Clin Med
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Comparative Study
Assessment centres for core medical training: how do the assessors feel this compares with the traditional interview?
In 2007, an assessment centre approach (a structured interview, a case-based discussion and a communication exercise) was implemented to replace the traditional interview for entry to core medical training. Feedback was obtained from 53 of 69 assessors, all consultants and most with extensive experience of the traditional system. Each station was rated by around 20 interviewers. ⋯ Comparison with the previous system was only provided by between 12 and 21 people per station. The structured interview was rated better (n=12), undecided (8), or worse (1); the case-based discussion better (16), or undecided (3); the communication station better (8), undecided (3), or worse (1). There is still work to do on the best components to include but the principle of multiple assessments to examine differing parts of the person specification seems, subjectively, to be supported.
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Two weeks after starting the oral contraceptive pill, a 16-year-old girl developed increasingly violent chorea and an evolving psychosis with prominent hallucinations, ideas of reference, and paranoia. An erythematous skin rash subsequently developed and Sydenham's chorea (SC) was diagnosed. ⋯ This case illustrates that severe psychotic features can occur in SC. It is recommended that antistreptolysin O titres and antibasal ganglia antibodies are checked early in patients with evolving movement disorders and prominent neuropsychiatric features, as the window for modifying the course of this immune-mediated disorder may be narrow.
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The potential for the holder of a senior academic post to influence the medical world is usually enshrined in their job description. Even though Oxford University failed to provide one, this account of 25 years of undirected activity suggests that such posts can influence events, albeit to a limited extent and not always in the expected direction.
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The Royal College of Physicians (RCP) is to host the European School of Internal Medicine for two years from 2009-10. This affords a unique opportunity for specialist registrars to exchange ideas about professional development and training and to make contacts with young internists from across Europe. Such links should prove useful for future RCP initiatives in European medicine.
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Despite a sustained and massive increase in spending with the NHS, the evidence that care has improved, other than in areas of performance that have been intensively managed or rewarded by additional cash bonuses, is poor to non-existent. This failure to achieve across-the-board improvement is attributable to the fact that the outcomes of healthcare are 'system properties' and are unlikely to improve as a result of more work being put through the same system, and instead will only improve if healthcare providers at all levels are actively encouraged to redesign the system to improve on current performance. ⋯ Examples are given from the centre-specific analyses published by the UK Renal Registry, a fully electronic registry that analyses data extracted direct from renal information technology systems used in each primary care trust that provides renal replacement therapy, and from other national and regional quality improvement programmes. The NHS has unrivalled opportunities to learn from high performance and to use this learning to narrow the gap between best and worst.