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Consultation Assessment and Improvement Instrument for Nurses (CAIIN) provides a set of competences that describe what a practitioner does when consulting with patients. These include behaviours to develop good relationships with patients, ways of communicating that allow the patient to tell the story of illness in their own words, practical procedures such as using diagnostic instruments and the thinking processes needed to make accurate diagnoses and negotiate the most appropriate care plan. This approach facilitates the development of a patient-centred, problem-solving style of consultation. This talk will describe the importance of this approach, and will describe how the CAIIN was developed from a similar instrument used with GPs and medical students, and continue by discussing how it can facilitate the teaching of advanced consultation skills to nurses in extended roles.

INTRODUCTION This paper seeks to describe the consultation strengths and weaknesses of senior medical students, the explicit and prioritised strategies for improvement utilised in student feedback, and curriculum developments informed by this work. METHODS Prospective, descriptive study of students on clinical placements in general practice. All were observed directly by 2 assessors in consultation with 5 patients in a general practice setting. Performance was judged against 5 categories of consultation competence and 35 component competences as contained in a modified version of the Leicester Assessment Package. Specific strategies for improvement were selected from a list of 69 previously formulated strategies. RESULTS Data from 1116 students were included. The consultation competences identified most frequently as strengths related to interpersonal skills, while weaknesses were mainly in the domain of clinical problem-solving. The median number of key strengths identified per student was 5, with 5 additional but lesser strengths. A median of 3 key and lesser weaknesses were identified. The average number of strategies selected to address an identified weakness was 1.2. Students rated the assessment process and its impact very positively. CONCLUSION The systematic assessment of the consultation competence of medical students by direct observation involving real patients is feasible and facilitates the 'educational diagnosis' of individuals and of their peer group. It has informed development of teaching and generated research hypotheses.

The aim of this work was to evaluate the impact of training in the use of the Consultation Assessment and Improvement Instrument for Nurses (CAIIN) in the context of expanding roles for primary care nurses. To achieve this, 10 experienced primary care nurses undertook a 3-day workshop in using the CAIIN to evaluate videotaped consultations between nurses and patients, and consultations between course participants and simulated patients. The impact of the workshop was assessed by questionnaire and semistructured interview. All participants found the CAIIN to be an acceptable approach to analyse and improve the consultation performance of themselves and others. They believed that it would further improve their existing skills, and provided a useful framework for learning those aspects of consultation competence in which they had less confidence. Several found role-play with simulated patients stressful. Concerns about the role of nurses in clinical problem-solving were reduced, but remained significant. The CAIIN was considered to have good potential as a learning tool as part of continuing professional development and clinical supervision. In conclusion, the rapidly expanding roles of primary care nurses requires serious consideration to be given to assessing and improving their consultation skills. The CAIIN provides an acceptable method of doing so. However, learning to use the instrument effectively requires expertise amongst teachers and significant protected learning time for nurses who become assessors or mentors of their peers.

The aims of this study were (a) to devise a set of prioritised criteria of consultation competence which primary care nurses need to acquire and (b) to determine the face and content validity of these criteria.The criteria of consultation competence as contained in the Leicester Assessment Package (LAP) were modified for use with primary care nurses and sent to a stratified sample of UK primary care nurses (n=1126) to determine their face and content validity.Support for the seven categories of consultation competence varied from 93-98% and for the 39 component competences from 88-98%. There was no consensus for alternative or additional categories or components. CONCLUSIONS; We have established the face and content validity of the derived competences. These are suitable for the teaching and assessment of consultation skills of primary care nurses, at all stages of their professional development, when incorporated within an educational package.

The article surveys the two-thousand-year relationship of Christianity and nationhood, suggesting an oscillation between an initial otherworldly universalism, reacting against the national particularity of Judaism and finding its political partner in the fourth century in the Roman Empire, and various forms of nationalism encouraged both within the autocephalous churches of Eastern Christianity and by the Western medieval development of nations issuing after the Reformation in state-based national churches, culminating in Germany in the pursuit of the Volk-church ideal. The role of the papacy, both through the Jesuits and through the Congregation of Propaganda Fide, in sustaining universalism is addressed. The re-emergence of the universalist dimension in the twentieth century is explored with regard to Protestantism through the ecumenical movement and the Oxford Life and Work Conference of 1937. The whole discussion makes repeated use of the second-century text, the Epistle to Diognetus.

Cet article propose une biographie de Oliver Welch (1902-1990), dont la carriere, sinon l'esprit, a ete un exemple assez typique du catholicisme anglais de son temps, ce qui l'attirait etant precisement un melange de liberalisme et de fidelite a la tradition. Toute sa vie il fut fortifie en cela par son attachement constant a sa soeur Werburg, a la fois artiste moderniste et moniale benedictine traditionnelle.

Objective To evaluate the use of a modified version of the Leicester Assessment Package (LAP) in the formative assessment of the consultation performance of medical students with particular reference to validity, inter-assessor reliability, acceptability, feasibility and educational impact. Design 180 third and fourth year Leicester medical students were directly observed consulting with six general practice patients and independently assessed by a pair of assessors. A total of 70 practice and 16 departmental assessors took part. Performance scores were subjected to generalizability analysis and students’ views of the assessment were gathered by questionnaire. Results Four of the five categories of consultation performance (Interviewing and history taking, Patient management, Problem solving and Behaviour and relationship with patients) were assessed in over 99% of consultations and Physical examination was assessed in 94%. Seventy-six percent of assessors reported that the case mix was ‘satisfactory’ and 20% that it was ‘borderline’; 85% of students believed it to have been satisfactory. Generalizability analysis indicates that two independent assessors assessing the performance of students across six consultations would achieve a reliability of 0·94 in making pass or fail decisions. Ninety-eight percent of students perceived that their particular strengths and weaknesses were correctly identified, 99% that they were given specific advice on how to improve their performance and 98% believed that the feedback they had received would have long-term benefit. Conclusions The modified version of the LAP is valid, reliable and feasible in formative assessment of the consultation performance of medical students. Furthermore, almost all students found the process fair and believed it was likely to lead to improvements in their consultation performance. This approach may also be applicable to regulatory assessment as it accurately identifies students at the pass/fail margin.

L'A. donne un apercu de la revue Journal of Religion in Africa depuis sa creation en 1967 par Andrew Walls jusqu'a nos jours. Il s'agit d'un survol a la fois de themes et de decennies, de pays, d'institutions et de carrieres personnelles, de trajectoires melees et diverses. Un pays ou une universite a fait avancer l'ensemble a une epoque, un autre a une autre epoque. Mais un seul nom etait la au commencement et y est encore aujourd'hui, pour une comprehension academique et pastorale. Les Prophetes bantous d'Afrique du Sud de Bengt Sundkler ont ete le grand initiateur en tant que premier vaste ouvrage bien documente, presque totalement branche sur les idees, espoirs et realisations des chretiens d'Afrique.

Background: Electives have the potential to have a very positive impact on the professional development of medical students. Education about issues in global health is widely regarded as a neglected area in the undergraduate curricula of many medical schools. Linking learning outcomes for global health to the elective offers a possible solution that avoids adding additional teaching to crowded courses.Conclusion: This commentary advocates caution as many potential learning outcomes are better addressed elsewhere and setting detailed outcomes erodes the essence of the elective – student choice.

La qualite essentielle de la spiritualite benedictine reside dans l'association de la recherche de Dieu et de l'acceptation des valeurs naturelles. On trouve dans la regle une limitation de l'ascetisme, une acceptation de l'humanite. La reference frequente de la regle aux enfants dans le monastere montre le role des benedictins dans l'education des jeunes. La familia benedictine est apparue comme une famille naturelle. La grâce complete la nature chez Benoit comme chez Thomas d'Aquin. Benoit est sans doute moins preoccupe par le peche qu'Augustin et Luther

Educators seek to influence attitudes as well as enhance knowledge and skills. We wanted to know how a one week course on global health had altered the attitudes of the learners. We were aware that analysing group responses to Likert items using an interval approach has methodological flaws. All 126 third-year students at Trinity College Medical School were invited to complete an attitude survey before and after the course, with 18 Likert items. Changes in attitudes to each item were analysed by interval and ordinal methods. A total of 82 (65%) students completed both surveys and gave consent. There was a nine-fold difference in attitude change by individual students. Attitudes changed markedly in relation to some items and little to others. Analysing responses using an ordinal method revealed significant change regardless of whether responses to each item before the course were clustered at one end of the scale or were more neutral. The most sensitive and reliable analysis was an ordinal approach, presenting degrees of attitude change by individuals to each item. When presented by the change step method in a histogram important attitude change by individuals within the group is revealed, that the interval method conceals.

evangelicals and the Orthodox, as recommended in Mark R. Elliott, ed., Christianity and Marxism Worldwide: An Annotated Bibliography (Wheaton, Ill.: Institute for the Study of Christianity and Marxism, 1988), or Paul Mojzes, ed., Church and State in Postwar Eastern Europe (New York: Green­ wood Press, 1987), remain the primary sources. The current standard treatments on Orthodoxy are Jane Ellis, The Russian Orthodox Church: A Contemporary History (Bloomington: Indiana Univ. Press, 1986);and Dim­ itry P. Pospielovsky, The Russian Church Under the Soviet Regime, 1917­ 1982, 2 vols. (Crestwood, N.Y.: St. Valdimir's Seminary Press, 1985). Perhaps the most comprehensive reference work now available is a three-volume series edited by Pedro (Sabrina) Ramet: Vol. 1: Eastern Chris­ tianity and Politics in the Twentieth Century (Durham, N.C.: Duke Univ. Press, 1988); vol. 2: Roman Catholicism and Politics in the Soviet Union and Eastern Europe (1989); and vol. 3: Protestantism and Politics in the Soviet Union and Eastern Europe (1992). My own chapter in volume 3 on Prot­ estantism in the USSR is an attempt at a detailed treatment through early 1991. Two book-length descriptions using the 1988 millennial celebrations for highlighting religious developments are Michael Bourdeaux, TheGos­ pel's Triumph over Communism (Minneapolis: Bethany House Publishers, 1991; British title: Glasnost, Gorbachev, and the Gospel); and Jim Forest, Religion in the New Russia (New York: Crossroad, 1990). Also helpful for an overall presentation of changes under Perestroika is the second edition of Kent Hill's Soviet Union on the Brink: An Inside Look at Christianity and Glasnost (Portland, Oreg.: Multnomah Press, 1991; 1st ed. title The Puzzle of the Soviet Church). Several new publications speak to the role of religion in the revolu­ tions of 1989-91 and the task for the churches: Niels Nielson, Revolutions in Eastern Europe: The Religious Roots (Maryknoll, N.Y.: Orbis, 1991); J. Martin Bailey, The Spring of Nations: Churches in the Rebirth of Central and Eastern Europe (New York: Friendship Press, 1991); Ron Davies, After Gorbachev? How Can Western Christians Help? (Eastbourne, Sussex: MARC [Monarch Publications], 1991); Paul Mojzes, Religious Liberty in Eastern Europe and the USSR: Before and After the Great Transformation (Boulder, Colo.: East European Monographs, distributed by Columbia Univ. Press, 1992). See also Walter Sawatsky, "Truth Telling in Eastern Europe: The Liberation and the Challenge," Journal of Church and State, Autumn 1991; Mark Elliott, "New Opportunities, New Demands in the Old Red Empire," Evangelical Missions Quarterly, January 1992,pp. 32-39; WilTriggs, "The Soviet Union: A Different Kind of Mission Field," Evangelical Missions Quarterly, October 1990, pp. 432-42; Igor Troyanovsky, ed., Re­ ligion in the USSR: A Guide to Christianity, Judaism, Islam, Buddhism, and OtherReligions in Today's SovietUnion(San Francisco: HarperSanFrancisco, 1991; offers statistics as of 1990).

SOUTH AFRICA HAS long been a fruitful field for the interaction of Christianity and politics. Its missionary tradition was fortunate in the early 19th century in stemming from Johannes Van der Kemp and John Philip, two exceptionally interesting and powerful characters who were both convinced that their religion had a great deal to say about slavery, colonialism and justice. While their example was not generally followed, it had enough continuators such as John Colenso, Arthur Shearly Cripps, John White and Trevor Huddleston, for it to remain a significant threat within the Christian presence, one which was continually irritating to protagonists of white