Clinical engagement: improving healthcare together.

Clinical engagement can achieve lasting change in the delivery of healthcare. In October 2011, Healthcare Improvement Scotland formulated a clinical engagement strategy to ensure that a progressive and sustainable approach to engaging healthcare professionals is firmly embedded in its health improvement and public assurance activities. The strategy was developed using a 90-day process, combining an evidence base of best practice and feedback from semi-structured interviews and focus groups. The strategy aims to create a culture where clinicians view working with Healthcare Improvement Scotland as a worthwhile venture, which offers a number of positive benefits such as training, career development and research opportunities. The strategy works towards developing a respectful partnership between Healthcare Improvement Scotland, the clinical community and key stakeholders whereby clinicians' contributions are recognised in a non-financial reward system. To do this, the organisation needs a sustainable infrastructure and an efficient, cost-effective approach to clinical engagement. There are a number of obstacles to achieving successful clinical engagement and these must be addressed as key drivers in its implementation. The implementation of the strategy is supported by an action and resource plan, and its impact will be monitored by a measurement plan to ensure the organisation reviews its approaches towards clinical engagement.

The natural history of tumours of the urinary tract.

Experimental and epidemiological evidence has implicated environmental factors in the increasing incidence of bladder cancer. Papillary tumours are less malignant than solid. Of 36 patients with papillary growths in the renal pelvis, 20 lived five years but 11 of 15 with solid tumours died within one year.Social and geographical influences have affected the incidence of adenocarcinoma of the kidney. Experimentally it has been produced by hormones, carcinogens, viruses and irradiation. Clinically the most adverse factor was histological anaplasia; renal vein invasion was three times as common in high-grade tumours. The postoperative five-year survival was 30 out of 42 patients with low-grade lesions but 12 out of 42 with high-grade lesions. In the case of low malignancy tumours without adverse factors, 25 out of 29 patients survived for five years. This unpredictable behaviour is characteristic of urinary tract tumours.

Some observations on attrition of students from canadian medical schools.

Students who entered their freshman year for the first time in 1958 and in 1959, from all medical schools in Canada, and those entering the four Western schools in 1960 were studied from the time they matriculated until they either graduated or withdrew from medical school. The rate of attrition is about 15% of matriculants each year, with the lowest rate at the University of Western Ontario (1.7%) and the highest at the University of Ottawa (33.6%) over the time period studied. Attrition was classified as academic and non-academic. Significantly higher rates were found in the case of non-academic attrition for women and in the case of academic attrition for Commonwealth students. Significantly higher rates for both types of attrition were found for older students and students who had attended undergraduate colleges different from their medical school colleges. It would appear from available statistics that the factors which combine to produce attrition are the intellectual and personality characteristics of the student, school promotional policies and evaluation methods.

Applications and enrolments at the Western medical schools: a study of medical matriculants for 1964.

All applicants and those who subsequently enrolled for the 1964-65 session in the Western medical schools were studied with the hope that it would encourage a national registration of applicants. Seven hundred and sixty-four applicants completed 865 applications for 288 places in four schools. Although the principal factor in selecting medical students in all Western schools is pre-medical performance, 49 "good-quality" (academically of good standing and under 30 years of age) resident applicants were not accepted in their own provincial school, and 49 places were filled with "poor-quality" students.The loss of good applicants to the Western medical schools and the 20% overlap of each school's applicant pool with that of other schools suggests that objective standards of quality must be developed, and that a regular annual national assessment of applicants should be conducted by the Association of Canadian Medical Colleges.

Medical education. II. Medicine or science--a study of career decisions.

A study of the career decisions of all students in a single matriculation cohort was undertaken in 1965 at the University of British Columbia. Studied were 64 premedical students, 112 ex-premedical students and 87 science students who had completed at least their second year. It was found by means of a questionnaire that medicine remained the career of high prestige for the three groups of students. In general the values and needs of the ex-premedical student were more similar to those of the science student than the premedical student. The loyalists to medicine were found to be more committed, self-assured, and orientated towards people and service. In addition, the premedical student was more concerned about his academic achievement but was also more confident of his progress. He emerged at the end of his training as the committed student who had chosen medicine at an early age and had remained loyal to his chosen career goal.