Context: A ssessment of clinical confidence and competence of senior medical students during an obstetrics and gynaecology clerk ship using an objective structured clinical examination ( OSCE ). Method: A questionnaire was distributed to senior medical students (n=47 ) to assess preand post-OSCE self-perceived con; dence and competence in five clinical sk ills: history tak ing, performing pelvic examination, interacting and communicating with patients, clinical reasoning and dealing with difficult patient situations. Pre- and post-performance con; dence levels were compared and correlated with OSCE scores. Results: The five clinical sk ills were significantly interrelated (p=0.001 ). There was no significant difference in OSCE performances between male (n=16 ) and female (n=31 ) students. Pre- and post-OSCE confidence in performing pelvic examination was significantly higher in female than male students (p=0.01 ). Post-OSCE confidence in clinical reasoning and dealing with difficult patient situations only were significantly increased in both groups (p=0.01 and p=0.02, respectively ). Pre- and post-performance confidence levels were not significantly correlated to OSCE scores. Conclusion: Of five clinical sk ills rated, self-confidence in clinical reasoning sk ills and dealing with challenging or complex patient problems only were significantly increased after an OSCE assessing competence. The content of some of our OSCE stations thus enhance confidence in these sk ills but psychometric and other characteristics of the OSCE such as duration and performance feedback mechanisms need further investigation.

In the United Kingdom, the Royal College of Speech and L anguage Therapists suggests that sociology should be included within the speech and language therapy curriculum. However, in spite of this, sociology is seldom given priority. A lthough the role of sociology with the curricula of other professions has been discussed, the role of sociology within speech and language therapy has not. Given the contemporary climate of competence-based training, the position of subjects such as sociology is being compromised. This paper sets out three reasons in support of including sociology within speech and language therapy by drawing on the distinction between a "personal education'' and a "semantic conjunction'' model of the relationship between theory and professional practice. First, it is argued that sociology mak es a valid contribution to an holistic approach to care-which is rapidly becoming the cornerstone of speech and language therapy practice. Second, this paper suggests that the inherent reflexivity within the discipline provides health professionals with an invaluable tool with which to engage in reflexive practice. Finally, it is argued that given the global emphasis on evidence-based practice, the study of sociology and sociological research methods equips therapists to interpret and conduct empirical research. This paper concludes by arguing that sociology should be viewed as an essential component of the speech and language therapy curriculum.

Aim: The purpose of this study was to identify the relationship between previous tertiary education back ground and the performance of first year medical students at Newcastle University, A ustralia. Specifically, we examined degree type ( i.e. arts, science, allied health, nursing or other professional back grounds ), level of degree completion ( fully or partially completed ), academic achievement ( grade point average ) and whether or not students had postgraduate qualifications. The relationship between age and gender was also examined. Method: A ll students admitted to the medical course from 1990 to 1998 with previous tertiary education experience who entered via the "standard'' entry pathway and sat the end of year examinations were eligible for the study (N=303 ). The outcome measures were the results of first assessment ("satisfactory'' versus "not satisfactory'' ) and final assessment of the first year ("satisfactory'' versus "not satisfactory'' ). L ogistic regression was used to examine the relationship between predictor variables and outcomes. Results: In relation to first assessment results, students with a nursing and arts back ground were significantly more likely to receive a "not satisfactory'' assessment ( RR=3.9, 95% CI: 1.6 - 7.7; RR=2.9, 95% CI: 1.2 - 6.8, respectively ), as were females ( RR=1.8, 95% CI: 1.1 - 3.5 ) and students with a grade point average of less than a distinction average ( RR=2.8, 95% CI: 1.6 - 5.2 ). A t final assessment, students with a nursing background and those with a less than distinction average were more lik ely to receive a "not satisfactory'' result ( RR=20.7, 95% CI: 3.5 - 123.9 and RR=4.0, 95% CI: 1.2 - 13.9, respectively ); consequently, they were required to repeat first year. Conclusion: Our research suggests that there are some medical student groups who encounter more academic difficulties than others in first year. Identifying these students can assist medical schools to focus academic support appropriately.

Introduction: During 1998 - 2000, an international team of five researchers described nine innovative health professions education programmes as selected by The Network : Community Partnerships for Health through Innovative Education, Service, and Research. Each researcher visited one or two schools. Criteria for selection of these nine schools included commitment to multidisciplinary and community-based education, longitudinal community placements, formal linkages with government entities and a structured approach to community participation. The purpose of these descriptions was to identify key issues in designing and im plementing community-based education. Methodology: Programmes in Chile, Cuba, Egypt, India, the Philippines, South A frica, Sudan, Sweden and the United States were visited. Before site visits were conducted, the researchers as a group agreed upon the elements to be described. Elements included overall institutional characteristics, curriculum, admissions practices, evaluation systems, research, service, community involvement, faculty development, postgraduate programmes and the school's relationship with government entities. Here I describe the common features of each of the nine programmes, their shared dilemmas and how each went about balancing the teaching of clinical competence and population perspectives. Lessons learned: Based upon an analysis of the cases, I present seven "lessons learned'' as well as a discussion of programme development, institutionaliz ation of reform and long-term im plications for health professions education. The seven lessons are:( 1 ) PBL and CBE are not seen as independent curricular reforms; ( 2 ) student activities are determined based upon sensitivity to locale; ( 3 ) health professionals need to work collaboratively; ( 4 ) there is a connection between personal health and population health issues;( 5 ) population health interventions and treatment strategies need to be appropriate to local conditions;( 6 ) graduates need to advocate for patients and the community in the public policy arena; and ( 7 ) organiz ational change tak es a long time. Conclusions: Despite their differences, all nine exemplars are engaged in processes of organiz ational change. Schools are becoming more community-oriented and socially accountable, and all of these programmes have accepted two fundamental tenets: "take public money, give to the public'' and "place matters''.

Objectives: To survey interns regarding their opinion of medical school learning needs for a range of core skills. Methods: A random sample of interns practising in New South Wales, Australia, who graduated from the state's three medical schools were surveyed two-thirds of the way through their first hospital year. They were asked whether there was a need for further medical school education for each of 226 core skills. Skills were grouped into five themes: management of clinical conditions; clinical investigations; clinical procedures; core practice; and professional development. Results: Frequency distributions weighted for age, gender and medical school background were calculated for each item. The 20 most frequently identified needs related to examinations of the eye and ear, nose and throat; managing uncooperative patients and difficult patient interactions; prescribing; writing not for resuscitation orders and death certificates. A lso included were procedural needs related to ear, nose and throat; plastering and wound management; and needs for more education in the management of clinical conditions related predominantly to "acute'' cases such as anaphylaxis and diabetic k etoacidosis. Conclusion: Interns were able to discriminate between their needs for different skills and identified many core sk ills for which they perceived there was a need for more medical school education. The implications for medical education are discussed.

Objectives: To describe attitudes of physicians and medical students at one medical school toward the role of dietetic treatment in patient care and toward adding nutritional education into the medical school curriculum. Study description: A cross sectional survey was conducted at Soroka University Medical Center and Ben-Gurion University's School of Medicine. The attitudes of 67 physicians and 62 medical students toward nutritional treatment were determined using an attitudes questionnaire. Results: Despite recommendations in medical treatment protocols to use dietary intervention as the primary treatment for several chronic diseases, physicians did not rate nutritional treatment as the most important treatment for these conditions. Students rated the im portance of nutritional treatment significantly higher for each of the medical conditions presented than did practicing physicians (p=0.001 ). A lm ost 50% of the physicians reported not using nutritional treatment due to lack of time and awareness of the available options. Physicians and students rated the im portance of nutrition education in the curriculum equally. Physicians who rated nutrition treatment as im portant also felt the need to add this subject to the medical education curriculum. Conclusion: Physicians and medical students agreed that dietary treatment and nutrition education are im portant. Our results suggest that there is good reason to introduce nutrition topics into medical school curricula. Improved nutritional knowledge in physicians would improve the teamwork capacity between physicians and dieticians in the realms of curative care and public health.

For the last 30 years or more the old war songs of medical education (community orientation, active learning, etc.) have been repeatedly ventilated in meeting after meeting, article after article. But of the present 1642 medical schools on the planet, only about 100 members of The Network and a few other have put these principles into practice, more or less. Obstacles and constraints are known. Is it the system, or the leadership, or the university culture, or the accreditation rules, or all of the above that are responsible for this lack of progress? Still, some overcame the obstacles, some removed the constraints. It would be useful to be better informed about HOW it was done. I suggest that Education for Health: Change in L earning & Practice ( EfH ) should present more articles explaining HOW successful schools managed to DO IT or WHY they were NOT able to DO IT.

The beliefs that teachers hold about the appropriate roles and responsibilities of teachers shape the ways they teach and the ways they think about teaching. In this paper I describe four teaching roles based on a taxonomy that I've recently developed. Teachers who are guided primarily by the Content Expert Role view themselves as experts who serve as resources, lik e book s or pictures. Teachers who are guided primarily by the Performance Role view themselves as agents who mak e learning happen by transmitting information or shaping students. Teachers guided primarily by the Interactive Role view themselves as guides who facilitate learning by interacting with learners. A nd teachers guided primarily by the Relational Role view themselves as engaged in relationships with learners for the purpose of helping them. Using examples taken from the health sciences I explain how each of the four teaching roles might succeed or fail depending upon the position that it occupies within a teaching - learning system. When teaching is viewed as part of a system, not as something a teacher does to a learner, teachers are successful if their particular contribution to the system is essential to the learning system. I also describe the process whereby teachers expand their belief system to include more roles. Such changes in belief systems are major shifts that qualify as "perspective transformations''. Perspective transformations tak e place slowly and are typically attended by strong emotions. I end this paper with advice to teachers regarding ways they can harmoniz e with the educational system or face the challenge of perspective transformation.