1. The current issue and full text archive of this journal is available at
www.emeraldinsight.com/2050-7003.htm
Promoting knowledge and
understanding in society
Training our students for effective
communication
Effective
communication
35
Darrell J.R. Evans
Department of Anatomy, Brighton and Sussex Medical School,
University of Sussex, Brighton, UK
Abstract
Purpose – The ability to communicate with society is one of the key skills by which our students can
help enhance knowledge and understanding of different subjects within the general population.
Unfortunately, up until recently few subject areas have provided tailored training for their students in
the art of communicating with different audiences, especially a non-specialist one. This review paper
aims to discuss the rationale for incorporating defined communication skills training (CST) into higher
education courses, focusing on medicine, other healthcare professions and science. In addition the review
aims to identify example methodologies used for the training and assessment of communication skills.
Design/methodology/approach – The approach taken for this review has been to: identify and
review national, subject specific and individual drivers for why higher education should be including
CST in their courses and programmes; evaluate some of the published approaches and innovations
used to introduce CST into higher education courses; and finally, assess the factors that curriculum
designers should consider when incorporating CST into their programmes or modules.
Findings – The review shows that there are a number of important drivers for including CST in
higher education curricula, especially training which is directed to communicating with non-specialist
audiences. The paper identifies a number of varied approaches for integrating training into existing
and emerging HE courses and modules, aimed at developing both oral and written communication
skills.
Originality/value – The paper demonstrates the need for CST in undergraduate courses and acts as
a challenge to others to devise strategies to ensure their students are ready and able to communicate
with society in the twenty-first century.
Keywords Communication skills, Education, Assessment, Students
Paper type General review
Introduction
The ability to communicate effectively is often of key importance when it comes to
delivering knowledge and generating understanding within different populations. The
creation of a global community that is interconnected by a wide range of technology
has provided us with a set of new opportunities and challenges that must be explored
to ensure public engagement remains high. Students at higher education institutions
(HEIs) are likely to be the next generation of experts and ambassadors in their
respective fields and therefore responsible for explaining and promoting
understanding to the public, highlighting implications and relevance of knowledge,
defending theories or data, and encouraging participation and dialogue from all
elements of society, especially young people. Despite this key future role, it is unclear
The author would like to thank all the students that have taken part in the projects he has
embarked on looking at communications skills development, in particular for their enthusiasm
and valuable comments. The author is also very grateful to Alison Bryson for editing the
manuscript.
Journal of Applied Research in Higher
Education
Vol. 3 No. 1, 2011
pp. 35-46
r Emerald Group Publishing Limited
2050-7003
DOI 10.1108/17581181111150892

2. JARHE
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whether universities and colleges have been proactive in their approach to helping
students develop their written and oral communication skills, particularly in relation
to communicating to wider audiences including groups without prior knowledge
of the subject in question. Without including some formal training within higher
education (HE) curricula, we are likely to continue to send out graduates that lack these
important skills and therefore impede their chances of becoming effective future
exponents in their field. Whilst not all students will have or wish to have high profile
roles, it is still important that all graduates are able to communicate their knowledge,
views and research to a wider audience and to debate, learn and listen with others.
This paper is therefore designed to discuss the rationale for incorporating defined
communication skills training (CST) into HE courses, focusing on medicine, other
healthcare professions and science. Suggestions are made for how training can be
integrated into all existing and emerging HE courses and modules, with examples
included of some of the approaches used to engage students in developing both
oral and written communication skills. The overall aim is to challenge others to devise
strategies to ensure their students are ready and able to communicate with society in
the twenty-first century. The approach taken for this review has therefore been to first
identify and review national, subject specific and individual drivers for why HE should
be including CST in their courses and programmes; second to evaluate some of the
published approaches and innovations used to introduce CST into HE courses; and
finally to assess the factors that curriculum designers should consider when
incorporating CST into their programmes or modules.
The drivers for CST
The Dearing Report of 1997, looking at the future of HE in the United Kingdom (UK),
highlighted four skills that it felt were key to the future success of graduates;
communication skills, numeracy, use of information technology and learning how to
learn (Dearing, 1997). The report recommended that the four key skills should be
incorporated into all HE programmes either by embedding within existing modules
or by creating parallel modules of skills development. Despite such recommendations,
it is unclear how many subject areas and institutions really reflected on the need for all
of these key skills, especially communication skills, and adapted their programmes
accordingly or instead felt that existing provision was adequate and that students
would simply “pick up” these attributes as courses went along. The difficulty for
institutions and individual courses has been to define what is meant by communication
skills and what elements of a skills package are necessary for a particular course or
module. It is clear that the driver for communication skills development is twofold; to
ensure all graduates can communicate not only with their specialist colleagues/peers
but also to wider non-specialist audiences. The ability to achieve both these
communication objectives is dependent on very similar principles such as clarity,
expression, level and accountability, however, the reasons for the specific approach
used for the two categories will differ. This is also true for the approaches taken
within each category with non-specialist communication, for example, usually divided
into direct or indirect communication (Resnik, 2001). Direct communication might be a
public lecture or debate, an internet article, a health-related leaflet or an advertisement
where the specialist is completely responsible for the content of the communication and
the approach taken. In contrast, an indirect approach such as a media interview or
where a magazine article incorporates views or information from the specialist, but is
written by someone else, relies on others to get the correct message across and to limit

3. the risk of miscommunication, and therefore the approach from the specialist may be
quite different. Despite these potential differences in style and particular approach, it is
important that students in an ever growing global society are presented with the main
principles of communication and more importantly are provided with opportunities
to practise learned skills and to receive critical feedback. By reading, writing and
communicating effectively students will be more able to make informed decisions as
members of the public on a range of issues and engage in critical thinking that many
issues require (Krajcik and Sutherland, 2010).
Over the last decade, there have been additional specific drivers for development of
communication skills in particular HE areas. These include medicine and the related
health professions where professional bodies have taken the lead on the development
of CST to improve the professional’s communication with patients and colleagues.
Science, in contrast, has not received the same explicit direction, although it has been
widely acknowledged by several influential bodies, including the Royal Society,
employers and by scientists themselves that specific CST is required in science-based
courses (Orr, 1996; Osborne et al., 2003; The Royal Society, 2006).
Communication skills in medicine and related professions
Co-ordinators of many medical and health-related curricula have been encouraged
to develop and enhance the CST offered to students, recognising that communication
with the public as patients is of fundamental importance, that specific training has
lasting effects and that good communication results in improved patient compliance
(Sherbourne et al., 1992; Teutsch, 2003; Roter and Hall, 2006). The General Medical
Council in the UK, for instance, requires that all medical students be able to
communicate clearly, sensitively and effectively with patients and colleagues by
spoken, written and electronic means (GMC, 2003, 2009). Communication skills are also
included as a core competency by the Accreditation Council for Graduate Medical
Education and the American Board of Medical Specialties. In response, medical schools
have in the last decade or so adapted their curricula to include substantive CST,
although the exact nature of the training is highly variable in content, duration and
assessment (Hargie et al., 2010). In the main, training largely focuses on oral
communication skills directed at history taking, breaking bad news, dealing with
angry or reluctant patients, demonstrating empathy or negotiating skills, etc., but does
not usually cover explicit training in explaining a particular health condition or issue in
lay terms or to larger audiences (Hargie et al., 1998; Deveugele et al., 2005). Whilst
oral communication skills feature strongly, the ability to communicate with patients
and the general population through written or electronic means does not appear to
be an aspect of many medical programmes and opportunities for writing for a
non-specialist audience have been few and far between, but are slowly growing
(Hargie et al., 1998; Tierney, 2003; Nestel and Kidd, 2004; Shapiro and Lie, 2004; Evans,
2007; Evans, 2008). This omission is surprising and worrying given the fact that many
people gain information and understanding of medical and related topics thorough
written media such as newspapers, magazines, leaflets, written correspondence and
of course the growing array of available internet sites. If medical and healthcare
professionals lack the skills necessary to contribute effectively to these media types
or are unable to convey their meaning to the non-specialist patient then
miscommunication and misunderstanding may result, which in turn may have
negative downstream effects (Resnik, 2001; Chen et al., 2000; Coulter et al., 1999;
Roberts and Partridge, 2006). Patients are often quite well prepared before their
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consultation, having researched their symptoms on the internet and therefore ready to
challenge the professional about their condition much more than they would have
in the past. This presents a new dilemma for the practitioner as they have to try to
“convince” the patient to agree to a recommended plan for treatment/care that is quite
different to one the patient may have read about or researched. Therefore the ability
to be able to convey information clearly and effectively (either orally or in writing),
whilst allowing the patient to remain at the centre of the decision-making process is
paramount and one that requires training.
Communications skills in science
Science-based disciplines appear to have been less convinced about the need for
specific communication skills development and this may be the result of there being no
specific drivers for change. Whilst science curricula are strong in appropriate content
and research-richness, as evidenced by quality assurance processes, many have no
overt signs of integrated CST whether for the specialist or non-specialist audience
(Poronnik and Moni, 2006). This seems strange given that science students are often
assessed on their ability to communicate research information and analysis of research
data using formats such as dissertation writing, production of posters and short
oral presentations (e.g. Krilowicz and Downs, 1999; Hannigan and Burnard, 2001;
Pocock et al., 2010). It is unclear as to the level of formal guidance and training
students receive in relation to preparing for these assessments or the subsequent
feedback that is given, but it is clear that in most cases neither training nor assessment
is directed to a lay or non-specialist audience. Science students may therefore be
disadvantaged when it comes to their ability to convey scientific information to
different audiences and this may lead to barriers in communication development.
Why should this be a problem? It could be argued that because a great deal of science
is funded by the public (e.g. through investments in HE and research grants) scientists
have a moral obligation to inform the public about scientific research and innovations
that are being developed thus helping to shape public understanding
and maintaining confidence. A well-informed public should ensure that opinion
becomes increasingly evidenced-based and misunderstandings do not become
perceived fact. Such misunderstandings usually come about through mistakes
(accidental or deliberate) in communication, ineffective communication skills or a lack
of expertise on the part of the communicator (Resnik, 2001; Shaikh and Scott, 2005).
Scientists are increasingly being asked to convey information to a lay audience
when writing grant applications or papers with many grant agencies for instance
asking applicants to submit abstracts or summaries of their intended work for both
specialist and non-specialist audiences. As writing grants and publishing papers
are key to successful career development and establishment of a good reputation then
creation of specific CST is necessary (Derish et al., 2007).
Scientists also have a perceived obligation to encourage the younger population
to become interested and engaged in science, particularly those children from
disadvantaged or unusual backgrounds, with widening participation now a common
goal for many universities. Figures suggest that school children are less likely to take
certain science subjects than in the past with UK advanced (A) level examination
entries in physics for example dropping 38 per cent from 1990-2005, whilst overall
entries in all subjects increased by nearly 15 per cent (Smithers and Robinson, 2005).
Although the most recent figures suggest a slight improvement in the numbers taking
courses such as physics it is clear that more needs to be done to promote such subjects

5. (Smithers and Robinson, 2009). By motivating youngsters to think about science, this
should help drive their potential for learning whatever career path they follow and
hopefully ensure that at least some will become enticed to be part of the next
generation of scientists. The ability to enthuse this population demands effective
communication skills as we are unlikely to widen participation and encourage
engagement if we talk or write in a language that people do not understand and,
instead, could alienate interested individuals.
Most scientists appear to want to engage with the non-specialist audience whether
they are policy makers, schools, industry, the media or the public at large. In a survey
carried out by The Royal Society (2006), 66 per cent of the scientists and engineers
questioned thought they (as a community) should communicate more with the
non-specialist public, and 74 per cent said that they had contributed to at least one
public-based event or publication in the 12 months before the survey. Despite this,
73 per cent of scientists and engineers said they had no training in media or public
engagement and those most likely to be involved with public engagement events
were those with previous communication training. As a result of their survey, the Royal
Society has recommended that scientists receive appropriate training at undergraduate
and postgraduate level. This does not mean that all scientists should or would want to
be exponents of generating public understanding of science, however, all scientists
should have the ability to explain their science to a number of different audiences.
Unfortunately for those wanting to be involved with public understanding of science
events and openings, several potential barriers exist. Many scientists, for example,
feel obligated to spend increased time on their research and this is not seen as being
aided by having to take time out to engage with the public, so most choose not to
engage. A number of researchers are also concerned that public engagement is not seen
as a positive driver for improving career prospects and more negatively that those
that do engage are seen as light-weight or failed scientists (The Royal Society, 2006).
Obviously institutions have a role to play in changing perceptions and recognising the
positive and real impact of public engagement, but introduction of CST, in whatever
form, into all programmes should begin to shape the perceptions of the next generation
of scientists and others so that engagement with the public is seen as a necessary and
integral part of their role.
CST and assessment
In view of the Dearing Report (Dearing, 1997), university departments and disciplines
have a key role to play in designing and implementing activities and programmes
aimed at developing the communication skills of their students. Whilst these should
of course be directed to the high levels of communication expected to ensure students
are able to engage with peers in their specialty, the non-specialist audience should also
be accommodated in all programmes. There is no set methodology for introducing
CST into courses and modules and the approach taken should very much be dependent
on the nature of the course, overall outcomes and the anticipated downstream
professional activity. This paper is not intended to map out a defined CST programme
to incorporate into HE courses, however, it does provide an opportunity to highlight
some practices and methodologies that are currently being used to engage with the
non-specialist. There are a host of approaches used to teach and assess communication
skills (see Table I for examples) although not all will be suited to a non-specialist
audience and therefore the spotlight here will be on activities that directly engage
with potential public audiences as well as those that are using new media technologies.
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Table I.
Example methodologies
for communication skills
training and assessment
for the specialist and nonspecialist audience
Written communication
Oral presentations
Poster presentations
Media presentations
40
Oral communication
Devising newspaper or magazine articles
Design of information leaflets/brochures
Creation of online materials including internet
articles, web pages
Journal and diary writing (personal portfolio)
Face-to-face or video-link interviews
(media, individual, group)
Telephone or interviews (media, individual,
group)
Peer observation with video playback
Specific role-playing
Didactic methods including lectures, DVDs, etc.
Oral examinations
Objective-structured examinations
Creating videos, audiocasts, etc.
Creating a lesson plan
Oral advertisements
Peer review of other presentations
Writing directed essays
Writing letters to individuals or media
Authoring opinion editorials and commentaries
Writing mock grant application or research
proposals
Mock paper writing
Abstract writing
Developing posters or advertisements
Creative writing
Book reviews
Peer review of other’s written work
A scan of the literature shows that most innovative and effective practices come from
medical courses and other associated healthcare professions as their curriculum
leaders have been influential in devising new approaches, because of the need for their
students to communicate with patients and colleagues on a day-to-day basis. It is
hoped that some of these examples and variations on their themes will be transferable
to many areas of HE and may also stimulate some new ideas.
Direct communication with non-specialist audiences
The most powerful routes for communicating directly with non-specialist audiences
are probably through face-to-face contact, via the media and also the creation of
directed presentational materials. Public interest in specific issues is often sparked by
watching or hearing media reports or interviews, reading articles in newspapers,
magazines or other non-specialist journals or by browsing online resources.
Appreciation by students of at least some of these approaches to promote
knowledge and understanding to the non-specialist will help students to identify the
principles of communication skills that are most effective. Moni and colleagues, for
example, have used the generation of the opinion editorial (Op-Ed) to assess the ability
of physiology and pharmacology undergraduate students to learn how to write for the
non-specialist (Poronnik and Moni, 2006; Moni et al., 2007). Following an initial
communication assignment, students were provided with specific training in
composing an Op-Ed before actually attempting an Op-Ed on a relevant scientific
article. Student work was assessed by specialists and non-specialists and results
showed that the Op-Ed assignments were of higher quality and more effective than
the original communication assignments suggesting the training improved student
ability. Students also believed that their skills in writing for a non-specialist audience
had improved.
Using a newspaper or magazine article approach to developing communications
skills has been used by several groups. Tierney (2003) used a university student

7. newspaper as an avenue for facilitating nursing students to write health-related
articles. The assignment was designed to act as a learning experience for both writers
and readers and to emphasise the consumer teaching and health promotion aspects of
the curriculum. The students were briefed on the assignment, were provided with
guidance on the approach and proposed topics and were given feedback during the
writing process. Students submitted articles of about 500 words in length and were
asked to make sure they were informative and educational rather than simply
entertaining. Despite some early negativity, as writing skills improved, the students
were more positive about the experience. Evans (2007) used a similar approach,
whereby medical students were asked to respond to a letter from a member of the
public regarding one of a number of clinical conditions by composing a short
(500 word) article for a fictitious newspaper. Students were provided with an initial
training session and written guidance in the form of a short scenario. Criteria-based
marking demonstrated that students had produced effective articles very much
directed to the non-specialist audience. Student feedback suggested that students
found the assignment challenging, but one that enhanced their communication skills in
a clinical context. In both of the cases outlined, students found the construction of a
short article to be more time-consuming than they first realised and that to craft
effective statements takes time and therefore such an assignment is not a soft option.
Evans has also used another approach to developing medical students’ ability to
write for the non-specialist audience by asking students to prepare patient-focused
information leaflets (Evans, 2008). The focus of the assignment was for small groups
of students to develop knowledge and understanding of particular clinical conditions
and to prepare materials to present accessible information to patients and their
families. Before developing the leaflets, students were given the opportunity to critique
existing patient information and learn about readability scoring. Evaluation of
the leaflets showed that students produced highly readable material targeted at a
non-specialist reader. Students rated the experience highly and said it enabled them
to appreciate the significance of effective communication skills. Medical students
are often given the opportunity to interview and interact with individual patients
(real or simulated) and therefore it is important for them recognise the distinction
between talking with or presenting to an individual (i.e. tailoring comments to that
individual) and presenting to a larger audience on a particular topic. This approach is
one way that this can be achieved.
Using new media to engage with the non-specialist
Dramatic advances in technology in the last few years have led to a real change in the
way information is accessed, used and transmitted, and requires us all to rethink
how effectively we communicate with each other. Nowadays, many of us do not give a
second thought to using mobile telephones or e-mail, accessing the internet using
wireless technology, logging on to social media sites or speaking to geographically
distant friends and colleagues in real time and “face-to-face” with programs such
as Skype. However, this is a fundamental change in the way communication is
approached and if we are to fully develop our students’ ability to communicate in
the twenty-first century then this needs to be recognised when designing any
formalised CST. Encompassing this diverse array of technologies and communication
platforms does present a potential problem though, with many HE practitioners
having not yet embraced these changes themselves. As educators we must also be
willing to at least explore new opportunities to communicate with our students and to
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ensure our practices and courses are fit-for-purpose. Encouraging colleagues to
incorporate some of these new technologies in their own teaching or assessment
portfolios will in turn provide opportunities for students to develop and demonstrate
their communication skills using platforms that are more familiar and “relevant” to
them. The danger is that this approach may alienate some academics who are less used
to using technology and therefore whatever strategy is used, encouragement and
support will be required to help guide staff. In many cases, though, the students will
help lead the development and potential success of using these technological
innovations.
With the development of the “net generation” of learners, it is not surprising that
many forms of electronic communication that contribute to new media such as podcasts,
blogs, social networks and virtual reality environments have been introduced into HE
teaching strategies (Kron et al., 2010). A survey of American medical students
demonstrates that they hold favourable views about the inclusion of new media
technology in medical education and believe that this would be useful in developing the
skills of public interaction and communication (Kron et al., 2010). Academics have
therefore begun to use such technologies for elements of CST both in terms of delivery
and also assessment. Green and Hope (2010), for example, have developed an assignment
for nursing students which focuses on creating videos that explain various conditions to
clients with no medical or scientific background. This was seen as more dynamic than
designing posters or pamphlets with 96 per cent of students agreeing that the approach
increased their ability to synthesise knowledge for non-specialist audiences. The finished
videos are then loaded onto a private class site in YouTube or Facebook for faculty to
assess and approve before allowing open access. Students appear to respond well to this
activity and produce effective and good quality productions.
Creation of web sites and other online materials such as wikis has been another
approach used to motivate students, whilst developing written communication skills.
One anatomy and physiology course requires first-year students to work as groups and
create web pages about specific diseases that have historical significance and which
are subsequently assessed by staff (Crisp et al., 2007). Whilst students learned about
communication skills and using new technology, the assessment did not demonstrate
enhanced learning of anatomy and physiology. Nevertheless, Crisp and colleagues
believe it is a valid and realistic assignment, but as students become more familiar with
technology it appears to be less of a motivational tool.
Incorporating opportunities into the curriculum
It is essential for curricula to adapt and change as subject areas evolve and develop to
ensure that courses remain fit-for-purpose, have assured quality and produce
the desired student learning experience. Unfortunately this often means that course
leaders have to create an effective balance on what to include, making sure that courses
do not become overburdened in content or assessment. Therefore the suggestion that
they need to include CST as a vertical or horizontal theme may not be immediately
welcome despite the drivers for inclusion already outlined. The challenge may be to
adapt existing teaching practices and assessments to incorporate elements of CST and
to use CST as a method for achieving other learning outcomes, skills and attributes.
This may be achieved, for example, by modifying a written assessment to include
an element directed at a non-specialist audience such as constructing a summary or
abstract to a paper or information article. Alternatively when presenting orally,
a student may be asked questions that require a more general response as well as those

9. that are more specialist in nature. A similar approach can be used when students are
defending a thesis or dissertation by allowing students to put their main findings into a
context (orally or in written form) whereby a non-specialist is the audience. In practical
sessions, students can be asked to demonstrate or explain methodologies at the level
of a non-specialist or even peers who are not familiar with the particular technique.
The expansion of widening participation programmes or schools outreach
interventions has introduced another opportunity for students to learn and practice
their communication skills with a less experienced audience. Often such activities
sit outside of the curriculum and are therefore not a burden on limited teaching time,
however, the opportunities are usually restricted to only a few students due to capacity
and other logistics. Whether a programme of CST is integrated into existing practices
or sits as a distinct theme, the programme should be gradual and progressive and
undoubtedly should include some provision for assessment, either formative or
summative. Assessment can therefore be adapted to not only examine knowledge
and understanding in a certain area but also competency in other skills. The key
appears to be that students receive multiple opportunities to learn and practise
their communication skills and, if possible, in a variety of different settings (Orr 1996;
Saxena et al., 2009). Without repeated practice there can be a deterioration in some
skills but if continued, improvement in the skills is evident (Humphris and
Kaney, 2001). Feedback is always welcomed by students and this element should be
embedded into the process so that students can not only develop their skills further
but also appreciate examples of feedback they may receive in the future from
non-specialists (Rees et al., 2002; Noble and Richardson, 2006). Inclusion of peer-to-peer
feedback or even non-specialist feedback at this stage of their training can be an
additional motivator (Yoo and Chae, 2011).
Much has been made of the non-specialist audience in this review without providing
a clear definition as to the exact nature of that audience. This has been deliberate
as providing a single definition is not simple as each audience is likely to differ in some
respect and it is unlikely that everyone would agree as to what a non-specialist
audience is. The audience, for instance, could be one of school children with a much
lower level of knowledge and understanding or an adult audience with little experience
of the broad subject area under discussion (e.g. no scientific background). Likewise
the audience could be a varied one with some people having a prior level of knowledge
of what is being presented and others having little background understanding.
Therefore when incorporating opportunities into a curriculum for CST, it is important
to provide context of the audience being targeted in each case so that the students
are aware of the level of knowledge and understanding of their audience and are able
to direct their communication in the most effective way. Inclusion of opportunities
that address a number of different audiences should provide students with more
experience and mean they are more adaptive in their communication whether it be
through written or oral means.
Conclusions
This paper demonstrates that there have been a number of drivers for delivering
aspects of communications skills training within HE curricula including national
drivers (e.g. the Dearing Report), subject drivers (e.g. General Medical Council) and
“individual” drivers (e.g. the results of the Royal Society Survey). The ability to
communicate effectively is seen as one of the key skills that enable specialists to
engage with each other and also non-specialist audiences and this has led to some
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individuals and institutions explicitly addressing the need for including CST in their
courses with a number of varied approaches being used including new media
opportunities. The incorporation of CST is not uniform across the sector, however, and
therefore the challenge is to encourage as many as possible to include opportunities
for their students and thus emphasising the importance of directing communication
to a specific audience. Provision of an educational experience that includes CST should
not only enable a student to explore their academic interest and demonstrate their
learning capabilities but also encourage development of the skills and attributes which
will prepare at least some of them to become part of the next generation of potential
subject advocates and prepare all of them for the specific challenges that an
interconnected community demands.
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Corresponding author
Darrell J.R. Evans can be contacted at: d.evans@bsms.ac.uk
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