The definitive version can be found at: http://onlinelibrary.wiley.com/ Copyright Wiley-Blackwell [Full text of this article is not available in the UHRA]This qualitative study was designed to examine why people with type 1 diabetes choose to discontinue continuous subcutaneous insulin infusion (CSII). The sample consisted of five adult participants with type 1 diabetes who had already taken the decision to discontinue CSII. Data were collected using audio taped, semi-structured interviews. Tapes were transcribed and analysed using a thematic analysis. Three themes emerged: (1) the challenges of wearing the pump, (2) lack of control over the pump, body and health, and (3) comparing expectations versus reality. Results are of relevance to people with diabetes, those professionals referring, commissioning and providing a service, and manufacturers

Foundation year one doctors (F1s) are expected to recognise and care for dying patients, but previous studies have found they can feel unprepared, stressed and unsupported when faced with such situations. Although hospice placements can provide good experiential learning for junior doctors, no studies to date have included F1s. This study used an interpretivist approach to explore educational opportunities and challenges in hospice placements from an F1's perspective. Six F1s who had recently completed hospice placements were interviewed individually. Data analysed qualitatively showed that F1s valued informal experiential learning and felt well supported by senior doctors. The most important learning outcome was the acquisition of enhanced communication skills and challenges included the risk of becoming medically deskilled. F1s felt their medical practice had changed as a result of hospice placement, most commonly in communication skills and recognition of the dying phase. The author recommends increased utilisation of hospice placements in foundation training programmes.

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Near-peer teaching (NPT) has been shown to be useful in undergraduate and postgraduate medical teaching, but there is sparse knowledge of its applicability in clinical settings, such as the ward round. The current study assessed the suitability of NPT on a consultant ward round and ascertained its advantages and disadvantages as a teaching method in this setting. NPT was trialled on three consecutive consultant ward rounds on a palliative medicine inpatient unit in a cancer centre. Both learner (three junior doctors) and facilitator (one consultant) views were sought via questionnaires and interviews. Data were analysed using thematic content analysis. All participants felt that NPT gave a better educational experience compared with traditional ward rounds. Participants found NPT improved their own teaching ability, was quick and easy to use, and was tailored to the learner. More advantages were cited than disadvantages. Disadvantages were only mentioned by senior doctors and included time off the ward round and lack of teaching for the senior member of the near-peer pair. Thus, NPT could be a useful educational tool to provide differentiated learning in busy clinical settings. However, more research is needed to ensure that it can meet the learning needs of senior trainees.

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