Background: Training in patient safety is an important element of medical education. Most educational interventions on patient safety training adopt a 'health-professional lens' with limited consideration on the impact of safety lapses on the patient and their families and little or no involvement of patients in the design or delivery of the training. Aims: This paper describes a pilot study to test the feasibility and acceptability of implementing a patient-led educational intervention to facilitate safety training amongst newly qualified doctors. Method: Patients and/or carers who had experienced harm during their care shared narratives of their stories with trainees; this was followed by a focused discussion on patient safety issues exploring the causes and consequences of safety incidents and lessons to be learned from these. Results: The intervention, which will be further tested in an NIHR-funded randomised controlled trial (RCT), was successfully implemented into an existing training programme and found acceptance amongst the patients and trainees. Conclusion: The pilot study proved to be a useful step in refining the intervention for the RCT including identifying appropriate outcome measures and highlighting organisational issues.

Background Rates of Clostridium difficile diarrhoea have recently been rising, with the elderly being at highest risk. Aim To compare the incidence of C. difficile colonization and diarrhoea in elderly patients treated for presumed infection with either empirical cefotaxime (CTX) or piperacillin–tazobactam (PT). Methods A prospective, ward‐based, crossover study was carried out on two well‐matched care of the elderly wards at a UK tertiary care hospital, in patients requiring empirical broad‐spectrum antibiotic treatment. Results There was a highly significant increased incidence of C. difficile colonization (26/34 vs. 3/14, P = 0.001) and diarrhoea (18/34 vs. 1/14, P = 0.006) in patients who received CTX as opposed to PT. DNA fingerprinting suggested that most infections arose from strains acquired from the hospital environment. Conclusions Elderly patients are significantly less likely to develop C. difficile diarrhoea after treatment with PT than after CTX. The source of C. difficile appears to be predominantly from the ward environment.

-Reforms to postgraduate training in the UK may affect recruitment to geriatric medicine. In 2005, a questionnaire survey was undertaken to determine the factors favouring geriatric medicine as a career choice and whether these might be used to influence recruitment.In all, 1,036 responses to the questionnaire were received (response rate 56.4%); 4% of the respondents decided to specialise in geriatric medicine as students, 3.8% of consultants and 8.6% of registrars decided as pre-registration house officers while 39% of consultants and 7% of registrars chose geriatric medicine while a middle grade in another specialty. The strongest influences on choice were clinical aspects of the specialty (34.1%) and inspirational seniors (26.2%). However, 9.2% of consultants and 10.1% of registrars subsequently regretted their career decision.Geriatric medicine seems to be a career choice for doctors of increasing maturity and including more posts in foundation programmes may not improve recruitment as anticipated. Although a small number of doctors regretted choosing geriatric medicine as a career, this was rarely to do with core aspects of the specialty. KEY WORDS: career choice, geriatric medicine, recruitment IntroductionPostgraduate training has changed dramatically with the introduction of Modernising Medical Careers (MMC) and the start of foundation programmes in August 2005. 1 One of the aims of foundation training is to enable trainees to experience a wider range of specialties during the early part of their career enabling them to make better informed career choices. It is hoped that foundation training may influence final career choices as doctors are expected to enter basic training upon completion of the programmes.Studies of the career choices of medical school graduates 2 have shown that about a quarter of doctors change their career choice between one and three years after qualification, and less than half consider their decision in year 3 as final. Respondents are not usually specific about a choice of specialty within hospital medicine; the small numbers of those that are, however, rarely express a preference to train in geriatric medicine. 3 Conflicting evidence exists as to whether early career choice is an accurate predictor of final career decisions. Eighty per cent of doctors who selected psychiatry three years after qualifying, for example, were still working in it 10 years later. 4 The 10th annual report of 1995 graduates performed by the BMA suggest different patterns. 5 Immediately after qualifying, 18% of graduates intended to pursue a career in general practice but 10 years later this figure rose to 35%. Conversely, in the same time frame, 20% intended to enter general medicine but this fell to just 6%.A survey of doctors currently training and working in geriatric medicine in the UK was recently undertaken to determine when they made their career decision, what the influencing factors were and whether they had any regrets. MethodsThe questionnaire was piloted on consultants and special...

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Hospital-at-home schemes are becoming an increasingly popular way of delivering health care world-wide. Schemes differ in the type of patients they cater for and in the intensity and complexity of treatment they provide. Although they have been in existence since 1961, there have been few randomized controlled studies to determine their effectiveness as an alternative to standard hospital care. Furthermore, some studies have produced conflicting results. Although there is accumulating evidence that they produce satisfactory patient outcomes and are acceptable to patients and carers, their cost-effectiveness is still uncertain. Further randomized controlled studies incorporating prospective cost analyses are needed. This paper discusses the evidence to support hospital-at-home as an alternative and complementary model of health care particularly for older people.