Beatrice Sandberg on 'Geistige Landesverteidigung (1933-1945)' all...

Poetische Ordnungen: Zur Erzählprosa des deutschen Realismus ed. by Ulrich Kittstein, Stefani Kugler

MLR, I03.4, 2008 II57 thosewriters whose confrontations with modernity attempt topreserve a consecrated poetic realm-and it isnot surprising to find Heine' smore direct approach evidenced inonly a fewwriters, such as Peter Riihmkorf, Giinter Kunert, andWolf Biermann. Phelan's readings are lucid and coherent throughout the monograph, and he argues his case forHeine themodernist well. Occasionally he fails to recognize the ambiva lence so prevalent inHeine's lyric, forexample in the last stanza of 'Sie saB3enund trankenam Teetisch', where it isnot at all clear how Heine's beloved would have fitted inwith theother participants, nor why she isabsent in the firstplace. At other points Phelan underestimates Heine's irony, such as in the third stanza ofHeimkehr III, where the idyll is surely undercut by thepolysyndeton of the final two lines. For the most part, however, Phelan is judicious inhis interpretations and charts a course that will surely receive the assent ofHeine scholars. Indeed, most of his audience will be predisposed to reject the censure ofKraus and Adorno and towelcome claims that castHeine as a central figure in an incipientmodernism. Whether Phelan's excellent and ambitious book will counter Heine's marginalization from the discourse of a modernist movement that has relegated him to an afterthought, and assist in reha bilitating him for a new generation of critics concerned with aesthetics, politics, and history, seems improbable, however much Heine scholars may desire thisoutcome. UNIVERSITY OF TENNESSEE, KNOXVILLE ROBERT C. HOLUB Poetische Ordnungen: Zur Erzdhlprosa des deutschen Realismus. Ed. by ULRICH KITTSTEIN and STEFANI KUGLER. Wiirzburg: Konigshausen & Neumann. 2007. 290 pp. ?39.80. ISBN 978-3-8269-3670-5. Selected works ofGerman realism are here defended against the familiar charge of provinciality by showing how texts are ordered by themaintenance and transgres sion of boundaries: geographical, racial, cultural, and between genders. In a dense, theory-laden introductory chapter, Patrick Ramponi examines globalization as im aged by the exoticism of colonial commodities inGustav Freytag's Soll undHaben, Wilhelm Raabe's shiftingpositions between cosmopolitanism and Bismarckian patri otism, and the sensitivity toworld events of the local lake inTheodor Fontane's Der Stechlin. Ulrich Kittstein approaches one more time the characterization of the Jew ish villains inSoll und Haben and Freytag's Der Hungerpastor, ascribing it to poetic realism's requirements for the figurationof antagonists, while observing that,even if anti-Semitism had not been intended by theauthors, the effect isno less problematic. Franziska Schossler recognizes theconventional scepticism towards thepossibility of Jewish assimilation pervading Theodor Fontane's L'Adultera. Similar to the ambiguous boundaries to the Jews are those to the gypsies. A spe cialist on this topic, Stefani Kugler, examines the relationship of nature and culture in Adalbert Stifter's Kazensilber, where thebrown girl appears to represent a childlike nature towhich the cultivated family has lost contact, leaving themwith anxieties and yearnings but without competence in dealing with natural dangers. Their ef fort to colonize and denature the girl fails, thus calling Stifter's pedagogical ideals into question. This is carefully argued, but I still do not understand what we are to make of the recurrentviolence and indifferent hostility of nature inStifter's stories in terms of 'das sanfteGesetz'. Herbert Uerlings combines an account of Swiss policy towards (or against) gypsies in the nineteenth centurywith a close reading ofGott friedKeller's Romeo und Julia auf demDorfe, where he endeavours to show that the community values towhich Sali and Vrenchen remain loyal are not supported by the text and that themoral disparagement of the black fiddler and his vagabond band seen through theireyes should not be accepted by the reader.The love-death is flight, II58 Reviews so that the disparaging newspaper report was not so wrong after all. The reading ishighly observant but worrisomely tends to deny the dignity thatKeller means to ascribe to theyoung couple. Anna-Lena Salzer's commentary on the gypsies inKarl May's Scepter und Hammer comes once again to his familiar antinomy between the liberal and tolerant intentions asserted by thenarrator and the feckless employment of every kind of group prejudice and stereotyping. Perhaps placed somewhat similarly to themarginalized gypsy is the innocently os tracized girl inRaabe's Else von der Tanne, where Andrea Riittinger finds thebound ary...

The Changing Role of the Reading Specialist in School Reform

Recently, a new role for the reading specialist has been suggested for schools with large numbers of struggling readers. This role conceptualizes the reading specialist not as some one who works directly with students (Quatroche, Bean, & Hamilton, 2001) but as someone who works directly with teachers as a coach and mentor. In this new role the reading specialist supports teachers in their daily work?planning, modeling, team-teaching, and providing feedback on com pleted lessons in collaboration with classroom teachers in a school. In addition, the reading spe cialist assists teachers by helping them understand the assessment and instructional cycle and how that cycle can help them as they develop lessons and or ganize their classes for instruction. In the No Child Left Behind legislation, the Reading First Initiative views reading coaches as a viable and important professional development component for Reading First schools in the United States (U.S. Department of Education, 2002). The purpose of this article is to discuss the changing role of reading specialists and their po tential new role as reading coaches. The article be gins with a discussion of the traditional role of the reading specialist as Title I teacher as it evolved un der the Elementary and Secondary Education Act (ESEA) of 1965 and the new role of the reading specialist as coach under Title I of the new ESEA of 2000.1 also discuss research on the benefits of coaches in the professional development of teach ers. In the second half of the article I discuss what reading coaches can do in schools. I end with some rules of thumb for effectiveness based on the ex periences of reading coaches.