Madeleine Gantley

The CeMENT project: a case study in change management

The Community Based Medical Education in North Thames (CeMENT) Project case study is a useful approach to analysing complex change facing the medical profession and all medical teachers. The project was a collaboration involving five North London medical schools to develop the community-based aspects of the undergraduate medical curriculum. The project management team was drawn from academic general practitioners, hospital specialists with expertise in medical education, and education. Complex change involving partnerships across organizational and functional boundaries is often extremely challenging in terms of coordination and management owing to its unpredictability and ownership problems. Success in change management could be enhanced by use of a framework that includes a clear statement of purpose, stakeholder concordance and trust, clear leadership and structures, and fast action together with recognition of achievements.

Patient empowerment and coronary heart disease

1 Editorial. When primum non nocere fails. Lancet 2000; 355: 2007. 2 Rohde H. Routine anal cleansing, so called “hemorrhoids”, and perianal dermatitis: cause and effect? Dis Col Rec 2000; 43: 561–62. 3 Mazier WP. Hemorrhoids, fissures, and pruritus ani. Surg Clin North Am 1994; 74: 1277–92. 4 Pfenninger JL. Modern treatments for internal haemorrhoids. BMJ 1997; 314: 1211–12. We did a qualitative study simultaneously with our trial. Although family physicians had some concern about prescribing budget limitations, probably the most important factor in not implementing secondary prevention in primary care was the lack of explicit understanding by those doctors that this task was their responsibility. We believe that the idea of patients’ empowerment entails a shift of power towards the patient and greater partnership between patients and clinicians. Interventions that achieve this effect may improve outcomes in patients with chronic disease. Asking a patient to visit their family physician for a blood test is not necessarily empowering, even if it does increase the rate of serum cholesterol. We should avoid conflating the giving of responsibility to patients for particular activities with patient empowerment.

Integrating genetics into primary care in practice

EDITOR—Emery and Hayflick continued the debate on integrating genetic medicine into primary care.1 We agree that primary care will identify people at genetic risk and help manage known risk not only for the patient but also for other family members. Emery and Hayflick define clear roles for primary care practitioners and draw on qualitative studies to claim that they are accepted roles of …

The University Linked Practices computer network project in East London and Essex: a qualitative evaluation

Undergraduate medical education is moving away from its traditional hospital setting into the community. Alongside this, there is a growing need to prepare medical students for workplaces that rely on information technology. The distribution of students to locations throughout the community presents major challenges regarding access to facilities usually found in medical schools. The University Linked Practices computer network was established to provide general practice teaching sites in east London and Essex with computer resources at least equivalent to those available centrally. This paper reports qualitative data from structured interviews with network users. Although practices already made extensive use of computers, levels of relevant training and experience among practice team members and students were minimal. Time constraints made progress difficult, but the use of the network for literature searching was already becoming established. Appropriate use in teaching should be integrated with new cur...Undergraduate medical education is moving away from its traditional hospital setting into the community. Alongside this, there is a growing need to prepare medical students for workplaces that rely on information technology. The distribution of students to locations throughout the community presents major challenges regarding access to facilities usually found in medical schools. The University Linked Practices computer network was established to provide general practice teaching sites in east London and Essex with computer resources at least equivalent to those available centrally. This paper reports qualitative data from structured interviews with network users. Although practices already made extensive use of computers, levels of relevant training and experience among practice team members and students were minimal. Time constraints made progress difficult, but the use of the network for literature searching was already becoming established. Appropriate use in teaching should be integrated with new curricula as they develop, and protected time made available.

Integrating genetics into primary care in practice [Letter]

EDITOR—Emery and Hayflick continued the debate on integrating genetic medicine into primary care.1 We agree that primary care will identify people at genetic risk and help manage known risk not only for the patient but also for other family members. Emery and Hayflick define clear roles for primary care practitioners and draw on qualitative studies to claim that they are accepted roles of …