A national medical education needs' assessment of interns and the development of an intern education and training programme

A needs' assessment of interns was undertaken using a self-completion questionnaire and a semistructured interview. The questionnaire explored to what degree graduates had been helped to acquire a range of competencies and professional characteristics. In the interviews graduates discussed their self-perceived learning needs, their educational and training experiences and made suggestions. A 25% random sample of 1996 graduate doctors was selected from the five medical schools in Ireland (n=95). The overall response rate was 88% (n=84). The software package SPSS was utilized to carry out descriptive statistics on the questionnaire data while the interview data were analysed qualitatively. Of the responders, 91% reported that they were not prepared for all the skills needed as an intern. History taking and clinical examination were considered well covered at the undergraduate level but little training was received in a range of professional competencies and personal characteristics. Formal education and training during the intern year was found to be poor. However, some skills and characteristics improved during the year as a result of work experience. In the interviews the graduates explored educational issues. They considered an improved clinical experience throughout the undergraduate years to be at the heart of curriculum development but stressed that, in order to succeed, it would have to be accompanied by leadership within the healthcare system and efforts to improve the learning environment.

Bronchopulmonary Kaposi's sarcoma in 106 HIV-1 infected patients

The objectives of this study were to describe the clinical and radiological features at presentation, and the natural history of HIV-related bronchopulmonary Kaposi's sarcoma. A retrospective review of medical records and chest radiographs was performed in 106 HIV-infected homosexual men with bronchopulmonary Kaposi's sarcoma diagnosed at bronchoscopy between September 1988 and November 1994. The majority of patients had evidence of advanced HIV disease at diagnosis (median CD4 cell count was 15 x 10(6)/l, range 0-288), and 93% had had a diagnosis of cutaneous Kaposi's sarcoma for a median duration of 11 months prior to diagnosis of their bronchopulmonary disease. The most frequent symptoms at presentation were cough (92%), dyspnoea (69%), pleuritic pain (20%), haemoptysis (13%) and wheezing (10%). The most common radiological finding in 73% of our series was of poorly defined and confluent opacities, with predominant middle and lower zone involvement. Median survival was 4 months (range 0-37 months) from diagnosis and 9 months (range 1-25) from the onset of symptoms. Treatment with either chemotherapy or radiotherapy was associated with a significantly reduced risk of death (hazards ratio (HR)=0.48, 95% CI=0.26-0.87). Factors associated with a poor survival, after adjustment for treatment effect were older age (HR=1.79, 95% CI=1.22-2.84) for each 10-year increase in age; a history of pleuritic pain (HR=2.97, 95% CI=1.39-6.32); presence of pleural effusion on X-ray (HR=2.01, 95% CI=1.13-3.59) and a prior diagnosis of cutaneous Kaposi's sarcoma (HR=1.8, 95% CI=1.00, 3.24). Bronchopulmonary Kaposi's sarcoma occurs mainly in patients with advanced HIV disease and a prior history of cutaneous disease. Survival is poor, and adverse prognostic factors include older age at diagnosis and the presence of pleural disease.