Stroke remains a leading killer and cause of disability in the United States. The incidence of stroke appears to be increasing while new advances in the management of stroke continue to emerge. These realities emphasize the need to communicate advances to health care providers and consumers. However, educating health care providers and consumers in rural states is often dif.cult due to dispersed geographic distribution and lack of resources. This project, utilizing teleconferencing technology, brought an educational program on stroke management for providers and consumers into rural communities. Community hospitals, with teleconferencing capability, were identi.ed throughout Vermont. Community providers and consumers were invited to participate in educational sessions using a variety of marketing methodologies. A multidisciplinary team designed two curricula (one for providers and one for health care consumers) on the management of stroke. A total of 211 health care professionals and 122 consumers participated in the program. Education session evaluations uggested that the program either met or exceeded participants' expectations for the majority of programs. This project demonstrated that academic centers can provide quality continuing medical education for their rural communities using teleconferencing technology. Experience with this program suggests that there are three key elements for success: adequate planning time, communication on multiple levels, and strong marketing strategies.

Introduction: A key concept for general practice nowadays is that of patient-centred medicine. In this model the physician's aim is to integrate the patient's experience of illness with the conventional understanding of disease, trying to reconcile the patient's agenda with his/her own. This paper describes a preliminary experience of a CME course on patient-centred medicine in Italy. Aim and Methods: The article focuses on a 7 hour course for teaching patient-centred medicine to Italian general practitioners. Assessment of the course was done both in terms of learner satisfaction and ef.cacy. Learner satisfaction was evaluated by a questionnaire with a 6-point Likert scale and course ef.cacy by a pre/post-paper-and-pencil test. Findings and Discussion: The pilot course on patient-centred medicine seems to obtain high satisfaction in participants. Furthermore, an increase in competence with regards to patient-centredness resulted after the course. The pilot study represents the .rst Italian CME seminar on patient-centred medicine. Results obtained both in terms of Satisfaction and ef.cacy suggest that the CME course is a valid educational tool. The opportunity to extend the experience to a higher number of participants is therefore recommended.

Introduction: Residents (RMOs) teach medical students in hospital wards, yet little evidence of ef.cacy is available for this activity. This study undertook to test the effectiveness of RMO teaching, and to delineate the principal barriers encountered. Methods: Medical students in their fourth year were assessed at baseline for clinical examination skills in ophthalmoscopy, neurological examination of the legs, and rheumatological examination of the hands. One group of RMOs (n=6) taught ophthalmoscopy to the students attached to their unit, while the second group of RMOs (n=6) taught leg examination to their students. The third examination skill was not taught, but was used as a control intervention. The students were evaluated in all three skills by an observed, structured clinical examination at the beginning and end of their six-week attachments. Results: There was a signi.cant improvement in the skill of ophthalmoscopy in the intervention group (p50.02), while the control group of students showed a decline in their abilities. The skill of examination of the legs improved after being taught, but not signi.cantly. The RMOs universally reported that dif.culty in .nding time was a major barrier to their ability to teach medical students, and most set up additional teaching sessions rather than incorporate the teaching into their routine ward work. Conclusions: RMO teaching of medical students is effective, particularly for a skill which is novel. The dif.culties arise in .nding a suitable time for these important clinical teachers to transfer their skills.

The School of Medical Sciences, KNUST, established in 1975, indicated its educational orientation to a community-based and community-oriented system using the problem-based learning approach. Falling victim to the phenomenon of brain-drain, the School developed a postgraduate medical curriculum which takes into account the needs and demands of national governments and communities for quality specialist care and equitable distribution of existing health facilities. There is an innovative communitybased fourth year for obstetrics and gynaecology, ophthalmology, otorhinolaryngology, paediatrics, surgery and medicine. After attainment of the Part I Examination, residents are sent to Ulm, Maastricht, Britain and the United States for clinical attachments for a period of 3 to 6 months before returning to sit for their Final Part II for the Fellowship of the West African College of Surgeons or Physicians (FWACS, FWACP). By ensuring that the Final Examinations take place after the elective attachment, none of the new breed of specialists so far produced has been lost to the Western world. The strengths and weaknesses of the programme are discussed.

A new interdisciplinary concept of medical and health care education has been introduced at Karolinska Institute in collaboration with the County Council in Stockhom under the motto Learning together to be able to work together. Centres of Clinical Education are built up in four major hospitals to promote meeting places during clinical education for students from different categories. During a three-year project more than 5000 students from four educational programmes have been involved medicine, nursing, occupational therapy and physiotherapy. The project started in 1998 and will turn into regular activities in 2002. The Centres consist of three parts. First is the Clinical Training Ward, a ward without patients where manual skills as well as skills in communication are taught, practised and videotaped. Second is the Clinical Education Ward, a student-driven ward where students during two-week periods experience their own professional roles in day-to-day work and learn how to work together. Third is the Multidisciplinary Team, where teachers from the four programmes plan and provide opportunities for students to learn together. Opportunities to meet and learn together have promoted a wider understanding of each professional in health care teams among students and staff. The Centres of Clinical Education provide excellent opportunities to bridge professional borders and to coordinate undergraduate studies and clinical reality.

Purpose: To develop a format for educating the appropriate health care professionals as to the relationships between periodontal inammation and increased risks for poor diabetes control, cardiovascular disease, cerebrovascular disease, pre-term low birth weight, pneumonia and gastric ulcer reinfection. Materials & Methods: Dental hygiene students in the Advanced Periodontology curriculum were instructed to review current literature regarding the increased risk for systemic health problems when periodontal inammation is present. Abstracts of the reviewed material were then presented in group setting to all course participants. For each systemic entity (diabetes, cardio/cerebrovascular disease, adverse pregnancy outcome, pneumonia, gastric ulcer) literature-based evidence of periodontal disease's association, affect, pathogenesis, validity and clinical signi.cance was determined. Consensus statements for each entity were developed and used as a basis for clinical interpretation. Following this, patient health-history materials were developed to obtain the necessary information from patients while educating them about the increased risk for systemic health problems when periodontal inammation is present. Lastly, correspondence materials were developed to alert managing physicians and medical auxiliaries about the increased risk for systemic problems in their patients who may present with periodontal inammation. A methodology which medical personnel can use to quickly screen for the presence of periodontal inammation in at-risk patients was also developed in these correspondences. Conclusion: An educational model and clinical materials were developed which are aimed at alerting patients, dental and medical personnel to the increased risk for systemic health problems when inammatory periodontal disease is present.

Context: Inef.cient and ineffective health care delivery has been of recent concern to most stakeholders in the process. Care provision systems will improve when care providers are educated to function as team members and to demons rate competencies required for practice in diverse, demanding, and ever-changing environments. Goal: In one School of Allied Health Sciences, faculty members from nine departments united to create an interdisciplinary curriculum designed to foster the achievement of common competencies essential for success in the workplace. Approach: Members of a Curriculum-2000 Task Force collaborated to: (1) review current literature, (2) articulate a set of common competencies across several disciplines, and (3) produce a proposal for achieving and measuring competencies in an interdisciplinary manner. Conclusion: Individuals from various disciplines can come to consensus about competencies that graduates should achieve. Such consensus is the .rst step in the direction of implementing a curriculum based on interdisciplinary competencies.

This paper discusses the need for doctors to further develop the use of professional learning in the workplace as an effective method of coping with change. It uses the recent introduction into the UK, by the government, of clinical governance as an example of how professional learning can help doctors both cope with this imposed change and recognise their ongoing need to undertake a different and changing relationship with society, and it lays the foundations for coping with further change throughout their careers.