A woman in a man's world.

Graduating from the University of Alberta in Chemistry (1963) and Medicine (1967), Jean was the founding Head of the Dalhousie Division of General Medicine, Associate Dean of Postgraduate Medical Education (1988-1996) and Associate Dean of Continuing Medical Education (1996-2002). She has served as President, Vice-President and Chair of numerous societies and as a member of several other national and international committees and boards. She is a Member of the Order of Canada and has two honorary doctorates.

Achieving the World Health Organization's vision for clinical pharmacology.

Clinical pharmacology is a medical specialty whose practitioners teach, undertake research, frame policy, give information and advice about the actions and proper uses of medicines in humans and implement that knowledge in clinical practice. It involves a combination of several activities: drug discovery and development, training safe prescribers, providing objective and evidence-based therapeutic information to ethics, regulatory and pricing bodies, supporting patient care in an increasingly subspecialized arena where co-morbidities, polypharmacy, altered pharmacokinetics and drug interactions are common and developing and contributing to medicines policies for Governments. Clinical pharmacologists must advocate drug quality and they must also advocate for sustainability of the Discipline. However for this they need appropriate clinical service and training support. This Commentary discusses strategies to ensure the Discipline is supported by teaching, training and policy organizations, to communicate the full benefits of clinical pharmacology services, put a monetary value on clinical pharmacology services and to grow the clinical pharmacology workforce to support a growing clinical, academic and regulatory need.

Generalism versus subspecialization: changes necessary in medical education.

During the initial Partners Meeting of the Association of Faculties of Medicine of Canada (AFMC), the Canadian Association for Medical Education (CAME), the College of Family Physicians of Canada (CFPC), the Medical Council of Canada (MCC), and the Royal College of Physicians and Surgeons of Canada (RCPSC) in May 2005, a plenary discussion and debate focused on the tensions that exist between generalist and subspecialty education within both the undergraduate and postgraduate educational programs in Canadian medical schools. Key issues identified in the debate included medical student selection, generalist representation on medical school faculty and in learning experiences, and the need for a greater teaching role and respect for generalism to be developed.

Experience with providing drugs for seniors in Canada.

The provincial and territorial governments in Canada are responsible for the provision of health care to all Canadians and, as part of this mandate, they provide drug coverage to all hospitalized patients regardless of age, and to seniors and patients with certain diagnoses, dependent on some forms of means testing. The federal government is responsible for regulation and setting standards for health care. It provides financial subsidies to the provincial programs as well as direct funding for specific groups of individuals. This article reviews the roles of each level of government in the provision of pharmaceuticals to seniors in Canada.

Helping family physicians improve their cardiac auscultation skills with an interactive CD-ROM.

INTRODUCTION: There have been few studies of the cardiac auscultation skills of residents and family physicians. This study assessed a group of family physicians' cardiac auscultation skills and use of a computerized self-instructional program to improve these skills. METHODS: Forty-two volunteer family physicians participated in an initial assessment of cardiac auscultation skills using test recordings of 12 common heart sounds. They were provided with a CD-ROM instructional program and were asked to devote 15 hours of self-study to the program and to return in 9 months for reassessment. RESULTS: The 42 family physicians in the initial assessment identified 39% of the heart sounds. Twenty-one returned for reassessment and showed significant improvement. Their initial mean score was 4.3 of 12 (35%), and their final mean score was 8.0 of 12 (67%). They found the CD-ROM program to be a valuable resource. The feature most liked was the unlimited opportunity to review sounds, cases, and tutorials. Most frequent problems related to computer access or skills. Eleven respondents reported using the program to resolve patient problems in their clinical practices. DISCUSSION: The cardiac auscultation skills of a group of volunteer family physicians showed low initial scores that improved significantly after self-study with a CD-ROM instructional program. The program was a valuable self-instructional aid, and physicians used it as a resource in clinical practice. However, only 50% of the initial group completed the self-study and returned for final assessment. Providing more support and assistance in the initial phase, especially with computer use, may enable completion of similar computerized self-study programs.

Drug policy: an oxymoron?

The use of the words "drug" and "policy" together highlights some of the inconsistencies and ironies in healthcare delivery in Canada. Not that the legislators and the government mandarins don't try to create and implement policy, but events (and the pharmaceutical industry) are always one step ahead so the policy-makers find themselves in the role of "follower" rather than "leader." It is time to re-examine the current approach to decision-making about pharmaceuticals and to identify a process that allows all Canadians to receive the care that was promised with the passage of the Canada Health Act.