The importance of the university as a setting for health promotion is increasingly being acknowledged. Part of this health promoting function includes curricular offerings to increase health awareness. However, there is a dearth of systematic evaluations of such courses. Objective: To evaluate the impact of a university level ''Health Awareness'' course on attitudes and behaviours of undergraduates enrolled in the course. Methods: A self-administered survey was used to assess attitude and self-reported behaviour of students at the beginning and end of the course. Paired analysis of means compared responses at pre and post assessments for groups of items within a particular health topic. Cross tabulations of stage of change at pre and post assessment indicated movement related to tobacco use, exercise, and nutrition. Results: Results indicated an improvement of at least 20% from pretest score in four out of eleven health topic areas, and of 10-20% in an additional five topical areas. In addition, movement in a health promotive direction along the stages of change was evident for smoking, eating fruits and vegetables, and exercise. Discussion: The results presented herein are encouraging and indicate support for the impact of a health awareness class on knowledge, attitude, and behaviour of undergraduate students. The two topical areas that did not show improvements between pre and post assessment were those (i) for which students already scored high at pre assessment, or (ii) which the course did not tackle specifically. Conclusions to be drawn are limited by several factors inherent in the design of this evaluation. Future evaluation should include a larger number of students and a comparison group.

Context: New Mexico is a sparsely populated rural state in the USA, with 20% of New Mexicans living in poverty. There is a need for physicians in the state, especially in primary care. New Mexico's only medical school, the University of New Mexico School of Medicine is state supported. New Mexico and its medical school have a vested interest in its graduates returning to the state to practice. Objectives: Evaluate the effects of early community preceptorships on graduating physicians' specialty choice and subsequent return to practice in the state where they attended medical school. Strategies: A Primary Care Curriculum (PCC) was introduced into the medical school in 1979. Students expressing interest in this programme were considered. Twenty students per year were assigned to the PCC. The remainder went through the traditional curriculum. The PCC used a problem-based learning model. All PCC students participated in a 16-week, one-on-one community preceptorship (Phase 1B) in a small or rural community during their first year. Graduates from 1983-1996 were analysed for specialty and practice location. Main outcomes: Of the 294 students doing Phase 1B, 99 (40%) returned to New Mexico to practice compared to 221 (32%) of traditional students. Fifty-eight (23%) of the Phase 1B students practice primary care compared to 112 (16%) of the traditional students. Conclusion: Self-selected students choosing and participating in early community-based clinical experiences coupled with problem-based learning are more likely to return to the state and to practice primary care.

Context: The University of Transkei (UNITRA) medical programme follows a problem-based learning and community-based education curriculum. Objective: To gauge the views of UNITRA medical students about their future, and their career intentions. Design: A semi-structured questionnaire on intentions to specialize or not, preferred place of work, overall view of the future, and careers guidance. Findings: The questionnaire was completed by 364 students (87.7% response rate). The sector preferences are 82.3% public, 6.8% university and 10.9% private. Place of work preferences are urban (37%), rural (27%), city (12%) and abroad (8%), while 16% have no preference. Rural preference varies from 48.5% among 1st year students to 5.9% among 6th year students, while urban preference are 26.2% for Year I and 64.7% for Year VI students. 89.8% of respondents intended to specialize, mainly in clinical fields, with the most influential factors in the choice of specialty being interest and challenge. Most students (78%) view the future positively, 13% say it is uncertain, 8% have no idea about the future; and 1% think the future is negative. Frequent reasons cited for a bright future are job-related, personal attitude, sense of achievement, and the type of training. Most students have received little or no career guidance and would like such topics in the curriculum. Conclusion: UNITRA medical students are optimistic about the future. The majority intend to stay in South Africa and work in the public sector, and most of them wish to pursue clinical specialties.

Context: There is growing international interest in teaching clinical skills in a variety of contexts, one of which is Clinical Skills Centres. The drivers for change making Skills Centres an important adjunct to ward and ambulatory teaching come both from within and outside medical education. Educationally, self-directed learning is becoming the accepted norm, encouraging students to seek and maximize learning opportunities. There are global changes in healthcare practice, increased consumerism and increasing student numbers. In some countries, professional recommendations influence what is taught. Increasingly, core skills curricula and outcome objectives are being defined. This explicit definition encourages assessment of the core skills. In turn, all students require equal opportunities to learn how to practise the skills safely and competently. The moves towards interprofessional education make joint learning in a ''neutral'' setting, like a Clinical Skills Centre, appear particularly attractive. Objective: To discuss the potential role of Clinical Skills Centres in skills training in developing countries and to consider alternative options. Discussion: Many developing countries seek to establish Clinical Skills Centres to ensure effective and reliable skills teaching. However, the model may not be appropriate, because fully equipped Clinical Skills Centres are expensive to set up, staff, and run. They are not the only way to achieve high quality clinical teaching. Suggested options are based on the philosophy and teaching methods successfully developed in Clinical Skills Centres that may fulfil the local needs to achieve low cost and high quality clinical teaching which is reflective of the local health needs and cultural expectations.

Background and objectives: Concordance has been suggested as a new way of describing the agreement about medicine taking during the consultation process. The aim is a decision on management agreed on by both doctor and patient. As such it has strong links with shared decision-making and patient partnership. In order to encourage doctors to adopt a concordant model, we need to foster a positive attitude towards the concept. We decided to investigate the attitudes of first and second year medical students towards concordance as a base for further educational interventions. Setting: The School of Medicine, Leeds University. Methods: We administered the Leeds Attitude toward Concordance scale (LATCon) to first and second year medical students at the beginning of the academic year, and to the same second year students after they had completed a written exercise relating to concordance. Results: The response rate was over 80% for each group. There was no difference in the attitudes towards concordance of the first years and the second years prior to the intervention. After they had completed the exercise, the second years' attitudes towards concordance improved by a small but significant amount. Conclusions: A paper-based exercise with questions focusing on concordance and based around cases appears to improve medical students' attitudes towards the concept. This exercise needs to be followed up with skills training and observation of role models in order that the attitudes of the students translate into practice once they are qualified.

Context: The existing top-down approach of the training is not appropriate to empower the community health volunteers to produce a sustainable change in their performance. Objective: To propose a conceptual model that relies on Freire's theory of empowerment education and the participatory action research methodology to empower the female community health volunteers (FCHVs) to increase their consciousness, competence and confidence in performing their job responsibilities. Method: The model explains the empowerment phenomenon as a process and outcome. As a process it occurs in the form of repeated reinforcement cycles with alternating activities of action and reflection and includes developing awareness, skills and confidence among FCHVs through small group activities. As an outcome, it results in the change in FCHVs' performance in increasing contraceptive acceptance among the rural women of reproductive age group. Conclusion: It is hoped that empowerment of FCHVs will bring sustainable change in their performance and will consequently produce notable improvement in the health of women and children in particular and in the community in general.

Context: The effectiveness of moving to compulsory, prescriptive continuing medical education (CME) for New Zealand general practitioners (GPs) is questioned. Motivational interviewing theory suggests that a series of interventions gradually increase awareness of the need to change until change is finally actioned. This study aimed to explore GPs' views on their need for CME, experiences regarding its provision and perceptions on the effect of CME in changing their clinical behaviour. Method: Qualitative study using semi-structured interviews of 24 GPs from Auckland and North Island rural areas assessing their CME experiences and preferences. Findings: All participants acknowledged that CME is a life-long process essential for GPs. Changing behaviour is generally seen as an incremental, evolutionary process with reinforcement of knowledge from different sources. Single events were perceived to effect change rarely. These were often high-impact, either punitive or incentive-based. GPs have a myriad of CME sources including reading, the internet, specialist letters, conversations with colleagues, quality assurance feedback, as well as traditional meetings. Credit-based quota requirements received mixed opinions but mostly were perceived negatively, discouraging needs-based approaches to learning. GPs' greatest barrier to obtaining CME is time. Discussion: GPs perform poorly in assessing their specific learning needs. Their behaviour change is likely to be incremental. Therefore multi-faceted interventions and reinforcement from different sources are likely to be most effective in changing clinical practice. Understanding this is important for CME providers, GP Colleges and funders. Narrow, credit-based approaches to CME may discourage time-strapped GPs obtaining motivation to change from exposure to a wide variety of CME sources.

Context: Partners in Health Education (PHE) is a Dartmouth Medical School elective that pairs first- and second-year medical students with local elementary school classroom teachers to provide health messages to students. The primary aim of the programme is to help medical students improve their communication skills through teaching children about health. Secondary aims are to teach children about health and the prevention of injury and disease and to support community teachers in their health promotion efforts. This report contains the results of the assessment of the programme's impact on the medical students. Methods: Sixteen first- and second-year medical students comprised the participants for the study. Students were assessed during their first and fourth teaching experiences using a variety of evaluation measures, including student surveys of expectations and perceptions; ratings of performance in the classroom by students, teachers, and classroom observers; coded videotapes of classroom teaching sessions; and performance on a measure of physician-patient communication skills. Findings: Over the course of the teaching experience, medical students' teaching and communication skills increased on a number of measures. Discussion: Programmes such as PHE can provide true service-learning experiences in which all participants benefit. Medical students can learn how to communicate about health, a set of skills they will need to become effective physicians. School children can learn about health, so they are empowered to take charge of their health and to make healthy choices.

Purpose: To evaluate the efficacy of training programmes for the village health practitioners aimed at improving primary orthopaedic and trauma care in our rural setting. Materials & Methods: Six year prospective study of training workshops in local health institutions was carried out using locally available manpower and materials. Results: After 6 years the evaluation of this programme shows a significantly improved (p<0.05) knowledge base and working skills after completion of training workshop. Summary: To avoid unnecessary complications, effective primary health care provided by an appropiately trained person should be available at the peripheral level. This training programme seems successful in achieving this goal and hence needs adoption for wider use in Nepal.

Objective: To explore the students' perceptions about their experience in a family medicine (FM) preceptorship in order to provide a sound basis for offering guidance to family medicine undergraduate education. Methods: During one full academic year at King Saud University, College of Medicine, Riyadh, Saudi Arabia, a self administered questionnaire was distributed to all students (n = 177) at the end of each 6 weeks family practice attachment course. Students were asked to rate their attachment by responding to a five-points Likert type scale questionnaire and other Yes/No questions reflecting different important points in teaching and training. Results: The teaching quality and the ability of the General Practitioners (GPs) preceptors to relate to students are rated very highly. Despite that, the majority of students (59.3%) feel their aims were not met during the attachment. Students indicate that there should be more teaching of practical procedure skills, more time allocated for discussion and a greater student involvement in the consultation. Conclusion: There is much to be retained in FM preceptorships that involves the caring and communication aspects of learning patient care. The study showed that practical procedure skills are desirable features of a preceptorship programme and that an emphasis on doing vs. observing is preferred by students. Some conditions designed to improve preceptorships are outlined and basic practicalities of adding a preceptorship to a practice are considered.