Medical student education for primary health care: who teaches what, when?

Since primary health care (PHC) is central to good doctoring and pervades all levels of medical services, a suitable system for teaching it must be developed. Whereas the traditional approach in teaching has been toward a set objective, PHC requires an approach that aims to meet urgent and changing needs. The PHC doctor must adapt to the prevailing requirements of his practice. Other teaching implications are those of organization and team training and continuing medical education. The conflict between different approaches is considered in an attempt to resolve the problem of who teaches what, when.

[The objective-structured clinical examination (OSCE)]. / Die objektief-struktureerde kliniese eksamen (OSKE).

The objective-structured clinical examination (OSCE) as described by Harden and Gleeson could be evaluated for a specific, limited skill (history and physical examination) on two third-year classes. The candidates were also evaluated on the same skills by conventional techniques in the Departments of Paediatrics, and Obstetrics and Gynaecology during the same examination period. The results were comparable and had significant Spearman rank correlations with the overall mark. The new method is highly acceptable to both students and examiners, and especially noteworthy was the fact that 93% of students experienced this test as a learning situation. They assessed it as an objective and fair evaluation, an opinion shared by most of the participating examiners. It would appear justified to use this test instrument more often, and in other combinations of disciplines and for other skills in subsequent years of the course.

[Mumps meningitis--bromine-82 partition test and cerebrospinal fluid glucose]. / Pampoentjie--meningitis--broom-82 partisietoets en serebrospinale vog glukose.

A case of mumps meningitis is reported where a low cerebrospinal fluid (CSF) glucose level, a positive bromine-82 partition test and the fact that the patient's sister had recently had tuberculous meningitis complicated the diagnosis. Mumps meningitis may be associated with low CSF glucose levels. Patients with viral meningitis usually have normal CSF glucose levels, and, during a recent study, false-positive results of 82Br partition tests were not found. Mumps meningitis, however, proves to be an important exception.