Context: There has been a considerable paradigm shift from a productcentred focus towards a patient-centered focus in pharmacy. Pharmaceutical care practice (Cipolle et al., 1998) can be seen as the latest proposal to transform the profession as mandated by most major professional associations in pharmacy. Pharmaceutical care is an innovative way of practicing pharmacy that has the potential to make drug-therapy safer, more effective, and more convenient for the patient. Even though pharmacists' time spent on customer communication has increased over time (Savage, 1999), this alone will not be sufficient to bring about a paradigm shift in view of what the pharmacist actually does to provide quality patient care. It appears equally important to reflect on how pharmacists practice pharmacy. Methods/Objectives: It is the aim of this discussion paper to argue for the importance of linking education and practice as a core part of the teaching of pharmaceutical care. Conclusions: In order for pharmacists to partake in truly interdisciplinary health care teams and the profession of pharmacy to demonstrate its unique and indispensable contribution to quality health care, pharmacy curricula would teach toward reflective practice, be problem-based, be positioned in collaborative teams, and have an outside (authentic) focus.

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Context: Longitudinal problem-based learning (PBL) tutorials are practiced at the Tokyo Women's Medical University. First year medical school students – most of whom are high school graduates with no medical background – often encounter difficulty identifying problems while solving PBL cases in basic science. The format of PBL case presentation may affect learning. Objectives: This study compares the learning outcomes of two cohorts of first year students who learned basic human biology through PBL cases presented in clinical vs. non-clinical formats. Methods: All first year students in 1995 and 2000 undertook PBL tutorials. The 1995 case was presented in a non-clinical format; the 2000 case was presented in a clinical format. Both cases had five identical pre-set learning objectives in basic science. By examining all written materials generated during the tutorial sessions, learning outcomes were categorized and the accomplishment of preset objectives was analysed. Findings: In 2000, the number of learning outcomes for clinical medicine was more than double compared to 1995, whereas the numbers of total and basic science learning outcomes were not significantly different. The number of preset objectives accomplished by the students was significantly higher in 2000. Thus, PBL case format affected the learning outcomes, enabling these first year students to achieve basic science objectives, while enhancing their interest in the clinical aspects of human biology. Conclusion: Learning outcomes in first year medical students may be enhanced when PBL cases designed to learn basic science contain relevant clinical elements.

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Context: In developing countries poor standards of clinical service may be an obstacle to medical education. The paper outlines the inadequate mental health service in Malawi, Central Africa, which as well as failing patients obstructs the training of health workers. Aims and objectives: A new mental health curriculum at Malawi's medical school is described. The notion of psychiatry as a medical speciality is abandoned and the focus moved to psychological and psychiatric factors as they present in general clinical settings and primary care. Students are encouraged to consider how they may address mental health issues through the many and varied roles which doctors in resource poor countries must fulfil (administrator, trainer, primary health care doctor, hospital physician). Relevance: This training strategy accords with a shift of attention among health service planners world-wide from specialist services towards primary care, and may generalize to other settings in which specialist clinical services are poorly developed.

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Background: Northern Australia is a geographically large region that has too few medical graduates and is a long way from Australia's metropolitan medical schools. This paper describes the establishment of a new medical school to serve these needs. Methods: The paper describes the steps in development and presents an overview of the innovative educational approach, based on best available educational evidence, that aims to produce a medical workforce that understand the health care needs of the region and want to practice there. Conclusion: The result is an innovative, highly integrated programme with different aspirations and a different student profile from other Australian medical schools.

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Background: Residential aged care staff play a significant role in the dayto-day lives of residents yet are faced with many barriers to providing care that promotes resident wellbeing. Approach: Action research is a useful approach for clarifying issues, identifying education and training needs, and identifying, and in some cases overcoming, organizational barriers to change. The Well for Life project aimed to enhance the social and physical health and well being of residents of aged care settings by empowering the staff of facilities to make change. The project had a particular focus on nutrition and physical activity. This paper reports on the action research group process undertaken during Phase I of the Well for Life project. Five residential aged care settings participated in the action research process facilitated by project staff independent of the facilities. The action plan and outcomes from one of these settings is used to illustrate the process and outcomes. Findings: The main findings of the project indicate that using a process that encourages staff involvement in identification of issues and actions can facilitate change in the practice of resident care. The action research groups identified specific gaps in knowledge and skill leading to targeted education that addressed areas of need. The importance of presenting information and learning opportunities for staff in a variety of formats was also recognized, as was the importance of organizational context, management support and empowerment of staff to make change.

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Context: Satisfaction is nowadays a valid measure of quality of care. Senior citizens are increasing in Chile and their treatment in primary care clinics, as well as the education of new professionals must take into consideration their special characteristics. Goal: Our intention was to investigate the degree of satisfaction senior citizens had with their health service and to identify those aspects able to be modified at the Medical Faculty in order to improve education of health professionals. Approach: Three hundred elderly attending Primary Care Outpatient Clinics of the city of Temuco, Chile, were interviewed using a satisfaction questionnaire developed by the Medical Outcomes Study carried out in USA. Findings: Senior citizens experience a high level on dissatisfaction with the health care they receive at the primary level. Doctors and nurses had a high qualification in relation to their technical skills, but a lower score if considering the education and information they give to patients. These results shall be used in order to modify attention to senior citizens as well as to include problems related to this group in the curricular reform plan and to improve attitudes of nursing and medical students.

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Purpose: To examine the usefulness of writing about a memory of an aesthetic experience, and then transfer the aesthetic experience to a health care situation. Methods: The study was accomplished at two university colleges of health sciences in Sweden. It started with student nurses (N=291) writing about a memory of an aesthetic experience. Then they transferred the aesthetic experience to a purposeful clinical practice. Findings: The results showed that each student could report on a positive memory of an aesthetic experience. Embedded in each story was an aesthetic experience that was meaningful to the student. Domains of memory most frequently reported were music, work of art and nature. Themes derived from the aesthetic memory were happiness and awareness. The awareness theme comprized the value of aesthetic experiences for the patients, and for student nurses. Conclusion: The process of writing about a memory of an aesthetic experience provided an alternative model for nursing education that could improve patient care.

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Background: Recent moves to integrate aspects of population health into medical curricula have created new staff development challenges for many institutions. Small group teaching in population health is a relatively new initiative, often requiring recruitment of additional staff and considerable training. This analysis identifies the tutor characteristics rated most positively by medical students in a small-group course in population health and discusses their implication for staff recruitment and development. Method: Retrospective evaluation of tutors by students using a self-administered questionnaire. Overall tutor rating was analysed against various tutor characteristics, using univariate logistic regression methods. Optional qualitative comments were summarized by thematic methods and triangulated with findings from the quantitative analysis. Results: Creating a supportive group climate was the tutor attribute most positively evaluated by students (OR=9.62, 95%CI 4.46– 20.83). Perceived interest in teaching (OR=8.93, 95%CI 3.83– 20.83) and the ability to give useful feedback (OR=8.40, 95%CI 4.07– 17.54) were also highly rated by students as valuable qualities in their tutors. Qualitative analysis highlighted the importance of informed comment, good knowledge and expert input from tutors. Conclusion: Whilst a degree of content expertise in population health was desirable in a tutor, its value was secondary to good facilitation skills and an enthusiasm for teaching when student evaluation was considered. Faculties implementing small-group methods of teaching population health should consider facilitation skills and interest in teaching as priorities when recruiting and training staff. As is the case for self-directed student-led learning in basic and clinical sciences, these appear to be more influential than content expertise, from the students' perspective.

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