Home, training and work: mobility of British doctors

This study examines the locations of family homes, medical schools and places of specialist training, and work of doctors qualifying from UK medical schools in 5 calendar years between 1974 and 1993. The contribution of each UK region to the medical workforce relative to its population is assessed and trends over time are examined. The relationship between place of family home and medical school attended is examined for 14,108 doctors. Career appointment location and its relationship to medical school and family home loc‐ation are examined for over 4000 doctors. For the qualifiers of 1983, an additional analysis incorporating place of training is included. Large differences were found in the percentage of medical students from local family homes attending each regional medical school. In some cases differences reflected local populations but other cases had no obvious cause. Over all cohorts studied, 38% of respondents attended a medical school in the region of their family home (32% of 1993 qualifiers), 42% held a career post in the same region as their medical school, and 38% held a career post in the same region as their family home. Among the qualifiers of 1983, 65% had a career post in the same region as their postgraduate training, 34% also attended medical school in the same region, and 19% also came from family homes in the same region. More women than men took up a career post in the same region as their postgraduate training. The relationships to family home and medical school did not differ by gender. Consultants appeared slightly less likely than GPs to have stayed within a region, but this difference was not statistically significant.     

A genetic and environmental time series analysis of blood pressure in male twins

Systolic and diastolic blood pressures were measured on 254 monozygotic (MZ) and 260 dizygotic (DZ) male twin pairs, during middle age (average age 48 years) and at two later age points. Genetic and environmental components of covariation were modeled by time series. For both measures, shared environmental influences were absent and specific environmental influences were largely time-specific. Although heritability was about 0.5 at each time point, genetic variation present at middle age contributed only about 60% to that present 9 years later, the remaining 40% being new. Fifteen years later, at the third time point, no new genetic variation was evident, variation in individual differences being entirely attributable to genetic differences laid down at the two earlier ages. © 1993 Wiley-Liss, Inc.     

Introducing expert systems to medical students using esta, Expert System Teaching Aid

Medical students are allocated little curriculum time for exposure to expert systems. ESTA, a computer model of an expert system, was developed to make best use of this time. The nature of the students' interaction with ESTA is described, and their reactions to the expert system concepts and the place of expert systems in medicine are presented. A discussion of these reactions draws some conclusions about teaching expert systems in particular, and computers in general, in the basic medical course.     

Eight years'' experience with a structured clinical examination

A structured clinical examination has been an integral component of the final-year examinations conducted by the Departments of Medicine and Surgery at the University of Adelaide for the last 8 years. It has been used as an alternative to the traditional clinical examination. This paper describes the results of ongoing student and examiner surveys carried out to determine their views and satisfaction with this new approach. It also briefly discusses the feasibility of introducing such an examination into a conventional medical school environment. The surveys showed a remarkable level of acceptance and support by both students and examiners. This positive reaction has been maintained over the 8-year period. The main reasons seem to be its perceived relevance and fairness. Students also appear to be directing their learning in a direction thought desirable by teachers. No significant problems have been encountered with the practical implementation of the method.     

Adverse learning strategy: the Adelaide Diagnostic Learning Inventory and its subscale replicability in a medical student population

The Adelaide Diagnostic Learning Inventory (ADLIMS) is a measure of learning styles and learning pathologies that was designed to investigate the impact of traditional approaches to learning versus problem-based learning and to identify students whose approach to learning tasks predicted poor academic performance. In this study, some important psychometric properties of the ADLIMS were examined, including its factor structure. In this study, factor replicability across samples was argued to provide a more robust and psychologically meaningful factor solution than that which can be obtained using traditional mathematical criteria. The results of the factor analysis did not confirm the presence of the four factor solution earlier reported for the ADLIMS, but did identify three clear factors that had very high replicability. An inspection of the items comprising these three factors showed that factor 1 tapped subjective distress related to poor study habits, lack of motivation to study, and distraction from social activities. Factor 2 tapped distress arising from high achievement expectations that were hampered by superficial or disorganized study habits that did not enable the student to grasp the relationships between concepts and ideas. Factor 3 tapped positive feelings and a sense of satisfaction associated with a problem-based approach to the learning of new study material. Although the internal reliability of the ADLIMS subscales met the requirements of a measure to be used in general research such as in the investigation of correlates among groups of medical students, they did not meet the higher requirements of a measure to be used to identify or predict individuals with pathological learning styles.     

Self-directed learning in anatomy: incorporation of case-based studies into a conventional medical curriculum

This paper reports an attempt to develop self-directed learning skills in second-year medical students by introducing case-based projects into the gross anatomy course at a long-established medical school. The programme and students' responses to a questionnaire completed at the end of the year are presented. Information on the various resources used by students to find information is given. The performance of students in the case-based components of the course has been evaluated and also in the more traditional end-of-year written examination. The data confirm that students have recognized that the projects were about obtaining a deeper understanding of the anatomy, and the programme appears to have promoted the use and study of library texts.     

维持肢体正常的运动感觉功能所需最少神经根数的实验研究

目的 研究臂丛神经根单发断，２根切断（不同方式联合）及３根切断后对肢体的影响，为治疗臂丛根性撕脱伤寻找更多的潜在移位神经，方法 ２５２只ＳＤ大鼠随机分为１３组：（１）第１－５组（单根神经根切断组）；每组１２只大鼠。分别切断Ｃ５－８Ｔ１各神经根；（２）第６－１２组（２根神经根切断组）；每组２４只大鼠。分别切断相邻及不相邻２根神经根，即Ｃ５，６，Ｃ６，７，Ｃ７，８，Ｃ８Ｔ１，Ｃ５，７，Ｃ６，８和Ｃ７Ｔ     

Reduction in sodium chloride intake: effects on urinary Na, K and aldosterone output in healthy free-living adults

Eleven healthy free-living adults (six women, five men) weighed and recorded all food and drink consumed and collected all urine for two non-consecutive 7-day periods whilst eating their usual diet (Period 1) and attempting to reduce salt intake (Period 2). Bread (including pitta bread) provided on average a quarter of total Na intake of subjects in Period 1 so that wholemeal bread made without added salt was made available in Period 2. All subjects achieved substantial reductions (mean 65%) in Na intake in Period 2 with no change in K intake so that the Na:K molar ratio fell from 1.3 to 0.5. Urinary Na output closely followed intakes and there was a large increase (mean 11.2 μg/d) in aldosterone excretion with a non-significant increase in K output. Simple linear relationships which allow prediction of Na and K intake from the more easily measured urinary output were derived.     

Teaching school health to undergraduate medical students

This paper describes a teaching programme for final- (sixth-) year undergraduate medical students during their 10-week term in child health. Students attend schools on two occasions and are actively involved in the physical, educational and emotional assessment of children. The advantages of the programme include active participation by the students, contact with children in a less threatening environment, learning new skills in the assessment of children, and knowledge of common screening procedures. Student evaluation of the programme has been positive.