Specialist training in emergency medicine needs to pay more attention to the acquisition of clinical skills and to preparation for management responsibility.

The effect of dissolved oxygen and changes in temperature upon the quinine standard used in the thiochrome reaction and upon thiochrome solutions is large enough to warrant an attempt to control these variables. Temperature effects can be minimized by the use of a water bath to keep the quinine at a standard temperature. The effect probably does not alter the thiochrome fluorescence very much if the room temperature does not vary greatly. Oxygen effects can be minimized by controlling the temperature of the quinine so that no dissolved air is lost, or b y the use of glass standards. Because of the shaking operation the oxygen content of thiochrome solutions is probably a constant factor. Since several types of instruments used to measure fluorescence will gradually heat up the cuvette chamber, the quinine standard should not be left in the instruments.T HAS long been apparent to many analysts that the thio-I chrome method of assaying the thiamine content of biological and other products is occasionally subject to unexplained sources or error that appear and disappear in an erratic manner. Usually these errors limit the accuracy of the method to from *5% to 110% (6), but they may be considerably larger, m has occasionally been observed in this laboratory. While engaged in an attempt to run down some of these sources of error the authors became suspicious of the accuracy of their quinine standard. The order in which samples of thiamine were oxidized and read against the quinine standards appeared to affect the results. If a sample of material was assayed twice on, any given day, and if several hours elapsed between the two oxidations, the last result was the higher if the same quinine standard was used for both oxidations, This phenomenon made it appear as if the quinine exhibited less fluorescence the longer it was used on any given day. The authors had been using fresh daily aliquots of the standard, kept at about 6" C. when not in use.According to Vavilov's equations (6) the fluorescence of a substance in solution is a function of the absolute temperature, other variables being constant. Vavilov also demonstrates the quenching of fluorescence by foreign molecules in the fluorescing solution. He divides quenching into two types (13): quenching by redistribution of the absorbed radiant energy among the degrees of freedom of the fluorescence molecule itself and collisions of the second type, which may or may not involve a chemical reaction. A consideration of Vavilov's work, together with the observations mentioned above, led to the conclusion that the possible effects of temperature and quenchers on the fluorescence of quinine and thiochrome should be investigated.Quenching by redistribution of energy among the molecules of the fluorophor, if it occurs in the quinine standards and in concentrations of thiochrome usually used in the thiochrome method, would appear to be a constant factor, at least for quinine. The only possibilities for quenching by foreign molecules lie in the presence of dissolved atmospheric gas...

Objective-To assess the quality of accident and emergency (A&E) medicine higher specialist training as perceived by current trainees and those who have recently completed training. Methods-Postal questionnaires to three groups of A&E specialists either currently in training or having recently completed training. Results-Levels of satisfaction were generally high. Previously identified deficiencies in management training remained and the implementation of guidelines regarding formative assessment and time for study and research was inconsistent. In many ways the proposals in Trainingfor the future' mirrored the course of action already taken by A&E for a shortened period of HST following general professional training.5 It is recognised that in order to maintain educational standards a more structured and intensive programme of HST is necessary. Against this background it seems appropriate to review the current state of HST in A&E.In this paper we assess the quality of training in A&E as perceived by recent and current trainees and discuss potential improvements to the current schemes. MethodsThree groups of trainees and former trainees were asked to complete questionnaires regarding aspects of their training.(1) Adequacy of recently completed training Postal questionnaires were sent to 42 consultants in A&E medicine who had been appointed from senior registrar posts within two years of the study. This study examined satisfaction with training in specific clinical, teaching and managerial skills at the end of training. Attitudes towards research as a component of HST was also assessed.(2) Current registrars-quality training?To assess the views of new entrants into HST, a list of registrars in A&E was compiled with the help of the Joint Committee on Higher Medical Training and the British Accident and Emergency Medicine Trainees Association (BAETA). A total of 110 questionnaires was sent out in early 1995. Respondents were asked to express their views on the quality of their training, including clinical skills and management. The allocation of protected study time and availability of study leave was also examined. (3) Training-supervision, assessment, and appraisal In order to assess the overall level of supervision to all trainees a questionnaire was circulated to registrars and senior registrars in A&E by regional representatives of BAETA. The relationships of the trainee with their trainer and educational supervisor and the occurrence of annual reviews of the trainee and appraisal of the training post were assessed.

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