Workplace-based assessment is a core element of the changes introduced in Modernising Medical Careers (MMC), yet it has been sparsely researched in the UK and there are still psychometric and validity data needed to support its introduction. Supervisors and tutors are wary of it, but it could replace external clinical examinations leading to a Certificate of Completion of Training. The theoretical background of assessment in the workplace is ‘Miller's pyramid’ of competence in which the trainee progresses from ‘knowing’ (tested by paper exam), through ‘knows how’, to ‘shows how’ (tested by the Observed Standardised Clinical Examination), and finally ‘does’ (assessed in the workplace) (Miller, 1990).
I think I can honestly say that I am a seasoned complainer, although I am careful not to attempt to be Mary Whitehouse and I do not assiduously scan the media looking for trouble. My interest in the area of stigmatization started with an episode of the TV drama Boon, where they suddenly had a character become ‘mentally ill’ so that he could conveniently shoot the hero to achieve a cliff-hanging end-of-series episode. Subsequently I specialised in the portrayal of mental illness in dramatic productions, joined the Public Education Campaign divisional network and had some media training. I have been listed as an expert in the portrayal of mental illness for five years but have never been approached for my advice on this area. However, following this year's announcement of the new Royal College of Psychiatrists' campaign ‘Changing Minds: Every Family in the Land’, I obtained all the names and addresses in Deborah Hart and Jill Phillipson's article above and stood ready to ‘do my bit’ for truth and honesty.
The release of the antipsychotic agents risperidone, sertindole and olanzepine forces difficult choices upon clinicians. The new compounds are better tolerated than neuroleptics, expensive and their long-term side-effects unknown. These choices can be made easier by the dose and side-effect minimisation procedure set out below, which aims to produce the greatest benefit and least harm from conventional neuroleptics.
ABSTRACT. A survey of the drugs given for physical complaints in two mental handicap hospitals is described. Thirty‐six per cent of 537 adults in hospital A and 43% of 944 adults in hospital B received medications and, of those who did, over hall in each hospital received only one drug. The hospital populations differed significantly but both showed a significant increase in total drug usage with increasing age in both sexes, higher among females in every group. This increase was greatest with C.V.S. drug usage, but it did not reach significance for the three most frequently prescribed groups, which were gastrointestinal drugs (to 13% of the total patients), vitamins and nutritional supplements (11%), dermatological (10%) and cardiovascular (10%) drugs. Menial level was significantly indirectly related to usage of gastrointestinal drugs, drugs for anaemia, and vitamins and nutritional supplements, and directly to usage of cardiovascular drugs.
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