Background: The community-based training of the University of Maiduguri Medical College was expanded in 1990 to cover three rural local government areas (LGAs) located between 25 and 145 km from the University. This study was conducted between March and May 2000 to assess the impact and level of awareness of the training in the three LGAs in promoting the ideals of Primary Health Care (PHC) and community-based medical education, as perceived by community leaders. Method: Focus group discussions (FGDs) were held with community leaders of each of the communities. Results: Consistency in the recollection of what time in the year and for how long the students were in the various communities indicates awareness in all the community leaders. They also indicated that the programme has had a positive impact on their community's health, they would like the students to focus on specific endemic diseases, such as guinea-worm, hypertension, etc, and intensify community outreach programmes, such as home visits and health education. Most participants indicated that their communities participated in the programme by providing accommodation, feeding and other logistics on an ad hoc basis. Community leaders mobilized the communities for health education and other related activities carried out by the students. Conclusion: The community-based medical training of the University of Maiduguri has increased community awareness of preventive aspects for various communicable and non-communicable diseases. In addition it has helped to encourage the communities to participate actively in supporting PHC activities.

Context & Background: Assessment of medical students using the traditional oral (viva) system has been marred by being highly subjective, non-structured, and biased. The use of the objective structured clinical examination (OSCE) would circumvent these disadvantages. The OSCE is, however, costly and time-consuming particularly if used for assessment of large numbers of students. The need for another form of examination that enjoys the advantages of the OSCE while avoiding its disadvantages in the face of limited resources has been the inspiration behind this innovative approach. Objectives: (1) To identify the characteristics of the new Video-Projected Structured Clinical Examination (ViPSCE). (2) To compare the acceptability of ViPSCE and OSCE by students and tutors. (3) To compare the time-effectiveness of ViPSCE and OSCE. Methods: We used a slide video projection to assess the surgical knowledge, problem solving and management abilities of 112 final year medical students at Alazhari University, Khartoum, Sudan. Students completed evaluation forms at the end of the examination. Results: The administration of the ViPSCE was smooth and straightforward. Feedback of the students showed that they preferred the ViPSCE to both traditional oral (viva) examination and OSCE. The examination time was 2 hours using video projection compared to the 6 hours that it used to take a class of 112 students to complete a classical OSCE. Conclusion: The ViPSCE is a better replacement for the traditional oral exam. It is much less time- consuming than traditional OSCE.

Context: Written communications have a long history in medicine. Today, doctors spend a significant part of their work time completing paper work. Although the importance of accurate written communications is acknowledged, medical curricula rarely include focused teaching on this topic. Objectives: The aim of this paper is to assess the feasibility of a teaching session for second-year medical students aimed at raising their awareness of written communications in the context of health care. Methods: Immediately after the session, students and tutors completed written evaluations of their experiences. Four months after the session the entire cohort completed a knowledge test, and scores of attendees and non-attendees were compared. Findings: Three of four learning objectives were completely met by at least half of the students and the exercises were rated as helpful. Students' and tutors' comments identified specific aspects of the session that require improvement, in particular, developing the exercise on patient-centred written communications. Students who attended the session scored significantly higher in a relevant knowledge test than nonattendees. Discussion: The session provided students with the knowledge to identify patientcentred written communications and other features of effective writing in the context of medical care. Conclusions: Introducing the topic early in the medical curriculum may prove valuable in establishing effective practice. Providing students with opportunities to revisit this important topic throughout their medical education may also be beneficial. The longterm impact of the session needs to be evaluated.

Objectives: To discuss the problems encountered teaching interviewing skills to first year medical students and describe their responses to a structured workshop in interviewing skills. Methods: Focus groups and a short evaluation questionnaire filled in by 56 first year medical students before and after a workshop in interviewing skills were used. Results: All students evaluated their skills very highly prior to the workshop. After participating in the workshop, students evaluated their skills as lower than before. Discussion: When communication skills are taught in an informal, unstructured manner, medical students might view this knowledge as unspecialized, repetitive, and even boring. It is suggested that employing a structured model for teaching doctor-patient communication skills awards psycho-social issues the status of formal knowledge. This can lead to students viewing communication skills as a relevant and consistent body of knowledge. Introducing a structured model can overcome two kinds of problems: overconfident students are formally introduced to unique aspects of medical interviewing, whilst those who lack confidence are offered a lifeline in the form of a structured model. Identifying possible sources of resistance to communications training has important implications for medical education as it allows for appropriate course planning and follow up.

Objective: Like many other medical education bodies, the Health Professions Council of South Africa has advocated changes in the education and training of medical practitioners. The suggested reform includes early clinical exposure in a range of settings. Early in the design of Curriculum 2001, a problem-based learning programme, health care visits in Year 1 were considered essential. Since the student population was diverse in many aspects, including age, it was necessary to evaluate whether students were prepared for the early exposure. Methods: Data on the impact of the health care visits were collected directly through a survey administered towards the end of the academic year and indirectly from student comments regarding their most rewarding experiences during the year. Results: Responses to survey items indicated that students were generally prepared for their health care visits and gave them insights into the activities of a medical practitioner. Sixty-nine per cent of students indicated that aspects of their health care visits, particularly the labour ward and an ambulance duty where many had hands-on experience, were their most rewarding experiences. Discussion and Conclusions: The decision of curriculum organisers to introduce students to patients in Year 1 of the new PBL curriculum was well received. Despite their young age, many students believed that they were psychologically prepared for this exposure. For many, it was the highlight of their academic year, often reinforcing their original desire to study medicine and allowing them to experience the real world of medicine.

This article provides an example of one form of action research, collaborative enquiry, in the health sector. It argues that collaborative inquiry is a powerful tool to develop reflective capacity among health workers and can facilitate the ownership of learning and the production of usable knowledge. It reports the results of a research project investigating the roles and functions of clinic supervisors in three districts in the Eastern Cape Province, South Africa. Background: Clinics are the cornerstone of the new district-based health system. They are staffed primarily by nurses and are often the only contact point for large parts of the rural population. In conditions of remoteness and isolation, clinic staff depend upon personal interaction with clinic supervisors to enable them to function productively. Yet experience has shown that supervisors do not always fulfil this role. This project aimed at gaining insight into the status of clinic supervision, understanding the factors that hinder effective supervision and making recommendations for improvements. Methodology: Using a participative approach of Collaborative Inquiry, a team of 10 clinic supervisors and the research co-ordinator collected data reflecting on their own practice over a period of 5 months. These data were then jointly analysed and written up. Conclusions: The participating clinic supervisors went through several periods of uncertainty, when many of them asked themselves why they agreed to this project. However, the engagement with stakeholders and colleagues and the joint analysis of research data soon proved to be a valuable source of insight. There was unanimity in the end that the research process had been very valuable and enabling.

Aim: This paper describes the development, implementation and evaluation of a new biomedical ethics course. The major educational goal was to enable the participants to critically analyse and resolve ethical dilemmas based on sound ethical and moral reasoning. Background: The course was developed and implemented in the Family Practice Residency Program (FPRP) in the Kingdom of Bahrain. Methodology: Thirty-six family physician trainees participated in this course in May 2002 and January 2003. The curriculum was divided into five sessions, and each session had specific objectives, contents and teaching methods. The course was evaluated using pre- and post-tests, direct observation of participants and overall course assessment. Results: Evaluations demonstrated that the participants scored higher in the post-test than in the pre-test. There was a significant statistical difference between the mean scores of both tests. After completing the course, participants produced more justifiable decisions than those generated at the beginning and felt more confident discussing and reasoning their decisions based on sound ethical and moral concepts. Conclusion: Our experience had demonstrated that the trainees benefited from a structured curriculum in biomedical ethics. We believe that the development and implementation of our course may serve as a case study for training and teaching postgraduates in the area of medical ethics.

Background: Empathy is critical to the development of professionalism in medical students, and the humanities-particularly literature-have been touted as an effective tool for increasing student empathy. This quantitative/qualitative study was undertaken to assess whether reading and discussing poetry and prose related to patients and doctors could significantly increase medical student empathy and appreciation of the relevance of the humanities for their own professional development. Method: In 2000-2001, first year students (n = 22) volunteered for an eight-session literature and medicine elective and were randomly assigned to either immediate participation in the class or a wait-list group, who participated in the same class 6 months later. Complete pre- and post-intervention data for 16 students from both groups were obtained for two quantitative measures of empathy and an attitudes-toward-thehumanities scale. Students also participated in a qualitative group interview pre- and post-intervention. Results: Empathy and attitudes toward the humanities improved significantly (p<0.01) after participation in the class when both groups of students were combined. The scaled treatment effect size was in the moderate range (≥0.60 standard deviation units) for both measures that had statistically significant pre-to-post changes. Furthermore, student understanding of the patient's perspective became more detailed and complex after the intervention. Students were also more likely post-intervention to note ways reading literature could help them cope with training-related stress. Conclusion: A brief literature-based course can contribute to greater student empathy and appreciation for the value of humanities in medical education.

Context: In many ways the task of physicians is to listen to stories and place them within larger social contexts. Problem-based learning (PBL) can potentially reinforce such a view of the physician's work. The conventional PBL case, however, largely replicates the medical record, which in turn, is restricted in its purview to biomedical concerns. The conventional case thus encourages an approach to clinical reasoning that insufficiently recognizes (1) the cross-cultural nature of all clinical encounters, (2) the central role of narrative, and (3) the political economic influences that contribute to disease and suffering in our world. Methods: We suggest ways to modify the traditional medical curriculum to include the learning of cross-cultural health through appropriately written problem-based learning (PBL) cases. We discuss two cases to illustrate how PBL cases can incorporate dialogue between patients and physicians, demonstrate the narrative character of the medical encounter and examine the political economic contributors to disease production. Conclusion: Fluency in language games other than that of biomedicine is required if students are to become more aware of the wider factors that contribute to suffering, and to be able to respond with compassion and understanding to that suffering. Our approach is a discursive practices approach to culture that emphasizes the emergent, participantconstructed qualities of social phenomena while also acknowledging large-scale social forces.