Context: No country, least of all poorly resourced countries such as India, can afford to lose too many medical students in their undergraduate years. It would be useful to have an instrument to identify those students who are vulnerable to academic failure at this level of training and to identify the features of the educational environment that they perceive differently from students who are succeeding academically in order to design intervention strategies. Gender differences in perceptions of the educational environment might well emerge in particular academic or cultural contexts, with particular curricula. The present study was motivated by this concern and focused on comparisons between academic achievers and under-achievers and male and female students of Kasturba Medical College, India. Objectives: (1) To compare the perceptions of the educational environment of academic achievers and under-achievers and to identify problem areas that should be remediated. (2) To identify whether there is any gender difference in the perceptions. Methods: The Dundee Ready Educational Environment Measure (DREEM) was administered to 508 medical students studying in the clinical years at the Kasturba Medical College in India. Item as well as scale scores were compared between academic achievers and under-achievers. Findings: Overall sample of the present study rated educational environment in this institution as average. The overall mean DREEM score was significantly higher for academic achievers. Compared to under-achievers, academic achievers scored significantly higher on perceptions regarding teachers, academic atmosphere and social selfperceptions. In addition to this, the overall rating (total DREEM score) of female students was significantly less compared to males in the academically vulnerable group. Conclusions: Perceptions of poor performers are significantly different from those of better performers in the same institution. More importance should be given to the perceptions of students to improve the educational environment, as perceptions are associated positively with learning outcome, learning approach and attitude toward studying. Use of the DREEM as a monitoring tool might permit timely interventions to remediate problematic educational environments.

Introduction: The Faculty of Medicine and Health Sciences (FMHS), follows a problem-based learning, integrated and community-based curriculum which reflects the specific needs of doctors working in Sarawak. Using paediatrics as an example, this paper describes the process of development of core content (knowledge, procedural and communication skills, attitudes), additional knowledge and special study modules at the FMHS. Objectives: In 2003, the Department of Paediatrics and Child Health conducted a workshop to evaluate and update its 5-year-old curriculum. Methods: The wise-men approach was adopted. Local and guest academicians (including members of the Department of Community Medicine and Basic Health Sciences), consultants, registrar, house officer and nursing staff of the Paediatric Department of Sarawak General Hospital (SGH), paediatric nursing lecturer and members of Medical Education Unit were involved. The review was based on three approaches: Problem/Task-based learning; Spiral curriculum; Outcome-based education. Results: Core content and additional knowledge topics were modified. The special study modules were retained, but their duration was reduced. It was recommended that the curriculum should be reviewed at regular intervals. Discussion: To select the core content and additional knowledge topics, clear and specific criteria were developed. Some topics were dropped, others were added, and some were moved from core to the additional knowledge section. Conclusion: It was a rewarding activity. The reviewed curriculum was received well by both the students and faculty. The enthusiasm and cooperation extended, especially by the faculty at SGH in the implementation of this curriculum, was remarkable.

Background: An interdisciplinary health promotion module, using the community-based teaching approach, is offered by the University of the Western Cape (UWC). Schools in Delft, a poor socio-economic area with high unemployment, crime and a range of social problems, are used as the teaching site. Aim: To assess the status of the health promotion initiatives in schools where students were placed. Method: A self-administered structured questionnaire for teachers and principals. Variables included were demographic data, views of health promotion, health promotion activities at the school, barriers and opportunities to implement health promotion activities. Results: A response rate of 68.75 % (n=55) for teachers and 100 % (n=4) for principals was obtained. Most (87%) teachers felt that health promotion has a place within the curriculum. They reportedly focused on topics related to health within the school curriculum. Partners, such as public health nurses, university students, and a pharmaceutical company, offer additional health promotion initiatives. These include general health checks, HIV/AIDS information, adolescent health and dental health. Barriers to initiate and sustain programmes include lack of resources, insufficient staff training, lack of commitment by both teaching staff and the community, insufficient time, the heavy workload of teachers, and communication problems as a result of language barriers. Only 36% of teachers felt the school environment was conducive to learning. Conclusion: Health promotion initiatives in the schools concerned are uncoordinated, erratic, based on the resources that the school has access to at a given time and the demands of the curriculum.

Context: Increasingly, health care facilities worldwide, particularly those that comprise the safety-net, are finding themselves understaffed and challenged to meet patients' needs. Identifying additional sources of support and resources is critical for facilities to be able to sustain current and develop new initiatives to improve patients' health. Approach: We present one community health center's reliance on a partnership with an academic medical/nursing institution to develop and initiate a depression screening and treatment project. Incorporating students to help implement or pilot a needed clinical service for a high prevalence condition presents significant rewards as well as challenges. Nevertheless, an academic-community partnership has the potential to initiate systems change at the clinical level. Results: Using a service-learning modality, medical and nursing students worked with health center providers to initiate a pilot depression screening and treatment program based on the chronic disease model. Implementation of this initiative succeeded in poising the health center for participation in a large, federally supported collaborative on depression in primary care. While students gained insight into some of the challenges faced by safety net providers and their patients, discontinuity in student availability led to uneven pacing in project implementation. Conclusion: Curricula that employ a service-learning framework can enable health care facilities world-wide to gain additional resources for needed initiatives. Students' learning experiences can provide an excellent mutually beneficial opportunity as a ''jumpstart'' for new evidence-based clinical initiatives and demonstration projects. Such programs can help meet the needs of patients while enhancing students' education. However, students can neither make up for staffing shortages nor be expected to maintain programs. In order to be successful for the long term, service-learning projects must skirt the pitfalls of the inherent logistical incompatibilities e.g. schedules and length of commitment, between academic institutions and health care facilities.

Introduction: Concerns have been growing about the effects of the working environment on junior doctors and the learning opportunities available to them. In order to identify problems and opportunities for improvement, we explored junior doctors' opinions about the transition from student to practitioner. Method: Seventeen recent graduates in four focus groups discussed the transition. Data analysis: Related comments were combined in the report of the discussions, which was approved by the participants. Results: The transition was perceived as a major change, particularly the increased responsibility and workload and contacts with other health care workers and patients. Preparation during undergraduate training was adequate as regards knowledge, communication, history taking and physical examination skills but not for pharmacological knowledge and patient management skills. Problems were connected with practical procedures and feelings of uncertainty. There was little formal education. Proposals to ease the transition were earlier patient contacts, more involvement in patient management and growing responsibility during clerkships. Discussion: Although the sample was small, the uniform opinion in all groups supports the validity of the findings. Junior doctors felt confident with regard to knowledge and skills, but experienced difficulties with patient management, practical matters and their role on the team. Contrary to the idea of an educational continuum, formal learning appeared to be very limited in the hospital environment. Conclusions: Preparation for medical practice may benefit from active involvement of clerks in patient management decisions and a gradual increase in responsibilities. An effective medical education continuum would require more attention for house officers' learning.

Introduction: Internship is a problematic phase in the training of doctors in India. At the end of their one-year Internship, students are not formally examined for proficiency, rarely a student is not given a satisfactory completion certificate and training is sometimes not supervised. Students are required to spend three months of this Internship in Primary Health Centres at rural postings. During this period the students often prepare for the written exams that would allow them to pursue post-graduate studies. Method: In a personal reflection, this situation is described in the current article. The author suggests several approaches to improve this unwanted situation, so that the rural postings could be taken more seriously by the students. Outcomes: Suggestions range from a post-internship examination, via the introduction of compulsory rural postings after graduation to an increase of the avenues for postgraduate training to include a course in family medicine and general practice. Conclusions: The objective of providing excellent training during internship periods cannot be achieved unless interns actively participate. If the current situation does not change, for example according to the suggested solutions, this valuable component of medical training will remain problematic, thereby hindering the optimal preparation of doctors for the entire spectrum of necessary health care in India.

Introduction: Despite considerable debate in the medical literature about the educational utility of pharmaceutical representatives (PR), little is known about their attitudes towards their role as marketers and/or educators, their ability to provide comprehensive information about products and their learning needs. Design: A survey. Subjects and Method: Questionnaires were mailed to 606 PRs from five Canadian pharmaceutical companies. Results: Of 309 (51%) respondents, 98% strongly agreed or agreed they had a role in educating doctors, while 52% strongly disagreed or disagreed their main goal was marketing. Overall, 92% agreed they had received adequate training to perform a wellinformed detail, and 96% reported the information they provide is accurate. The majority (66%) felt a university-accredited program would improve the quality of their detailing. Conclusion: Most PRs believe their main goal is education. Despite most reporting that they had received adequate training, they felt that a university-accredited educational program would improve the quality of detailing. The number of years that a PR spent in the industry appears to have an effect on how they perceive their role.

Objective: Assess the perception of stress amongst medical students and their coping strategies. Methodology/Study design: A cross sectional study using a semi-structured self administered questionnaire was carried out over four weeks, using a small sample of students of all categories and classes of a medical college. Results: A total of 264 students out of 300 (88%) filled in the questionnaire. Inability to cope, helplessness, increased psychological pressure, mental tension and too much workload are 'stress factors' for students. A considerable majority (>90%) think that they have been stressed at one time or another. Ninety-four per cent of males have experienced stress. The senior students of the fourth and final year feel more stressed (95% and 98% respectively). Low moods, inability to concentrate, loss of temper are most common symptoms. Females report more symptoms. Academics and exams are the most powerful stressors. Sports, music, hanging out with friends, sleeping or going into isolation are various coping mechanisms. Stress can affect the academic performance. If needed, students prefer to talk to a peer. They demand more recreational activities on campus, revised schedule of academics and exams, better counselling facilities and improvement in student-teacher relationship. Conclusion: The prevalence of perceived stress seems to be high among medical students, which tends to affect not only their academic performances but also all aspects of health. Review of academics and exam schedules, more leisure time activities, better interaction with the faculty and proper guidance, advisory services and peer counselling at the campus could do a lot to reduce the stress.

Objective: The purpose of this study was to explore the knowledge and attitudes towards violence against women among fourth (final) year baccalaureate nursing students and fifth (final) year medical students from two distinct educational institutions in India. Methods: Data were collected from 440 students using two questionnaires: the Student Exposure to Woman Abuse Questionnaire (SEWAQ), and the Inventory of Beliefs about Wife Beating (IBWB). Results were analysed based on gender, profession, and educational institution. Findings: Nursing students believed that they had received more classroom preparation and practical skills to better prepare them to assist abused clients than male and female medical students. Only 38% of the participants believed that they had acquired classroom knowledge on woman abuse through their respective educational programs, whereas 43% thought they had practical skills to care for victims. All participants were sympathetic toward abuse victims, but demonstrated varying attitudes about the justification for abuse against women, help given to victims, punishment of the offender and the effect of woman abuse. Female medical students believed more strongly than males and nursing students that wives do not gain from being beaten. Conclusions: Congruent with existing literature, the study demonstrated that health care students in India do not receive sufficient training, practical skills and classroom knowledge to effectively manage abuse against women.

Context: It often takes a long time before the results of medical research are actually used by health care practitioners in day-to-day clinical settings. This problem, referred to as ''the evidence-to-practice gap'', has significant implications for patient health care. Practitioners have difficulty keeping up with the latest information in part because it is reported in hundreds of journals that may not be easily accessed and understood. Approach: This essay conceptualizes the evidence-to-practice gap as a communication problem and suggests how academic research can be translated into messages that are easier for practitioners to access, comprehend and incorporate into their medical practice. A ''translation framework'' shows the importance of targeting messages to specific audiences and provides a communication-based conceptual approach for summarizing research for clinicians. Practical Implications: Targeting the results of academic research to practitioners will decrease the time it takes for patients to benefit from the latest medical evidence. Translation guidelines can help health researchers write more effectively for both academic and practitioner audiences. Since the evidence-to-practice gap is a systemic problem that begins with how we train our health researchers, educators should consider addressing this topic in the health professions classroom. The framework presented here can serve as the basis for an instructional unit on interpreting and reporting research findings. Finally, information technology can play a much larger role in the communication process because of the enormous advantages of quick access and data organization that computers and the Internet provide. Practitioner-targeted research summaries could be made available on government or not-for-profit sponsored websites as well as by journals themselves. Funding opportunities exist for research that focuses on how technology can help improve health care, and so the time is right for health researchers to investigate ways of making their studies more accessible and quickly usable via web-based distribution. The potential of medical science should not be limited by an information delivery system that we have the knowledge, expertise and resources to improve.

Although increasingly used as a modality in medical education, Problem-Based Learning (PBL) remains somewhat overlooked in the training of public health students (Pham & Blumberg, 2000). This project involved a pilot test of a web-based community simulation as a PBL platform in an undergraduate health behavior course. Purpose: To develop and pilot test a web-based computer simulation as an implementation of problem-based learning in an undergraduate public health behavior course. Method: Using a web-based simulation platform, a virtual community was designed in which the effects of a mock infectious disease outbreak could be studied and various interventions could be tested. Upon completion of the semester course, 14 undergraduate public health education students completed a survey and participated in a focus group to determine issues related to the simulation. Research focused on whether the simulation was perceived as motivating and which aspects were found to be confusing, ineffective or unrealistic. Findings: Results of the study suggested that a PBL experience based on a community simulation may be effective in providing a motivating and interesting PBL tool for instructing undergraduate public health students. A majority of students agreed that the experience was more motivating and interesting than a more traditional assignment. Design recommendations include an emphasis on incorporating a rich multimedia background, realistic communication and project management tools and the capability for students to submit formatted documents. Further study of attitudinal differences and attainment of learning objectives is recommended between students participating in the simulation experience and those engaging in a traditional assignment.