G.M. Wilson

Osteoporosis and fractures following thyrotoxicosis.

Abstract The severity of osteoporosis in thyrotoxic patients before and after treatment was assessed by measuring the density and mineralisation of the cortical midshaft of the middle metacarpal and the cancellous distal end of the radius. In untreated thyrotoxicosis loss of bone density was found in both sexes and at all ages, but particularly in women over 50. Treatment by drugs, surgery, or 131-iodine restored the bone in the younger men and women. In the older patients, especially the women, a severe degree of osteoporosis persisted and this was associated with an increased incidence of fractures.

EXAMINATION OF CLINICAL EXAMINERS

Abstract The poor correlation between the marks awarded in the clinical tests in medicine and surgery, and between the medical clinical test and the written objective paper, suggested the need for more detailed investigations into the reliability of clinical examinations. Two examiners independently marked 29 candidates in a clinical examination in medicine, and the marks awarded were compared. In another examination 28 different students were examined on one short case by two examiners and the examination was recorded on videotape. This was subsequently marked by a further twelve examiners and again on two further occasions by the original examiners. Marks awarded by one examiner often varied considerably from those awarded by another examiner for the same performance. Inconsistency in the same examiner was also evident. This observed variation must be more widely recognised in determining the fate of candidates in clinical examinations.

SELF-POISONING AND ALCOHOL

Abstract The incidence of self-poisoning has risen in recent years and constitutes a major challenge to preventive medicine. Retrospective and prospective surveys have established that in Glasgow abuse of alcohol is a major associated factor. Amongst male patients heavy drinking preceded the taking of an overdose of drugs in about 70% of cases, and in them the mean blood-alcohol concentration on admission to hospital was 146 mg. per 100 ml. Other associated factors were unemployment well above the average in the city, crime, and a history of drug abuse. Of the women about 40% had taken alcohol before the overdose, and their mean blood concentration was 102 mg. per 100 ml. Abuse of alcohol by a husband or parent combined with assaults and financial difficulties frequently precipitated self-poisoning in female patients.

An experiment involving substitution of tape-slide programmes for lectures.

Abstract A group of 4th year students were taught part of an endocrinology course by programmed tape-slide presentations in place of conventional lectures. Kindermann audiovisual tutor machines and audio-tape cassette players with automatic hand viewers were used. The students taught in this way significantly improved their positions in the class and reacted favourably to the experiment.

PLASMA-CALCITONIN IN DISORDERS OF THYROID FUNCTION

Abstract Plasma-calcitonin and bone density were measured in patients with untreated and treated thyrotoxicosis and treated primary hypothyroidism. The mean plasma-calcitonin levels in each of these groups did not differ significantly from that found in healthy subjects. Several of the older untreated and 131 I-treated thyrotoxic patients were osteoporotic. No correlation was found between the plasma-calcitonin concentration and the bone density.

Medical students repeating the fourth year at the University of Glasgow1

The fourth year of medical studies at the University of Glasgow is an integrated course. In addition to clinical teaching in the wards the students receive systematic instruction in medicine and surgery to which there are contributions from physicians, surgeons, pathologists, psychiatrists, and teachers from other disciplines. Examinations covering the years work replace the written part of the final MB, ChB examination in medicine and surgery, previously taken at thc end of the sixth year. Marks are allocated as follows: 20% each for an examination in December, March, and June covering the terms work, 20% in June for an examination covering the years work, and 20% for a dissertation on some topic in medicine. The examinations are of the objective type in which a common stem is followed by a set of six items, any number of which may be correct. The questions are marked as previously described (Harden, Lever, and Wilson, 1969; Lever, Harden, Wilson, and Jolley, 1970). Dissertations are scored independently by a minimum of two examiners for originality, accuracy, review of the literature, and presentation. Where there is a discrepancy they are assessed by a third examiner. Students who fail to obtain a pass mark for the years work have the opportunity t o redeem themselves in an oral examination in June. Those who fail to do so have another written and oral examination in September. Students failing to pass in June or September are required to repeat the years work. At this stage of the students career repetition of a year of study implies a serious defect in either the student or the teacher, as faults in selection procedures or failure of the student to

M.R.C.P. (U.K.) EXAMINATIONS IN 1970

Abstract The results of the M.R.C.P. (U.K.) examinations in 1970 have been compared with those of the M.R.C.P. (London) in 1965. For British medical graduates the modal interval in 1970 between primary qualification and gaining the M.R.C.P. was three years, in contrast with five years in 1965. Of the successful candidates 59% completed the examination within four years of qualification. Women were under-represented in relation to number of medical graduates. Those from Oxford and Cambridge gained the diploma most quickly and formed the highest proportion from the British medical schools. On the basis of the geographical distribution of the successes the suggestion is made that the clinical part of the examination should also be held in provincial centres.

GENERAL PROFESSIONAL TRAINING IN MEDICINE

A programme of general professional training in medicine based on the Royal Commission report has been in operation at the Western Infirmary, Glasgow, and associated hospitals since 1969. It involves a two-year rotation through general medicine, dermatology, psychiatry, paediatrics, geriatrics, and a variety of medical specialties. A third year is spent as far as possible in one unit of the doctors choice. The scheme has been popular with trainees and senior staff. A high pass-rate has been achieved in the M.R.C.P.--23 out of 26 being successful within the three-year period. The trainees have subsequently taken up a wide variety of hospital posts within the broad division of medicine or entered general practice. The concept of a broadly based three-year period of general professional training in medicine has proved both practical and useful.

DURATION OF POSTGRADUATE MEDICAL TRAINING

Abstract A study of doctors appointed to consultant posts in general medicine and medical specialties in Great Britain and Northern Ireland in 1971 and 1972 has shown that the interval between primary qualification and consultant post is commonly 10-12 years. A majority of those acquiring consultant appointments in general medicine completed general professional training and the M.R.C.P. within 4 years after qualification, but thereafter the modal time spent in further training was 7 years. In medical specialties the time taken to acquire the M.R.C.P. was slightly longer but the subsequent period was shorter. An investigation of those passing the M.R.C.P. in 1965 showed that 37% were still in training posts 6 years later and 39% had consultant appointments. The Joint Committee on Higher Medical Training has recommended a 4-year period in higher medical training; but at present this is much exceeded, an inordinate time being spent in the registrar grade after acquiring the M.R.C.P. A considerable change in hospital staffing will be required if the recommendations of the J.C.H.M.T. are to be implemented.