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Teodorczuk and Morris explore how novel research approaches, such as Cultural Historical Activity Theory, might shed light on how tensions can be negotiated as medical education continues to globalize. [ABSTRACT FROM AUTHOR]

Background Access to a well-trained workforce is one of many factors underscoring the global health divide that separates industrialized and developing nations. This paper describes the distribution and physician output of the world's medical schools, compares regional physician to population ratios, examines population trends and points out potential mismatches between output and anticipated demographic changes. Method This paper has used multiple data sources in published and electronic form from organized medicine, international health institutions and the medical literature. In addition, a stratified, random survey of 130 medical schools was conducted to determine annual numbers of graduates. Results Tracking the number and distribution of medical schools and their student capacity is a complex task. The number of medical schools and the estimated number of graduates per population vary by region. In areas of predicted substantial population growth, the production of physicians is neither adequate to meet future needs, nor sufficient to overcome low physician–population ratios. Regions with high physician–population ratios and either expected population decline or small population gains over the next 50 years appear to have an over-capacity to train medical students. Conclusion This paper emphasizes the need for new methods of tracking the global pipeline of medical education and of establishing ways of sharing expertise. The growing interdependence of nations, accentuated by globalization of the world's economies, our shared goal of achieving health for all and the migration of physicians across borders highlight the need to understand the global capacity to educate the next generation of physicians. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 545-551 Context Most US medical schools have instituted cultural competence education in the undergraduate curriculum. This training is intended to improve the quality of care that doctors, the majority of whom are White, deliver to ethnic and racial minority patients. Research into the outcomes of cultural competence training programmes reveals that they have been largely ineffective in improving doctors' skills. In varied curricular formats, programmes tend to teach group-specific cultural knowledge, despite the vast heterogeneity of racial and ethnic groups. This cultural essentialism diminishes training effectiveness. Methods This paper proposes key curriculum content changes and suggests the inclusion of an intersectional framework in the cultural competence curriculum. This framework maintains that racial and ethnic minority groups hold multiple social statuses, called social locations, which interact with one another to uniquely shape the health views, needs and experiences of the individuals within the groups. Social locations include those defined by race, ethnicity, gender, social class and sexuality, which are experienced multiplicatively, not additively, within a particular social context. Cultural competence education must go beyond simplified cultural understandings to explore these more complex meanings. Doctors' ability to understand, communicate with and treat diverse groups can be vastly improved by applying an intersectional framework in academic research, self-awareness exercises and clinical training. Results Integrating an intersectional framework into cultural competency education can better prepare doctors for caring for racial and ethnic minority patients. This paper recommends curriculum elements for the classroom and clinical training that can improve doctor knowledge and skills for caring for diverse groups. Medical schools can use the proposed model to facilitate the development of new educational strategies and learning experiences. These improvements can lead to more equitable care and ultimately diminish disparities in health care. Although these recommendations are designed with US schools in mind, they may improve doctor understanding and care of marginal populations across the world. [ABSTRACT FROM AUTHOR]

Background Problem-based learning (PBL) as an approach to the instruction of medical students has attracted much attention in recent years. However, its effect on the performance of its graduates is the subject of considerable debate. This article presents data from a large-scale study among graduates of a problem-based medical school and those of a conventional medical school to contribute to this discussion. Purpose To study the longterm effects of problem-based medical training on the professional competencies of graduates. Methods A questionnaire was sent to all graduates since 1980 of a problem-based and a conventional medical school. Participants were requested to rate themselves on 18 professional competencies derived from the literature. Results The graduates of the PBL school scored higher on 14 of 18 professional competencies. Graduates of the problem-based school rated themselves as having much better interpersonal skills, better competencies in problem solving, self-directed learning and information gathering, and somewhat better task-supporting skills, such as the ability to work and plan efficiently. There were no sizeable differences with regard to general academic competencies, such as conducting research or writing a paper. Graduates from the conventional school rated themselves as having slightly more medical knowledge. The findings were shown to be valid and robust against possible response bias. Conclusion The findings suggest that PBL not only affects the typical PBL-related competencies in the interpersonal and cognitive domains, but also the more general work-related skills that are deemed important for success in professional practice. [ABSTRACT FROM AUTHOR]

Background The assessment of clinical procedural skills has traditionally focused on technical elements alone. However, in real practice, clinicians are expected to be able to integrate technical with communication and other professional skills. We describe an integrated procedural performance instrument (IPPI), where clinicians are assessed on 12 clinical procedures in a simulated clinical setting which combines simulated patients (SPs) with inanimate models or items of medical equipment. Candidates are observed remotely by assessors whose data are fed back to the clinician within 24 hours of the assessment. This paper describes the feasibility of IPPI. Results A full-scale IPPI and 2 pilot studies with trainee and qualified health care professionals has yielded an extensive data set including 585 scenario evaluations from candidates, 60 from clinical assessors and 31 from simulated patients (SPs). Interview and questionnaire data showed that for the majority of candidates IPPI provided a powerful and valuable learning experience. Realism was rated highly. Remote and real-time assessment worked effectively, although for some procedures limited camera resolution affected observation of fine details. Discussion IPPI offers an innovative approach to assessing clinical procedural skills. Although resource-intensive, it has the potential to provide insight into individual's performance over a spectrum of clinical scenarios and at no risk to the safety of patients. Additional benefits of IPPI include assessment in real time from experts (allowing remote rating by external examiners) as well as provision of feedback from simulated patients. [ABSTRACT FROM AUTHOR]

Background Doctors' interpersonal and communication skills correlate with improved health care outcomes. International medical organisations require competency in communication skills. The Accreditation Council for Graduate Medical Education (ACGME) developed a toolbox for assessing this competency and 5 others, yet none initially for teaching these skills. Purpose and methods The original focus in the development of the ACGME competencies was evaluation. This paper represents a significant step toward defining methods for teaching communication skills competencies. A total of 16 medical education leaders from medical schools worldwide, participating in the 2003 Harvard Macy Institute Program for Physician Educators, worked together to: (1) further define the ACGME competency in interpersonal and communication skills; (2) delineate teaching strategies for each level of medical education; and (3) create a teaching toolbox to integrate communication skills competencies into medical curricula. Four subgroups defined subcompetencies, identified teaching strategies for undergraduate, graduate and postgraduate medical training and brought their work to the larger group. The expanded communication competencies and teaching strategies were determined by a consensus of the larger group, presented to 80 Harvard Macy Scholars and Faculty for further discussion, then finalised by consensus. Conclusion The teaching toolbox expands the ACGME core communication competencies, adds 20 subcompetencies and connects these competencies to teaching strategies at each level of medical training. It represents the collaboration and consensus of a diverse international group of medical education leaders in a variety of medical specialities and institutions, all involved in teaching communication skills. The toolbox is applicable globally across different settings and specialities, and is sensitive to different definitions of health care. [ABSTRACT FROM AUTHOR]

Background The continued reduction in junior doctors' hours in the UK has made it necessary to re-examine traditional assumptions about the synonymous natures of training and service. This paper researches senior house officers' (SHOs) perceptions of ‘service’ and ‘training’, with reference to where they place activities along the training/service continuum, and the factors that lead them to classify these activities in the way they do. Methods Questionnaires were sent to all identified SHOs at Plymouth Hospitals NHS Trust (40% response rate). Three focus groups were held with 5 SHOs, 3 consultants and 2 clinical tutors. Quantitative data derived from the questionnaires were analysed usingspss. Qualitative data collected in the focus groups was coded with the aid ofn6, which facilitated the thematic analysis of transcripts. Results Analysis of the quantitative data allowed the construction of the training/service continuum diagram. Identified factors affecting the perceived training/service balance of SHO activities included: frequency, time, type and nature of work, number of patients, supervision, interaction, other commitments, purpose and focus of the activity, the individual trainee and trainer, and experience and competence. Discussion It is no longer appropriate to assume that all junior doctor activities represent either training or service individually: activities are perceived differently along the training/service continuum depending on their execution and their relation to the SHOs' learning curves. Within the reduced hours framework, it is necessary to match this balance to experience, in order for both training and service requirements to be satisfied. [ABSTRACT FROM AUTHOR]

Multidisciplinary and interprofessional working is currently a priority in health care policy, in caring for patients and in health professional education. Realising multidisciplinary approaches presents challenges in the context of changes in doctors' and nurses' roles and the increased emphasis placed on communication with patients. In communication in consultations, explanations are employed in the service of numerous activities, including decision making, diagnosis and physical examination, but they have been little studied. This paper presents findings from a comparative study of doctors' and nurses' communication with patients in multidisciplinary health care, focusing on diabetes in primary care. Video- and audio-recorded consultations were subjected to conversation analysis. Output from discussion groups with patient representatives and health professionals underwent qualitative analysis. Distinctive features of explanations in nurses' and doctors' consultations with patients were identified. These can be understood by reference to patterns of communication. Nurses' communication was mediated by patients' contributions; doctors' communication gave an overarching direction to the consultation as a whole. While nurses' explanations began from the viewpoint of a patient's responsibility and behaviour, doctors' explanations began from the viewpoint of biomedical intervention. Their consultations lent different opportunities for patients' involvement. Nurses' and doctors' communications each exhibit their own distinct features. Specification of these features, when considered in the context of a particular consultation activity such as explanations, allows both recognition of the distinct contributions each profession can offer and identification of ways of combining these to maximum effect. This has implications for policy, for practice and for interprofessional education. [ABSTRACT FROM AUTHOR]

Feedback on presentation skills is important for developing skilled educators, but often this feedback is based on evaluation tools that have been developed with little concern for psychometric issues or for how the information will be used for feedback. The purpose of this study was to develop a reliable participant questionnaire to assess the quality of continuing medical education (CME) presentations and to provide presenters with feedback.The questionnaire was developed using an iterative approach, with doctors as raters, and tested during a variety of CME presentations. The resulting questionnaire consists of 9 items rated on a 7-point Likert scale. The psychometric analysis reported in this paper was completed using data from grand rounds presentations.Psychometric analysis, based on 319 evaluations from 17 presentations (average of 19 evaluations/presentation), revealed a high level of reliability (0.91), indicating that the items met a reasonable standard and that the raters were discriminating between the quality of the presentations adequately.This 9-item, participant questionnaire provides a reliable measure of the quality of CME presentations, while also providing presenters with useful feedback. Further studies will investigate if this instrument can be used to assess other CME formats and how best to provide feedback to presenters. [ABSTRACT FROM AUTHOR]

Nurse-led gastrointestinal endoscopy is a priority clinical area in the UK. Endoscopic procedures are challenging to learn, requiring a combination of technical competence (manipulating a flexible endoscope and interpreting the findings) and interpersonal skills (engaging effectively with a conscious patient who is frequently apprehensive). This paper explores the potential of an innovative, scenario-based approach which links a simulated patient with a computer-driven virtual reality (VR) training device for flexible sigmoidoscopy. Within this safe yet realistic quasi-clinical environment, learners carry out the procedure while interacting with the ‘patient’. Communication skills are assessed by simulated patients, while quantitative performance data relating to the procedure is generated automatically by the VR simulator. This pilot study took place within a nurse practitioner endoscopy course. A mixed methodology combined qualitative and quantitative data (observation and interview studies, communication rating scales and a range of computer-generated output measures from the VR simulator) in a multifaceted evaluation. Seven nurses took part in the study. Participants found the scenarios to be a convincing and powerful learning experience. All experienced high levels of anxiety. Simulated patients identified strengths in participants' communication skills, together with areas for development. Simulator-based practice led to an improvement in objective performance measures. Scenario-based training provides a powerful learning experience, allowing participants to build their technical expertise and apply it within a holistic clinical context without the risk of causing harm. We used this pilot study as a springboard for discussions over wider implications of procedure-based skills training, locating it within the literature on expertise and situated learning. [ABSTRACT FROM AUTHOR]

In the article, the author discusses the importance of rural medical education research in the professional identity development of medical educators, physicians and other health care professionals. Also cited are the need for medical schools to produce professionals who will serve the communities around their educational institutions, and the key effect of a dose-response relationship in the decision of learners to practise in a rural region.

Introduction: Dyad learning occurs when two students work together to acquire new skills and knowledge. Several studies have provided evidence to support the educational rationale for dyad learning in the controlled simulated setting. However, the role of dyad learning in the clinical setting remains uncertain. Unlike the simulated setting, learning in the clinical setting depends on a complex interplay between medical students, doctors, nurses and patients potentially making dyad learning less valuable in clerkships. The objective of this study was to explore how key stakeholders perceive the value of implementing dyad learning during medical students' clinical clerkships. Methods: In a constructivist qualitative study, we conducted 51 semi‐structured interviews with 36 key stakeholders involved in dyad learning, including 10 medical students, 12 doctors, five nurses and nine patients. Data were coded inductively using thematic analysis, then coded deductively using stakeholder theory as a theoretical framework. Results: We found that stakeholders generally perceived the educational impact of dyad learning in the clinical setting similarly but disagreed on its value. Students emphasised that dyad learning made them participate more actively during patient encounters and patients did not mind having two students present. Doctors and nurses considered dyad learning disruptive to the balance between service and training and reported that it did not resonate with their perception of good patient care. Conclusion: Dyad learning enables students to be more active during their clinical clerkships, but it easily disrupts the balance between service and training. This disruption may be exacerbated by the shifted balance in priorities and values between different stakeholder groups, as well as by making implicit teaching obligations more explicit for supervising doctors and nurses. Consequently, implementing dyad learning may not be perceived as valuable by doctors and nurses in the clinical setting, regardless of its pedagogical rationale. The authors demonstrate that collaborative learning between pairs of medical students is perceived and valued differently by different stakeholders in the clinical setting, particularly with respect to tge patient perspective. [ABSTRACT FROM AUTHOR]

The authors reflect on medical professionalism in reference to the articles published within the issue. The authors suggest that doctors must practise within health care systems established by society which are believed to be corrosive to traditional professional values. They contend that the authors of both articles failed to emphasize the responsibility of either individual doctors or the profession to wider society. They add that medicine's obligations to society are also essential.

Objectives: Health care students face many situations during their education that might be emotionally challenging. Students are confronted with illness, suffering, death, patient treatment dilemmas, and witnessing unprofessional behaviour on the part of health care professionals. Few studies have focused on what these experiences lead to in relation to the process of becoming a professional. The purpose of the study was to explore medical students' main concerns relating to emotionally challenging situations during their medical education. Methods: A constructivist grounded theory approach was used to explore and analyse medical students' experiences. Data were gathered by means of focus group interviews, including two interviews in the middle and two interviews at the end of the students' undergraduate programme. A total of 14 medical students participated. Results: Students' main concerns relating to emotionally challenging situations were feelings of uncertainty. These feelings of uncertainty concerned: (i) insufficient knowledge and skills; (ii) the struggle to manage emotions in patient encounters; (iii) perceived negative culture and values amongst health care professionals and in the health care system, and (iv) lacking a self‐evident position on the health care team. The first two aspects relate to uncertainties concerning their own capabilities and the other two aspects relate to uncertainties regarding the detached medical culture and the unclear expectations of them as students in the health care team. Conclusions: In the process of becoming a physician, students develop their professional identity in constant negotiation with their own perceptions, values and norms and what they experience in the local clinical context in which they participate during workplace education. The two dimensions that students have to resolve during this process concern the questions: Do I have what it takes? Do I want to belong to this medical culture? Until these struggles are resolved, students are likely to experience worry about their future professional role. The authors examine how the interaction between medical students' experiences of emotionally challenging situations and feelings of uncertainty influences the process of becoming a physician. [ABSTRACT FROM AUTHOR]

Context In teaching hospitals, junior trainees (first-year residents and third-year medical students) are responsible for patient follow-up and documentation under the supervision of senior team members. In order to support trainees in their role, supervisors need to understand how trainees approach these tasks and how they can be coached to develop best practices. Objectives The purpose of our study was to explore the range of practices used by junior trainees in clinical settings. Methods Constructivist grounded theory was used to guide the collection and analysis of data on follow-up and documentation during 34 observation periods with 17 junior trainees. Data sources included field notes, field interviews and de-identified copies of patient charts. We also held two focus groups with four attending physicians in each. Results We were able to describe three interrelated characteristics that influenced a trainee's approach to and ability to perform the tasks of patient follow-up and documentation: (i) diligence; (ii) relationship to the team (dependent, independent, collaborative), and (iii) level of performance ( Data Gatherer, Sensemaker, Manager). Diligence and relationship to the team appeared to influence the quality and focus of a trainee's approach at all levels of performance. Level of performance was felt, by focus group attending physicians, to reflect a developmental progression of knowledge and skills. Conclusions Our findings contribute to the existing literature in three ways. Firstly, they extend our understanding of how junior trainees approach the task of in-patient follow-up and clinical documentation and the value of those activities. Secondly, they provide new insights to support formative and summative assessment. Finally, they contribute to a growing body of literature exploring the factors that impact trainees' roles and interactions with the team. Future research should focus on validating our findings and exploring their utility in the development of novel assessment strategies. [ABSTRACT FROM AUTHOR]

The article discusses medical appraisals in Great Britain, arguing that additional support services should be offered for physicians found in the amber zone of performance after being evaluated. Topics include medical regulations, relicensing, objectives for improvement, and context-mechanism-outcome (CMO) configurations

Objectives Medical teaching teams ( MTTs) must balance teaching and patient care in the face of three challenges: shifting team membership, varying levels of learners and patient complexity. To support care, MTTs rely on a combination of recurrent oral and written communication practices (genres), such as admission, progress and discharge notes. The purpose of this study was to explore how these genres influence the team's ability to collectively care for patients. Methods This was a multiple case study with data collected through observations and audio-recordings of 19 patient cases focusing on admission review discussions and chart documents throughout the hospitalisation. Participants included 14 medical students, 32 residents and 10 attending physicians rotating through one of three internal medicine MTTs. We used constant comparative analysis to identify recurrent patterns across the multiple cases, which were further elaborated in a return-of-findings focus group. Results The MTT genre system facilitated the care of patients through 'progressive collaborative refinement' ( PCR): MTTs use case and data reviews to collaboratively and progressively refine their understanding of the patient's problems and develop strategies for addressing them. Progressive collaborative refinement was apparent through modifications made in the documentation. Although modifications were a necessary component, they were not sufficient: some modifications were made without refinement. We characterised incidents of failed modification as 'fragmentation'. Three types were observed: conceptualisation, documentation and continuity of care providers. In most cases, all three were present and interacted to impede PCR. Conclusions Progressive collaborative refinement was used by MTTs to provide the optimal care to patients. Progressive collaborative refinement was impeded by a lack of continuity of care providers and gaps between communication genres that fragmented conceptualisation and documentation. Progressive collaborative refinement can be understood as both an overarching process and a shared but unstated ideal. Through defining and describing PCR, the present findings can be used to improve communication and teaching. [ABSTRACT FROM AUTHOR]

Medical Education 2010: 44 : 236–247 Objectives This study was performed in order to gather insight into the well-being of Dutch medical residents. Methods In 2005, all Dutch residents registered through the Medical Registration Committee ( n = 5245) were sent a self-report questionnaire to assess socio-demographic and work-related characteristics, burnout and engagement. Results Of the 5140 eligible residents, 2115 completed the questionnaire (41%). Of those, 21% fulfilled the criteria for moderate to severe burnout and 27% were highly engaged with their work. Women reported more emotional exhaustion and less depersonalisation than men; age was weakly but significantly related to depersonalisation, and married residents and parents reported less depersonalisation than their single or childless counterparts. More men than women were found to be highly engaged and men specifically reported more vigour. Number of years in training was weakly but significantly related to absorption. With regard to occupational risk factors, significant between-group differences were found for the effects of clinical setting on emotional exhaustion, engagement, vigour and absorption. Residents in training in a mental health clinic were most emotionally exhausted and those in a rehabilitation centre were least engaged. General surgery represented the specialty with the lowest number of residents suffering from burnout, followed by obstetrics and gynaecology and any supportive specialty. General surgery residents were also found to be more highly engaged, vigorous, dedicated and absorbed than others. Conclusions As more than a fifth of the medical residents who responded could be diagnosed as suffering from burnout, we conclude that this problem needs addressing in the Dutch health care system, especially given that a relationship was proven between burnout and suboptimal patient care. We must look for solutions and interventions which will improve the work situation of medical residents. Striving for healthy workers in health care has to become daily practice. [ABSTRACT FROM AUTHOR]

Context The use of information and communication technologies (ICTs) for supporting interprofessional communication is becoming increasingly common in health care. However, little research has explored how ICTs affect interprofessional communication, or how novices are trained to be effective interprofessional ICT users. This study explores the interprofessional communication strategies of nurses and doctors (trainees and experts) when their communications were mediated by a specific ICT: an electronic patient record (EPR). Methods A total of 72 doctors and nurses participated in this 8-month study on a paediatric in-patient ward. Eighty hours of non-participant observations and 20 semi-structured interviews were conducted. All data were rendered anonymous prior to analysis. Using a constructivist grounded theory approach, one researcher read and analysed all data recursively. As emergent themes were identified, exemplary portions of the data were discussed with three additional researchers to resolve discrepancies and confirm the coding structure. Expertise literatures informed the final analyses. Results Three interprofessional communication strategies were identified: (i) all participants routinely formulated ‘workarounds’ to circumvent problematic EPR-mediated communications; (ii) workarounds were classifiable as instances of Abandoning, Forcing or Submitting to the EPR, and (iii) novices learned workaround strategies through an informal curriculum, but they did not learn to manage the interprofessional effects of these workarounds. Conclusions Trainees relied on workarounds as simplified routines, demonstrating routine expertise. Staff members, demonstrating adaptive expertise, used workarounds as part of a broader network of people and communication tools. Explicit training regarding this network and the ways in which workarounds conceal this network may help trainees develop adaptive expertise. [ABSTRACT FROM AUTHOR]

Background Internationally, there are increasing numbers of women entering medicine. Although all countries have different health care systems and social contexts, all still show horizontal (women concentrated in certain areas of work) and vertical (women under represented at higher levels of the professions) segregation. There is much discussion and competing explanations about the implications of the increasing numbers of women in the medical profession. Aims The purpose of this review was to explore the evidence, issues and explanations to understand the effects of the changing composition of the medical profession. Conclusions This review identified evidence that delineates some of the effects of gender on the culture, practice and organisation of medicine. There are problems with some of the research methodologies and we identify areas for further research. To understand the effects of the changing gender composition of medicine it will be necessary to use more sophisticated research designs to explore the structural, economic, historical and social contexts that interact to produce medical culture. This will provide a basis for exploring the impact and implications of these changes and has immediate relevance for workforce planning and understanding both the changing nature of health professions' education and health care delivery. [ABSTRACT FROM AUTHOR]

Context Personal attitudes of doctors towards cultural diversity may influence the delivery of clinical care. Yet whether medical schools should assess a student's cultural awareness and if so, how, has not been specifically debated. Objective To establish the views of key stakeholders in medical education on the assessment of awareness of cultural diversity within the undergraduate curriculum. Methods Semi-structured interviews were undertaken, using sampling and snowballing, with 61 stakeholders, including policymakers, teachers of diversity, students, service users and carers. The data were analysed qualitatively using quasi-statistical and template approaches and themes identified. Results Three main themes emerged. The first was ambivalence over the need to assess students. Most felt students should be assessed to ensure the subject was taken seriously. Some were concerned that assessment might encourage false attitudes. The second theme was uncertainty over the best methodology. Objective structured clinical examinations (OSCEs) were the most favoured method. Significant concern was expressed that this alone was sufficient. The third theme was concern that current assessment methods do not identify students with inappropriate attitudes that are potentially detrimental to patient care. Conclusions Assessment of cultural awareness should be attempted but it needs to be multifaceted. The OSCE alone is inadequate. Other tools, such as reflective portfolios, need evaluation. [ABSTRACT FROM AUTHOR]

Background In the Netherlands the medical education system is in the process of being transformed to establish a more demand-oriented health care system. This transformation may entail the occupational restructuring of the medical profession. Meanwhile, on the supply side, the career intentions of future doctors are also changing. Objectives We aimed to categorise medical students' prevailing career intentions and to examine to what extent newly proposed medical occupations that may be part of the transformation process correspond with these career intentions. Methods We carried out expert interviews and a feedback round to gain input for a survey among students. From the demand perspective, 11 experts proposed non-traditional medical occupations and evaluated these on the basis of job characteristics relevant to a doctor's career choice. Subsequently, students from 5 universities filled out a questionnaire to rate these job characteristics by their importance and the proposed occupations' attractiveness. Results Four different clusters of career intentions were categorised as patient-oriented expert, career-oriented specialist, lifestyle-oriented generalist, and balance-seeking realist. These clusters differ in terms of the ways in which students feel attracted to the proposed occupations. The career-oriented specialists feel least attracted and the lifestyle-oriented generalists most attracted to the occupations. Discussion The experts' call for shorter postgraduate programmes to educate patient-oriented doctors partly matches students' career intentions. Most students share the intention of obtaining a direct care position that provides ample task variation, which may explain the appeal of the occupations ‘emergency doctor’ and ‘basic specialist’. The limited interest in specific patient groups suggests a need for more exposure to the occupations linked to these groups. [ABSTRACT FROM AUTHOR]

To determine whether improvements gained in general practitioners' (GPs') self-perceived competency, attitudes and knowledge after an intervention in adolescent health care designed with evidence-based strategies in continuing medical education, are maintained longterm, 5 years post intervention. The intervention was designed with evidence-based strategies in continuing medical education.We carried out a follow-up postal survey of the cohort of metropolitan Australian GPs trained in the intervention 5 years previously.Subsets of the original measures, used in the randomised controlled trial of the intervention, were selected to re-assess the GPs by postal survey. Self-perceived competency, attitude and knowledge were measured. Doctors were also asked about further training in adolescent health over the 5 years since the intervention and about self-reported practice.A total of 46 of 54 (85%) of the original intervention group returned a questionnaire. Scores at 5 years were all higher than at baseline (P < 0.01) and improvements were sustained in all measures from 12 months to 5 years after the intervention. In all, 25/46 (54%) doctors had received further training in related areas over the 5 years, but this did not improve sustainability. A total of 45/46 (98%) reported maintaining their clinical approach to youth and 22/46 (46%) reported maintaining practices to address systemic barriers to adolescent health care access.Quality education designed according to evidence-based strategies of effectiveness has advantages for longterm sustainability. [ABSTRACT FROM AUTHOR]

Doctors have high levels of self-treatment, investigation and referral, but little is known about how medical students seek health care.We carried out a questionnaire survey of Year 2 and 4 students, exploring their health-seeking behaviour and attitudes to self-care.A London medical school.The response rate was 80%. Nearly all students (99%) were registered with a general practitioner (GP). A total of 43% had informally consulted doctors who were friends or relatives in the previous 12 months (61% of those with a doctor as a family member had informally consulted, and 33% of those without a doctor as a family member had informally consulted;P = 0.001). In all, 13% of Year 4 students and 2.2% of Year 2 students had received a prescription from a friend (P = 0.007). Almost a quarter (22%) of Year 4 and 1.3% of Year 2 students reported having directly contacted a specialist (P = 0.01). A third (32%) (43% Year 4, 1.3% Year 2;P = 0.006) of those referred in the previous 12 months had contacted the consultant directly. In all, 9.2% (0% Year 2, 20% Year 4;P = 0.001) had initiated their own investigations, and 25% (47% Year 4, 7% Year 2;P = 0.001) had been examined by a colleague. Students agreed that it was appropriate for doctors to self-investigate (52%), self-refer (59.1%) and self-prescribe (39.2%).Medical students appear to bypass their GPs and initiate investigations, referrals or treatment. This is associated with increased clinical access or access through family members. Self-management of illness is learnt early on in students' careers and is increased with availability and increasing clinical access. [ABSTRACT FROM AUTHOR]

To determine whether weekly e-mails of structured, critically appraised summaries of new articles, within the format of a Weekly Browsing Journal Club (WBJC), would encourage use of evidence in practice.Randomised controlled trial.A sample of 107 academic general internists were randomly assigned to receive either the WBJC (n = 54) or a health news website (n = 53) by e-mail on a weekly basis for 3 months. Participants completed a pre- and post-intervention questionnaire that measured their use of evidence in practice, attitudes about the role of evidence in practice, critical appraisal ability and reading habits.Of 107 participants, 90% completed the trial. At baseline, when faced with questions, they found answers on which to base their clinical decisions 67% of the time. Participants incorporated evidence into patient care for 60% of patients and read evidence to help make decisions for 25%. After 3 months, the groups did not differ in the use of evidence in practice. Changes in attitudes toward the role of evidence in practice and in self-perceived critical appraisal ability were also similar. The subjects spent 2.2 hours reading 4.3 journals per week. Weekly reading time decreased by 10 minutes in the WBJC group, but increased by 26 minutes in the control group (P = 0.02). At study completion, 82% of the WBJC group were satisfied with the intervention and 90% asked to continue.While doctors appreciated these summaries, which improved their reading efficiency, the intervention had little impact on their use of research evidence in practice. [ABSTRACT FROM AUTHOR]

To investigate cognitive schemas and schema systems used by hospital doctors to influence prescribing, particularly in terms of making appropriate prescribing decisions, and to compare the numbers and content of schemas between doctors with different levels of experience.Qualitative interviews with a purposively selected sample.Seven pre-registration (PRHOs) and 5 senior house officers (SHOs) and 5 consultants from a range of medical specialties in a teaching hospital.The qualitative analysis of the themes and patterns explored during the interviews indicated that all doctors articulated schemas that influenced their behaviour. The junior doctors seemed to have simplistic schemas, with interdoctor agreement; the consultants appeared to have more sophisticated schemas, with greater individual variation. Those schemas adopted by the PRHOs (prescribing‘novices’) could be subsumed by, rather than contradicted by, those of the consultants (prescribing‘experts’), with a transitional stage demonstrated by the SHOs. The most noticeable distinction was the greater emphasis by consultants on holistic patient care and what might be seen as their separate schemas for appropriate prescribing stemmed from that premise. In contrast, junior doctors appeared to have had a single schema that encompassed both prescribing generally and appropriate prescribing.Although the design of this study was cross-sectional rather than longitudinal, the findings suggest that the acquisition and adjustment of schemas and schema systems are significant factors in the professional development of the hospital doctor from novice through to expert. It could be hypothesised that house officers possess simpler schemas as a way of coping with their job demands, which evolve in complexity as they gain experience. However, the transitional stage found with the SHOs is critical during cognitive development, with implications for the training and support available to doctors throughout their professional careers. [ABSTRACT FROM AUTHOR]

To establish, as part of a wider study into specialty choice and job satisfaction, whether the personality profiles of a sample of doctors differed from those of the UK population at large, i.e. their potential patients, and the implications this might have for the doctor/patient consultation process. The Myers-Briggs Type Indicator (MBTI)®, which measures normal personality differences, was administered by post to five cohorts of doctors ( n = 464) who had qualified from a London medical school during the 1980s. United Kingdom. 313 (67.5%) of the medical graduates. Personality profiles of the respondents compared to those of the UK adult population norms, a proxy for their potential patients. The doctors in this sample differed significantly from the UK adult population norms on most of the dimensions of personality measured, including those which measure an individual's preferred mode of perception, i.e. how one likes to take in information and learn about things. This suggests potential points for miscommunication in the doctor/patient consultation process. This research should be replicated to see if the results are generalizable. Nevertheless, the findings do indicate that these doctors might benefit from education in the concept of psychological type differences and how these could affect communication with their patients. Training in how to ‘flex’ their consultation style, when necessary, to take into account possible personality differences between themselves and their patients could enhance the outcome of the interaction for both parties. [ABSTRACT FROM AUTHOR]

ObjectivesThe UK General Medical Council’s Performance Procedures were introduced in 1997. This study aimed to assess the changing knowledge and attitudes about the procedures in British doctors at the time of their introduction and in the following 2 years. MethodsThree questionnaire surveys, of separate representative samples of 800 UK doctors, were carried out in November of 1997, 1998 and 1999. The surveys assessed awareness of Good Medical Practice, attitudes to the Performance Procedures, agreement with Duties of a Doctor as a basis for disciplinary procedures, and attitudes to the Performance Procedures. ResultsAlthough awareness of the procedures increased over the period 1997–99, there was no concurrent increase in agreement with the core principles of the procedures, the Duties of a Doctor, which are spelled out in Good Medical Practice. Of 12 separate attitudes to the procedures, changes were found in eight over the time period, all but two of which were negative, and not in support of the procedures. Nevertheless many doctors were changing their practice as a result of the procedures, and that proportion increased during the period 1997–99. ConclusionsAlthough doctors became more aware of the procedures, that increasing awareness was not accompanied by an increasing agreement with the procedures’ underlying principles or their wider implications. [ABSTRACT FROM AUTHOR]

ObjectivesTo assess the views of the general public and general practitioners (GPs) on the General Medical Council’s Good Medical Practice. MethodsA large national consumer survey organization (MORI) was commissioned to conduct a survey of a representative sample of the general public using quota sampling methods with randomly selected sampling points across Great Britain. A similar survey was carried out of GPs across Great Britain. Questions were asked of the general public about their perceptions on medical practitioners keeping their knowledge sufficiently up to date to do their job, on complaints being properly investigated, and about doctors being removed from the General Medical Council register if they failed to perform a specifically defined duty. The GPs were asked the same questions about duties. The general public was also asked whether they worked in the National Health Service (NHS), about any recent experiences as a patient in the NHS and whether they had ever complained about a doctor. ResultsA total of 1949 people were interviewed in their homes along with 199 GPs. Over one-third either worked in the NHS or had friends or relatives who worked in the NHS. Eleven per cent felt they had reason to complain about a doctor although only 6% had made a formal or informal written or verbal complaint. The general public and GPs held similar views on reasons for doctors being removed from the register, although the public’s threshold was somewhat lower than the doctors. ConclusionsGPs and the general public have similar views on good medical practice, although the degree of concern shown by the public is greater than that registered by doctors. Both groups show similar patterns of variation in their perception of the importance of some duties compared with others. [ABSTRACT FROM AUTHOR]

Discusses the various aspects of managed care. Opinion of physicians about the concept of managed care; Problems faced by doctors in the U.S.; Reason for the development of managed care; Benefits and shortcomings of managed care; Uncertainty in medical colleges about the curriculum for managed care; Response of community doctors to managed care; Need for a high quality and equitable health care system.