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The emergence of healthcare assistants (HCAs) in general practice raises questions about roles and responsibilities, patients' acceptance, cost-effectiveness, patient safety and delegation, training and competence, workforce development, and professional identity. There has been minimal research into the role of HCAs and their experiences, as well as those of other staff working with HCAs in general practice. Lessons may be learned from their role and evidence of their effectiveness in hospital settings. Such research highlights blurred and contested role boundaries and threats to professional identity, which have implications for teamwork, quality of patient care, and patient safety. In this paper it is argued that transferability of evidence from hospital settings to the context of general practice cannot be assumed. Drawing on the limited research in general practice, the challenges and benefits of developing the HCA role in general practice are discussed. It is suggested that in the context of changing skill-mix models, viewing roles as fluid and dynamic is more helpful and reflective of individuals' experiences than endeavouring to impose fixed role boundaries. It is concluded that HCAs can make an increasingly useful contribution to the skill mix in general practice, but that more research and evaluation are needed to inform their training and development within the general practice team. © British Journal of General Practice 2008.

PROBLEM ADDRESSED: The Family Medicine Residency Program at the University of Alberta has used academic sessions and clinical-based teaching to prepare residents for private practice. Before the new curriculum, academic sessions were large group lectures given by specialists. These sessions lacked consistent quality, structured topics, and organization. OBJECTIVE OF PROGRAM: The program was designed to improve the quality and consistency of academic sessions by creating a new curriculum. The goals for the new curriculum included improved organizational structure, improved satisfaction from the participants, improved resident knowledge and confidence in key areas of family medicine, and improved performance on licensing examinations. PROGRAM DESCRIPTION: The new curriculum is faculty guided but resident organized. Twenty-three core topics in family medicine are covered during a 2-year rotating curriculum. Several small group activities, including problem-based learning modules, journal club, and examination preparation sessions, complement larger didactic sessions. A multiple-source evaluation process is an essential component of this new program. CONCLUSION: The new academic curriculum for family medicine residents is based on a variety of learning styles and is consistent with the principles of adult learning theory. This structured curriculum provides a good basis for further development. Other programs across the country might want to incorporate these ideas into their current programming.

This article describes a curriculum in oral surgery for undergraduate dental education in the United Kingdom prepared by the Education Subgroup of The British Academic Oral and Maxillofacial Surgeons. This group is made up of representatives from each of the 13 UK Dental Schools, one Irish Dental School and one Post-graduate Institute. The document represents a group consensus of an undergraduate UK oral surgery curriculum that is founded on the frameworks outlined by the General Dental Council, the Quality Assurance Agency for Higher Education and the Association for Dental Education in Europe. Our curriculum document is more prescriptive than the information available in the aforementioned documents. It is based on UK undergraduate oral surgery experience and thus attempts to set achievable core competencies and, in a few areas, challenges the available curriculum and related documentation. © 2008 Blackwell Munksgaard.

Background. The State of Victoria in Australia introduced Chinese medicine practitioner registration in 2000 and issued its education guidelines in late 2002 for introduction in 2005. This study obtained practitioners' views on desired capabilities for competent Chinese medicine practice and to identify professional development needs. Methods. A questionnaire, consisting of 28 predefined capabilities in four categories with a rating scale of importance from one to five, was developed and sent to all registered Chinese medicine practitioners in the State of Victoria, Australia in October, 2005. Results. Two hundreds and twenty eight completed questionnaires were returned which represented a response rate of 32.5%. Of the four categories of capabilities, technical capabilities were considered to be the most important for clinical practice. Specifically, the ability to perform acupuncture treatment and/or dispense an herbal prescription was ranked the highest. In contrast, research and information management capabilities were considered the least important. The educational background of practitioners appeared to be an important factor influencing their rating of capabilities. Significantly, nearly double the number of practitioners with Australian qualifications than practitioners trained overseas valued communication as an important capability. For continuing professional education, clinical skills courses were considered as a priority while research degree studies were not. Conclusion. Registered Chinese medicine practitioners viewed skills training as important but did not support the need for research and information management training. This represents a significant hurdle to developing Chinese medicine as a form of evidence-based healthcare. © 2008 Xue et al; licensee BioMed Central Ltd.

Workers with disabilities are entitled to have their individual needs accommodated in a way that allows them to perform the essential duties of their job. However, adults with disabilities are often lacking in career development and are ill-prepared to negotiate workplace accommodations. This has led educators to seek workplaces that can accommodate the needs of adolescents with disabilities, so these adolescents can learn to negotiate accommodations and enhance their career development through work-based education. This paper reports on two case studies in which employers had agreed to accommodate the needs of adolescents with disabilities participating in work-based education. Social Cognitive Career Theory (SCCT) framed the analyses of these two cases - a case of a student with physical disabilities and a case of a student with developmental disabilities. SCCT proves valuable in understanding the role of work-based education in the career development of disabled youth. © 2008 IOS Press. All rights reserved.

Individuals make choices in, and adjust to, a world of work that is often a moving target. Because work is so central to human functioning, and transitions in and out of work can have major mental health repercussions, the authors argue that applied psychologists in health services need to understand those transitions. This article focuses on the different types of transition throughout a person's working life and the resources needed at different stages to ensure the success of these transitions. The authors start by examining the roles of capability and adaptability in supporting and facilitating adjustment to work transitions and their relation to identity development. They then examine the role of social and institutional contexts in shaping work transitions and their outcomes. The authors focus on voluntary versus involuntary transitions and then broaden the lens in discussing the policy implications of research on work transitions. © 2008 American Psychological Association.

Objective: This study reports student outcomes for the Kansas Consumers as Providers (CAP) training program. Graduates provide mental health services to other consumers in the community. CAP is a semester-long class plus a 104-hour internship in a social service agency. Methods: This paper reports on the results of a two-year quantitative, longitudinal study of people with psychiatric disabilities who completed the program. Results: Graduates had statistically significant pre-post differences in employment and post-secondary education enrollment at all three follow-up points. Conclusion: Results suggest that CAP graduates can and do provide valuable mental health services to other consumers. Copyright 2008 Trustees of Boston University.

Objective: This study was undertaken to devise a suitable survey instrument to measure morale, and to undertake an assessment of morale amongst vocational dental practitioners (VDPs) in the UK. Design: Postal questionnaire survey. Setting: Dental vocational training schemes in the UK. Subjects: Vocational dental practitioners. Method: A confidential postal questionnaire was used to measure levels of morale among all VDPs in the UK in 2007. Results: A response rate of 76.7% was achieved. The mean morale score for Scottish VDPs was significantly higher than that of the Northern Irish VDPs, which in turn was significantly higher than those of the VDPs in England or Wales. In England and Wales females recorded higher morale scores than males. Lowest morale scores were associated with statements referring to concerns about future changes to NHS dentistry, and the limits on treatment within the NHS system. The highest scores were associated with good working relationships. Conclusion: The use of an appropriately tested questionnaire has provided a convenient objective measure of morale. The morale of VDPs in the United Kingdom was lower than expected. Scottish VDPs recorded higher morale scores than other VDPs and responded more positively in the survey instrument. The most negative responses from all VDPs were regarding the effect of the NHS system on treatment and concerns about future changes to the NHS. © 2008 Macmillan Publishers Limited. All rights reserved.

The goal of all dental schools is to develop competent, knowledgeable dentists who have excellent communication skills and a sense of social responsibility. This paper describes the theoretical reasoning behind the design of an innovative dental curriculum constructed from first principles in the UK. The recognised theories of psychologists, educationalists and sociologists of the twentieth century have informed our educational decisions. In practice, this translates to a blended learning environment with problem-based learning (PBL) case scenarios at its heart. The learning of clinical and communication skills, which begins in year 1, week 1, is absolutely integral to the case scenarios, as are ethics and professionalism. PBL is supported by a comprehensive e-learning platform, plenary lectures, workshops, clinical and life science teaching delivered by core academic staff and guest speakers who are the experts in our 'community of practice' in which the students are the novices. We believe that the whole is best described as 'enquiry-based learning'. © 2008 Macmillan Publishers Limited. All rights reserved.

OBJECTIVE: To investigate the reasons for family medicine graduates' career choices. DESIGN: Qualitative study using focus groups and one-on-one interviews. SETTING: University of Calgary in Alberta. PARTICIPANTS: Seventeen male and female second-year family medicine residents, representing a range of ages and areas of origin, enrolled in the 2004 urban and rural south streams of the family medicine residency program at the University of Calgary. METHOD: During the final month of training, 2 focus groups were conducted to determine graduating students' career choices and the reasons for them. After focus-group data were analyzed, a questionnaire was constructed and subsequently administered to participants during face-to-face or telephone interviews. MAIN FINDINGS: Most residents initially planned to do urban locums in order to gain experience. In the long term, they planned to open practices in urban areas for lifestyle and family reasons. Many residents from the rural stream had no long-term plans to establish rural practices. Most residents said they felt prepared for practice, but many indicated that an optional third year of paid training, with an emphasis on emergency medicine, obstetrics, and pediatrics, would be desirable. Reasons cited for not practising in rural areas were related to workload, lifestyle issues, family obligations, and perceived lack of medical support in the community. Only 4 female graduates and 1 male graduate intended to practise obstetrics. The main reason residents gave for this was inadequate training in obstetrics during residency. Finances were cited as a secondary reason for many choices, and might in fact be more important than at first apparent. CONCLUSION: Despite its intention to recruit family medicine graduates to rural areas and to obstetrics, the University of Calgary residency training program was not successful in recruiting physicians to these areas. The program likely needs to re-examine the effectiveness of current approaches. If other programs are having similar difficulties recruiting graduates to obstetrics and rural practice, perhaps changes in policies should be considered.