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PubMed2002

Hostile teaching hospitals and friendly district general hospitals: final year students' views on clinical attachment locations.

CONTEXT: The NHS Plan has indicated the need to increase the number of doctors in the NHS. To accommodate the substantial increase in student numbers in Birmingham, clinical teaching will need to expand from its traditional base within established teaching hospitals (THs) to district general hospitals (DGHs). Previous studies elsewhere have suggested the experience of students who undertake clinical attachments in DGHs is different from that of students attached to THs. We sought to investigate whether such differences exist in the West Midlands region and to explore the opportunities and problems such differences may present to educators and students alike. METHODS: A questionnaire-based survey of the TH and DGH experiences of all medical students in their final year (2000/01) of undergraduate training at the University of Birmingham Medical School was carried out. RESULTS: A total of 80% of students responded. Respondents indicated that both the identification of learning objectives and the provision of teaching to meet such objectives were likely to occur in TH and DGH settings equally. However, other differences emerged, suggesting that DGHs offer a friendlier and more supportive learning environment, with greater opportunities for the acquisition of hands-on practical experience. CONCLUSIONS: At present, the popularity of DGHs derives from the attitudes of staff and the opportunities for hands-on experience. However, as student numbers increase, DGHs may be required to take on additional teaching commitments. Will DGHs be able to retain their existing educational characteristics or will they take on those associated with established THs?

Attitude of Health Personnel↗
PubMed2000

Tissue factor expression and multidrug resistance in cancer: two aspects of a common cellular response to a hostile milieu.

Tissue factor (TF) is the main physiological initiator of blood coagulation and its activation or de-encryption within plasma membranes is important for trapping, extravasation and angiogenesis in the development and spread of solid malignancies. Multidrug resistance is also an adaptive response in malignant (and normal) cells. It is often mediated by the over-expression of the P-glycoprotein (P-gP) efflux pump. Both TF and P-gP tend to be expressed together, perhaps as part of a coherent 'crisis management' response of cells to environmental change or challenge. An associated feature in such a response appears to be the reversal of normal phospholipid charge asymmetry in the plasma membrane bilayer. Responses to environmental stimuli affect function in normal and malignant tissue. Uniting the study of TF expression or de-encryption and MDR-1 phenotype would be biologically enlightening and might ultimately influence clinical cancer management and the control of thrombotic problems associated with treatment.

ATP Binding Cassette Transporter, Subfamily B, Mem↗