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Aims and methodWith increasing numbers of students and falling numbers of individuals receiving electroconvulsive therapy (ECT) it has been difficult to timetable all students to witness ECT, and it has been suggested that this experience may be dispensed with. However, we wondered how the experience of witnessing ECT might enhance students' knowledge and, just as importantly, challenge negative perceptions of ECT. We surveyed students' attitudes and knowledge at the beginning and the end of their 8-week attachment in psychiatry.ResultsThere appears to be a clear benefit in terms of knowledge and positive attitudinal change for students who both witness ECT and receive a lecture on the subject.Clinical implicationsDirect observation of ECT can challenge and affect attitudes in ways a lecture may not. Any changes to the provision of ECT teaching for medical students, including replacing witnessing ECT, needs to be carefully developed and assessed.

Introduction: Clinical empathy is the cornerstone of a good patient-clinician relationship. is study aims to examine the impact of an empathy teaching innovation (ETI) on empathic communication in medical students, which was introduced in a new medical curriculum and incorporates clinical skills and patient contacts from students' rst-year study. Method: A cluster randomised controlled trial (RCT) collected data on medical students' self-reported empathy using the Je erson Scale of Physician Empathy (JSPE), simulated patients' ratings of each student using the Je erson Scale of Patient Perception of Physician Empathy (JSPPPE) and students' performance in an objective structured clinical examination (OSCE). Half of the medical students (n = 39) received the ETI and the other half (n = 40) acted as the control group. e ETI is a 1-hour actor-led empathy workshop focusing on "being-in-role" and how to "walk a mile in the patient's shoes", previously shown to improve medical students' empathy scores. Results: e medical students who received the ETI were rated as more empathetic by the simulated patients, with statistically signi cant correlations between patients' perception of empathy and the consultation performance for the intervention group, but not for the control group. However, the ETI did not signi cantly enhance student self-reported empathy. Conclusions: is study presents the ETI as a short intervention tool for improving medical students' portrayal of clinical empathy, as perceived by simulated patients. Findings raise interesting questions for medical educationalists regarding the use of simulated (or actual) patients' reports on empathy.

BackgroundIn a manner similar to the television action hero MacGyver, health services researchers need to respond to the pressure of unpredictable demands and constrained time frames. The results are often both innovative and functional, with the creation of outputs that could not have been anticipated in the initial planning and design of the research.DiscussionIn the conduct of health services research many challenges to robust research processes are generated as a result of the interface between academic research, health policy and implementation agendas. Within a complex and rapidly evolving environment the task of the health services researcher is, therefore, to juggle sometimes contradictory pressures to produce valid results.SummaryThis paper identifies the MacGyver-type dilemmas which arise in health services research, wherein innovation may be called for, to maintain the intended scientific method and rigour. These 'MacGyver drivers' are framed as opposing issues from the perspective of both academic and public policy communities. The ideas expressed in this paper are illustrated by four examples from research projects positioned at the interface between public policy strategy and academia.