This study indicates that both interobserver and intraobserver agreement was higher in experienced versus nonexperienced ENT surgeons. Agreement ranged from poor to excellent in both groups. The current results suggest that experience in performing DISE is necessary to obtain reliable observations.

ObjectiveSynthesise evidence about the impact of family medicine/general practice (FM) clerkships on undergraduate medical students, teaching general/family practitioners (FPs) and/or their patients.Data sourcesMedline, ERIC, PsycINFO, EMBASE and Web of Knowledge searched from 21 November to 17 December 2013. Primary, empirical, quantitative or qualitative studies, since 1990, with abstracts included. No country restrictions. Full text languages: English, French, Spanish, German, Dutch or Italian.Review methodsIndependent selection and data extraction by two authors using predefined data extraction fields, including Kirkpatrick’s levels for educational intervention outcomes, study quality indicators and Best Evidence Medical Education (BEME) strength of findings’ grades. Descriptive narrative synthesis applied.ResultsSixty-four included articles: impact on students (48), teaching FPs (12) and patients (8). Sample sizes: 16-1095 students, 3-146 FPs and 94-2550 patients. Twenty-six studies evaluated at Kirkpatrick level 1, 26 at level 2 and 6 at level 3. Only one study achieved BEME’s grade 5. The majority was assessed as grade 4 (27) and 3 (33). Students reported satisfaction with content and process of teaching as well as learning in FM clerkships. They enhanced previous learning, and provided unique learning on dealing with common acute and chronic conditions, health maintenance, disease prevention, communication and problem-solving skills. Students’ attitudes towards FM were improved, but new or enhanced interest in FM careers did not persist without change after graduation. Teaching FPs reported increased job satisfaction and stimulation for professional development, but also increased workload and less productivity, depending on the setting. Overall, student’s presence and participation did not have a negative impact on patients.ConclusionsResearch quality on the impact of FM clerkships is still limited, yet across different settings and countries, positive impact is reported on students, FPs and patients. Future studies should involve different stakeholders, medical schools and countries, and use standardised and validated evaluation tools.

BackgroundDuring workplace based learning students develop professional competences and an appropriate performance. To gain insight in the learning process and to evaluate competences and performance, assessment tools are essential and need to be of good quality. We aimed to construct a competence inventory applicable as an instrument to measure the content validity of workplace based assessment tools, such as portfolio.MethodsA Delphi study was carried out based on the CanMEDS Roles Framework. In three rounds, experts (N = 25–30) were invited to score the key competences per CanMEDS role on relevance (6-point Likert-scale), and to comment on the content and formulation bearing in mind its use in workplace based assessment. A descriptive analysis of relevances and comments was performed.ResultsAlthough all competences were scored as relevant, many comments pointed at a lack of concrete, transparent and applicable descriptions of the key competences for the purpose of assessment. Therefore, the CanMEDS roles were reformulated in this Delphi procedure as concrete learning outcomes, observable and suitable for workplace based assessment.ConclusionsA competence based inventory, ready for validating workplace based assessment tools, was constructed using a Delphi procedure and based on a clarification and concretisation of the CanMEDS roles.

Backgrounds: An intercultural society facilitates equitable and respectful interrelations. Knowing and understanding each other's sociocultural and linguitic contexts is a prerequisite for an intercultural society. This study explores the concepts of health and illness among healers of indigenous ethnicities in Southern Ecuador. Methods: A qualitative observational study with eleven focus groups was conducted in three locations in Southern Ecuador; a total of 110 participants the Shuar, Kichwa and Mestizo ethnic groups were included. A phenomenological and hermeneutic analysis was conducted. Results: Fourteen main subtopics around of two predefined themes, i.e., "Health" and "Illness" were identified: 1) four bodies, 2) religiosity, 3) health as a good diet, 4) health as god's blessing or a gift, 5) health as balance/ harmony, 6) health as community and social welfare, 7) health as potentiality or a skill, 8) health as peacefulness, 9) heath as individual will, 10) illness as an imbalance, 11) illness as bad energy, 12) illness as a bad diet, 13) illness as suffering or worry, and 14) illness from God, Nature and People illness. By analysing all the topics' and subtopics' narratives, a health and illness definition was developed. The principal evidence for this new framework is the presence of interculturality as a horizontal axis in health. The indigenous perspective of health and illness focus on a balance between 4 bodies: the physical, spiritual, social and mental bodies. Additionally, "good health" is obtained through of the good diet and balanced/harmony. Conclusion: Indigenous healers in Southern Ecuador have views on health and illness that differ from the Western biomedical model of care. These different views must be recognized and valued in order to build an intercultural (health) system that empowers both ancestral and modern medical knowledge and healing.

High-quality training is a prerequisite to teaching future general practitioners. To inspire and guide all countries to implement General Practice (GP) specialist education and training and bring it to the highest standards, we aimed, within the European context, to produce a collaborative document entitled 'Educational Requirements for GP Specialty Training'. Through an iterative process existing documents from the European Academy of Teachers in GP and Family Medicine (EURACT) and the World Organization of Family Medicine Doctors (WONCA) were collated. Other reports, grey literature about specialty GP training and requirements for trainees, trainers and training institutions were included. State-of-the-art GP specialty training 'core' competences, characteristics and essential features of GP are described. General principles and specified tools for training and assessment are summarised. Recommendations on the duration and place(s) of training and selection of trainees are provided. Trainers should be accredited teachers and quality training institutions are essential. New insights, existing gaps and issues for debate have highlighted areas for further research. This document was produced in the specific context of Europe but its general principles are relevant to GP training in all countries.