A general approach to curriculum design in the context of Problem-Based Learning (PBL) is outlined. Ten general 'steps' for problem-based curriculum development are proposed, using the case study methodology to describe the underlying iterative process. Examples are given from the case of the development of a public health professions education curriculum. The process starts with defining the purpose of the curriculum. General objectives are generated in a top-down fashion. The prior knowledge, skills and misconceptions of future students are considered. A preliminary schedule of the curriculum is developed, including sketches of unit blueprints. These are further elaborated. Unit subgoals are related to planned educational activities. Only then, are the learning materials created, with problem writing as the most important aspect. In developing a problem-based curriculum, assessment deserves special attention, because of its influence on the learning process. Finally, educational organization, curriculum management and evaluation procedures are considered.

SummaryPropofol is frequently associated with pain on injection. Previous studies have suggested that chilling of the propofol decreases pain significantly. This prospective, randomised, double-blind trial was designed to assess the effectiveness of cold propofol compared with propofol premixed with lignocaine in minimising pain on injection. Patients were allocated to one of four groups: propofol lignocaine 0.1 mg.kg ÿ 1 , propofol lignocaine 0.2 mg.kg ÿ 1 , cold propofol and a control group consisting of propofol premixed with normal saline and maintained at room temperature. The results of this study show that cold propofol is associated with a very high incidence of injection pain while lignocaine 0.1 mg.kg ÿ 1 premixed with propofol significantly decreases the incidence of pain (p < 0.001). Increasing the dosage of lignocaine above 0.1 mg.kg ÿ 1 , however, does not significantly decrease the incidence of pain further. The addition of lignocaine also significantly decreases the incidence of excitatory side-effects.Keywords Anaesthetics; intravenous; propofol. Complications; pain. ...................................................................................... Correspondence to: Dr A. K. Parmar Accepted: 20 May 1997 Propofol possesses many characteristics of an ideal intravenous anaesthetic agent, providing a smooth induction and a rapid recovery. However, it has been reported to evoke considerable pain on injection in 10-100% of patients [1][2][3][4]. Numerous methods have been advocated to alleviate this pain. McCrirrick et al. demonstrated that the incidence of pain was decreased significantly when propofol was administered at a temperature of 4 ЊC [5]. A subsequent study, designed to assess the effectiveness of pretreatment with intravenous cold saline, found no statistically significant difference between the following treatment groups: cold propofol, propofol with lignocaine 0.05% and unmodified propofol preceded by cold saline [6]. The aim of this study was to assess the effectiveness of cold propofol compared with propofol premixed with lignocaine in minimising pain associated with the injection of propofol. MethodsApproval for this prospective, randomised, double-blind clinical study was obtained from the Institutional Ethics and Research Committee. The study was undertaken in 153 patients (ASA Class 1 and 2), aged 18-65 years, who presented for elective surgery under general anaesthesia. Written informed consent was obtained from all participating patients. The following groups of patients were not studied: pregnant/lactating mothers, patients with a history of epilepsy or cardiac conduction defects, patients on anti-arrhythmic drugs or analgesics, patients with disorders of lipid metabolism or in conditions where lipid emulsions must be used cautiously and patients with a past history of an adverse response to propofol or lignocaine.Patients were randomly allocated to one of four groups as categorised in Table 1. All mixtures were freshly prepared and were well mixed prior to injection...

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There is considerable variation in the reported frequency of teaching consultation skills, the models used, and the preparation of trainers for teaching, despite a systematic approach to teacher training in the Yorkshire Deanery.