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Consideration needs to be given to the appointment of curriculum leads for patient safety who should be encouraged to work strategically across disciplines and topic areas; development of stronger links with organisational systems to promote student engagement with organisation-based patient safety practice; and role models should help students to make connections between theoretical considerations and routine clinical care.

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Although methodological modification might enhance the potential for success in future studies of this sort, more fundamental difficulties concerning general practitioners' attitudes to research and their professional responsibilities lie at the heart of our recruitment problems.

Although the intervention showed promise, we failed to demonstrate significant reduction in non-attendance rates, as a result of texting appointment reminders to patients who persistently fail to attend their general practice appointments.

GPs are conditionally willing to use new consultation media if clinically appropriate and if medico-legal and technical support is available.

Background The use of remote online delivery of summative assessments has been underexplored in medical education. Due to the COVID-19 pandemic, all end of year applied knowledge multiple choice question (MCQ) tests at one UK medical school were switched from on campus to remote assessments. Methods We conducted an online survey of student experience with remote exam delivery and compared test performance in remote versus invigilated campus-based forms of similar assessments for Year 4 and 5 students across two academic years. Results Very few students experienced technical or practical problems in completing their exam remotely. Test anxiety was reduced for some students but increased for others. The majority of students preferred the traditional setting of invigilated exams in a computer lab, feeling this ensured an even playing field for all candidates. Mean score was higher for Year 4 students in the remotely-delivered versus campus-based form of the same exam (76.53% [SD 6.57] vs. 72.81% [6.64]; t438.38 = 5.94, p = 0.001; d = 0.56), whereas candidate performance was equivalent across both forms for Year 5 students. Conclusions Remote online MCQ exam delivery is an effective and generally acceptable approach to summative assessment, and could be used again in future without detriment to students if onsite delivery is not possible.

PURPOSE We sought to explore general practitioners' satisfaction with their patient visits and the congruity between this satisfaction and new models of practice, such as those implicit in the new general medical services contract in the United Kingdom. METHODSWe undertook a qualitative study using audio recordings of patient visits and in-depth interviews with 19 general practitioners in Lothian, Scotland.RESULTS Doctors' reports of satisfying and unsatisfying experiences during consultations were primarily concerned with developing and maintaining relationships rather than with the technical aspects of diagnosis and treatment. In their most satisfying consultations, they used the interpersonal aspects of care, in particular their sense of knowing the patient, to effect a successful outcome. Success was seen in holistic terms-not as the prevention, treatment, or cure of a disease, but as restorative of the person. Positive experiences were implicated in maintaining their identity as "good" doctors. Negative experiences sometimes challenged this identity, and doctors resisted this challenge by fi nding explanations for unsatisfactory experiences that distanced themselves from their source or cause. CONCLUSIONThe attributes of a satisfying encounter found in this study derive from a model of practice that prioritizes the distress of patients, which cannot be measured, above the technical and quantifi able in diagnosis and treatment. Preoccupation with that which is technical and measurable in health care system reforms risks defi ning a model of practice with purpose and meaning not congruent with doctors' experiences of their work and may result in further destruction of professional morale. INTRODUCTIONI n the past 15 years the United Kingdom has undergone radical change in the management and delivery of general practitioner services. These changes, organized around new contracts between doctors and the National Health Service (NHS), 1 have been paralleled by shifts in the rhetorical focus of general medical practice. First, there has been a move away from a physician-centered model of practice in which professional knowledge and authority took precedence toward a patient-centered model of care.2,3 Second, evidence-based medicine has replaced clinical experience as the dominant rationale for choice of therapies. 4 As a result, clinical care is more explicit for patients and more routine for doctors, with individual physicians supported, and sometimes disciplined, in their application of evidence-based solutions to clinical problems by decisionsupport tools, such as guidelines.These changes imply that best practice is constituted by the patient's view of quality 5 METHODSTo examine how general practitioners obtain satisfaction from their consultations, we undertook a qualitative study involving audio recordings of consultations and semistructured interviews with 19 general practitioners. This study was conceived and conducted before implementation of the new general medical services contract in the Uni...