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Objectives: This cross-sectional study examines the selfreported empathy levels of undergraduate students in five different health sciences disciplines before and after one year of training at the St Augustine Campus, University of the West Indies. Methods: Students enrolled into the schools of dentistry, pharmacy, medicine, veterinary medicine and nursing self administered the Jefferson Scale of Empathy on entering their first year of training (n=355). Mean empathy scores were then compared between and among groups to scores on retesting at the end (n=366) of their first year using independent t-tests and one way between groups using ANOVA with planned comparisons. Results: Female students and students older than 27 years were found to be more empathic than male students and those less than 21 years respectively. The highest mean empathy scores on entry to university were noted in nursing and dental students. On repeat testing mean empathy scores declined in all 5 groups, with the declines among medical, nursing and dental students achieving statistical significance. Conclusions: This study shows that the decline in self reported empathy scores starts during the first year of training. Whilst this decline may be partly due to a 'settling in' phenomenon with a change from idealism to realism, students may also be displaying an adaptive response to new responsibilities and an increasing workload. With the current trend of blurred professional boundaries for healthcare providers, empathy is an important skill to be developed by all disciplines. Health educators now need to consider addressing those factors that may check its further decline.

BackgroundEducating nurses to doctoral level is an important means of developing nursing capacity globally. There is an international shortage of doctoral nursing programmes, hence many nurses seek their doctorates overseas. The UK is a key provider of doctoral education for international nursing students, however, very little is known about international doctoral nursing students' learning experiences during their doctoral study. This paper reports on a national study that sought to investigate the learning expectations and experiences of overseas doctoral nursing students in the UK.MethodsSemi-structured qualitative interviews were conducted in 2008/09 with 17 international doctoral nursing students representing 9 different countries from 6 different UK universities. Data were analysed thematically. All 17 interviewees were enrolled on 'traditional' 3 year PhD programmes and the majority (15/17) planned to work in higher education institutions back in their home country upon graduation.ResultsStudying for a UK PhD involved a number of significant transitions, including adjusting to a new country/culture, to new pedagogical approaches and, in some cases, to learning in a second language. Many students had expected a more structured programme of study, with a stronger emphasis on professional nursing issues as well as research - akin to the professional doctorate. Students did not always feel well integrated into their department's wider research environment, and wanted more opportunities to network with their UK peers. A good supervision relationship was perceived as the most critical element of support in a doctoral programme, but good relationships were sometimes difficult to attain due to differences in student/supervisor expectations and in approaches to supervision. The PhD was perceived as a difficult and stressful journey, but those nearing the end reflected positively on it as a life changing experience in which they had developed key professional and personal skills.ConclusionsDoctoral programmes need to ensure that structures are in place to support international students at different stages of their doctoral journey, and to support greater local-international student networking. Further research is needed to investigate good supervision practice and the suitability of the PhD vis a vis other doctoral models (e.g. the professional doctorate) for international nursing students.

Success in improving diabetes care is associated with certain organizational features of primary health care teams. Experimental studies are required to determine whether the development of teamwork enables practice teams to identify and overcome systematically the obstacles to improved quality of patient care that face them.

Objectives To elicit general practitioners' and practice nurses' accounts of changes in their clinical practice or practice organisation made to claim a pilot health promotion payment. To describe attitudes towards the piloted and previous health promotion payments. Design Qualitative, semistructured interview study. Setting 13 general practices in Leicester. Participants 18 general practitioners and 13 practice nurses.