Background: Limited research has investigated the specific needs of patients with advanced incurable cancer. The aim of this study was to describe the prevalence of perceived needs among this population. Methods: Medical specialists from two regions in New South Wales, Australia, identified patients with advanced, incurable cancer, who were estimated to have a life expectancy of <2 years and were not receiving formal palliative care. Of the 418 eligible patients, 246 (59%) consented to participate. Consenting patients completed the Needs Assessment for Advanced Cancer Patients questionnaire, which has demonstrable validity and reliability. Patients' perceived needs were assessed across the seven domains of the questionnaire: psychological, daily living, medical communication and information, symptom related, social, spiritual and financial needs. Results: Patients identified the greatest areas of need in relation to psychological and medical communication/information domains. Patients' specific needs were highest in dealing with a lack of energy and tiredness, coping with fears about the cancer spreading, and coping with frustration at not being able to do the things they used to do. Conclusion: This study indicates that patients with advanced, incurable cancer have high levels of unmet needs, especially in relation to the areas of psychological and medical communication/information needs. The data have the potential to guide the development of interventions aimed at meeting the current unmet needs of patients with advanced, incurable cancer.

This paper will argue that undergraduate medical courses are failing to provide students with adequate training in the area of clinical skills. Some of the reasons for this failure include changes in the health system leading to increasing commitments for clinicians, fewer patients as clinical case examples and limitations in current teaching methods. Current clinical teaching methods measure progress through completion of clinical "blocks" of learning and one-off clinical examinations. This paper offers an alternative approach to clinical teaching in undergraduate medicine. In this approach, each student's progress is measured through the attainment of a predetermined level of competency in dealing with a range of clinical conditions. Some of the benefits of a new approach to clinical teaching in undergraduate medicine include flexibility for both students and clinicians in terms of when and where clinical learning can occur, a significant emphasis on active learning, and increased generalization and integration of learning.

This paper reports on the development and piloting of a systematic review and meta analysis of research on the effectiveness of problem based learning (PBL). The systematic review protocol was pilot tested with a sample of studies cited as providing "evidence" about the effectiveness of PBL. From the 5 studies mentioned in the sample of reviews, 91 citations were identified, and 15 of these were adjudged to meet the review inclusion criteria. Of the 15, only 12 reported extractable data. All of these studies used PBL in higher education programs for health professional education. The review has established that the limited high quality evidence available from existing reviews does not provide robust evidence about the effectiveness of different kinds of PBL in different contexts with different student groups. It is apparent that there is scope for a systematic review of PBL that is specific in terms of the intervention being evaluated, comprehensive in terms of strategy used, and methodologically rigorous. One appendix contains the coding sheet used, and the other is a bibliography of reviewed papers. The second part of the paper is the review protocol. (Contains 1 figure, 10 tables, and 91 references.) (SLD) Reproductions supplied by EDRS are the best that can be made from the original document. PERMISSION TO REPRODUCE AND DISSEMINATE THIS MATERIAL HAS BEEN GRANTED BY M. Newman TO THE EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) 1 U.S. DEPARTMENT OF EDUCATION Office of Educational Research and Improvement EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) dThis document has been reproduced as received from the person or organization originating it. 0 Minor changes have been made to improve reproduction quality. Points of view or opinions stated in this document do not necessarily represent official OERI position or policy. A pilot systematic review and meta-analysis on the effectiveness of Problem Based Learning Mark Newman Middlesex University On behalf of the Campbell Collaboration Systematic Review Group on the effectiveness of Problem Based Learning MIDDLESEX UNIVERSITY BEST COPY AVAILABLE

BACKGROUND Debate abounds regarding the most appropriate candidates to admit to medical school. This paper examines whether there is any advantage to admitting 'graduate' entrants over secondary school leavers on selected medical school and practice outcomes.AIM To compare the medical school experiences, research and academic achievements and practice outcomes of graduates who entered 1 medical school in Australia directly from high school (secondary school entry) to those of graduates who entered with tertiary level education (tertiary entry).DESIGN AND METHODS Cross-sectional study using a mail-out survey to graduates from the first 16 graduating years (1983-98 inclusive) of the University of Newcastle Medical School.RESULTS Secondary school entrants were, on average, 8 years younger than tertiary entrants and were less likely to have received rural-based schooling. However, there were no differences with respect to gender or type of secondary school attended (public or private). Motivations for studying medicine did not generally differ according to entry type, except that more secondary students were motivated by parental expectations and more tertiary entrants were motivated by the need for professional independence and the desire to prevent disease. A greater proportion of tertiary entrants experienced stress at medical school. However, secondary students experienced more stress due to doubts about being a doctor, while tertiary entrants experienced more stress due to lack of leisure time, finances and balancing commitments. There were no significant differences between the groups in terms of academic performance (as measured by the award of medical school honours) or research outcomes (as measured by completion of a research degree during or after medical school training, publication of scientific papers or holding career posts in the research sciences). There were no differences in career positions held by clinicians, choice of general practice or another specialty as a career, practice location (rural or urban) or employment sector (public or private).CONCLUSION There is no clear advantage, at least on the outcomes measured in this study, to limiting medical school entry to either those candidates from secondary school or those with tertiary backgrounds. Medical schools could reasonably broaden their selection criteria to include more graduate entry candidates in addition to secondary school leavers without compromising medical school and practice outcomes.

Medical EducationVolume 38, Issue 9 p. 921-923 Responses to the pilot systematic review of problem-based learning Mark Newman, Mark NewmanSearch for more papers by this authorPiet Van den Bossche, Piet Van den BosscheSearch for more papers by this authorDavid Gijbels, David GijbelsSearch for more papers by this authorJean McKendree, Jean McKendreeSearch for more papers by this authorTony Roberts, Tony RobertsSearch for more papers by this authorIsobel Rolfe, Isobel RolfeSearch for more papers by this authorJohn Smucny, John SmucnySearch for more papers by this authorGiovanni De Virgilio, Giovanni De VirgilioSearch for more papers by this author(Campbell Collaboration Review Group on the Effectiveness of Problem-based Learning), (Campbell Collaboration Review Group on the Effectiveness of Problem-based Learning)Search for more papers by this author Mark Newman, Mark NewmanSearch for more papers by this authorPiet Van den Bossche, Piet Van den BosscheSearch for more papers by this authorDavid Gijbels, David GijbelsSearch for more papers by this authorJean McKendree, Jean McKendreeSearch for more papers by this authorTony Roberts, Tony RobertsSearch for more papers by this authorIsobel Rolfe, Isobel RolfeSearch for more papers by this authorJohn Smucny, John SmucnySearch for more papers by this authorGiovanni De Virgilio, Giovanni De VirgilioSearch for more papers by this author(Campbell Collaboration Review Group on the Effectiveness of Problem-based Learning), (Campbell Collaboration Review Group on the Effectiveness of Problem-based Learning)Search for more papers by this author First published: 24 August 2004 https://doi.org/10.1111/j.1365-2929.2004.01943.xCitations: 11 Mark Newman, Evidence for Policy and Practice Information and Coordinating Centre, Social Science Research Unit, Institute of Education, University of London, 18 Woburn Square, London, WC1H ONR, UK. Tel: 00 44 207 6126575; Fax: 00 44 207 6126400; E-mail: m.newman@ioe.ac.uk. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume38, Issue9September 2004Pages 921-923 RelatedInformation

Aim There are data to suggest that medical school may not adequately prepare doctors for practice and that there are deficiencies in undergraduate teaching of skills in history taking, physical examination, diagnosis and management (clinical skills). There is a need to re-evaluate methods by which we can teach clinical skills effectively. This aim of this review was to describe the literature concerning the important principles underpinning effective clinical learning. Subsequently a structured learning tool and teaching process was developed in order to support these principles.Method The principles of effective clinical learning were derived after a search of the medical education and relevant behavioural science literature. Consequently, a structured learning tool and teaching process was developed in order to potentiate the translation of these principles into practice for medical school training in clinical skills.Results Ten principles were derived from the 68 articles referred to in this review. These were: making active decisions, an individual focus to learning, gaining experience, feedback to the learner, reciprocal learning, holistic care, relevant learning, feasibility, cost efficiency and mentoring. A process for history taking, physical examination and management plan was developed for medical students which incorporated these principles.Conclusion Relevant literature can provide the foundations for teaching and learning methods in medical education. We plan to trial this method and evaluate the impact on student learning outcomes.

Aims This study examined the relationship between the performance of first year medical students at the University of Newcastle, Australia, and admission variables: previous educational experience, and entry classification (standard - academic or composite, Aboriginal and Torres Strait Islander, or overseas), age and gender.Methods Admission and demographic information was obtained for students who entered first year medicine at Newcastle between the years 1994 and 1997 inclusive. Academic performance was measured according to results of first assessment ('satisfactory' vs. 'not satisfactory') and the final assessment of the first year ('satisfactory' vs. 'not satisfactory'). Logistic regression was used to examine the relationship between predictor variables and outcomes.Results Assessment and admissions information was obtained for 278 students, 98% of all students who entered the medical course between 1994 and 1997. Regression analysis of first assessment indicated that Aboriginal and Torres Strait Islander and overseas students were significantly more likely to be 'not satisfactory' than all other students (RR = 3.1,95% CI: 1.4-6.7 and RR = 1.5, 95% CI: 1.2-1.8, respectively). Analysis of final assessment indicated these two student groups were also significantly more likely to be 'not satisfactory' than all other students (RR = 4.5, 95% CI: 1.4-13.5 and RR = 3.5, 95% CI: 1.2-10.8, respectively). At first assessment, students entering via the standard academic pathway and older students were less likely to be 'not satisfactory' (RR = 0.6, 95% CI: 0.5-0.7 and RR = 0.8, 95% CI: 0.7-0.9, respectively). However both these differences were not evident at final assessment. There were no significant relationships between performance in first year and the remaining variables.Conclusions Aboriginal and Torres Strait Islander, and overseas medical students had academic difficulties in the first year of the course, suggesting the need for extra course support. The result may reflect the educational and other obstacles these students must overcome in order to enter and progress through their medical degree. More research is warranted to explore the extent to which these differences persist throughout the medical degree.

AIM:The primary aim of the study was to compare the practice outcomes of doctors who graduated from a non-traditional, problem-based medical school (University of Newcastle) with those of graduates from a traditional programme (University of Sydney), matched randomly on the background characteristics of graduation year, age, gender, and rural primary and secondary school education. Our secondary aim was to differentiate admission from curricular influences by comparing the outcomes of Newcastle and Sydney graduates who entered medical school under similar admission criteria ('traditional academic' entry).DESIGN:Nested case-control analysis in a retrospective cohort study.METHODS:A validated mail-out survey was distributed to all Newcastle and Sydney graduates registered to practise in the state of New South Wales, Australia.OUTCOME MEASURES:Current main occupation (clinician or other), clinical career choice (family medicine and psychiatry or other specialties), practice location (urban or rural) and employment sector (public or private).RESULTS:A total of 513 Newcastle respondents (68% of the original, eligible Newcastle sample) were each matched randomly with a Sydney respondent according to the four background characteristics. Medical school background was not related to main occupation; over 90% of all graduates were employed in clinician positions. A greater proportion of Newcastle than Sydney graduates were either training or qualified in family medicine or psychiatry rather than in other specialties. The school of graduation was not related to practice environment; fewer than 20% of all graduates were working in rural locations and around 25% were employed in the public sector. There were no differences in outcome between Newcastle and Sydney graduates who had entered medical school under similar academic criteria.CONCLUSION:Our study suggests that initial selection procedures of medical school candidates with particular background characteristics and attributes may influence practice outcomes. Further research is required to confirm these findings.

OBJECTIVE:To examine the scope of intern prescribing practices by determining: the proportion of prescriptions that interns chart compared with other medical staff; the proportion of intern-charted prescriptions for which interns are sole decision-makers; whether or not intern-initiated prescribing varies with respect to the specialty to which they are attached, the shifts they are working and the types of charts they are using; the types of clinical conditions for which interns initiate prescribing decisions; and the drug classes that interns use for their self-initiated prescribing.DESIGN:Prospective study of a random sample of intern-charted prescriptions.SETTING:Two teaching hospitals of the Hunter Area Health Service, Newcastle, Australia. The study was conducted from the fifth to the eighth month of the intern training year.MAIN OUTCOME MEASURES:The proportion of prescriptions charted by interns that resulted from their own decision-making, the circumstances relating to this, clinical conditions for which they prescribe and drugs prescribed.RESULTS:A total of 17,895 prescriptions were examined--3437 (19%) were intern-charted. Interns reported they were the sole decision-makers for 19% (95% CI: 14 -24%) of prescriptions they had charted. Interns were more likely to initiate decisions in accident and emergency (OR=7.5, 95% CI: 2.2- 25.2) and obstetric and gynaecology (OR=2.3, 95% CI: 1.6 -3.2) rotations than in medicine and were more likely to initiate decisions on night (OR=7.3, 95% CI: 3.4- 15.5) and weekend (OR=1.7, 95% CI: 1.0 -3.2) shifts than during the day. They were also more likely to prescribe on the "as required" (OR=36.6, 95% CI: 20.6-65.0), "statim" (OR=26.1, 95% CI: 17.0- 40.1) and "intravenous" (OR=7.2, 95% CI: 4.3-12.3) charts compared with "regular" charts. A total of 52% of intern-initiated prescriptions were for symptom relief; pain, insomnia and nausea; and 75% of the drugs for which interns made independent decisions were analgesics, antithrombotic agents, psycholeptics, antispasmodics, laxatives and anti-asthmatic agents.CONCLUSION:Interns have a limited role with respect to independent prescribing and take the sole responsibility for only one-fifth of the prescriptions they chart. This limited, albeit safe, approach to prescribing may impact significantly on an intern's opportunity to acquire the skills necessary to become an independent, rational prescriber.

OBJECTIVES:To examine the self-reported influences on intern prescribing practice.DESIGN:Qualitative interviews with a cross-sectional cohort.PARTICIPANTS AND SETTING:Ten interns practising in two urban teaching hospitals in New South Wales, Australia.RESULTS:The interns identified a number of factors that improve their confidence and perceived competence and allow them to extend their existing skills. These were approachable, available and up-to-date teachers (most often registrars and subspecialty nurses and pharmacists); timely, relevant and practical teaching (such as interactive bedside teaching); concise and widely accepted resources (such as prescribing pocket guides); and a constructive manner on the part of senior staff for dealing with prescribing errors. Interns also identified influences that are detrimental to confidence, conflict with their perceptions of appropriate prescribing and inhibit learning and skills acquisition. These were unapproachable, physically and mentally remote teachers (most often consultants); theoretical, inconsistent and irrelevant teaching (such as grand rounds or didactic education sessions); inconsistent and inaccessible resources; and a confrontational and accusatory way of dealing with prescribing errors. The added pressures of time, hospital hierarchies and the indirect influence of drug company promotion also impeded acquisition of good prescribing habits.CONCLUSIONS:At a critical time in skills development, interns encounter many forces that can potentially impact on prescribing practices in both positive and negative ways. Our data contribute to the understanding of the multifaceted learning environment of interns and may be useful in providing a foundation for prescriber education programmes tailored to the specific needs of junior doctors.

AIM:To describe and evaluate the effectiveness of a new method of teaching clinical skills designed to increase students' active and self-directed learning as well as tutor feedback.METHODS:A total of 22 consenting Year 4 medical students undertaking general practice and general surgery clinical experience were involved in a pre- and post-test research design. In the initial period of the study, students were taught clinical skills in a traditional manner. In the second phase a clinical teaching strategy called systematic clinical appraisal and learning (SCAL) was utilised. This learning strategy involved active and self-directed learning, holistic care and immediate feedback. Students independently saw a patient and were asked to make judgements about the patient's potential diagnosis, tests required, management, psychosocial needs, preventive health requirements, and any ethical problems. These judgements were then compared with those of the clinical supervisor, who saw the same patient independently. Students recorded details for each consultation. Comparisons were made of the two study periods to examine whether the use of SCAL increased the number of students' independent judgements, perceived student learning, tutor feedback and self-directed learning.RESULTS:During the SCAL learning period, students reported making a greater number of statistically significant independent judgements, and receiving significantly increased tutor feedback in both general practice and general surgery. The number of learning goals set by students was not found to differ between the two periods in surgery but significantly increased in general practice in the SCAL period. Students' perceptions of their learning significantly increased in the SCAL period in surgery but not in general practice. During the traditional learning period in both settings, there was limited student decision-making about most aspects of care, but particularly those relating to prevention, psychosocial issues and ethics.CONCLUSIONS:The SCAL approach appears to offer some advantages over traditional clinical skills teaching. It appears to encourage active and independent decision-making, and to increase tutor feedback. Further exploration of the approach appears warranted.

The objectives of the study were to report the development of a core curriculum that details the clinical conditions medical students should be able to manage upon graduation; and to canvass the opinion of interns (first-year postgraduate doctors) regarding their perceptions of the level of skill required to manage each condition. Literature relating to core curriculum development and training of junior medical officers was reviewed and stakeholders in the education and training of medical students and junior doctors in the state of New South Wales, Australia (intern supervisors, academics, registrars, nurses and interns) were consulted. The final curriculum spanned 106 conditions, 77 'differentiated' and 29 'undifferentiated'. Four levels of skill at which conditions should potentially be managed were also identified: 'Theoretical knowledge only'; 'Recognize symptoms and signs without supervision'; Initiate preliminary investigations, management and/or treatment without supervision'; and 'Total investigation, management and/or treatment without supervision'. The list of conditions in the curriculum was converted to a survey format and a one-in-two random sample of interns (n = 193) practising in New South Wales who graduated from the state's three medical schools were surveyed regarding the level of skill required for managing each clinical condition at graduation. A total of 51.3% of interns responded to the survey. Interns felt they should be able to initiate preliminary investigation, management and/or treatment for most conditions in the curriculum, with more than half acknowledging this level of management for 53 of the differentiated and 28 of the undifferentiated conditions. It is concluded that developing core curricula in medical education can involve multiple stakeholders, including junior doctors as the consumers of educational experiences. The data gathered may be useful to medical schools revising their curricula.

AIM:The purpose of this study was to identify the relationship between previous tertiary education background and the performance of first year medical students at Newcastle University, Australia. Specifically, we examined degree type (i.e. arts, science, allied health, nursing or other professional backgrounds), level of degree completion (fully or partially completed ), academic achievement ( grade point average) and whether or not students had postgraduate qualifications. The relationship between age and gender was also examined.METHOD:All students admitted to the medical course from 1990 to 1998 with previous tertiary education experience who entered via the "standard" entry pathway and sat the end of year examinations were eligible for the study (N=303). The outcome measures were the results of first assessment ("satisfactory" versus "not satisfactory") and final assessment of the first year ("satisfactory" versus "not satisfactory"). Logistic regression was used to examine the relationship between predictor variables and outcomes.RESULTS:In relation to first assessment results, students with a nursing and arts background were significantly more likely to receive a "not satisfactory" assessment (RR=3.9, 95% CI: 1.6- 7.7; RR=2.9, 95% CI: 1.2-6.8, respectively), as were females (RR=1.8, 95% CI: 1.1-3.5) and students with a grade point average of less than a distinction average (RR=2.8, 95% CI: 1.6-5.2). At final assessment, students with a nursing background and those with a less than distinction average were more likely to receive a "not satisfactory" result (RR=20.7, 95% CI: 3.5-123.9 and RR=4.0, 95% CI: 1.2-13.9, respectively); consequently, they were required to repeat first year.CONCLUSION:Our research suggests that there are some medical student groups who encounter more academic difficulties than others in first year. Identifying these students can assist medical schools to focus academic support appropriately.

OBJECTIVES:To survey interns regarding their opinion of medical school learning needs for a range of core skills.METHODS:A random sample of interns practising in New South Wales, Australia, who graduated from the state's three medical schools were surveyed two-thirds of the way through their first hospital year. They were asked whether there was a need for further medical school education for each of 226 core skills. Skills were grouped into five themes: management of clinical conditions; clinical investigations; clinical procedures; core practice; and professional development.RESULTS:Frequency distributions weighted for age, gender and medical school background were calculated for each item. The 20 most frequently identified needs related to examinations of the eye and ear, nose and throat; managing uncooperative patients and difficult patient interactions; prescribing; writing not for resuscitation orders and death certificates. Also included were procedural needs related to ear, nose and throat; plastering and wound management; and needs for more education in the management of clinical conditions related predominantly to "acute" cases such as anaphylaxis and diabetic ketoacidosis.CONCLUSION:Interns were able to discriminate between their needs for different skills and identified many core skills for which they perceived there was a need for more medical school education. The implications for medical education are discussed.

AIM:To assess whether there is any advantage to be gained with respect to performance in the first year of postgraduate medical training (internship) by selecting medical school candidates with different educational backgrounds. Specifically, we were interested in comparing the performance ratings of interns who entered medical school with secondary (directly from high school) or tertiary (at least one year of a university degree) level educational backgrounds.FOCUS:We compared the performance ratings of interns according to the subjects or degree undertaken at a secondary or tertiary level, respectively. The effects of age and gender were also examined to determine their influence on performance ratings.METHOD:All graduates (N=235) from the University of Newcastle Medical School, Australia who commenced their intern year in the state of New South Wales from 1993 to 1996 inclusive were eligible for the study. The outcome measure was a score derived from a valid and reliable clinical supervisor rating scale. Independent variables were level of previous educational experience (secondary or tertiary entry), and subjects studied by secondary level entrants (predominantly science or equal proportions of humanities and science) and degree undertaken by tertiary level entrants (arts or science or allied health or nursing).RESULTS:The records of 173 (73% of eligible sample) were included in the analyses. There were no significant differences between the mean ratings of interns with respect to previous educational background, subjects studied at secondary school or degree undertaken. Age and gender did not significantly affect performance ratings.

CONTEXT:Research on the factors affecting progress in medical schools has typically focused on mainstream (non-Indigenous Australian, non-international) students in traditional, didactic programmes. These results may not be applicable to students, particularly those from culturally diverse backgrounds, undertaking problem-based learning courses. OBJECTIVE:This study used qualitative methodology to explore and compare factors affecting progress for mainstream Australian students (non-Indigenous Australian, non-international) and international students (full fee-paying students who had relocated countries to study) in a problem-based learning medical course. Intervention strategies were devised on the basis of the participants' experiences. METHODS:Six focus group discussions were conducted (three with mainstream Australian and three with international participants). Transcripts of these discussions were coded and analysed independently by two researchers and discussed until consensus was attained. RESULTS:Participants identified both positive and negative experiences related to the course structure, which were consistent with previous findings. The participants' experiences demonstrated a relationship between sense of 'belongingness' to the medical school community, participation in learning opportunities and progress through the course. CONCLUSIONS:The results suggest that interventions aimed at reducing barriers to progress need to promote students' confidence, motivation and subsequent participation in course learning opportunities. These results have application to other problem-based learning courses particularly those which face the challenge of providing an optimal learning environment for students from diverse backgrounds.

To examine the ability of interns to prescribe appropriatelyfor common clinical conditions at the commencement and completion of theintern year. Interns' perceptions of their ability to prescribe and theperceived influences on their practices were also assessed.The study was conducted at a teaching hospital in urban NewSouth Wales, Australia. A self-complete questionnaire was administered to56 interns at the beginning and end of internship. At the beginning of theyear respondents were asked to identify how equipped they felt they wereto perform specific functions related to prescribing practice. Interns werealso asked to write hospital prescriptions for four common clinical casesscenarios: post-operative pain, urinary tract infection, asthma, andcommunity-acquired pneumonia. At the end of the year interns were askedto prescribe for the same clinical scenarios and also asked to identify themain influences on their practice.At the beginning of the year 54% of interns felt equipped tochoose an appropriate drug for common clinical conditions, however, fewfelt they were able to determine the appropriate dose (23% of respondents)or dose frequency (25%).A previously validated four-point rating scale was used by two assessorsto judge appropriateness of prescribing [Kappa = 0.6]. At the beginning ofthe year at least two-thirds of interns were prescribing `inappropriately'for all clinical conditions. By the end of the year 75% were prescribing`appropriately' for all conditions.The main perceived influences on prescribing practices were registrars,consultants, books and pharmacists.The use of hypothetical clinical cases to exploreprescribing ability has shown that doctors are ill-equipped to performvarious aspects of prescribing on graduating from medical school. Althoughour findings may not translate into practice directly they highlight theexistence of a potential problem that warrants further study, especially inthe areas of actual practice and the influences on it in the earlypostgraduate years.

Considerable debate has occurred about educational processes within undergraduate courses for healthcare professionals. Less attention appears to have been directed to issues of curriculum content.This paper examines the potential influence of curriculum content on a number of outcomes, and examines the methods that can be used determine curriculum content. The balance between different content areas in a curriculum has the potential to affect allocation of human resources, research capacity and output, and hence the power base of discipline groups. Changes to the balance of content will therefore be sensitive, and threatening to some groups. While the optimal way to determine curriculum content would be on the basis of evidence from experimental studies, such studies have not been conducted. Opinion-based approaches have been commonly used. While such processes demonstrate increasing commitment to determining content that is most relevant to producing good clinicians, the results depend on the stakeholders involved. Despite the considerable difficulties in conducting rigorous research concerning curriculum content, there is a need to develop a research agenda in this area.