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Context The White Paper, The New NHS: Modern, Dependable, once again heralds change and new expectations of primary care in the UK. Objectives This discussion paper aims to encourage reflection on the implications for primary care teams of current governmental strategy, and to address the pivotal role which education can play in equipping practitioners for their roles. Key areas The paper examines the opportunities and threats for primary care in the new NHS developments, the strengths and weaknesses of the role that education currently plays in primary care, and how recent innovations might be used to give a more holistic approach to the needs of practitioners. The challenges for clinical governance of lay engagement and ethical decision making are seen as two crucial outcomes for an educational strategy which must be practice-led, and must interface individual practitioner education with the needs of the team and the community as a whole. I draw on a range of policy documents and educational literature to alert the reader to the different choices which can be made when thinking about appropriate educational models and methods; and offer a detailed structure for a practical educational strategy that may effectively unite theory and practice. The key elements are a three-tier link between practices, primary care groups, and district-level resources for all educational and training activity, and the aim of continuing multiprofessional development which will underpin the new NHS.

SUMMARY The Permanent Working Group of European Junior Hospital Doctors (PWG) represents the interests, in international matters, of trainees from 23 member states. The PWG recognizes the importance of postgraduate training (PGT) in the maintenance of high quality health care delivery, and in this paper presents its current policy on PGT. This replaces its policy previously published in Medical Education 1989, 23, 339–47. The paper examines the context within which PGT occurs, and calls for an urgent review of its provision and funding. Basic principles, such as PGT existing within a continuum of medical education and the application of a quality assurance-based model, underpin the development of later sections on the structure, process and outcomes of PGT. These recommend the establishment of structured training programmes which should incorporate modern educational practice in the provision and monitoring of PGT. Emphasis is placed on the opportunities for training in the clinical setting and the utilization of a range of educational techniques. Evaluation and guidance by and of clinical supervisors and designated trainers is linked with the responsibilities of the trainee, and is placed within the context of a system of accountability, thus closing the quality assurance cycle. It is recommended that the views of the consumers of PGT, the trainees, are more fully considered in the development of training programmes. Finally, the potential for further harmonization is considered, with cautious advances being proposed.

Summary As a reflection on the Edinburgh Declaration, this conceptual synthesis presents six important challenges in relation to the role of medical education in meeting current national health priorities. Context This paper presents a conceptual synthesis of current efforts in medical education to incorporate national health priorities as a reflection on how the field has evolved since the Edinburgh Declaration. Considering that health needs vary from country to country, our paper focuses on three broad and cross‐cutting themes: health equity, health systems strengthening, and changing patterns of disease. Methods Considering the complexity of this topic, we conducted a targeted search to broadly sample and critically review the literature in two phases. Phase 1: within each theme, we assessed the current challenges in the field of medical education to meet the health priority. Phase 2: a search for various strategies in undergraduate and postgraduate education that have been tested in an effort to address the identified challenges. We conducted a qualitative synthesis of the literature followed by mapping of the identified challenges within each of the three themes with targeted efforts. Findings We identified six important challenges: (i) mismatch between the need for generalist models of health care and medical education curricula's specialist focus; (ii) attitudes of health care providers contributing to disparities in health care; (iii) the lack of a universal approach in preparing medical students for 21st century health systems; (iv) the inability of medical education to keep up with the abundance of new health care technologies; (v) a mismatch between educational requirements for integrated care and poorly integrated, specialised health care systems; and (vi) development of a globally interdependent education system to meet global health challenges. Examples of efforts being made to address these challenges are offered. Discussion Although strategies for combatting these challenges exist, the effectiveness of educational models depends on them being locally adaptable and applicable. Curricular reform must go hand‐in‐hand with research and evaluation to develop comprehensive futuristic models of teaching and learning that will adequately prepare health professionals to address the challenges.

INTRODUCTION: This paper describes the development and implementation of an educational intervention to help general practitioners (GPs) recognise young people with first episode psychosis. METHOD: The Medical Research Council complex interventions framework was used to guide the development of the intervention. The theoretical phase included a literature review of previous educational interventions in primary care and consideration of the literature on attitude formation and change, and the relationship between attitudes and behaviour. The modelling phase included focus groups with GPs and service users, and a training needs analysis questionnaire administered to GPs. The 2-stage intervention consisted of a video featuring role-plays of primary care consultations, GP-led discussion and discussion with early intervention service users. The acceptability and utility of the educational programme was evaluated using a 5-point Likert scale questionnaire administered at the end of each session. RESULTS: General practitioners from each of the 39 intervention practices participated in the initial session and from 27 practices in the booster session. Information about symptoms and signs of first episode psychosis was the most valued aspect of the initial session. The booster session was also well received, with GPs valuing the opportunity to gain insight into first episode psychosis from users. CONCLUSIONS: This paper adds a pragmatic description to the literature on the development of educational interventions in primary care. The Medical Research Council framework helped to identify and clarify component parts of the intervention and how the active components may relate to the expected outcome of behaviour change.

Objectives In Japan, regulatory intervention aimed at preventing a prospective surplus of physicians is an important medical issue. The study committees organized by the Ministry of Health and Welfare (MHW) in 1986, 1993 and 1998, concluded that the number of physicians would exceed demand for their services in the future. As a result, the government planned to reduce the number of medical students. However, MHW has not been successful in the intervention so far, as shown by the fact that their initial plan for a 10% reduction in the number of students enrolled in medical school has not been attained. In this paper, we examine why the MHW policy failed. Methods We reviewed those forecasts performed by past MHW study committees and examined whether the government policy of controlling physician training was appropriate. Additionally, we did a preliminary projection of specialty-specific demand for physician services as a reference for future physician manpower policies in Japan. Results We found that both conflicts among various interest groups and a lack of precise projections of physician services hampered the proper formation and implementation of a physician manpower policy in Japan. Conclusions It might be necessary to examine the appropriateness of the MHW policy in reducing the overall number of students enrolled in medical schools. As a first step in formulating and implementing a physician manpower policy, we should begin to consolidate the necessary data to conduct precise and proper projections of future physician demand.

Context Cultural factors in health and illness, and an awareness of community health needs analysis, are important issues for medical education. Both have received relatively little recognition in the medical education literature. This paper describes the development of an educational attachment to remote predominantly Maori rural communities in New Zealand. The twin purposes of the programme were to encourage students to adopt broad public health approaches in assessing the health needs of defined communities, and to increase their awareness of the importance of cultural issues. Methods During a one week attachment, 51 students from the Wellington School of Medicine were hosted in six small communities in the East Cape region of New Zealand. Students gained an insight into the health needs of the communities and were encouraged to challenge their own attitudes, assumptions and thinking regarding the determinants of health and the importance of cultural factors in health and illness. The programme included both health needs assessment and cultural immersion. Students made visits with primary health care professionals and were also introduced to Maori history and cultural protocol, and participated in diverse activities ranging from the preparation of traditional medicines to performing their own songs in concert. Conclusions The students evaluated the course extremely highly. Attachments of this sort provide an opportunity for students to appreciate how cultural values have an impact on health care, and how they also make the teaching and learning of topics such as community health needs analysis an enjoyable and dynamic experience.

This paper explores the fundamental reasons for partnership in health care and medical education. It reviews the philosophical and policy contexts of health care trends and suggests that many of these trends can be summarized as a process of diffusion relating to: (a) what is on the health agenda, (b) who sets the health agenda and (c) the increasing indeterminacy of the health agenda. Various aspects of the 'social turn' in health care are introduced and offered as a partial explanation for the diffusion of the health agenda. Finally, some of the implications of these discussions for medical education are set out, in particular the need for partnerships within and beyond the academy.

Capacity-building programmes in low-income countries (LICs) are subject to a tension between the requirement to best train workers to fulfil national needs and the requirement to meet international expectations of their students, academics and institutions. This paper presents a theoretical framework developed from a case study of an undergraduate degree programme in Malawi and explores how national needs and international expectations can be managed in health profession settings in LICs to ensure successful curriculum development.An inductive qualitative methodology, grounded theory, combined with open-ended interviews with students, graduates, tutors and external stakeholders in the programme, was used to develop a theoretical framework.A total of 22 interviews were performed; their analysis conceptualised the tension between national needs and international expectations, and resulted in 12 codes, in four categories: competing and advancing agendas; processes of collaboration; developing a programme or professional identity, and perceptions of programme change.This study describes a conceptual framework highlighting three particular areas for analysis to aid in understanding how to best manage competing agendas. These areas refer to, respectively, the significance of international expectations, the organisational climate, and the development of a professional identity.

Summary. This paper presents the current status of school health policy at US medical schools and discusses implications for medical students with respect to physical health and occupational risks. The authors discuss the responsibility of schools to ensure that students are healthy and fit, both for their own benefit and to provide models of good health maintenance for their future patients. Schools have an obligation to monitor public safety issues, particularly in cases of chemical impairment, student mistreatment, and infection control procedures.

Summary. Medical ethics play an essential role in the practice of medicine, in the care of individual patients, in the allocation of health care resources, and in the formulation of health care policy. A specific body of knowledge, ‘biomedical ethics’, has developed which applies ethical theory to biomedical practice. This has provided doctors with tools systematically to integrate rational ethical analysis into clinical decision-making. Training in the discipline of biomedical ethics is now required for all doctors in Canada. The goals, content areas, learning objectives, and learning methods considered appropriate for advanced training in this field for medical specialists are provided in this paper. Six topic areas are discussed: introduction to ethical theory, clinical ethics, professional ethics, ethics of human experimentation, ethics of health policy, and independent study. Ways this curriculum could be organized and evaluated are also offered.

In order to make training more relevant to community needs, medical educators throughout Thailand have been attempting to address issues concerning the training of their undergraduates. Support for a reorientation of medical education and acceptance of the frame-work put forward by the World Health Organization are evident in national health plans and in national medical education conferences. This paper outlines some of the basic problems faced by health policy makers in Thailand and presents a brief chronology of recent events in the history of medical education in Thailand.

This paper reports information obtained from 499 participants during the course of a national series of workshops conducted in eleven government medical schools in Indonesia. The information analysed provided an independent check of claims made by previous investigators relating to the extent to which Indonesian medical schools had progressed towards curriculum re-organization consistent with national policy for the reform of undergraduate medical training. The majority of participants had developed and completed course programmes based on instructional objectives, which was seen as being broadly consistent with previous claims. Evidence is presented of continued curriculum-development activity several years after the cessation of external intervention through the national workshop programme. Findings are discussed in relation to national policy and strategies for maintenance of curriculum-development activities after cessation of intervention programmes.

Summary The Alma Ata Declaration ‘Health for All by the Year 2000’ lays heavy emphasis on the development of competent primary care services. The World Health Organization does not see different sorts of country, developing or developed, as having the same health problems nor as achieving the same level of health in terms of the amelioration of these problems by the year 2000. In this paper a conceptual model of a rational health service is presented, the shortfalls from it are examined, and whether they reflect deficiencies in basic medical education is considered.

Summary. It has been argued that health promotion should be included in the medical curriculum, if medical education is to match the needs and health goals of communities. In spite of the medical profession's awareness of the importance of health promotion, few universities in the UK have introduced a substantive course on the subject. This paper describes the teaching of health promotion in Nottingham Medical School. It identifies the aims and objectives of the course which are amongst others to develop an understanding of: the factors which influence the perception and experience of health and illness; the concepts of health promotion and health education; the scientific basis of health promotion; the relative effectiveness of approaches used; the measurement of health status and health behaviour; and health policy and planning. An innovative element of the teaching involves a community project which gives students experience of health promotion in practice. Evaluation of the impact of the course suggests that students perceive it to be interesting, stimulating and enjoyable, whilst examination and continuous assessment indicate that it has also influenced students' knowledge and understanding of the subject.

Since health care and the practice of medicine have become major topics for social and political comment a variety of expectations have emerged which, in a sense, define an idealized image of the medical profession and its work. Different sectors of the community tend to place different emphasis on specific aspects of doctors' roles. This paper reviews those specific expectations which have been expressed by patients, sociologists, allied health professionals, governments and health administrators, and derives from them objectives for medical education.