The potential for refining nitrogen fertiliser management through accounting for climate impacts: An exploratory study for the Tully region.

Increasing the precision of nitrogen (N) fertiliser management in cropping systems is integral to increasing the environmental and economic sustainability of cropping. In a simulation study, we found that natural variability in year-to-year climate had a major effect on optimum N fertiliser rates for sugarcane in the Tully region of north-eastern Australia, where N discharges pose high risks to Great Barrier Reef ecosystems. There were interactions between climate and other factors affecting crop growth that made optimum N rates field-specific. The regional average optimum N fertiliser rate was substantially lower than current industry guidelines. Likewise, simulated N losses to the environment at optimum N fertiliser rates were substantially lower than the simulated losses at current industry fertiliser guidelines. Dissolved N discharged from rivers is related to fertiliser applications. If the reductions in N applications identified in the study occurred in the Tully region, the reduction in dissolved N discharges from rivers in the region would almost meet current water quality improvement targets. Whilst there were many assumptions made in this exploratory study, and there are many steps between the study and a practically implemented dynamic N fertiliser recommendation system, the potential environmental benefits justify field validation and further development of the concepts identified in the study.

Training for visiting registrars: experience in East Anglia, UK.

A questionnaire was sent to 24 visiting registrars in East Anglia to obtain information on their perceptions of their training experiences. The results suggest that the needs of overseas doctors and the requirements of training authorities would benefit from organisational changes aimed at improving selection and training programmes. Formal training programmes are needed, tailored to an individual's requirement, with identification of educational supervisors for each trainee. An improved system of introduction to the National Health Service is also required.

Training for medical teachers: a UK survey, 1993.

Opportunities and resources for training of medical teachers have been criticized in recent UK reports. A survey of undergraduate and postgraduate medical deans showed that training courses were available at most institutions, though only a few were specifically designed for medical teachers. Many new and specific courses are being planned and many new appointments are being made in medical education at both medical school and postgraduate levels. While the outcome of greater resources for training of medical education cannot yet be determined, we conclude that criticisms are being speedily addressed.

Sustaining and rewarding clinical teaching.

High standards of clinical teaching are essential in the training of medical students but greater prominence needs to be given to its importance. Strategies are described by which one medical school has raised the awareness of clinical teaching and supported those who deliver it.

Parental problems influencing the academic achievement of medical students: a prospective study.

The 227 students offered places in the 1988 medical student intake at the University of Queensland were surveyed regarding their demographic characteristics. This was correlated with the students' subsequent performance and persistence during the first year of the medical course. Coming from a lower socioeconomic background and having family problems were both associated with either a decreased academic performance or an increased attrition rate. The results are discussed, relevant literature is reviewed and suggestions for further research are made.

Undergraduate obstetrics and gynaecology in the United Kingdom and the Republic of Ireland, 1989.

Undergraduate obstetrics and gynaecology has given rise to concern at a time when the community has become increasingly sensitive about genital structure and function and human reproduction. A survey of clinical schools in the United Kingdom and the Republic of Ireland shows that an average of 11 weeks is available for undergraduate learning in the discipline. Nearly all schools provide written aims and objectives for clinical students. Pelvic examination is taught in what is concluded to be a sensible and responsible manner; students are expected to conduct an average minimum of eight deliveries. Family planning instruction is seen as generally inadequate. Comparison of clinical courses with those in Australia and New Zealand shows striking similarities. Undergraduate courses need to be under constant review and revision so that the best students are encouraged to see obstetrics and gynaecology as a desirable career path.

Mature-age entrants to medical school: a controlled study of sociodemographic characteristics, career choice and job satisfaction.

A comparison of 121 mature-age and 270 normal-age entrants who graduated from the University of Queensland Medical School between 1972 and 1987 shows that mature-age entrants are some 7 years older, are more likely to come from public (state) schools and less likely to have parents in professional/technical occupations. Otherwise, the two groups were similar in terms of gender, marital status, number of children, ethnic background and current practice location. The educational background of mature-age entrants prior to admission includes 44.6% with degrees in health-science areas and 31.4% with degrees in non-health areas. Reasons for delayed entry of mature-age entrants include late consideration of medicine as a career (34.7%), financial problems (31.4%), dissatisfaction with previous career (30.6%), poor academic results (19.8%), or a combination of the above factors. Motivations to study medicine include family influences (more so in normal-age entrants), altruistic reasons (more so in mature-age entrants) and a variety of personal/social factors such as intellectual satisfaction, prestige and financial security (similar for both groups) and parental expectations (more so in normal-age entrants). Mature-age entrants experienced greater stress throughout the medical course, especially with regard to financial difficulties, loneliness/isolation from the students and family problems (a greater proportion were married with children). While whole-course grades were similar in both groups, normal-age entrants tended to win more undergraduate honours/prizes and postgraduate diplomas/degrees, including specialist qualifications. Practice settings were similar in terms of group private practice, hospital/clinic practice or medical administration, but there was a greater proportion of mature-age entrants in solo private practice, and a smaller proportion in teaching/research. If given the time over, some two-thirds of both groups would choose medicine as a career. Reasons for job satisfaction include helping patients, intellectual stimulation and financial rewards. Reasons for dissatisfaction include pressure of work, red-tape/paperwork, 'doctor-bashing', long working hours, emotional strain, financial pressure, unfulfilled career expectations and irritation with trivial medical complaints.

Undergraduate education in obstetrics and gynaecology in Australia and New Zealand, 1989.

Medical schools in Australia and New Zealand provide an average of 10.7 weeks for instruction in obstetrics abd gynaecology. The stated aims and objectives in 14 clinical schools vary from none at all to those which establish the programme with great clarity. The learning exercises provided vary from the conventional, ward and clinic-based to those with an accent on observing closely a mother, her baby and her family. Newer methods for learning about pelvic examination have not been widely adopted. Schools expect students to gain experience in an average of 9 vaginal deliveries. Competition with midwives for available deliveries was described by 9 clinical schools. The survey shows a need for greater emphasis in text books on communication skills and psychological aspects of patient care.

Careers in medicine: appointment to specialist training posts in Queensland in 1988.

Appointments to accredited specialist training positions in the State of Queensland, Australia in 1988 were analysed to show the success rates of applicants. Women were less likely to apply for training, but gained proportionately more appointments than men. Other factors in success were application from a major teaching hospital, graduation from the State medical school and, for new applicants, an honours degree. The success rates in various specialties differed significantly as did their appeal to women and to honours graduates. It is concluded that new graduates need better information and advice on career choice and that individual disciplines need to look carefully at the image and organization of their training programmes.

The pre-registration year 1983-1988.

The pre-registration year, a mandatory period of general clinical training in the United Kingdom, has been the subject of recent comment and criticism. The literature on the year is analysed, taking as a starting point and framework the 1983 review by the Association for the Study of Medical Education (ASME), and focusing on the 1987 Recommendations of the General Medical Council. It is concluded that the pre-registration programme has been improved, but that attention needs to be given to house officers' hours of duty, to career counselling for them and to training for teachers and supervisors.

Ultrasound imaging in the management of ovulation stimulation.

The present role of ultrasound imaging in the assessment of ovarian response to gonadotrophin therapy was assessed by comparing a group of patients in whom ultrasound was used to determine suitability of follicles for induction of ovulation with a group in whom ultrasound was not available. Ultrasound provides new and useful information, and may allow a reduction in the incidence of multiple pregnancies.

The rise of the caesarean section: a review.

Caesarean section is of recent development as a credible procedure. A rapidly increasing incidence in many countries has led to a far-ranging concern. Proposed causes for the increase include insistence on repeat operations and a resultant cumulative effect, more frequent diagnoses of disproportion and ineffective labour, the use of fetal heart monitoring, and a steady trend away from vaginal breech delivery. Increased perinatal morbidity is seen in Caesarean section, together with a qualified increase in perinatal mortality. Maternal morbidity is greater and maternal death rates are reportedly 2-4 times greater in Caesarean section births. More work is needed on the psychosocial sequelae of abdominal delivery.