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    “Broken” pathways : understanding the licensing experiences of overseas-trained medical doctors in Aotearoa New Zealand : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Development Studies at Massey University, Palmerston North, Aotearoa New Zealand
    (Massey University, 2024) Thomas-Maude, Johanna
    More than 40% of registered medical doctors in Aotearoa New Zealand received their primary medical qualifications overseas. Within this landscape, the pathways that international medical graduates (IMGs) must follow to achieve professional licensing depend on their background. This research explores IMG experiences of these processes using a capabilities approach to mobility justice, finding that although pathways to registration exist on paper, many are broken, unpredictable, and often unattainable in practice. General registration is available to doctors who completed their primary qualifications, or have worked for a minimum time period, in 24 high-income, Global North countries known as Comparable Health Systems (CHS). Other IMGs must apply for registration by taking a medical knowledge examination from the United Kingdom (U.K.), Australia, Canada, or the United States of America (U.S.A.), demonstrating English language competency, and taking the New Zealand Registration Examination (NZREX), which evaluates context-specific clinical skills. While completing these steps is time-consuming and costly, IMGs on the NZREX pathway are also required to complete two years of supervised work in local hospitals. First year positions, known as Postgraduate Year One (PGY1), are limited and prioritised for New Zealand medical graduates (NZMGs). As a result, a bottleneck has delayed or prevented many of these IMGs, typically originating from Global South countries, from finding PGY1 employment. This research addresses a knowledge gap by exploring the relationship between IMG experiences, professional outcomes, and their designated pathway to registration. An exploratory sequential mixed methods research design was employed, consisting of semi-structured interviews of IMGs (n = 24) and local experts (n = 9), an online questionnaire of IMGs (N = 80), and a document analysis of historical policies, grey literature, and media reports (N = 370), across three phases. The project was framed by a capabilities approach to mobility justice that evolved alongside the research design, data collection, and analysis. This theoretical approach considers what IMGs in Aotearoa New Zealand are able to “be” and “do” as migrant professionals, through four key components known as the 4Ps. The 4Ps comprise professional mobilities and capabilities, (inter)personal mobilities and capabilities, mobilities and capabilities in practice, and mobilities and capabilities power regimes. Combining empirical data with this theoretical lens highlights how medical registration pathways and policies contribute to uneven mobilities and capabilities among IMGs in Aotearoa New Zealand. Injustices are produced through misrecognition and the arbitrary exclusion of individuals who did not train in CHS countries. Such arbitrary exclusions, in turn, produce brain waste, whereby some IMGs already residing in Aotearoa New Zealand were unable to work as doctors, or experienced significant delays in registration, even during the COVID-19 pandemic. This situation is detrimental not only to these IMGs, but also to the chronically under-resourced local medical workforce and, consequently, the broader population in need of healthcare. Furthermore, colonial vestiges can be seen to have contributed to a recurring cycle of policy changes, which have culminated in contemporary licensing policies strongly resembling those from 1905. To create more just pathways for registration for IMGs in Aotearoa New Zealand, this (post)colonial cycle needs to be examined, evaluated, and broken, paving the way for more equitable medical regulation.
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    Multiple veterinary stakeholders' perspectives on important professionalism attributes for career success in veterinary clinical practice : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Veterinary Science at Massey University, Manawatū, New Zealand
    (Massey University, 2020) Gordon, Stuart John Galt
    There is an increasing body of literature on professionalism in the health sciences. Most research has, however, elicited the opinions of single groups of experts and tried to use these to generalise across the profession. The aim of the thesis was, therefore, to gain a broad understanding of professionalism by appraising the voices of many tiers of veterinary stakeholders involved in veterinary clinical practice. Through a mixed methods approach using card-sort analysis, online questionnaires, focus groups, critical incident reporting and analysis of client complaints, information was collected from first year and final year Massey University veterinary students, clinical veterinary practitioners and veterinary clients. An online questionnaire was also used to gather the final year veterinary students’ opinions on veterinary professionalism pedagogy. The iterative sampling method ensured that a wide range of perceptions were represented. These multiple perspectives, along with the existing knowledge contained within the literature on veterinary and medical professionalism, provide the basis upon which to develop a theoretical framework on professionalism in the veterinary context. The synthesis of data into a framework was undertaken primarily through a grounded theory approach. The research also provides support for the importance of including professionalism in veterinary curricula. Three overarching themes emerged from the analysis of the veterinary stakeholders’ opinions, namely: ‘committing to best practice’, ‘building the veterinarian-client relationship’ and ‘client expectations’. The framework of veterinary professionalism that has evolved from scrutiny of these themes revolves around the principles of ‘veterinary care’. Career success and satisfaction for practising clinical veterinarians hinges on three crucial domains of veterinary care: ‘patient-centred care’, ‘relationship-centred care’, and ‘self-care’. The focus of patient-centred care is the animal, while the foci of relationship-centred care are the client and veterinary colleagues. The self-care domain focuses on the practising veterinarian as a person. Professionalism, therefore, fundamentally revolves around veterinarians’ accountability to a social contract with patients, clients and colleagues as well as to themselves. Analysis of veterinary student opinions on the teaching of professionalism revealed constructive viewpoints and recommendations. Students recommended that the veterinary professionalism course be embedded across the whole primary veterinary teaching programme, including in the early years of study. It was further suggested that role-playing and reflective practice should be used throughout the programme to support the development of professionalism. The need to assess professionalism adequately and appropriately was also highlighted, as was the need to include rewards for displays of good professional behaviour. The potential for the hidden curriculum and negative clinical role models to undermine the teaching of professionalism was also addressed. Additionally, students recommended that the veterinary professionalism curriculum should prepare graduates for the job market by accommodating the requirements of veterinary employers. This research represents the first time that the opinions of multiple veterinary stakeholders on the attributes of professionalism important for career success have been solicited in one series of research studies. Furthermore, this study has used novel methodologies to determine the opinions of stakeholders. For the first time, a card-sort analysis has been used to solicit veterinary students’ opinions and the critical incident technique has been used to determine the perspectives of practising veterinarians. Analysing client complaints lodged with the Veterinary Council of New Zealand also represents an original method of determining those attributes of professionalism that will promote veterinary career success and satisfaction. By seeking the perspectives of multiple veterinary stakeholders, the body of knowledge about professionalism has been extended. Furthermore, the neoteric framework of veterinary professionalism, developed in the study, could help to form the basis for constructing a robust curriculum prescribing the teaching and assessment of veterinary professionalism. It may also be used by veterinarians as a guide in the practice of veterinary medicine and in their relationships with patients, clients, colleagues and society.
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    How psychologists view and engage with competence in their practice : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Albany, New Zealand
    (Massey University, 2018) Taylor, Kristin
    The purpose of this study was to gain insight into how psychologists view and engage with competence and identify the factors that they determine as supporting or inhibiting competent practice. To date, few studies have examined the elements psychologists identify as shaping the development of their professional competence. It is hoped by doing so, strategies can be implemented that develop, maintain, and enhance competence and encourage active participation in the Continuing Competence Programme (CCP). Having an agreed definition of the qualities required to be competent is essential to evaluate, improve, and ensure quality assurance in psychological practice. Ten psychologists from the clinical and industrial organisational scopes participated. Semi-structured interviews were used; questions were designed to act as prompts and to ensure no relevant themes were overlooked. The interviews were recorded then transcribed and analysed using thematic analysis. Results indicated that while the participants understood the meaning of competent practice, how they relate that to their practice and how this influences their participation in the CCP varies. The participants discussed the value of, and the challenges associated with, achieving, demonstrating, and measuring competence and the consequences this has on their practice, their clients and themselves. They also identified factors that encourage, develop, and maintain competence and those factors that are threats to competence. It is essential to understand how an individual perceives competence as this will determine how they view and engage with competence in their practice. Understanding this will assist with competency development, maintenance, measurement and demonstration across the professional lifespan.
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    Developing clinical skill competency of undergraduate nursing students utilising a simulated psychomotor skill laboratory and model of self-directed learning : an evaluation research study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University
    (Massey University, 2003) Vernon, Rachael Anne
    Nursing education today emphasises higher-level thought processes than in the past. The requirement for Bachelor of Nursing students to also demonstrate competence in the core clinical skills is critical for safe professional practice. Balancing curricular emphases on technical knowledge, clinical and interpersonal skills, ethical decision-making, and other critical thinking skills is becoming increasingly difficult for nurse educators. Changes in the health sector have resulted in increased complexity of care, reduced numbers of venues for clinical practicum experiences, and increased financial costs associated with student practicum. The commitment to ensure that students have requisite clinical skills appropriate to each stage of their programme, prior to their clinical practicum involves curricular, pedagogical and financial considerations. Drawing on international literature and a Faculty committed to the development of nursing knowledge and skill, discovery, reflection and self-directed learning, the Eastern Institute of Technology (EIT) implemented the use of the Clinical Arts and Technology Centre and a cooperative model of self-directed learning into the Bachelor of Nursing curriculum in January 2000. The Clinical Arts and Technology Centre is an "enhanced" clinical simulation laboratory that provides students with the facilities and resources to support and enhance their knowledge and skills in preparation for clinical practicum. This Evaluation Research study explores and determines the effectiveness of the Clinical Arts and Technology Centre and the cooperative model of self-directed learning in terms of student clinical competency outcomes, and student satisfaction with the facility and model of self-directed learning. An extensive review of literature was undertaken in relation to the development and use of clinical simulation laboratories, clinical simulation, and models of self-directed learning in nursing education. A combination of qualitative and quantitative data collection methods were used including a pre piloted research questionnaire and a collation of student competency assessment outcomes. One hundred and fifty-six EIT Bachelor of Nursing students participated in the study. Statistical research findings and themes that emerged demonstrated a high level of overall student satisfaction with the facility resources and model of learning and provide direction for future facility and resource development, and ongoing quality improvement initiatives.