Clin Med
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A pilot of core medical training (CMT) was conducted in 2006-7 with 160 trainees and 130 supervisors in the 10 hospitals within the Mersey Deanery. Questionnaires and focus groups were used to gain feedback from trainees and supervisors in relation to the components of CMT (the curricula, workplace-based assessments, appraisal, and the e-portfolio). There was generally a positive attitude to the CMT package. ⋯ Many of the benefits of the components of CMT depended on the skill of the supervisor. The time required for effective training supervision and workplace-based assessments was identified as an important issue. This pilot was invaluable in informing the widespread implementation of CMT in 2007.
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This case represents latent autoimmune diabetes in the young (LADY), and demonstrates that autoimmune diabetes can be slowly progressive even in younger patients with insulin independency period lasting for more than two years.
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Polymyalgia rheumatica (PMR) was defined in 1957 and is linked with giant cell arteritis (GCA) in approximately 25% of cases. The peak incidence is between 60 and 75 years old and is increasing with the ageing population. Polymyalgia rheumatica is a clinical diagnosis without a 'gold standard' serological or histological test and there are other conditions that may mimic PMR. ⋯ The rate of reduction should be adjusted depending on the individual's response. Where temporal arteritis is suspected, this manifestation of GCA is a treatable medical emergency to prevent possible blindness, and steroids should be commenced immediately. There remain many unknowns in the cause, diagnosis and treatment of PMR and its overlap with GCA, and it is an ongoing challenge requiring further research.
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Postgraduate medical training presents many instances in which a junior doctor must decide whether it is appropriate to proceed without the advice, supervision or practical assistance of a senior. These decisions, vital to the development of any doctor, are commonly made in the context of providing medical treatment to acutely unwell patients or undertaking practical procedures. ⋯ The relevance of each of these factors is explored in the context of two scenarios. In this way a simple framework to assist junior doctors in considering the risks and benefits of their intended actions is presented.