CeMENT: a multidisciplinary teaching programme
Editor ± Wallace et al. have achieved much with CeMENT, a multidisciplinary teaching programme across the primary-secondary care divide, which delivers clinical methods teaching to a large student body in the three senior years of four independent medical schools. They have also successfully incorporated teacher training in their programme alongside structured formative and summative assessments of students. Moreover, they have demonstrated that teaching in primary care is more highly valued by students than that in secondary care and have discussed some of the tensions funding of such teaching creates. Nevertheless we would take issue with their claim that `until now there has been little attempt to develop the teaching of clinical method which accurately re ̄ects current clinical practice by providing students with integrated general practice and hospitalbased clinical attachments'. We would draw readers' attention to our earlier publications in Medical Education describing an integrated course in clinical methods taught jointly by general practice and hospital teachers at Leicester. This course included reliable assessments which were regarded as educationally useful by students and it was delivered by primary and secondary care teachers who had undergone a systematic and continuing programme of teacher training. We also quanti®ed the greater satisfaction of students with primary care teaching and speculated why this was so and how teaching hospital trusts could narrow the gap. We would encourage other schools to instigate such programmes.
Teaching and assessment in the consultation. A workshop for general practice clinical teachers.
A faculty development programme for general practice clinical teachers offered a skills development workshop which specifically addressed the skills needed when teaching and assessing students consulting with patients. The course was sequential, that is, a group moved on to a new skill only when its members could demonstrate mastery of a lower-order skill. Participants practised skills and received feedback on their performance from peers and learners (students and trainees). Participants comments about the course were highly favourable and the majority foresaw a general improvement in their own personal consultation skills as a result. They recognized that the use of a valid and reliable set of criteria (the Leicester Assessment Package) was essential in order to make correct judgements about consultation performance before instituting remedial teaching.
Effects of thyrotropin-releasing hormone and a thyrotropin releasing hormone analog on growth and selected plasma hormones in lambs.
An 8-wk growth trial was conducted to assess the effects of continuous infusion of thyrotropin-releasing hormone (TRH) and an active TRH analog less than Aad-His-Pro-NH2 (the less than Aad is L-pyro-alpha-aminoadipic acid) on growth trial performance, carcass composition and hormone profiles of growing lambs. Both drugs were infused at 600 micrograms X lamb -1 X d -1 with 16 lambs/treatment. Both TRH and less than Aad-His-Pro-NH2 decreased average daily gain (ADG; P less than .01) and increased feed conversion (FC; P less than .01) compared with saline infused controls. Average daily feed intake was not altered. Carcasses of lambs given TRH or less than Aad-His-Pro-NH2 contained fewer kilograms of moisture (P less than .05) and appeared to contain fewer kilograms of protein. Thyrotropin-releasing hormone and less than Aad-His-Pro-NH2 increased thyroid gland weights (P less than .05), but pituitary gland weights were not different. Plasma thyrotropin (TSH) concentrations were increased by both drugs compared with control lambs, peaking at 4 to 7 d after initiating infusion. However, by 14 d, TSH concentrations returned to control levels. Triiodothyronine (T3) and thyroxine (T4) were elevated by both drugs over the entire 8-wk trial, with peak levels reached at 10 d and maintained for the duration of the study. Both TRH and less than Aad-His-Pro-NH2 increased prolactin over the entire period. Growth hormone levels were not altered by either drug. The effects of less than Aad-His-Pro-NH2 infusion on growth trial performance, carcass composition and hormone profiles of growing lambs were very similar to TRH. The negative effects of TRH and less than Aad-His-Pro-NH2 infusion on ADG, FC and carcass protein appear to be the result of elevated T3 and T4 levels.