Witnessing history: a personal view of half a century in public health.

Former Chief Medical Officer Sir Kenneth Calman recently celebrated 50 years in medicine. It was a period which saw the evolution of the public health agenda from communicable diseases to diseases of lifestyle, the change from a hospital-orientated health service to one dominated by community-based services, and the increasing recognition of inequalities as a major determinant of health. This paper documents selected highlights from his career including the Aberdeen typhoid outbreak, AIDS, bovine spongiform encephalopathy, foot and mouth disease, radioactive fallout, the invention of computerised tomography and magnetic resonance imaging, and draws parallels between the development of the modern understanding of public health and the theoretical background to the science 100 years earlier.

Evolutionary ethics: can values change.

The hypothesis that values change and evolve is examined by this paper. The discussion is based on a series of examples where, over a period of a few decades, new ethical issues have arisen and values have changed. From this analysis it is suggested that there are a series of core values around which most people would agree. These are unlikely to change over long time periods. There are then a series of secondary or derived values around which there is much more controversy and within which differences of view occur. Such changes need to be documented if we are to understand the process involved in the evolution of differences in ethical views.

Postgraduate specialist training and continuing professional development.

Specialist education and continuing professional development are likely to change considerably over the next 20 years. This will reflect the context within which medicine is practised. This will include changes in disease patterns, population structure, medical advances, information technology and, perhaps most powerfully, public involvement. In speciality education there will be a need to define more clearly both the role of the specialist, and the competences to be achieved. CPD is the longest period of education and, as such, it is the phase during which there is likely to be greatest change in clinical practice. There is a need to develop mechanisms to assure the public that doctors continue to practice up-to-date medicine, and that there is confidence and trust in the process.

Reforming higher specialist training in the United Kingdom--a step along the continuum of medical education.

OBJECTIVES: The requirement to align the arrangements for postgraduate training in the United Kingdom with those elsewhere in the European Community provided the opportunity to review and reform our arrangements for higher specialist training. This paper describes the case for change--the strengths and deficiencies of the traditional pattern of postgraduate medical training, demographic influences in the medical workforce and the need for a more structural or planned approach to training. CONCLUSIONS: Over the past 5 years substantial progress has been made: the introduction of new regulatory arrangements and a new higher specialist training grade; the development of a managed and flexible system for delivering training to standards set by the Royal Colleges and which can accommodate the needs of those pursuing academic and research medicine; and the opportunity for trainees' progress to be measured against published curricula. The significant programme of change has been underpinned by careful workforce planning and the publication of comprehensive guidance. Significant reform of higher specialist training has been achieved. This paper also makes the case for a more strategic approach to planning and developing medical education across the continuum, from entry to medical school until retirement, which can guide medical education and improve patient care into the next millennium.

Certification in postgraduate medical education.

This paper sets out some of the issues relating to certification of specialists. It first defines the purpose of certification as assuring the public of the level of competence of specialist practice. It then describes some of the issues involved, which include the assessment of competence, the need for public involvement, the issue of re-certification, and the problem of dealing with poor doctors. It concludes with a challenge to doctors to seize the opportunities and to enhance the quality of teaching and research in medical education.

The ethics of allocation of scarce health care resources: a view from the centre.

Resource allocation is a central part of the decision-making process in any health care system. Resources have always been finite, thus the ethical issues raised are not new. The debate is now more open, and there is greater public awareness of the issues. It is increasingly recognised that it is the technology which determines resources. The ethical issues involved are often conflicting and relate to issues of individual rights and community benefits. One central feature of resource allocation is the basing of decisions on the outcomes of health care and on their subsequent economic evaluation. The knowledge base is therefore of great importance as is the audit of results of clinical treatment. Public involvement is seen as an integral part of this process. For all parts of the process, better methodologies are required.