Primary immunodeficiency studies at University of Alabama at Birmingham

Over the past two decades the genetic bases for virtually all the well-characterized primary immunodeficiency syndromes have been identified. The investigation of rare, poorly differentiated immunodeficiencies is being hampered by a preoccupation of funding agencies with hypothesis-driven proposals that apply poorly in the case of individual patients. Recent studies at our institution in collaboration with groups at NIH have resulted in the identification of two separate kindreds bearing unique mutations in molecules affecting immune function and a chromosomal linkage in a third family. Thus, a potential solution to the funding problem for studies in primary immunodeficiency could lie in the centralization of investigative expertise and support, perhaps within the walls of the National Institutes of Health, as has been done with great success in Europe.     

Community-based clinical education at the University of Birmingham Medical School.

Throughout the United Kingdom, medical schools have begun to make significant changes in the content and delivery of their undergraduate curricula in response to a number of social and educational forces. In particular, many schools have begun to focus increasingly on community-based education. This and other changes mirror developments that have taken place in other countries and in the context of other health care systems, with such forerunners as Harvard, Maastricht, and McMaster having had a fundamental influence. In this article, the authors describe the forces for curricular change in the United Kingdom and the specific recommendations for change made by the General Medical Council. They then discuss in detail the new curriculum at the University of Birmingham medical school, focusing in particular on a community medicine module, where students spend ten days per academic year learning in general medical practices in and around the city of Birmingham.     

The representation of ethnic minorities at genetic clinics in Birmingham.

A study of the ethnic distribution of families attending genetic clinics in Birmingham has shown a deficit of Afro-Caribbean and Pakistani families. The former may be because of a deficiency of autosomal recessive diseases other than sickle cell disease, but the numbers are too small to be certain of this. The deficit of Pakistani families is probably for a variety of causes, such as a poorer attendance rate at clinics unless there is some encouragement, and a lack of awareness of, or interest in, genetic issues.     

Further observations on the Birmingham chimaera.

The appropriate ABH-gene specified glycosyltransferases in the plasma of the Birmingham chimaera were estimated. These observatiions and the demonstration of A1Leb blood group specific glycosphingolipid in the plasma indicate that the minority population of red blood cells probably represents the true blood groups of the patient.     

Community voices: views on the training of future doctors in Birmingham, UK

The United Kingdom (UK) population is diverse with nearly 6% minority ethnic communities. Both patients and doctors experience difficulties when dealing with someone from a different ethnic group. Medical education has failed to keep pace with the changing needs of the diverse population. We report a project in which 12 established (religious/cultural and specific interest) community groups expressed their views on what future doctors should learn about serving diverse populations. Data were obtained by group discussion and through the media using a structured format. Fifteen themes emerged which were grouped under three broad themes: firstly, the identification by group members of their perception of the 'differences' in social and cultural beliefs and behaviours of their individual community; secondly, the identification of characteristics of a culturally sensitive doctor; and lastly, recommendations for changes in medical training. New teaching has been introduced to the medical curriculum that incorporates the themes raised by the communities and which reflects consciousness raising and communication issues.