["The consultation lab"--training clinical communication]. / "Konsultationslaboratoriet"--traening i klinisk samtale.

Discourse is the doctor's most essential tool. Since 1992, 500 Danish GPs have participated in "The consultation process I" and videosupervision in Greece. Participants are divided into groups of six. Each group works in a virtual consultation lab in which doctor-patient role plays are videotaped and supervised according to a specific matrix. In this experimental setting we have further sophisticated the nine phases (the P-R-A-C-T-I-C-A-L model) of the consultation process and improved our matrix for group supervision of video sessions. Typical individual pitfalls in doctor-patient communication have been demonstrated. Participant doctors were allowed to freely explore individual styles, and then establish how they were perceived by their "patients'"; they have learned how patient experience of a consultation varies. Furthermore, the courses helped to create networks: several groups met later, and a great many of these GPs have joined medical student tutoring. This way, the courses have contributed to more efficient work practices and job satisfaction, to professional advances, and to a lasting of the quality of upgrading in general practice.

[Mortality of anorexia nervosa in Denmark 1970-1987]. / Dødeligheden af anorexia nervosa i Danmark 1970-1987.

Eight hundred and fifty-three patients were admitted to psychiatric institutions in Denmark with anorexia nervosa between 1970 and 1986. Based on register information, 50 deaths were recorded during a mean follow-up period of 7.8 years. Amongst these, five were males and 45 females. The standardized mortality ratio (SMR) was 9.1 in both sexes. The SMR was maximal during the first year after index admission. Suicide was the dominant cause of death amongst subjects who died from unnatural causes (18 of 22 cases). Among those who died from natural causes (24 subjects), 13 individuals died from anorexia nervosa, and 11 individuals died from other illnesses.

Mortality in anorexia nervosa in Denmark during the period 1970-1987.

In this nation-wide register linkage study of the mortality among psychiatric in-patients with anorexia nervosa who were admitted between 1970 and 1986 (n = 853), 50 deaths were recorded during a mean follow-up period of 7.8 years (6680 person-years of observation). Among male subjects, five of 63 probands died, and the mean age at death was 24.5 years (range 14.2-48.1 years). Among female subjects, 45 of 790 probands died, and the mean age at death was 36 years (range 18.1-64.7 years). The standardized mortality ratio (SMR) was 9.1 in both sexes. A significantly increased SMR was demonstrated in males up to 5 years after index admission, and for females up to 15 years. There was no mortality among childhood-onset female subjects, but among males one death was recorded in this age group. In male subjects the highest SMR was found among those with index admission in the second decade of life, and in females among those with index admission in the third decade of life. The SMR was maximal during the first year after index admission. Suicide was the dominant cause of death among subjects who died from unnatural causes (18 of 22 cases). Among those who died from natural causes (24 subjects), 13 individuals died from anorexia nervosa and 11 individuals died from other illnesses.

[Incidence of eating disorders in psychiatric health services in Denmark 1970-1993]. / Incidens af spiseforstyrrelser i psykiatrisk sygehusvaesen i Danmark 1970-1993.

By means of data from the nationwide Danish Psychiatric Case Register all first-ever diagnosed patients with eating disorders in Danish psychiatric in- and day-patient services were identified for the period 1970-1993, comprising 1529 persons in all, with 92% being female. Based on age-specific and age-standardized rates the regression lines were calculated for various definitions of eating disorders and definitions of periods. All were found to be increasing significantly. The maximum increase in rate was found among 15-24 year-old females: 0.40 per 100,000 per year. No changes in incidence were found in males.

Incidence of eating disorders in psychiatric hospitals and wards in Denmark, 1970-1993.

Two previous studies in Denmark found diverging results in analyzing trends in new cases of eating disorders in the psychiatric in- and day-patient services, although the same data source, the nationwide Danish Psychiatric Case Register, was used. The present study--also using information from the nationwide Danish Psychiatric Case Register, but correcting for several register biases--confirms a highly significant increase in new cases of eating disorders in psychiatric hospitals and wards. The increase is seen exclusively in younger females. The diverging results in the previously mentioned studies in Denmark may be ascribed to methodological issues.

Comprehensive evaluation of specialist training: an alternative to board examinations in Europe?

Demands for specialist examinations grow in a new Europe with open borders for labour force, including medical doctors. Significant mechanisms stimulating this development are outlined. In the light of an analysis of the purpose of evaluation of postgraduate medical education, a warning is expressed against simplistic approaches and solutions. The measurement of clinical competence is complex and requires clarification of concepts, unveiling of needs, understanding of methodology, acceptance of consequences, and consideration of resource aspects of the different types of evaluation available. In order to emphasize the educational purpose of specialist training, a comprehensive formative evaluation process is suggested as an alternative to specialist examinations. This should involve both the trainee and the institution. Europe should not automatically imitate North America, and a supernational examination system with its many pedagogical, methodological, legal, and resource problems may not be the right approach to the assurance of quality in postgraduate medical education in Europe.

[Future collaboration in medical education in Scandinavia]. / Det fremtidige samarbejde om laegeuddannelse i Norden.

The Nordic Federation for Medical Education is in the process of re-organisation. Owing to increasing cooperation with the remainder of Europe, it is desirable that the Nordic countries unite to preserve the structure of Nordic medical education.

[Scandinavian evaluation of the World Conference on Medical Education]. / Nordisk vurdering af verdenskonferencen om medicinsk undervisning.

The article summarises 22 recommendations for future action regarding medical education that were evolved at the conference in Edinburgh in 1993. The necessity of closer integration between the various phases of medical education was strongly emphasised at the conference.

[Increased incidence of anorexia nervosa in Denmark]. / Oget incidens af anorexia nervosa i Danmark.

Register information from the Danish Central Psychiatric Register about 915 anonymous patients, who during the period 1970-1989 had their first admission to a psychiatric institution in Denmark and had an eating disorder as their main diagnosis, ICD 8 306.50-59, were studied with regard to change in incidence. The incidence of these admissions increased from 0.42/100,000 in 1970 to a maximum of 1.36/100,000 in 1988. For women 15-24 years of age the incidence increased three times to 8.97/100,000 in 1989. During the time of our investigation, the number of discharges of patients with an eating disorder as their main diagnosis was constant from somatic hospitals, whereas discharges in general from psychiatric institutions increased.

[Anorexia nervosa in Denmark--changes in diagnosis]. / Anorexia nervosa i Danmark--diagnoseskift.

Using information retrieved from the Danish Central Psychiatric Register, 1017 anonymous patients who had been admitted to Danish psychiatric institutions during 1968-1986 under a diagnosis of eating disorder ICD 8,306.50-59 were traced throughout their altogether 3419 admissions over the same time period with the aim of examining the stability of the initial diagnosis. Fifty-nine percent maintained the diagnosis of eating disorder. Diagnostic change was found in 22%. Nineteen percent had eating disorder registered only as a subsidiary diagnosis. Two-thirds were readmitted. Diagnostic changes were mainly to and from those of personality disorder or neurosis. Only six percent ended up as being diagnosed with a psychosis. The high frequencies of diagnostic changes and subsidiary diagnoses support the concept of eating disorder as a clinical syndrome with fluctuating symptoms.

Medical specialization in Europe: the way forward. Promotion of educational quality.

The medical specialties are being intensively reconsidered in the countries of Europe. The important need is for promoting improvement of educational training programmes. Evaluation and improvement of specialist training programmes is the priority and not the setting up of qualifying examinations. The first necessity is to safeguard 20 years of evolution in postgraduate training. Support for the educational process is essential, to a much greater extent than occurs at present, if standards are to be improved and the confidence of the public is to be retained. The EC medical education system is the only existing international structure in medical education which is controlled by law, and is on that basis alone of the greatest interest.

Incidence of anorexia nervosa in Denmark.

From 1970 to 1989, 915 people were admitted for the first time to psychiatric institutions in Denmark and had as their main diagnosis an eating disorder, ICD-8 306.50-59. The incidence of these admissions increased from 0.42/100,000 population in 1970 to a maximum of 1.36/100,000 in 1988. During the time of our investigation, the number of discharges of patients with an eating disorder as the main diagnosis was constant from somatic hospitals, whereas discharges from psychiatric institutions increased.

Reflections on possible virtues of European medical education.

Political and social development in Europe will lead to increased mobility of doctors between countries as well as opening up new possibilities and horizons for educational institutions. In this emerging process the charge that universities are too traditional to change may not be valid when the virtues of academic traditions in Europe are considered. When those virtues are taken into account, they are seen to facilitate the integration of more current goals for future development into undergraduate medical curricula. The use of external examiners between different countries in Europe will promote greater quality in European medical education.

[Psychotherapy of patients with schizophrenia. Study of the significance of group supervision]. / Psykoterapi af skizofrene. En undersøgelse af betydningen af gruppesupervision.

A Danish centre contributed 12 cases to a Nordic multicentre investigation concerning the psychotherapy of psychoses. Patients admitted consecutively to the psychiatric hospital with the diagnoses of schizophrenia, schizophreniform psychosis or schizoaffective psychosis were offered psychotherapy at least once weekly for two years in addition to the other treatment modalities administered. In the Danish design, the process of supervision in relation to the processes of psychotherapy was investigated. In the present article, examples are presented illustrating how core psychotic mechanisms in the patients are reflected not only in process-facilitating but also in process inhibiting psychotherapeutic interventions. The data of the investigation are these interventions which are written down prospectively in the summaries of the supervision.

[Medical education in the USSR. Possibility of cooperation with Scandinavia]. / Laegeuddannelse i USSR. Samarbejdsmuligheder med Norden.

The article describes the medical training at the basic and the advanced levels in the USSR together with the cooperation agreements in the field of education which have been signed by the Nordic Federation for Medical Education and the Postgraduate Medical Institute (USSR, Leningrad).

An assessment of priority and educational value in a medical curriculum.

A randomly selected group of teachers, students, first-year graduates (junior doctors in the first year of postgraduate training after their final medical school examination), general practitioners and specialists responded to a postal questionnaire designed to assess their views on the priorities in medical curriculum and the educational value attributed to its content. Comparisons were made among the five participating groups and the outcome of the assessment was compared with the existing curriculum.