Medical education
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All general practitioners (GPs) are expected to have an appraisal from 2002 and the first cohort will experience revalidation in 2005. Although there is a link between appraisal and revalidation, this has yet to be clarified. ⋯ A better understanding of knowledge, beliefs and attitudes towards appraisal will ultimately help in setting up a successful appraisal system for GPs. The current emphasis on appraisal as an educational tool will help to foster positive attitudes. The relationship between appraisal and revalidation needs to be clarified. Concerns relating to lack of time and resources for appraisal and revalidation need to be addressed by primary care organisations.
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As health care delivery systems experience economic and competitive challenges, institutional mergers have become a means for economic survival. Academic hospital mergers are well chronicled, yet little has been written about postgraduate, or residency, training programme mergers and their human and programmatic consequences. Mergers present opportunities to strengthen and redesign residency programmes, but risks include programme disruption, resident and faculty morale, and housestaff and faculty recruitment and retention. Mergers can cause a sense of disequilibrium, influencing resident and staff perceptions of job security, commitment to teaching, and even the viability of the residency programme. ⋯ Successful residency training programme mergers require a carefully planned and executed series of actions that minimise disruptions. Effective communication on all levels is key. Success is associated with effective leadership, good communication skills, an open process with physician input, attention to institutional cultures, and a relatively short timetable. Most important is the continuous involvement, input, and creation of the programme by those most affected.
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In order to emphasise learning more than control, from autumn 2000 we have invited medical students to propose questions for their own written examination in family medicine. One out of three student's proposals was guaranteed to be a part of their coming written examination, possibly somewhat modified. ⋯ Encouraging students to write questions for their own examination makes them feel more confident during the examination period, and may increase their reflective learning, without seriously limiting topics studied or violating the control function of the examination.