Postgraduate Medical Journal

EDITORB.I. Hoffbrand, London

EDITORIAL BOARD

P.J. Barnes, LondonG.F. Batstone, SalisburyC. Coles, SouthamptonG.C. Cook, LondonA.H. Crisp, London

P.N. Durrington, ManchesterJ.C. Gingell, Bristol

T.E.J. Healy, ManchesterG.R.V. Hughes, London

D. Ingram, LondonP.G.E. Kennedy, GlasgowK.T. Khaw, Cambridge

L. Kreel, LondonJ.G. Lewis, Edgware

J.S. Malpas, LondonR.I. McCallum, Edinburgh

P.J.A. Moult, LondonM.W.N. Nicholls, London

N.T.J. O'Connor, ShrewsburyR.E. Pounder, London

M.C. Sheppard, BirminghamD.R.J. Singer, LondonI. Taylor, Southampton

P. Turner, LondonJ.A. Vale, BirminghamP.D. Welsby, EdinburghW.F. Whimster, London

National Association of Clinical Tutors RepresentativesI.J.T. Davies, Inverness R.D. Abernethy, Barnstaple

International Editorial RepresentativesG.J. Schapel, AustraliaP. Tugwell, Canada

J.W.F. Elte, The NetherlandsE.S. Mayer, USAF.F. Fenech, MaltaB.M. Hegde, India

C.S. Cockram, Hong Kong

Editorial AssistantMrs J.M. Coops

Volume 67, Number 793November 1991

The Postgraduate Medical Journal is publishedmonthly on behalf of the Fellowship ofPostgraduate Medicine by the Scientific &Medical Division, Macmillan Press Ltd.

Postgraduate Medical Journal publishes originalpapers on subjects ofcurrent clinicalimportance. Each issue contains commissionedreview and leading articles but unsolicitedsubmissions are also welcome. Each issue alsoincludes 'Letters to the Editor', book reviewsand an international postgraduate diary. Manyissues contain papers or abstracts of symposiadevoted to a single subject, and the fullproceedings ofmeetings are published assupplements to the Journal. The Journal, as theorgan of the Fellowship ofPostgraduateMedicine, is dedicated to advancing theunderstanding and practice ofpostgraduatemedical education and training.

The Fellowship of Postgraduate Medicine wasfounded after the First World War and was apioneer in the United Kingdom in the develop-ment ofprogrammes ofpostgraduate study inall branches ofmedicine (see PostgradMedJ 61,1). It always has been, and remains, independentof University, Health Service and Government.Currently the Fellowship works closely with theNational Association of Clinical Tutors infurthering mutual aims. Amongst otheractivities, the Fellowship provides researchgrants and support for young investigatorsespecially those working temporarily in the UK.

Further details of the Fellowship ofPostgraduate Medicine can be obtained fromThe Executive Secretary, The Fellowship ofPostgraduate Medicine, 6 St Andrew's Place,London NW1 4LB.

The Journal is covered by Current Contents,Biological Abstracts, ASCA, ISI/BIOMED,Index Medicus, Excerpta Medica and ScienceCitation Index.

1991 The Fellowship of PostgraduateMedicineISSN 0032-5473

Manuscripts and all editorial correspondence,including books for review should be sent to:

The Editor, Postgraduate Medical Journal,6 St Andrew's Place, London NWl 4LB, UK.Tel: 071-935 5556, Fax: 071-224 3219.A 'Notice to Contributors' is usually publishedon the inside back cover ofeach issue. The Editorreserves the right to make changes which mayclarify or condense papers where this isconsidered desirable.

All business correspondence, and reprint requestsshould be addressed to the Scientific & MedicalDivision, Macmillan Press Ltd, Houndmills,Basingstoke, Hampshire RG21 2XS.Telephone: (0256) 29242; Fax: (0256) 810526

Subscription price per volume of twelve issuesEEC £120.00; Rest of the World £130.00 orequivalent in any other currency. Orders mustbe accompanied by remittance. Cheques shouldbe made payable to Macmillan Press, and sentto: the Subscription Department, MacmillanPress Ltd, Brunel Road, Houndmills,Basingstoke, Hampshire RG21 2XS, UK.Where appropriate, subscribers may makepayments into UK Post Office Giro AccountNo. 519 2455. Full details must accompanypayments.

Enquiries concerning advertising space or ratesshould be addressed to: Michael Rowley,Advertisement Manager, Macmillan Press Ltd,4 Little Essex Street, London WC2R 3LF.Telephone: 071 836 6633; Fax: 071 379 4204.

All rights of reproduction are reserved in respectof all papers, articles, illustrations, etc.published in this journal in all countries of theworld.

Authorization to photocopy items for internalor personal use, or the internal or personal useof specific clients, is granted by The Fellowshipof Postgraduate Medicine for libraries and otherusers registered with the Copyright ClearanceCenter (CCC) Transactional Reporting Service,provided that the base fee of $3.50 per copy ispaid directly to CCC, 21 Congress St., Salem,MA 01970, USA. 0032-5473/91 $3.50 + $0.00

Typeset by Elite Typesetting Techniques,Southampton

Printed in Great Britain by Latimer Trend

Whilst every effort is made b the ublishers and editorial board to see that no inaccurate or niisleading data, opinion or statement appears in this Journal,they wish to make it clear t at the data and opinions appearing in the articles and advertisements herein are the responsibility of the contributor oradvertiser concerned. Accordingly, the publishers and The Fellowship, the editorial committee and their respective employees officers and agents acceptno liability whatsoever for the consequences of any such inaccurate or misleading data, opinion or statement. Whilst every eNort is made to ensure thatdrug doses and other quantities are presented accurately, readers are advised that new methods and techniques involving drug usage, and described withinthis Journal, should only be followed in conjunction with the drug manufacturer's own published literature.

d J1 The Fellowship of Postgraduate Medicine, 1991

Conference Report

National Association of Clinical Tutors - SummerMeeting 1991

The National Association of Clinical Tutors' (NACT)Summer Meeting took place in Jersey on Friday andSaturday, 9th & 10th May, 1991. There was an excellentattendance - over 85 tutors attended from England,Scotland, Wales, Northern Ireland and Jersey. The themefor the meeting was 'Educational Contracts' and howthey should be written, implemented and then how toassess the clinical performance.

After a pleasant introduction to Jersey and its healthscenario by Dr Harvey Besterman, the clinical tutor inJersey, the conference got down to business with theChairman, Michael Pagliero, introducing new conceptsof educational contracts.Mr Michael Roberts, Postgraduate Dean for the South

Western Region, gave the Dean's view, in which heemphasized that 1991 was a learning year and that no oneappeared to have read 'Working for Patients'.' Thebudgets for 1991 were based on last year's estimates andin his opinion were a recipe for disaster. His Region wasestablishing a contract for one year only- the unit in theDistrict or Hospital would be responsible for providingpostgraduate education and any shortfall would be metby that Unit. One of the more sensitive areas which needsthorough exploration is the question of study leave - whois taking study leave and more importantly, who is nottaking study leave.Dr Gifford Batstone, the immediate past Chairman of

NACT, gave the clinical tutors' viewpoint. He saw thePostgraduate Dean entering into 'a contract' with the unitgeneral manager and then both combining with theclinical tutor to enter into a business plan to providepostgraduate education for the Unit. The business planwould be proactive, involving the District EducationCommittee and the consultant body and would look atthe current task and desired state of postgraduate educa-tion and from there evolve a strategy. It was mostimportant that there should be a 'mission statement', inother words, a purpose outlining aims and objectives.Locations such as postgraduate centres, general practicesurgeries and libraries should be looked at and currentactivities re-examined and where necessary new develop-ments made, for example in career counselling andmedical audit. Dr Julian Turner, an Educational TrainingCourse Organizer, concentrated on the training contractmade between the consultant trainer and his juniorhospital doctor trainee. He thought it essential thatconsultant trainers are paid for their teaching time sincethis can help to reinforce accountability. There seemed tobe five relevant criteria which would be used in approvingconsultant trainers and what he considered vital in thedevelopment of any system: the trainer should demon-strate enthusiasm, should undergo a prior trainingcourse, should provide 'protected' time for teaching,should demonstrate that he has assessed his trainee andthat the trainee has assessed him on a regular basis, andfinally the trainer should have supportive colleagues.

Subsequently members formed a number of smallgroups to deliberate on specific topics. One group,

considering the question 'What contractual obligationshas a consultant to teach?' were of the opinion thatinvestment in medical training does not provide imme-diate returns but that consultant teaching does develop alearning ethos in the unit and by introducing medicalaudit, trainers could assess trainees and trainees assess theconsultants.The question 'Should clinical tutor's sessional time be

over and above his contractual clinical duties or should itdisplace some of these clinical duties?' produced a fiercegroup discussion which overflowed into the plenarysession - a vote was taken showing that 20% of all themembers present would be prepared to give up clinicalduties. This was a significantly higher percentage thanwhen the matter was raised 4 years ago at a NACT WinterMeeting.Another group topic was 'What can deans expect of

clinical tutors?' These deliberations showed a wide rangeof activity - career counselling, implementing Collegerecommendations, representation at inspection, assessingthe amount and quality of education, monitoring studyleave, updating audit, general practice education andensuring up-to-date education of College tutors.Another group considered the educational needs of

Senior House Officers (SHO) and felt that the consultantand SHO should meet early and regularly, enquiring ofcareer intentions and expectation of Juniors. Thereshould be ongoing assessment, monitoring of perfor-mance and aptitude and most importantly there should befeedback and a checklist should be kept.On a slightly different task another group was asked

'Should all consultants be required to train?' Somethought that there should be one consultant in a depart-ment who would be the 'teacher' and opinions wereexpressed that consultants should be seconded to exper-ienced general practice trainers for a period of training,and that if consultants were found to be not teaching theyshould be threatened with having the accreditation oftheir SHO jobs withdrawn.At the end ofthe plenary session, the Dean summed up,

reiterating that it was essential to take managers with uson postgraduate education and that there should be aregular chain of command.Dr Jennifer King, a psychologist, introduced the

afternoon session which was entitled 'Educational Con-tracts: How do we implement and monitor them?' Herintroduction was brief and stimulating and set the scenefor the next speaker, Professor Tom Hayes, University ofWales College of Medicine and Postgraduate Dean forWales, who spoke on the assessment of clinical perfor-mance. He gave a brief overview of all the possiblemethods of assessing the professional performance ofdoctors in training. He looked at the purposes ofassessment, stressing the need to provide feedback to thejunior doctor as an essential part of career guidance.He outlined the competencies which we could use in

performance appraisal and the methods of assessingclinical skills. Many of the terms he used, although wellknown to the general practitioners in the audience werevery new to consultant tutors, e.g. OSCE, MEQ's, greycases and PMP's etc. This led on to the selection ofappropriate assessment methods and he underlined the

Postgrad Med J (1991) 67, 1025 1026

1026 CONFERENCE REPORT

importance of the assessment being formative and notsummative.He was followed by Dr Michael Ruscoe, a General

Practitioner Clinical Tutor and Course Organizer inCornwall, whose subject was SHO training. He outlinedthe system of training for general practice, which isstructured and evaluated, staffed by trained and accoun-table teachers and underpinned by sound educationaltheory, and challenged hospital doctors to show that theyhave the same. He looked at what is required in order toput SHO education on a professional basis and thoughtthat the question could be answered on two broad fronts,educational and managerial. He pointed out that one ofthe prerequisites of successful education is assessmentand that, once a doctor's educational needs have beenestablished, a teaching programme can be devised.

If General Practitioner Vocational Training has been asuccess, he believed that this is for two reasons - the GPteachers are trained and they are paid. To his knowledge,no consultants are actually paid to teach. He envisagedsome consultants being identified as being keen to becomeprofessional teachers, attending training courses and,when trained, entering into contracts under which theywould agree to devote, for example, one session eachweek to the education of one or more (probably three orfour) junior doctors. He was quite sure that we cannotallow the present chaotic and unstructured system oftraining the next generation of doctors, to continue.

This was revolutionary stuff - not everyone agreed -but it led into the next session of small group work wherethe groups discussed various problems pertaining to theSHO, his training, his assessment, and importantly, hiscounselling.

After the group work, Dr Gifford Batstone gave adissertation on 'Coercion'. His theme was that ifwe usedcoercion we admit defeat and he was very much againstusing draconian measures but in favour of establishing an

ethos of education within the department and hospital.Some ofthe new educational targets were threatening andhe would attempt to defuse this by involving districtcounsellors anticipating problems, motivating traineesand consultants and educating doctors to the manage-ment of change.The next morning we discussed 'Women in Medicine',

in small groups followed by a short plenary session. It wassad - and disturbing - to see how difficult it was, amongthe tutors, to break down the prejudice against womenholding part-time consultant posts gained in part-timetraining. The old argument of continuity of care was putforward, but this was firmly dismissed by the moreenlightened who pointed out that what is important isconscientious care. Many speakers voiced the opinionthat the three main reasons for failure were lack offunding, inflexibility and the view held by many consul-tants that those who had trained part-time had got in bythe back door! This was followed by a talk given by Dr J.Lewis on 'The German Occupation of Jersey'. This wasfascinating as was the guided tour of the GermanUnderground Hospital which followed.

It was a new departure for the Conference to look veryhard at education and educational methods. The groupswere about the right size and put in a lot of hard work toachieve aims and objectives. It was a far cry from theusual meeting with the same lectures with the dark blueslides and it meant that everyone was involved andhopefully should have got something from the Con-ference.

Well done, Mike Pagliero!

R.D. AbernethyClinical Tutor,

North Devon Medical Centre,North Devon District Hospital,

Barnstaple EX31 4JB.

Reference

Workingfor Patients. The Secretaries of State for Health, Wales,Northern Ireland and Scotland. HMSO, London, 1989.

P1 The Fellowship of Postgraduate Medicine, 1991

Postgraduate News and Views

Continuing medical education for general practi-tioners - MP's flying circus,Michael Pagliero, F.R.C.S.Chairman of the National Association of Clinical Tutors,writes:

Unlike his metropolitan colleagues, the rural generalpractitioner (GP) is not spoilt for choice when it comes toeducational activity and must rely heavily on his post-graduate centre. Even that however may be difficult forthe distances involved can often be an obstacle for themore remote practices. For many, the Thursday lunch-time lecture, what with driving time and the oftendaunting task of finding a parking space, can mean a 3hour round trip which is far too large a chunk out of theclinical day. Distance learning packages andjournals mayof course be a part solution, but in East Devon we haveadopted the 'Mohammed' principle that if the GP cannotcome to the postgraduate centre, then the postgraduatecentre must come to the GP. As clinical tutor I arrangemonthly meetings in peripheral parts ofthe district duringthe winter months which are proving very popular. Dueto the fortuitous initials of the author, the process hascome to be affectionately known as 'MP's Flying Circus'.The GPs come from 4 small communities to the east of

Exeter enclosed by the Exe Estuary and the River Sid,namely Exmouth, Budleigh Salterton, Woodbury andSidmouth. Each year a 'chairman' is appointed by hiscolleagues who is generally one of those who failed toattend the final meeting of the previous year. His task istwo fold - firstly to consult his colleagues for a list of'experts' whom they would like to meet to pick theirbrains and, secondly, to be the one who attends eachmeeting to propose a vote of thanks to the guest and thesponsoring pharmaceutical representative. The rest is upto the clinical tutor and centre administrator.

'Experts', usually consultants, are approached with alist of dates and the programme slowly grows. A flurry ofcorrespondence between the centres, consultants, caterersand 'drug reps' develops into a smart programme in aneye catching colour, large enough to be 'blue tacked' tothe surgery notice board and be seen, yet small enough tofold into the average GPs wallet.Equipment is not often needed, but the postgraduate

centre does keep for the purpose a mobile and easilytransportable slide projector, overhead projector, projec-tion screen and flip chart over and above the centres'static' equipment. We do not allow 'static' equipment tobe moved - nothing would be more frustrating than todiscover just before a meeting in the postgraduate centrethat the necessary audio-visual equipment is in the boot ofsomeone's car miles away! The mobile equpiment hasproved very useful on many occasions.The time and place for the meetings must rely on the

preferences of the group. The time of 7.30 pm has provedfairly acceptable to allow evening surgeries to be com-pleted. By starting the evening with refreshments, we havehelped those whose surgeries overrun. They will not miss,therefore, any pearls ofwisdom, but merely have to resortto the well practised habit, learnt by necessity as medical

students, of bolting their food. No one day of the week isuniversally suitable and consequently we rotate the dayfrom Monday through to Thursday to give everybody anequal opportunity to attend. The venue needs to be warm,quiet and convivial with a centre location and easyparking. We have found the East Devon GolfClub Houseto be an ideal place - the last 4 ball having groped its wayoff the 18th green in the gloom some 3 hours previously.The golf club caterers are only too anxious to have sometrade at this lean time of the year. The comfortable chairsgathered around the log fire provide the perfect setting.The meal is essential, we believe, with colleagues

gathered around the table promoting a camaraderieessential for the success of these meetings. Several of theparticipants come straight from their surgeries in any caseand would undoubtedly be discouraged if there were norefreshment available. We are not short of sponsorship -each autumn my secretary is inundated with requestsfrom representatives who are only too pleased to havesuch a captive audience to discuss their products and areeven more delighted to host the dinner at golf club priceswhich are considerably cheaper than would be found inthe high street.

After supper the format is extremely relaxed, keepingaway from the didactic lecture. In fact the 'expert' ispositively asked to come unprepared or at least to beprepared for anything. He is shown to his chair with a cupof coffee or preferred alternative and when comfortablyseated, questions flow. There is little need to have achairman except to call a halt at an appropriate time,usually considerably longer than the prescribed I hour. Itis up to the audience to keep the 'victim' to the point andup to the 'victim', who undoubtedly will have one or twothings he or she wishes to get across, to ease the discussionaccordingly.Most importantly, however, is whether this process is

of educational value. Does it adhere to good educationalprinciples? George Brown urges us to reflect on oureducational programmes and introduced a useful mne-monic for those who share my poor memory and wish tolook at education critically - 'SONAR'.' This refers to the5 ideal educational attributes namely Safety, Objectivity,Needs, Activity and Relevance.

Certainly these meetings are Safe. A small group offamiliar colleagues gathered around the fire is about asunthreatening and SAFE as one could ever wish toachieve. The sessions tend to be more OBJECTIVE thanthe lecture where the speaker calls the tune. The objectiveis to update knowledge which implies a starting point andan end point. The end point is defined by the specialist,but the starting point can only be defined by the generalpractitioner. What lies between is the curriculum. TheNEEDS of the Practitioners are well satisfied. Theydecide at the outset what subjects they wish to discussduring the term and which specialist they would like tojoin them. The sessions are certainly ACTIVIST as thereis always plenty of free exchange ofideas and opinions. Atsuch an informal gathering nobody is too selfconscious tojoin in. Finally RELEVANCE is assured by the veryquestions that the general practitioners choose to ask.There is very little educational time wasted in thesesessions.

Postgrad Med J (1991) 67, 1031 1032

1032 POSTGRADUATE NEWS AND VIEWS

But enough of theory, what do the customers think?The group is made up of about 35 GPs plus a couple ofvocational trainees. Bearing in mind that 5 are 'on duty',the average attendance has been 15 (50%). These figuresspeak for themselves. The popularity has spread and wenow receive requests from neighbouring practices to joinin. However, this has had to be carefully watched just incase the group becomes too big making it less 'Activist'and possibly less 'Safe'. The creation ofadditional groupsmight be preferable to the formation of larger groups. Ithink the present numbers are about right and similarsized educational groups have been formed in the adja-cent countryside.

Finally with the advent of the postgraduate education-al allowance I have had to ask whether my 'customers'would wish me to seek educational approval which itwould certainly justify based on the criteria produced bythe South West General Practitioner Committee. Theanswer from the group and adjacent groups was aunanimous NO - the fuss of collecting the money, payingthe speaker, filling in attendance registers, etc wasjust not

considered worth the bother. Each group felt that theywould come whether or not it had approval. Indeed, I donot perceive the need to induce GPs to engage incontinuing medical education on my patch! By the sametoken, speakers need no encouragement. We offer no feefor the privilege of meeting with and speaking to theircommunity colleagues. It should be pleasure itself andmore so should the assembly show its appreciation in thecustomary tangible and usually liquid form!

I commend this process to clinical tutors and GPs alike,but make no claim to its conception. I was introduced tothe idea by the Totnes Practice that lies in the SouthDevon District in which I am on the staff but not clinicaltutor. They invite Torbay consultants in rotation to theirmonthly dinner plus 'inquisition'. My time seems to comeup about every 5 years. Its serious intent was demon-strated to me on my second visit when I responded to aquestion from a senior practitioner about the indicationsfor the repair of a hiatus hernia. When I finished helooked me straight in the eye and said 'Mike - that's notwhat you said last time!'

Reference

1. Brown, G. & Atkins, M. Effective Teaching in Higher Educa-tion. Methuen, London, 1988.

Postgrad Med J (1991) 67, 1033- 1034 D The Fellowship of Postgraduate Medicine, 1991

Book Reviews

Clinical Autonomic Research, Vol 1, March 1991, Editor-in-Chief C.J. Mathias. Pp. 100, illustrated. OfficialJournal of the Clinical Autonomic Research Society.Rapid Communications, Oxford.

Clinical Autonomic Research is a new international Jour-nal, the first volume ofwhich appeared in March 1991. ItsEditor-in-Chief is Dr C.J. Mathias of St Mary's Hospital,assisted by an eminent and lengthy Editorial Board. Thepurpose of the Journal is to cover 'the different aspectsconcerning function of the autonomic nervous system inboth normal and diseased man'. Its range is thereforewide since it covers neurology, cardiology, physiology,pharmacology as well as interdisciplinary studies. Thefirst issue aptly reflects the specific aims of the Journal inthat it contains a number of original articles describingresearch in both humans and experimental animals.There is a strong cardiovascular input but also someinteresting neurology. The March issue also has a numberof succinct short Meeting reports as well as Proceedingsand Abstracts of the recent Autonomic Research SocietyMeeting in London. I found the Short Reports partic-ulary useful and I believe that the combination of originalarticles, reviews, meeting reports and Proceedings is onethat will prove attractive to readers. The Journal is wellillustrated and the standard of presentation generallyhigh. I think this is going to prove to be a very usefuladdition to the current literature on the autonomicnervous system and it should be taken by all good medicallibraries.

Professor P.G.E. KennedyInstitute of Neurological Sciences,

Southern General Hospital,Glasgow G51 4TF.

Liberating Medicine, David Seedhouse. Pp. xxi + 160.John Wiley & Sons, Chichester, New York, Brisbane,Toronto, Singapore, 1991. Paperback £11.95.

David Seedhouse's book is an essay on uncertainty:uncertainty in scientific knowledge, technical com-petence, communication, ethics. While a great deal ofmedical science is as close to certainty as anything can be,much is not and its application is still more uncertain.This simple message is not novel but the author'spresentations and subsequent argument certainly are.They make the book an attractive introduction to concep-tual problems in medicine for undergraduates and post-graduates alike. After exploring uncertainty in the consul-ting room and in underlying concepts ofnormality, healthand disease the core of the book discusses a practicalmodel - the rings of uncertainty - that aims to enhancedoctors' understanding of their role and of medicine'spurpose. He concludes with an account of 'the reasonabledoctor' and some of the most helpful insights into theoften sterile territory of inter-professional relationships.

Opportunities for discussion are offered throughoutand as an intensely practical introduction to medicalethics for student groups can scarcely be bettered. It isequally stimulating to the individual reader. Indeed theonly improvement I can suggest for the next edition is ashort annotated bibliography covering the main themes,such as 'health' and 'autonomy'. If you want to thinkabout medicine, go and buy it. You too may find itliberating. Strongly recommended.

J. SaundersNeville Hall Hospital,

Abergavenny,Gwent NP7 7EG.

Books Received

Atlas en Couleurs de Chirurgie Digestive, vols 1 & 2.Translated into French by Professeur M Guntz. Pp. 896,illustrated. Piccin Nuova Libraria S p A, Padua, 1991.Hardback, 1585F.

Behavior and Medicine, Danny Wedding. Pp. xix + 522,illustrated. Mosby Year Book, St Louis, London,Sydney, Toronto, 1991. Paperback, £25.00.

Drug Discovery - a Casebook and Analysis, Robert A.Maxwell and Shohreh B. Eckhardt. Pp. xxv + 430.Humana Press, Clifton, New Jersey, 1991. Hardback£75.60.

Examining Doctors, Medicine in the 1990s, DonaldGould. Pp. x + 148. Faber and Faber, London, Boston,1991. Hardback, £12.99.

Free Radicals and Food Additives, edited by Okezie I.Aruoma and Barry Halliwell. Pp. xvii + 200, illustrated.Taylor & Francis, London, New York, Philadelphia,1991. Hardback, £35.00.

A Guide to Infectious Diseases, M.G. Brook & M.F.McGhee. Pp. 230. Radcliffe Medical Press, Oxford, 1991.Paperback, £12.50.

Medical Audit Primer, Nancy Dixon. Pp. 150. HealthcareQuality Quest, Romsey, Hants, 1991. Paperback, £25.00.

Medical Aspects ofExercise- benefits and risks, Report ofthe Royal College of Physicians. Pp. 33. Royal College ofPhysicians, London, 1991. Paperback £7.50.

1034 BOOKS RECEIVED

Nurse Practitioners, Working for Change in PrimaryHealth Care Nursing, edited by Jane Salvage.Pp. xii + 152. Kings Fund Centre, London, 1991. Paper-back, £8.50.

Post Viral Fatigue Syndrome, edited by Rachel Jenkinsand James Mowbray. Pp. xxiii + 462. John Wiley& Sons,Chichester, New York, Toronto, Singapore, 1991. Hard-back, £60.

The Surfactant System of the Lung, Prevention andtreatment of neonatal and adult respiratory distresssyndrome, edited by E.V. Cosmi, C.G. Di Renzo andM.M. Anceschi. Pp. xviii + 216, illustrated. Macmillan,Basingstoke, 1991. Hardback, £45.00.

Vitamin C and Cancer - Medicine or Politics?, EvelleenRichards. Pp. xii + 264. Macmillan, Basingstoke, 1991.Hardback, £35.00.

P( , The Fellowship of Postgraduate Medicine, 1991

Postgraduate Diary

Institute of Cancer ReseachRegular programme of seminars and teaching sessions

throughout the year.Information: The Dean, Institute of Cancer Research,Haddow Laboratories, 15 Cotswold Road, Belmont,Surrey SM2 5NG, UK.

National Heart and Lung InstituteCourses leading to award of University Diplomas in

Cardiology and Thoracic Medicine. Short Courses,meetings and symposia are held throughout the year.

Postgraduate Office, National Heart and Lung Institute,Dovehouse Street, London SW3 6LY. Tel: 071-351 8172.

Institute of Child HealthShort courses booklet available.For further details please apply to: Anne Crowley, Short

Courses Office (Room 6), Institute of Child Health, 30Guilford Street, London WCIN IEH. Tel: 071-829 8692 (direct).

Institute of Dental SurgeryCourses for M.Sc. in various aspects of dentistry, Dip-loma in Dental Public Health, basic medical sciences,etc.

Information: The Dean, Institute of Dental Surgery,Eastman Dental Hospital, Gray's Inn Road, LondonWC1X8LD, UK.

Hunterian InstituteLong and short courses in basic medical sciences for

primary FRCS (including revision courses inAnatomy/Physiology/Pathology), Primary FDS, FFApart 2 held through the year.

Courses in Clinical Surgery for final FRCS held in Springand Autumn. Anastomosis Workshop; AO course offracture treatment.

Details and applications: The Hunterian Institute, RoyalCollege of Surgeons, Lincoln's Inn Fields, LondonWC2A 3PN. Tel: 071-405 3474.

Institute of Laryngology and OtologyPre-FRCS and DLO exam courses. Advanced courses on:Temporal bone surgery - November and June. Anaes-thesia for ENT - October. Rhinology and Surgery ofthe Nasal Cavity and Paranasal Sinuses - October.Nasal Plastic and Facial Soft Tissue Surgery - Feb-ruary. Pathology of the Ear, Nose and Throat - June.

Applications and enquiries: Cheryl Overington, Secretaryto the Dean, Institute of Laryngology and Otology,330/332 Gray's Inn Road, London WC1X8EE.

Institute of NeurologySandoz Foundation advanced lectures on clinical and

experimental neurology. Each Wednesday eveningthroughout academic year.

Details: Institute Registrar, National Hospital, QueenSquare, London WCJN 3BG, UK

RPMS Institute of Obstetrics and GynaecologyCourse in Obstetric Anaesthesia and Analgesia 12-14November 1991.

Details of symposia from: Symposium Secretary, RPMSInstitute of Obstetrics and Gynaecology, Queen Charlot-te's Hospital for Women, Goldhawk Road, LondonW6 OXG, UK.

Institute of OphthalmologyRegular courses in ophthalmology held throughout the

year.17/25 Cayton Street, London EC] 9AT, UK.

Institute of OrthopaedicsProfessional Unit Pre-Operative Conferences - Mondays

11.00 a.m. at Middlesex Hospital and Thursdays9.30 a.m. at Stanmore.

Professorial Unit Residents' Seminars/Conferences -

Thursdays 8.00 a.m. at Stanmore.Course on disorders of the knee - September to December

1991.Details: Miss A.M. Lucas, Postgraduate Secretary,

Institute of Orthopaedics, The Middlesex Hospital,London WI. Tel: 071-380 9418.

Institute of PsychiatryProgramme of courses and lectures.Community care for elderly people with dementia -

psychosocial issues. 18 November 1991.BMDP PC for multivariate analysis 10-12 December

1991.Recent advances in couple therapy, 29- 31 January 1992.International Symposium: Neuroimaging in Psychiatry-

3/4 February 1992.Details: Mrs Leo Wilding, Conference Office, Institute of

Psychiatry, De Crespigny Park, London SE5 8AG. Tel:071-703 5411 ext 3170.

Institute of UrologyShort courses on aspects of urology and nephrology -

throughout the year.One year Diploma courses in urology and nephrologycommencing September each year.

Advanced stone management course - held twice yearly.Applications and enquiries: The Dean, Institute of Urology,172-176 Shaftesbury Avenue, London WC2H8JE, UK.

Royal Postgraduate Medical SchoolRegular courses on advanced topics.School Office, Royal Postgraduate Medical School,Hammersmith Hospital, Du Cane Road, London W12 OHS,UK

Royal Free Hospital School of MedicineMRCP Part II. 5-day course for clinical examination.Monday 10 February to Friday 14 February 1992.

Details from: Dr Geraint James, Visiting Professor ofMedicine, The Royal Free Hospital School ofMedicine,Pond Street, Hampstead, London NW3 2QG. Tel: 071794 0500 ext 3931.

Postgrad Med J (1991) 67, 1035 1037

1036 POSTGRADUATE DIARY

London Sports Medicine InstituteLecture series:6 November 1991 Viral illnesses in sport and their

investigation13 November 1991 Sports medicine in general practice20 November 1991 Head and neck injuries in sport27 November 1991 Exercise and the skeleton4 December 1991 Traumatic knee injuries in sportDetails: London Sports Medical Institute, clo Medical

College, St Bartholomew's Hospital, CharterhouseSquare, London ECIM 6BQ.

Third International Conference on Systemic LupusErythematosusQueen Elizabeth II Conference Centre, London, UK.

13- 15 April 1992.Details: Industrial Seminars, 90 Calverley Road, Tun-

bridge Wells, Kent TNJ 2UN, UK.

University of Michigan Medical SchoolFiberoptics Workshop for the Difficult Airway 8 - 11

March, 1992.Red Lion's La Posada Resort, Scottsdale, Arizona.Details: Angela Voeller, Towsley Center for Continuing

Medical Education, Department of Post GraduateMedicine, The University of Michigan Medical School,PO Box 1157, Ann Arbor, Michigan 48106-9869, USA.

Royal Society of HealthConferences;

Accidents in the home - 26th November 1991.Risks, dignity and responsibility in residential homes -5th December 1991.

Information: Conference Department, The Royal Societyof Health, 38a St George's Drive, London SW] V 4BH.

The Fellowship of Engineering and The Royal Society ofHealth

Conference 'Improving patient care: the biomedical engin-eering challenge' - 28th November 1991 at King's FindCentre, London NWI.

Details: Christa Langan, The Fellowship of Engineering,2 Little Smith Street, London SWIP 3DL.

Techniques and Applications of Molecular BiologyA course for medical practitioners.10- 13 December 1991. University of Warwick.Details: Dr Rachel Strachan, Department of

Biologicaciences, University of Warwick, CoventryCV4 7AL.

MSD Foundation - Tutorship CoursesThese are designed for general practitioners who are

prepared to examine the role and tasks ofpostgraduatemedical education in times of change.The next course will be held at the Marina PosthouseHotel, Hull on 27-29 November 1991.

Details: The MSD Foundation, 5 Arden Crescent, LondonE14 9WA.

London School of Hygiene and Tropical MedicineMSc, diploma and research degree courses in public

health and tropical medicine.Enquiries: The Registrar, LSHTM, Keppel Street, LondonWC1E 7HT.

IgA Nephropathy "The 25th Year"International symposium, Nancy, France. 31 August - 2

September 1992Details: Laboratoire d'Immunologie, BP 184, Avenue de la

Foret de Haye, 54500 Vandoeuvre-les-Nancy, France.

Sixth International Conference on Behcet's DiseaseTo be held in Paris, France, June 30 to July 1, 1993Information: B. Wechsler, M.D., Pitie-Salperie're Hos-

pital, 47/83 Bd de l'H6pital, 75014 Paris Cedex 13,France.

National Association of Clinical TutorsThe Association assists clinical tutors in their role as

leaders in district medical education. Membership isopen to University-appointed clinical and GP tutors.

The Association arranges courses for the training andcontinuing professional development of clinical tutorsand holds Winter and Summer Meetings for allmembers.'How to be an effective Clinical Tutor' - 5/6 December1991, Bristol.Counselling Course - 12/13 March 1992, Stoke Roch-ford, Lincs.Summer Meeting - May 1992 - Bangor, N. Wales.

Information about the NACT and its activities can beobtainedfrom The Secretariat, National Association ofClinical Tutors, 6 St Andrew's Place, London NWJ4LB. Tel: 071 935 5556.

NEWSLt-General Sir Robert Drew the President and Hon.

Officers of the Fellowship of Postgraduate Medicineand the Editor of the Post Graduate Medical Journalwere represented by Mrs. J.M. Coops (ExecutiveSecretary, Fellowship ofPostgraduate Medicine) at theservice of thanksgiving for the life of Lt-General SirRobert Drew held at the Royal Hospital, Chelsea onFriday 4th October, 1991.

POSTGRADUATE DIARY 1037

Medica Edhucatlon and Training in Europe: the futurePrefiwy Aweowacneent

October lst/2nd 1992 at the Royal Coliege of Physicians, 11 St Andrew's Place, London NW1 4LE (by kindpermission of the Treasurer).'Medical Education and Quality of Medical Care in Europe: Aims and- Objectvs for the Future'. A majorinte ional con s bringing to the leade of medical education and health care in Europe. Theprogramme is designed toe critically the political and eduational implications in medical training inEurope following hamonisation in 1992.Sessions will include preentations and discussion on:1. Diretvas for health professionals; 5. Educational reearch and development (including2. Harmonisation of hospital training programmes; primay care); and3. Monospeciality initiatives; 6. Recommendations and implementation.4. Training and quality of care initiatives;Speakers will be invited from al European Commission countries. The conference language will be English.The programme will include tunity for free dis o folowing the formal presentations.Ifyouareinterestedin receivingfurtherinformation on the meetingandon regstration,pLase ceommicate with:Dr M. W.N. Nicholls, Chairman - OrganLsg Committee, Fellowsh4p ofPostgraduate Medicine, 6 St Andrew'sPlace, London NWI 4L3. Tel: (44) 071 935 5556. Fax: (44) 071)224 3219.

Royal College of Obstetricians and GynaecologistsINTENSIVE THEORETICAL COURSE

MUC^OG- PART II13th-18th JanurTy 1992.

to be held atThe Royal College of Obstetricians and Gynaecologists

Special Features Include: Vivas- and MCQ practice Numbers: 40, Non-residentialClosing Date: 13th November 1991-for further details please contact:Postgraduate Eucation Department

RCOG27 Sussex Place

London, NWl 4RGTel: 071-262-5425 ext: 245