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Objective: To explore attitudes among National Health Service consultants responsible for delivering basic clinical teaching to medical students., Design: Postal questionnaire., Subjects and Setting: A total of 308 acute hospital trust consultants working in 4 'new' and 4 'established' teaching hospitals in the West Midlands metropolitan area, and involved in the delivery of clinical teaching to Year 3 medical students at the University of Birmingham Medical School during 2002-03., Main Outcome Measure(s): The questionnaire explored contractual requirements, actual teaching commitments and perceptions of medical students' knowledge and attitudes. Responses from doctors and surgeons and from respondents working in established and new teaching hospitals were compared., Results: A total of 249 responses were received (response rate 80.8%). Although many consultants enjoy teaching students, their enjoyment and their ability to deliver high standards of teaching are compromised by time and resource constraints. For many the situation is aggravated by the perceived inappropriate organisation of the clinical teaching curriculum and the inadequate preparation of students for clinical practice. Linking these themes is the overarching perception among teachers that neither service nor educational establishments afford teaching the levels of recognition and reward associated with clinical work or research., Conclusion: To overcome barriers to teaching requires more reciprocal links between hospital staff and medical schools, opportunities for consultants to understand and to comment on curricular and timetable developments, and, perhaps most importantly, recognition (in contractual, financial, managerial and personal terms) of the importance of undergraduate teaching in the competing triad of service, research and education.

Aims: It has been suggested that adenocarcinomas of the lower oesophagus and gastric cardia should be reclassified as oesophagogastric junction (OGJ) cancers. This study aimed to define the frequency of OGJ cancers in a geographically defined population of 4.3 million people., Methods: All cases of oesophageal and gastric cancer occurring in 1993 were identified by the North Western Regional Cancer Registry. A total of 1192 hospital case notes were reviewed and a study group of 1067 patients was defined. Tumour involvement was documented at individual subsites in the oesophagus and stomach, allowing for tumour presence in more than one oesophageal/gastric subsite., Results: There were 627 tumours in men and 440 in women. The tumour was confined to the oesophagus in 281 (26.3%) cases and to the stomach in 454 (42.6%) cases. The tumour encroached upon or crossed the OGJ in 332 (31.1%) cases. Overall, tumours involved the cardia, OGJ, or lower oesophagus in 633 (59.3%) cases; in 179 (18.5%) cases the tumour involved the lower oesophagus but not the OGJ, and in another 122 (11.4%) cases the cardia was involved but not the OGJ., Conclusions: Oesophagogastric cancers in this population predominantly involve the OGJ, lower oesophagus, and/or cardia.

Background: Recent guidelines have suggested that testing young dyspeptic patients for Helicobacter pylori infection will produce more appropriate referrals for endoscopic investigation. Our aim was to describe how awareness of patient H. pylori status changes the practice of general practitioners (GPs) who do not currently use H. pylori testing and/or eradication in their management of dyspepsia. We studied a 5 per cent systematic sample (n = 177), stratified by health authority, of GPs in the North West region of England., Methods: A questionnaire-based assessment of self-reported practice of young patients with dyspepsia was carried out., Results: Over three-quarters of GPs would choose eradication therapy rather than ulcer healing drugs if they knew the patient was positive for H. pylori infection. Twenty-nine per cent of GPs would refer for endoscopy when the patient's H. pylori status was unknown, 32 per cent when it was positive, and 22 per cent when it was negative. However, GPs responded in an inconsistent manner to knowledge of patient H. pylori status. Some chose to refer positive patients only, others only patients with negative status, and a minority would refer both positive and negative patients., Conclusions: Until the use of H. pylori tests in primary care populations has been evaluated in appropriate prospective randomized controlled trials, advocates of testing as a means to reduce endoscopy referrals should be cautious about its potential impact on service workload.