Learning in vivo

Regulations about Skills Development Funds received and spending

On 1 April 2013 new regulations (RSA 2012) about monies received by Sector Education and Training Authorities (SETAs); mandatory and discretionary grants; proportion of administration costs; discouraging accumulation of surpluses; and related came into effect. Simultaneously the previous grant regulations were repealed, namely Government Notice No R713 in Government Gazette No 27801 of 18 July 2005 and Government Notice No R88 in Government Gazette No 29584 of 2 February 2007.

Of particular importance to higher education programmes that contains work-integrated learning in the curriculum is §6 (pp. 11-13), “allocation of discretionary grants by a SETA”:

• §6(12)—“at least 80% of discretionary grant funding must be allocated to PIVOTAL programmes”, which are defined (p. 5) as an acronym meaning “professional, vocational, technical and academic learning programmes that result in qualifications or part qualifications on the National Qualifications Framework …” [also §3(6)]
• §6(11)—addressing scarce and critical skills through programmes designed to address such, which include work-integrated learning must be the key focus of SETAs. Work-integrated learning is defined (p. 6) as an umbrella term for curricular, pedagogic and assessment practices; integrating formal learning and workplace concerns; culminating in a qualification or part thereof; and may include practicums, professional practice, internships, workplace experience, industry-based learning, cooperative education, service learning, real work learning, placements, experiential learning, and clinical placements
• §6(14)—obtaining the funding above is subject to a legal person completing and submitting a PIVOTAL training plan and report as per annexure 2 (private), sections E & F (pp. 22-23) or (public), sections G & H (pp. 30-31). A legal person [§6(10), p. 12] includes public education and training institutions; an employer or enterprise that falls within the jurisdiction of a SETA, but includes those not required to pay the skills levy; and other such as NGOs [refer to §6(7), p. 12].
• §6(15)—however, employers with less than 50 employees will not have to submit the PIVOTAL training plan and report indicated above, “but will be asked to provide information on participation in PIVOTAL programmes and the impact of these”. SETAs will develop suitable templates for small and micro enterprises.
• Note, however, §7 specifies that the “SETA criteria for grants must be approved by the SETA Accounting Authority before funds are allocated”; and §8 that each SETA is required to prepare and distribute a schedule indicating the dates by which applications for grants must be submitted and the timeframes for disbursements [also §3(7)].
• §6(1-2 & 4-5)—each SETA must develop a Sector Skills Plan (SSP) in accordance to the National Skills Development Strategy and strategic goals; and each SETA must annually approve a Discretionary Grants Policy, developed in accordance to the issued DHET guidelines; which will determine and specify its discretionary grants allocation to meet the sector’s needs through different delivery models and project types that will be deployed.
• §6(3)—each SETA’s Annual Performance Plan (APP) clarifies how discretionary grants are allocated to prioritise skills development of the sector through public education and training institutions.
• §6(9)—the Discretionary Grants Policy of each SETA must “indicate the purpose of the various grants, funding frameworks and projects …”; and give the communication procedures, which must embrace the “principles of transparency, opened, access and fairness” [§6(8)].

The remainder of the regulations deal with (§1) definitions; (§2) specifying the limitations on administrative costs of SETAs; (§3) the compliance of SETA finances and financial management; (§4) the allocation of mandatory grants, and (§5) the payment mandatory grants to levy paying employers; (§9) the payment of services rendered by SETAs; (§10) the repeal of previously published regulations; and (§11) finally the short tile and commencement of the regulations.

Republic of South Africa. 2012. Skills Development Act (97/1998). The Sector Education and Training Authorities (SETAs) grant regulations regarding monies received by a SETA and related matters. Government Gazette Vol. 570; Regulation Gazette No 9867; Government Notice No R990; Gazette No 35940; 3 December 2012. The Government Printing Works.

Gazetted Terminology for Professional Nurse and Midwife Education and Training

The terminology for cooperative and work-integrated education within the South African nursing education and training sphere is worth noting. It is gazetted that the Minister of Health, after consultation of the South African Nursing Council (SANC)—a statutory body—in accordance to §58(1)(f) of the Nursing Act (Act No 33 of 1995); made regulations pertaining to the education and training of professional nurses and midwives.

Of specific interest are the definitions of:

• Clinical accompaniment, which “means a structured process by a nurse education institution to facilitate assistance and support to the learner by the nurse educator at the clinical facility to ensure the achievement of the programme outcomes;”
• Clinical facility, which “means a continuum of services to promote health and provide care to individuals and groups, used to teach learners;”
• Clinical learning opportunities, which “means the range of learning experiences available in a healthcare setting or other experiential learning sites for a learner to gain the required clinical skills;”
• Clinical placement, which “means the period spent by a learner in clinical and other experiential learning sites to ensure that the purpose of the programme is achieved;”
• Clinical supervision, which “means the assistance and support extended to the learner by the professional nurse or midwife at a clinical facility with an aim of developing a competent, independent practitioner;”

The gazetted regulations further includes several other definitions of terminology such as assessment / assessment method / integrated assessment / assessor / moderation / moderator; competence / learning outcomes / programme outcomes; comprehensive nursing; fundamental learning; programme / qualification; and recognition of prior learning. The regulations further deal with issues such as requirements for registration in the two said nursing categories; accreditation of education institutions; admission criteria; minimum programme requirements; clinical education and training; the assessment and moderation of learning outcomes; transfers; recognition of prior learning; application of these regulations, as well as transitional arrangements.

Nursing Act: Regulations: Approval of and minimum requirements for education and training of learners leading to registration in categories professional nurse and midwife, (G 36235, RG 9927, GoN 174), 8 March 2013

Three modes of experiential education

The Best Practices for Legal Education (2007) publication of the Clinical Legal Education Association (CLEA) represents the fruit of 25 years of rich dialogue among American law teachers, lawyers, and judges, regarding the education of lawyers. In the foreword is stated that the American Bar Association convened a 1984 conference ‘Legal Education and the Profession: Approaching the 21st Century’. The foreword further states that in 1987 Justice Rosalie Wahl of the Minnesota Supreme Court and Chair of the ABA Section of Legal Education and Admissions to the Bar rhetorically asked:

Have we really tried in law school to determine what skills, what attitudes, what character traits, what quality of mind are required of lawyers? Are we adequately educating students through the content and methodology of our present law school curriculums to perform effectively as lawyers after graduation?

The purpose of this elaborate prologue is to convey the credible nature of the three modes of experiential education identified in Chapter 5: Best Practices for Experiential Courses (pp 121 – 152, note that the page numbers of individual online chapters differ from the full publication) of the CLEA Best Practices for Legal Education (2007: 122), namely:

• In-house law clinics offering students opportunities to represent clients or perform other professional roles under the supervision of members of the faculty
• Externships — where students represent clients or perform other professional roles under the supervision of practicing lawyers or they observe or assist practicing lawyers or judges in their work
• Simulation-based courses granting students hypothetical situations to assume professional roles and perform law-related tasks

These three modes, although many different terms are used, are common in many disciplines, for example:

• Practicals, laboratory work, applied field experiences facilitated and managed by lecturers
• Work-integrated/experiential/work-based learning in the occupational field under supervision of an experienced practitioner
• Simulated learning providing experience in hypothetical situations

Brayne, Duncan and Grimes (1998: 244) address externships as a means for law students to obtain a credit “working in legal settings”. It is interesting to note that “in the United States, students may not receive financial compensation for work which warrants educational credit”. Brayne, Duncan and Grimes (1998) identify both advantages and disadvantages with regard to externships. Potential advantages include “lower costs, variety of opportunities, work experience, service to the community, and flexibility”. As far as disadvantages are concerned, the main one identified is the potential “lack of control over the quality of the educational experience”.

Brayne, H; Duncan, N & Grimes, R. 1998. Clinical legal education: active learning in your law school. London: Blackstone.

Stuckey, R & Others. 2007. Best Practices for Legal Education. United States: Clinical Legal Education Association. Retrieved 2 November 2011 from: http://www.cleaweb.org/best-practices -- note the hyperlink to the best practices blog at the bottom of the web page.

What are experiential programmes?

The Clinical Legal Education Association (CLEA) Best Practices for Legal Education (2007: 165, note that the page numbers of individual online chapters differ from the full publication) defines experiential programmes as those “rely on experiential education as a significant or primary method of instruction”. The experiences of students in the roles of lawyers, in simulations, as well as “their observations of practicing lawyers and judges” play an important role. The integration of theory and practice through “combining academic inquiry with actual experience” is regarded as experiential education.

Learning is not education, because learning happens as part of life through experiences, observations and eavesdropping. Education comprises learning opportunities that were designed; are managed; and may involve guided experience. Although law students may derive valuable learning experiences from part-time work experiences in legal settings, the CLEA Best Practices for Legal Education (2007: 165) argues cannot be regarded “experiential education because the learning in such environments is not necessarily accompanied by academic inquiry”.

Stuckey, R & Others. 2007. Best Practices for Legal Education. United States: Clinical Legal Education Association. Retrieved 2 November 2011 from: http://www.cleaweb.org/best-practices

Doing law as means to learning about law

In the developed, technocratic world people—especially younger generations—became accustomed to virtual realities on PC screens. Interactive PC games offer excitement, insight and fulfilment. Clinical simulations could offer similar stimulus, engagement observation how law works. Brayne, Duncan and Grimes (1998: 173) state aptly “doing law as means to learning about law is different from learning the law by reading it”. Reconstruction of legal incidents through the vehicle of simulations; and the presentation of social problems as law ‘cases’; are but two examples. A legal problem on paper does not contain the uncertainties, emotions and interactions that form part of the real-world realities of, for example, the attorney’s office, the police station or the courtroom.

Brayne, Duncan and Grimes (1998: 174) observes that “simulation is commonly regarded as a valuable part of clinical teaching, but one which is the poor relation of the real-client clinic”, because simulation lacks the “startling and awakening encounters … of coping with people” present in legal practice “who have a need of legal expertise”. On the other hand, simulations can provide opportunities not readily available and can invoke the emotions and flow of adrenalin associated with daily client work.

In undergraduate legal education, simulations would inculcate appropriate behaviours in addition to the realisation that there is more to lawyering than mastery of legal knowledge. Simulations further offer students safe opportunities to experiment and to learn from mistakes.

Brayne, Duncan and Grimes (1998: 183) emphasise that simulation can never be an alternative to real client work, but within a spectrum of teaching methods simulations could contribute to effective law learning.

Brayne, H; Duncan, N & Grimes, R. 1998. Clinical legal education: active learning in your law school. London: Blackstone.

Learning in Work and the Community (LiWC)

Learning in the Workplace and Community (LiWC) is, according to Victoria University, "an umbrella term that encompasses the many models and integrated approaches to teaching, learning and assessment that involve learning in and through the workplace and community. These LiWC models and approaches may include but are not limited to, projects in a workplace, practical, co-operative and clinical placements, fieldwork, simulated learning environments, apprenticeships, traineeships or internships and enterprise initiatives."

Preceptorship & preceptorial

During an elaborate literature review about in vivo learning and related concepts—in particular the function of overseeing and facilitating learning through experience in a real-life context—I found several terms, such as mentor and supervisor, including preceptor.

Recently, I was struck by the word precept, meaning "a commandment or direction given as a rule of action or conduct; an injunction as to moral conduct; a procedural directive or rule, as for the performance of some technical operation" and preceptory, meaning "historically the headquarters of any of the various orders of Christian Knights, within a given geographic area, governed by a preceptor, who was answerable to the Grand Master of the respective order." I found this odd and intended to look into the meanings. It slipped out of my mind and slipped back in today.

In contrast to the words precept and preceptory, the meaning of the word preceptor is "an instructor, teacher or tutor; an expert or specialist, such as a physician, who gives practical experience and training to a student, especially of medicine or nursing [Originating from Middle English, from Latin praeceptor, from praecipere, to teach]". Another explanation for preceptor brings the two meanings closer together, namely "A preceptor is a teacher responsible to uphold a certain law or tradition, a precept".

Most interesting, a Princeton University webpage states that the "Preceptorial method, introduced in 1905 under Woodrow Wilson's leadership, is a method of study whereby a small group of students meets in regular conferences with a faculty member. Wilson first described his proposal as a modified form of the Oxford tutorial"—it reminds me of my undergraduate days of group classes to discuss in smaller groups the work dealt with in the main lectures.

In another blog post I shared my literature review findings of August 2008 about perceptorship and on clinical accompaniment. According to Dube (2004) the concept preceptorship originated in the late sixties and early seventies. Dube (2004) asserts that preceptors instil confidence in preceptees and empower them. Barnum (1997, p. 8) states that precepting gives the new entrant a "chance to be the role, to internalise the role … new roles, like new robes, have to be worn a while before they fit comfortably" and concludes that "roles are not taught, but caught". However, Flynn (1997) asserts that a preceptor programme needs to be carefully planned to be effective and Dube (2004) cautions that the effectiveness is reduced if the preceptor: preceptee ratio is increased.

Preceptorship is among others defined as a "[a] period of practical experience and training for a student, especially of medicine or nursing, that is supervised by an expert or specialist in a particular field; [b] a defined period of time in which two people (a nurse with a student nurse or an experienced nurse with a new graduate) work together so that the less experienced person can learn and apply knowledge and skills in the practice setting with the help of the more experienced person; and in graduate education [c] a period of hands-on training under a physician or surgeon skilled in a technique–eg, placement of a stent in a coronary artery, or laparoscopic surgery". Another definition of preceptorship—emphasis added—sounds very similar to a definition of work-integrated learning: "Practical experience in medical and health-related services that occurs as part of an educational program wherein the professionally-trained student works outside the academic environment under the supervision of an established professional in the particular field".

Peer teaching

Live broadcasting and an expert panel appear to be worth considering for numerous communities of practice for peer teaching and learning from peers.

Sitting on the patio (18 Nov 2009) of our timeshare unit, at Ballito, KwaZulu-Natal, Martie excitedly shared an item (one of many as we relax together) from page 15 of the Longevity of August 2008: “live [medical] procedures … broadcasted interactively to large audiences around the world, is gaining momentum” state BEAM ME UP, IN THE NEWS column.

The news item elaborated on this form of peer teaching, informing readers about Dr Farrel Hellig, a South African cardiologist that conducted surgery at Sunninghill Hospital, in Johannesburg, transmitted live to the European Cardiology Congress, held in Barcelona, Spain. A panel in voice contact afforded delegates in attendance, some 1000 top cardiologists from the world, the opportunity to raise questions while Dr Hellig performed four surgical procedures. Such technological initiatives bring together a cardiology community as a whole in sharing knowledge in a real-life (in vivo) setting.

Professional bodies may use such live broadcastings for continued professional development.

Conference organisers may schedule such events as part of the programme.

Organisations may schedule such training or developmental opportunities, if the necessary technological infrastructure is accessible.

I worked for a group of companies that quarterly held in-house conferences to share technical and safety improvements, initiatives or accomplishments. Instead of gathering (which has particular value) this kind of peer teaching could have been used most effectively.

Welcoming, restoring, dwelling and parting

Larson (2009) indicates that “in recent years, several have suggested that education be thought of as an act of hospitality”. Think of a student required to undergo in vivo learning, in terms of Oden’s (2001) four movements of hospitality:

1.    Welcoming—the workplace mentor’s receiving of the student and sincere offer to serve.

2.    Restoring—involves addressing the student’s most immediate needs, for example, put the student at ease, giving the student an orientation and see to the student’s safety.

3.    Dwelling together—Oden calls it the “hospitality of presence”, the mentor’s demonstration of willingness to share her/his work knowledge, experiences and expertise; involving the student in day-to-day work happening and answering the student’s questions; but also asking the student’s opinions and listen to the student’s suggestions in terms of academic knowledge.

4.    Sending forth (parting)—Larsen (2009:49) explains that “this act of letting go is possible because the preceding acts of hospitality have empowered the guest, preparing her for her own responsibilities”. The mentor enables the student to complete the required work-integrated/in vivo learning; submit the necessary evidence of learning for assessment and move forward towards obtaining the qualifications and entering the community of practice.

Larson (2009:52-53) concludes “just think of the ways in which we could promote effective teaching and enhance student learning if we worked to create spaces … if we think of our work in terms of Oden’s (2001) four movements of hospitality”.

Larson, MH. 2009. Welcoming and restoring, dwelling and sending: creating a space of hospitality in faculty education. Journal of Faculty Development, 23(1), 48-53.

Oden, AG (Ed.). 2001. And you welcome me: a sourcebook on hospitality in early Christianity. Nashville, TN: Abingdon.

The power of real-life learning for university students

When encouraged to make a paradigm shift to a learning centred university, faculty often revert to provide problem-based learning activities or use applied assignments such as real life examples/ scenarios (Scott, Lisagor & Marachi 2009:17-18). One such an example is the teaching of a physical therapy course for infants. The course was less effective when the lecturer used dolls for demonstrations of particular techniques. One semester, Scott, Lisagor & Marachi (2009:18) reports, "she decided that she would bring real infants into the class for the students to practice the therapy techniques; however, she discovered that she needed to teach her students the reality of working with infants who are heavy (not light like a doll), don't have good head control, and don't sit still and will cry while you attempt to use a particular therapy technique. The learning she observed among the students was markedly more profound with this real-life approach."

Consistent with this, many faculty commented on the importance of using assignments that encourage students to go out into the community, using case studies, or take opportunities for teachable moments (Scott, Lisagor & Marachi 2009:18).

Scott, W; Lisagor, T & Marachi, R. 2009. Learning centred universities: the changing face of higher education. Journal of Faculty Development, 23(1), January 2009.

techne, episteme, poiesis, praxis & phronesis

Charles Sides and Ann Mrvica differentiates between five (5) very important Aristotelian concepts:

• techne - what people can do; a state of capacity to make; the rational method involved in producing an object or accomplishing a goal or objective
• episteme - a fixed set of information possessed by people; a system of understanding or a body of ideas which give shape to theoretical knowledge
• poiesis - means 'to make'; it is an action that transforms; it refers to 'bringing-forth'; a threshold occasion: a moment of ecstasis when something/s becomes another
• praxis - a practice (as distinguished from theory); application of skill; conduct in a public space considered as excellence
• phronesis - the capability to consider the mode of action in order to deliver change, especially to enhance the quality of life; some believe it includes the ability to reflect upon; it is practical wisdom, knowledge of the proper ends of life, in contrast to sophia - involving wisdom concerning universal truths; science

Sides and Mrvica believes that internships - as form of learning - are pursuing techne, poiesis and praxis (pp. v & 1-2). Through internships knowledge communities are sustained. When deliberating about evaluation of internship, they add the term phronesis (pp. 95-98).

I found this differentiation extremely valuable.

Sides CH. & Mrvica A. 2007. Internships, theory and practice. New York: Baywood.

Knowledge - Competence - Performance - Action

The educational psychologist George Miller (in Norcini 2003) put forward a framework—illustrated in figure 1—for the assessment of clinical competence, i.e. proficiency based on actual observation of symptoms and treatment of disease in patients (Dictionary.com).

Miller (in Norcini 2003) differentiates between ‘action’, which is at the top of the framework, and lower levels, such as knowledge (at the lowest level), competence and performance. ‘Action’ is about what happens in practice. Norcini (2003) argues that the methods of work-based assessment should target the ‘action’ level. Care should be taken how data, for the basis of judgement, are collected. Data sources, such as diaries and portfolios, are recommended, but also observation.

 

 

Norcini, J.J. 2003. Work based assessment, ABC of learning and teaching in medicine. British Medical Journal, (326)7392, 5 April 2003, 653-5.

Promoting the notion of cross-pollinating theories and practice

It has been an enriching experience to have attended the Unisa Teacher Education at a Distance conference the past week. Attached (Download Dr_T_Groenewald-Quality_in_vivo_learning.ppt) please find my personal presentation at the conference.

A number of issues stood out to me, worth capturing for further exploration:

• Graduates enter work and are confronted by unscripted stuff, they often sink or swim. Curriculum design should contemplate the kinds of problems graduate are likely to be confronted with and concentrate on equipping students to deal with these.
• Indigenous knowledge should not be dismissed, there is much to learn; but should not be exploited either, without rewarding the knowledge carriers/holders fairly.
• We must be careful with what lens we approach things, there are many other viewpoint also!
• Learning in vivo should, like most learning, be staggered.
• Practice is merely an activity, whereas participation is about learning derived from active experience (Do not dismiss this idea as just playing with words).

There were many other inspiring ideas contained in presentations that are  specific to teacher education. One such idea is the process of lesson study: teachers gather to critique a teacher's lecture and all learn from it. The emphasis here is on continued professional development. It certainly has application possibilities in many other occupational/professional fields. The idea of subjecting yourself, your practice to scrutiny of other; as well as partaking in constructive critique of peers. 

Effective accompaniment for deep learning

A more recent (early eighties, according to Motlhale, 1999) concept in nursing education is accompaniment. She indicates that the divide that was developing between theory and practice in nursing necessitated the introduction of an accompanist. “Accompaniment of the student means to escort, attend, guide and to coexist” (Motlhale, 1999, p. 5) and is derived from the French word ‘accompagner’, which has both an instrumental and expressive meaning. The accompanist is a creator of a learning environment (Klopper, 1999) with a deliberate goal in mind, namely accompanying the student on her learning path of self-reliance and independence. Accompaniment includes a number of clinical teaching activities. Motlhale (1999, pp. 99-105) presents 15 guidelines — see first table below, under five sub-headings, for effective accompaniment of students. Klopper (1999, pp. 28-30) presents six principles — see second table below, a learning accompanist should keep in mind to achieve deep-holistic learning.

Klopper, H. 1999. Nursing education: a reflection. Pretoria: Amabhuku.

Motlhale, L. M. 1999. Guidelines for effective student accompaniment during community health nursing science clinical practice. M Cur dissertation, Rand Afrikaans University, Johannesburg.

Development from rule-based to context-based behaviours

The acquisition of skills, according to Andrews and Burruss (2004), is a developmental process, a movement from rule-based behaviours to context-based behaviours. Six stages of development are identified. The table below illustrates the description of Andrews and Burruss (2004) about the progressive development from rule-based behaviours to context-based behaviours. Rules gradually become subliminal, integrated with intuition and tacit knowledge emerges.

Andrews and Burruss (2004) argue that residents should be exposed to a variety of ways of assessing patients, diagnosing and planning of treatment. This is possible through supervisor contact with several clinicians, in different clinical settings and exposure to a spread of patients across the continuum of disease severity. They substantiate their argument by pointing out that learning theory suggests that repetition (multiple learning ways and methods), as well as timely feedback and acceptance of responsibility for one’s actions together contribute to learning effectiveness. Assessment is further an important form of learning. Four levels of assessment are encouraged, namely (a) the recollection of facts, principles and theories; (b) the ability to solve problems and describe procedures; (c) demonstration of skill in a controlled setting; and (d) real practice. These four levels are alternatively referred to as knows, knows how, shows how and does (Andrews and Burruss, 2004, p. 14). The four levels provide a framework for resident learning and assessment. The overt act of assessment or measuring brings about greater awareness. And therefore improves learning. In this regard Andrews and Burruss (2004) further point out that the American Council for Graduate Medical Education in September 1997 shifted the focus from assessing the potential of programmes to measuring the actual success.

Andrews, L.B. & Burruss, J.W.B. 2004. Core competencies for psychiatric education, defining, teaching and assessing resident competence. Washington, DC: American Psychiatric Publishing.

Vivo is derived from the Latin vivus, meaning living. In vivo is in the living organism, as opposed to in vitro which is outside of the organism. Often, in vitro (laboratory or simulated environment) learning precedes the in vivo learning.

in vivo, noun [pronounced: in vee-voh]

      occurring or made to occur within a natural [or real-life] setting or living organism [organisations seen as such]; literally, “in life”, in vivo conditions are distinguished from those that might exist only in a laboratory; in a real-life situation <observing a patient's behaviour in vivo>

      adjective: within a living organism; "in vivo techniques" [learning derived from the real-life experience]

      adverb: in the living organism; "studies conducted in vivo" [experience within a real-life]

Tesch (1990) explains that language is both a means of communication and manifestation of culture. Different sub-cultures have different systems of terms that are shared among the members who attach specific meaning to those terms. Rhetoric, Morton-Cooper and Palmer (2000) argue, refers to the concepts and language that are used to influence and persuade people. Rhetoric is useful to indicate the underlying values and assumptions of the actions and motivations of groupings of people. Examining the rhetoric help people account for what they do and why they do it. This blog reviews the use of terms associated with learning from experiences and the rich rhetoric of different sub-cultures.

For example, clinical training is common practice in medical education. The word clinical literally means “at the bed-side”. It is derived from the Greek word klinikos, which means bed. Clinical training then implies training at the bedside. Other terms that are often used include residency, clinical practice and/or rotations, supervision, clinical accompaniment, precepting, elective, field work practice, etc.

Morton-Cooper, A. & Palmer, A. 2000. Mentoring, preceptorship and clinical supervision: a guide to professional roles in clinical practice. 2nd edition. London: Blackwell Science.

Tesch, R. 1990. Qualitative research: analysis types and software tools. New York: Falmer.

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