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During early postgraduate medical training, all trainees would benefit from understanding the concepts of palliative medicine. But what should the training objectives be and where should training be provided? What should be the content of the experience and the range of methods used in training? What is the value of exposure to a range of medical and nonmedical specialists and how should postgraduates be supervised? [ABSTRACT FROM PUBLISHER]

The question of what makes 'good medical ethics' is explored focusing on the principles and values of the clinical professions, how these are integrated into patient care and shared with the wider public and on the central importance of good communication. The need for an effective learning base at all stages in professional careers is emphasised and the importance of measuring and monitoring outcomes of care and public health issues from an ethical perspective is discussed while acknowledging the difficulties of doing so. The possibility of establishing a wider forum to discuss this topic is mooted. The essay emphasises the importance of practising what we preach., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

The hypothesis that values change and evolve is examined by this paper. The discussion is based on a series of examples where, over a period of a few decades, new ethical issues have arisen and values have changed. From this analysis it is suggested that there are a series of core values around which most people would agree. These are unlikely to change over long time periods. There are then a series of secondary or derived values around which there is much more controversy and within which differences of view occur. Such changes need to be documented if we are to understand the process involved in the evolution of differences in ethical views.

Specialist education and continuing professional development are likely to change considerably over the next 20 years. This will reflect the context within which medicine is practised. This will include changes in disease patterns, population structure, medical advances, information technology and, perhaps most powerfully, public involvement. In speciality education there will be a need to define more clearly both the role of the specialist, and the competences to be achieved. CPD is the longest period of education and, as such, it is the phase during which there is likely to be greatest change in clinical practice. There is a need to develop mechanisms to assure the public that doctors continue to practice up-to-date medicine, and that there is confidence and trust in the process.

Objectives: The requirement to align the arrangements for postgraduate training in the United Kingdom with those elsewhere in the European Community provided the opportunity to review and reform our arrangements for higher specialist training. This paper describes the case for change--the strengths and deficiencies of the traditional pattern of postgraduate medical training, demographic influences in the medical workforce and the need for a more structural or planned approach to training., Conclusions: Over the past 5 years substantial progress has been made: the introduction of new regulatory arrangements and a new higher specialist training grade; the development of a managed and flexible system for delivering training to standards set by the Royal Colleges and which can accommodate the needs of those pursuing academic and research medicine; and the opportunity for trainees' progress to be measured against published curricula. The significant programme of change has been underpinned by careful workforce planning and the publication of comprehensive guidance. Significant reform of higher specialist training has been achieved. This paper also makes the case for a more strategic approach to planning and developing medical education across the continuum, from entry to medical school until retirement, which can guide medical education and improve patient care into the next millennium.

This paper sets out some of the issues relating to certification of specialists. It first defines the purpose of certification as assuring the public of the level of competence of specialist practice. It then describes some of the issues involved, which include the assessment of competence, the need for public involvement, the issue of re-certification, and the problem of dealing with poor doctors. It concludes with a challenge to doctors to seize the opportunities and to enhance the quality of teaching and research in medical education.

Resource allocation is a central part of the decision-making process in any health care system. Resources have always been finite, thus the ethical issues raised are not new. The debate is now more open, and there is greater public awareness of the issues. It is increasingly recognised that it is the technology which determines resources. The ethical issues involved are often conflicting and relate to issues of individual rights and community benefits. One central feature of resource allocation is the basing of decisions on the outcomes of health care and on their subsequent economic evaluation. The knowledge base is therefore of great importance as is the audit of results of clinical treatment. Public involvement is seen as an integral part of this process. For all parts of the process, better methodologies are required.

This paper set out to examine the role of medicine and medical practice. It has done so by posing a series of questions related to the role of the doctor, health and health care, and the patient-doctor relationship. One of the objectives was to re-examine some of the principles of medical practice, another to consider a vision of medicine for the future. The result of this examination has not turned up anything particularly new or original. What it has done, I believe has been to endorse the principles of medicine which have been established for thousands of years. Yet perhaps in some ways they need to be re-asserted and discussed afresh. Because of the enormous changes in society, in health care and the external and internal pressures on doctors, such values can be forgotten or lost. Change is inevitable and doctors must adapt to meet the changes. They must do so in a positive way and wherever possible take the lead in shaping the health and health care of the future. The values of the future are those of the past, though the setting and context may be quite different. These values include, the importance of caring, the central role of communication, the need to be involved in health as well as illness, the implications of making a diagnosis and the fundamental nature of education and training. There is a need to retain common sense and perspective in making decisions. My vision of the future of medicine is therefore clear.(ABSTRACT TRUNCATED AT 250 WORDS)

To define the major problems faced by pre-registration house officers, 328 critical incidents from 200 house officers and related staff were collected. Each incident was analysed and key words representing the main features were abstracted. These were then aggregated into eight broad categories; personal aspects, clinical skills, communication and relationships, problem-related, organization skills, education, dying patients, and administration. Further analysis of the incidents suggested a series of conclusions which include the need for effective supervision of the house officer with feedback on performance. An induction/orientation period is necessary; there is evidence that a proportion of house officers need additional experience of practical procedures; house officers often have difficulty in setting priorities and they have little experience, prior to qualification, of organizational skills; during the year they are very busy with little time off. Facilities and accommodation may be less than adequate. They perceive a lack of support from senior staff to help with personal problems and career guidance; they are conscious that communication skills are of great importance and would like additional help with this; there is little time for formal education during the year. The range of clinical material presented is enormous, however, and the challenge for medical education is to ensure that the opportunities for learning are not missed.

To examine the effect of platelet-active drugs on the spread of blood-borne tumour cells, two murine tumours, sarcoma 180 (S-180) and TLX-5 lymphoma, were selected. Following intravenous (IV) injection into CBA mice the former elicited thrombocytopenia and formed discrete pulmonary tumours, whereas the latter failed to elicit thrombocytopenia and formed discrete tumours in all visceral organs examined except the lungs. S-180 cells were injected IV into mice pre-treated with RA233 (known to prevent thrombocytopenia and thrombus formation) and TLX-5 cells were injected IV into mice pre-treated with Corynebacterium parvum (known to induce thrombocytopenia and thrombus formation). RA233 pre-treatment did not change survival time or incidence of S-180 pulmonary tumours but did result in a higher incidence of extrapulmonary tumours and a lower tumour cell burden immediately after injection. Pre-treatment with C. parvum resulted in a higher TLX-5 tumour cell burden but not discrete tumours in the lungs. On the basis of known drug activities it is proposed that thrombocytopenia induced in these experiments is in part a reflection of thrombus formation in the lungs which influences the speed of passage of tumour cells through capillaries. In some cases this may lead to a changed anatomical distribution of tumour lesions.

The development of a computerised medical and dental manpower database for medical education in the West of Scotland is described. The purpose of the database is to provide the West of Scotland Committee for Postgraduate Medical Education with information on the career patterns of doctors and dentists, and to assist in the planning of training. Data collection is from a wide variety of sources and confidentiality and security are paramount. A standing committee, representing all professional interests, has been central to the development of the database. It has acted as policy-maker and adviser, and has been concerned with the way in which the data is used. At each stage in the development, this committee has been fully consulted. The data collected is both of a personal and professional nature and is validated annually by sending a copy of the data to each doctor or dentist for checking. This has highlighted some deficiencies in the data, which now contains information on over 6,000 doctors and dentists. Requests for information from the database are carefully scrutinised by the standing committee before the data is released.