WHAT HELP AND HINDERS DOCTORAL STUDY: VIEWS AND EXPERIENCES OF NON-MEDICAL CONSULTANTS Dr Chris Inman Programme Director MSc in Advanced Practice at BCU

PRESENTATION OF THE MAIN FINDINGS This session will present some of the findings and related literature from qualitative research exploring the motivations, experiences and practices of students involved with PhD/Doctoral study The participants research tended to focus on psycho-social care questioning some medical approaches. Their populations included people with dementia; mental health problems long-term conditions; midwifery etc.

THE LITERATURE REVIEW The literature review explored: Careers in the NHS for non-medical practitioners whose roles involve expert clinical practice; research; education; and leadership Part time doctoral study – the effect of PT study Influences on the progress of study

CAREERS IN THE NHS FOR NON-MEDICAL PRACTITIONERS CONTEXT ‘ ’Super-nurse’’ (Making a difference DH 1999) Raising the glass ceiling for non-medical professionals - nurses, midwives and allied health professionals include physio; OT; SLT (600,000 registered nurses in UK) Doctors’ hours reduced ( EU Working Time Directive) Demographic time bomb and increase in complex conditions, technology and treatments

PART TIME DOCTORAL STUDY The literature suggests: Challenges implicit in part time PhD study cause dissonance and influence motivation (Wisker et al 2003) Students focus on supervisor’s support to reduce fragmented engagement with the research community Supervisors are said to prefer the ‘’ideal type’’ -full time student.

METHODOLOGY – A QUALITATIVE, EXPLORATORY DESIGN Three research questions were identified: What motivates senior practitioners to study at Pg level? What is involved in undertaking and making progress with doctoral research? What is the experience of family, home, work and university and what are the sources of support? Method – focus groups of 6-10 senior practitioners and 6 individual interviews with women

MAIN THEMES Prove to myself Get a buzz The organisation Support Inequality

FINDINGS AND DISCUSSION THEME ONE Participants proving themselves ‘’it is a personal strive to prove yourself to somebody’’ I don’t know if I haven’t to prove something to myself as well’’ (FG1) ‘’I’m more credible … wanted the challenge’’ (FG2) Elements of obsessive behaviour have been previously noted by Rugg and Petre (2004)

PROVE TO MYSELF ‘’I’d like to say it’s all art, esoteric really but it can’t be can it because … you want to have the personal achievement …[as well as] the philosophy [But it’s] partly a selfish thing’’ If I’m really honest about this … because I left school with one ‘O’ level … I want to know whether I can work at that level, but I’m also interested in the subject’’

PROVE TO MYSELF The acknowledgement of a ‘‘partly selfish thing’’ is resonant of Gilligan’s (1989) feminist ‘‘morality of care and responsibility’’ where ideally women would be able to fulfil family responsibilities without sacrificing their own needs The data suggests women are not prepared to openly acknowledge feminist inclinations and tend to adopt a covert feminist persona

Kohiberg’s ‘Morality of Justice’ Gilligan’s ‘Morality of care and responsibility’ Feminine carerFeminist carer Based on western positivistic tradition of reasoning – responding to others Conflicting responsibilities interpreted as moral dilemmas Non-medical consultants’ self blame for selfishness in doing study Non-medical consultants resisting the male dominant trend - adopted autonomous, independent behaviour Participants relationship to feminine and feminist carers Source Hughes (2002) adapted

PROVE TO MYSELF Another stated ‘‘I’ve always had issues about how bright I think I am’’. ’’A rare-ish kind of thing …make me feel I’ve really pushed myself to the limits’’ Leonard (2001:7) suggests women are disadvantaged because ‘’the curriculum and pedagogy’’ are not set by women To some extent the women are surprised to find themselves studying at this level Ingliss (1998) writes of women’s gender constraints that result from the gender socialisation process

PROVE TO MYSELF Research focusing on a stigmatised population ‘’This will make a big difference to the way people will view the client group that’s the big motivator probably 50%, the rest is personal …’’ A synergy between intrinsic and extrinsic motivators can be noted in participants with personal and professional satisfaction which suggests ‘self-actualisation’ and even ‘transcendence’ when insights lead to optimal progress (Maslow and Lowery 1998:6)

GET A BUZZ Clear indications emerged of immersion in research, being inspired, being consumed, driven, proud, possessive and controversial these can be equated with the research ‘high’ ’’Well I’m doing a PhD, I think the reason that I did it, I really enjoyed my master’s, loved doing the research and really get a buzz out of doing the research…’’

GET A BUZZ One new NMC was on the brink of enrolling ‘’This new post … that’s woken me up … I’m beginning to get itchy to do something else ‘’ There are numerous ‘’how to survive a thesis’’ type books but few feature enjoyment … this leads towards the most positive finding and suggestion that the most rewarding aspect of non-medical consultants role – that of ‘working on the research’ and ’getting a buzz’’

GET A BUZZ One person later left her job to prioritise her research ’’I want to do this thing … (speciality) was my sort of passion, that and the practice development. I’m inspired to almost try and prove some of the key (medical) research is wrong. It is fascinating … For me, consumed because your doing it’’ Abercrombie (1993) indicates that following initial resistance to change, learning that engages and challenges the student can emancipates them from their previous thinking

GET A BUZZ Again the conviction ‘’There is none over and above the piece of research I’m doing, that’s one of the buttons that inspire me’’ to improve care Mezirow’s (1978) ‘transformational influences’ involves being open minded and ‘letting go’ to relinquish some basic values and assumptions used to function previously. It introduces uncertainty which initially can be unwelcome until ‘insights’ occur and it can promote inspiration

GET A BUZZ ‘’Feeling everything else is under control… feeling well… having the place to myself… being able to write or think’’ ‘’You can’t switch on and off … but once your on a roll … it’s a pain when you think… I can’t really stop now, you've got to keep at it ’’ ‘’Capturing them before you lose them is the thing’’ ‘’But there are some days when I sit down thinking I can’t do this today’’ HESA part time study – completions had declined

DOCTORATE QUALIFICATIONS OBTAINED BETWEEN 1995 AND 2006 BY UK RESIDENTS (HESA) Source HESA January 2008 Type of student 1994 / / / / Full time1,385 2,45010,515 12,950 2 UK domiciled 8001,490 6,400 7,215 3 Female ,665 3,355 4 Male ,735 3,865 5Part time6,174 9,100 3,605 3,565 6 UK domiciled4,169 6,090 2,740 2,650 7 Female1,399 2,400 1,155 1,215 8 Male2,770 3,600 1,585 1,435

Data Regarding Doctorate Qualifiers from HESA (2008) Full-time doctorate qualifiers men and women of UK domiciled people had increased nine fold with 800 in 1994/5 and 7,215 in 2005/6 A greater increase is shown for full-time women with a fourteen fold increase from 243 qualifiers in 1994/5 and 3,325 in 2005/6 Part-time doctorate qualifiers men and women shows a substantial decline with 4,169 in 1994/5 and 2,650 in 2005/6 However only a small decline has occurred for part-time women with 1,399 in 1994/5 and 1,215 in 2005/6

GET A BUZZ ’’It goes in fits and starts … I’m actually taking my study leave in blocks’’ ’’It’s a hard slog … you make sure you pick a subject that you feel really passionate about or you’re not going to survive’’ Gilligan (1989) critiques the feminine model because it is a ‘world apart, separated politically and psychologically from the feminist model which depict a realm of individual autonomy’’. These women’s quotes can be linked with feminism … but they tended to deny this

GET A BUZZ The participants tended to identify with a feminine code claiming to prioritise all family concerns and close relationships. Their behaviour however was more reflective of feminism and had the potential to create conflict due to: Ruthlessness and single mindedness to progress with their part time thesis The need for self-fulfilment and reward

THEME THREE - THE ORGANISATION A paradox emerged in that managers assumed non-medical consultants needed to study at doctoral level and this provided kudos for the trust so they automatically paid fees BUT made little commitment to protecting study time ’’There’s no infrastructure … no tradition, no understanding of what [time] is needed’’ ’’Just being registered is actually not a lot of good’’ and another said ’’ I’ve had my fees paid’’ ‘’There’s nothing on trust policy [about time] it only goes to Master’s level’’ Erdman (2005) expressed concern about study time for nurses

THE ORGANISATION There was a general assumption the doctoral study would be beneficial both personally and professionally ’’Expectation at work … needed for my own [academic] credibility, status, confidence to facilitate others’’ Jonathan (1997) suggests in education can provide an ’’illusion of freedom’’ If the thesis provided an ‘illusion of freedom’’ it rapidly became apparent that it was an illusion when the reality within the organisation became apparent

THE ORGANISATION Another participant said ’’We’ve got to differentiate … we’re getting more and more nurses with masters…’’ ’’They (doctors) certainly wouldn’t value the fact that you weren’t on the ward and you were swanning off to do a PhD’’ Alvesson(2002) advocates being wary of judging complex ‘organisations as homogenous on a limited number of values’ arguably for these participants the policy was consistently minimal but homogenous across employing trusts

ORGANISATION The vast majority of participants were convinced of the merits of education for their work ‘’The highest academic accolade’’ ’’Any education the I have done in the past or any sort of development has made me better at what I’m doing’’ This can be challenged from a critical theorist perspective. The recent shift by governments to treat education as a marketable commodity to be distributed and consumed causes concern that ‘knowledge would cease to be an end in itself’ (Lyotard 1994:5)

1 st Essential to progressSupport from family Guidance from supervisor 2 nd Accessibility highly valued Other Non-medical consultants Colleagues 3 rd Of decreasing importance as the thesis became established University peers THEME FOUR SUPPORT Relationships and guidance – importance to students

SUPPORT - FAMILY Family were generally viewed as important for support ’’My partner understood my ideas and that was really important’’ ’’Inspirational but not in the sense of a figurehead … if you say that’s a load of [rubbish] somebody is going to get upset’’ Conversely some less welcoming attitudes were also reported from partners ’’You’re not going up there [university] again?’’ ’’My husband is picky and he’ll criticise … I can feel myself bristling’’

Valued comfort zone and different types of family support Over-supportive Interest and positive critique Unwelcomed reader and critic Threat to ownership Valued comfort zone Causing ‘ bristling ’

SUPPORT – FRIEND OR FOE The power balance with supervisors changed with individuals and over time ’’My second supervisor had what I would call a more traditional viper type supervision approach whereas my first was what I would call a critical friend’’ ’’I felt them advocating their particular approaches … and I found that annoying because I knew what they were doing … after a while I said I wanted to change the way we were working… now I actually enjoy the joint supervision’’ The students were astute observers and the process was dynamic but there was an assumption that changing supervisor needed to be avoided

FINALLY INEQUALITY The participants considered that a hierarchy existed enabling some practitioners in the health service to have greater access to protected study time At the peak were doctors, next came scientists, AHP and finally nurses and midwives The inequality was verbalised in various ways one participant’s perception was summarised as: ’’Your only a nurse … not a real PhD’’ Coats (1994) suggests that a backlash is experienced when the position of women is considered to have been advanced This ties in with Foucault theory of gender and power

GENDER ISSUES FOR NON- MEDICAL CONSULTANTS FOUCAULT’S (1984) THEORY OF GENDER AND POWER Predominantly female health care practitioners’ senior roles Advanced and Non-medical consultants slowly becoming established in the from 1993 until the present Western developed nations with gender centred conflict Non-medical consultants consider individual are blocking progress with their thesis rather than joining forces to influence change to the national system Inequality struggles – tend to focus on the immediate local enemy Non-medical consultants striving for status and credibility with thesis work but concerned it may be deemed ‘only a nursing PhD’ Gender struggles focus on the effect of power associated with privilege

RECOMMENDATIONS INCLUDE National group action would strengthen support for doctoral study and especially protected study time Universities prepare new and potential students for the complexity of emotional response from partners, family and colleagues Alert managers to the contradictions involved in paying fees but not protecting study time Dissemination through conferences and publication

THANK YOU! Any Questions?