The influence of structural and institutional change on teaching and culture in clinical settings: an exploratory study.

OBJECTIVES: Learning in clinical settings is a function of activity, context and culture. Glasgow University's Medical School has undergone significant curricular change in recent years. This has coincided with change to National Health Service consultants' contracts, the introduction of the European Working Time Directive and the Modernising Medical Careers training initiative. We wished to explore teachers' and students' perspectives on the effects of change on our clinical teachers' capacity for teaching and on medical culture. METHODS: A qualitative approach using individual interviews with educational supervisors and focus groups with senior clinical students was used. Data were analysed using a "framework" technique. RESULTS: Curricular change has led to shorter clinical attachments in the senior clinical rotation, which combined with more centralised teaching have had adverse effects on both formal and informal teaching during attachments. Consultants' NHS contract changes the implementation of the European Working Time Directive and changes to postgraduate training have adversely affected consultants' teaching capacity, which has had a detrimental effect on their relationships with students. Medical culture has also changed as a result of these and other societal influences. CONCLUSIONS: The apprenticeship model was still felt to be relevant in clinical settings. This has to be balanced against the need for systematic teaching. Structural and institutional change affects learning. Faculty needs to be aware of the socio-historical context of their institutions.

Making sense of ethics and law in the medical curriculum.

The moment a patient comes into the treatment room, the medical professional is placed in both an ethical and a legal context. The task for medical teachers is to equip students for this clinical reality in a way that makes sense both to the learners and to the variety of medical educators in the school, all of whom will have their own interpretations of the nature of this subject area. Ethics and law in the medical curriculum (Dowie and Martin 2011), aims to provide an understanding of how ethics and law can be incorporated into the curriculum in a structured, coherent, and logical manner. It is essential that we begin with a vision of the primary purpose of our course, and clarify the overall domain of learning to which it relates. Rather than presenting students with a miscellany of ethico-legal topics, their learning can be reinforced by constructing a frame around the key emphases in law and ethics. A professional ethics frame is proposed, highlighting the everyday, theory-based, habits, intentions, consequences and society elements of this approach. The course also has to be mediated within the wider curriculum, and this benefits from a coherent and communicated course scheme that is directly meaningful within the educational setting of the medical school. Finally, within the Guide, examples of humanistic schemes are presented that centre on aspects of boundary in patient care, themed around body, person and community of practice.

HIV testing in dementia: clinical, ethical and patient safety implications.

This article presents patient safety issues along with the professional and ethical challenges in relation to UK guidelines on HIV testing in patients who are incapacitated as a result of dementia. Current protocols are designed to protect the patient, but may have undesirable consequences for patients, carers and doctors.

Platelet Aggregation in Primary Raynaud's Phenomenon and the Effect of Enalapril Administration.

Platelet aggregation using a single platelet counting technique in whole blood, was determined on 18 patients with primary Raynaud's phenomenon and 17 age-matched controls. Platelet aggregation in the Raynaud's patients was also assessed during a double-blind, crossover trial to investigate the efficacy of the angiotensin converting enzyme (ACE) inhibitor, enalapril. There were no differences in platelet aggregation to collagen, arachidonic acid, ADP or PAF, or in plasma levels of beta-thromboglobulin (BTG), platelet factor 4 (PF4) or thromboxane B(2) (TxB(2)) between the Raynaud's group and the normal controls. Similarly, there were no differences in these parameters in the Raynaud's group during treatment with enalapril when compared to placebo. It is concluded that patients with primary Raynaud's phenomenon have no evidence of abnormal platelet aggregation or increased platelet activation, and that platelet aggregation is not affected by enalapril.

A de novo X;13 translocation with abnormal phenotype.

We describe a female infant who presented with hypotonia and developmental delay. Her karyotype showed a de novo balanced translocation between the X chromosome and chromosome 13, with breakpoints at Xq13 and 13p11. The normal X was late replicating in all cells examined. The cause of this patient's abnormal phenotype is discussed.