Background:
Educational supervision (ES) is considered to be an essential component of basic specialist training in psychiatry in the UK. However, previous studies have indicated variation in its provision, and uncertainty about structure and content. Workplace-based assessments (WPBAs) were introduced in 2007 as part of major postgraduate medical training reform. Placing considerable time demands on trainees and supervisors alike, the extent to which WPBAs should utilise ES time has not been specified. As ES and WPBAs have discrete (although complementary) functions, there is the potential for this increased emphasis on assessment to displace other educational needs.
Methods:
All junior doctors and their educational supervisors in one UK psychiatry training scheme were surveyed both before and after the introduction of WPBAs. Frequency and duration of ES were established, and structure, content and process were ascertained. Opinions on usefulness and responsibility were sought. The usage of ES for WPBAs was also assessed.
Results:
The response rate of 70% showed general agreement between trainees and supervisors, but some significant discrepancies. Around 60% reported 1 hour of ES taking place weekly or 3 times per month. Most agreed that responsibility for ES should be shared equally between trainees and supervisors, and ES was largely seen as useful. Around 50% of trainees and supervisors used 25-50% of ES time for WPBAs, and this did not appear to affect the usefulness of ES or the range of issues covered.
Conclusions:
ES continues to be an important component of psychiatric training. However, using ES for WPBAs introduces the potential for tension between trainees’ education and assessment by emphasising certain training issues at the expense of others. The impact of reduced training time, WPBAs and uncertainties over ES structure and content should be monitored to ensure that its benefits are maximised by remaining tailored to individual trainees’ needs.

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Background:
It is important to demonstrate learning outcomes of simulation in technology based practices, such as in advanced health care. Although many studies show skills improvement and self-reported change to practice, there are few studies demonstrating patient outcome and societal efficiency.The objective of the study is to investigate if and why simulation can be effective and efficient in a hi-tech health care setting. This is important in order to decide whether and how to design simulation scenarios and outcome studies.
Methods:
Core theoretical insights in Science and Technology Studies (STS) are applied to analyze the field of simulation in hi-tech health care education. In particular, a process-oriented framework where technology is characterized by its devices, methods and its organizational setting is applied.
Results:
The analysis shows how advanced simulation can address core characteristics of technology beyond the knowledge of technology’s functions. Simulation’s ability to address skilful device handling as well as purposive aspects of technology provides a potential for effective and efficient learning. However, as technology is also constituted by organizational aspects, such as technology status, disease status, and resource constraints, the success of simulation depends on whether these aspects can be integrated in the simulation setting as well. This represents a challenge for future development of simulation and for demonstrating its effectiveness and efficiency.
Conclusion:
Assessing the outcome of simulation in education in hi-tech health care settings is worthwhile if core characteristics of medical technology are addressed. This challenges the traditional technical versus non-technical divide in simulation, as organizational aspects appear to be part of technology’s core characteristics.

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Background:
Both university and non-university stakeholders should be involved in the process of curriculum development in medical schools, because all are concerned with the competencies of the graduates. That may be difficult unless appropriate strategies are used to motivate each stakeholder. From 1999 to 2006, eight medical schools in Vietnam worked together to change the curriculum and teaching for general medical students to make it more community oriented. This paper describes the factors that motivated the different stakeholders to participate in curriculum change and teaching in Vietnamese medical schools and the activities to address those factors and have sustainable contributions from all relevant stakeholders.
Methods:
Case study analysis of contributions to the change process, using reports, interviews, focus group discussions and surveys and based on Herzberg’s Motivation Theory to analyze involvement of different stakeholders.
Results:
Different stakeholders were motivated by selected activities, such as providing opportunities for non-university stakeholders to share their opinions, organizing interactions among university stakeholders, stimulating both bottom-up and top-down inputs, focusing on learning from each other, and emphasizing self-motivation factors.
Conclusion:
The Herzberg Motivation theory helped to identify suitable approaches to ensure that teaching topics, materials and assessment methods more closely reflected the health care needs of the community. Other medical schools undertaking a reform process may learn from this experience.

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Background:
A sound knowledge of pathophysiology of a disease and clinical pharmacology and therapeutics (CPT) of a drug is required for safe and rational prescribing. The aim of this study was therefore to assess how adequately the undergraduate CPT teaching had prepared interns in Nigeria for safe and rational prescribing and retrospectively, to know how they wanted the undergraduate curriculum modified so as to improve appropriate prescribing. The effect of internship training on the prescribing ability of the interns was also sought.
Methods:
A total of 100 interns were randomly selected from the Lagos State University Teaching Hospital (LASUTH), Ikeja; Lagos University Teaching Hospital (LUTH), Idiaraba; General Hospital Lagos (GHL); the EKO Hospital, Ikeja; and Havana Specialist Hospital, Surulere. A structured questionnaire was the instrument of study. The questionnaire sought information about the demographics of the interns, their undergraduate CPT teaching, experience of adverse drug reactions (ADRs) and drug interactions since starting work, confidence in drug usage and, in retrospect; any perceived deficiencies in their undergraduate CPT teaching.
Results:
The response rate was 81%. All the respondents graduated from universities in Nigeria. The ability of the interns to prescribe rationally (66, 81.4%) and safely (47, 58%) was provided by undergraduate CPT teaching. Forty two (51.8%) respondents had problems with prescription writing. The interns would likely prescribe antibiotics (71, 87.6%), nonsteroidal analgesics (66, 81.4%), diuretics (55, 67.9%), sedatives (52, 62.9%), and insulin and oral hypoglycaemics (43, 53%) with confidence and unsupervised. The higher the numbers of clinical rotations done, the more confident were the respondents to prescribe unsupervised (chi2= 19.98, P< 0.001). Similarly, respondents who had rotated through the four major clinical rotations and at least a special posting (chi2= 11.57, P< 0.001) or four major clinical rotations only (chi2= 11.25, P< 0.001) were significantly more confident to prescribe drugs unsupervised.
Conclusions:
Undergraduate CPT teaching in Nigeria appears to be deficient. Principles of rational prescribing, drug dose calculation in children and pharmacovigilance should be the focus of undergraduate CPT teaching and should be taught both theoretically and practically. Medical students and interns should be periodically assessed on prescribing knowledge and skills during their training as a means of minimizing prescribing errors.

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