Aims-To determine the potential efficiency of molecular markers specific for neoplastic change-mutations ofthe K-ras oncogene and the p53 tumour suppressor gene-in diagnosing pancreatic carcinoma. Methods-Archival cytology samples obtained from 17 patients with established pancreatic carcinoma were assayed for alterations in K-ras and p53. To detect changes in p53 expression, iimmunocytochemistry with polyclonal antibody CM1 was performed on the archival cytology slides after destaining. Mutations in K-ras codon 12 were then analysed on the scrapings of the same slides using mutant enriched polymerase chain reaction (PCR) amplification and restriction fragment length polymorphism analysis with allele specific oligonucleotide hybridisation for confirmation and characterisation. Results-False negative results were recorded for five of the cytology slides when compared with p53 immunostaining ofthe surgical resection specimen. These five cases had been stained previously with Giemsa which interacts adversely with the immunostaining in contrast to the Papanicolaou procedure. The K-ras codon 12 mutations followed the well established distribution frequency and spectrum for pancreatic cancer and corresponded with the findings in the resection specimens in all cases. Two scrapings yielded insufficient DNA for PCR. Importantly, for two cases with an inconclusive cytology diagnosis on routine light microscopy, the diagnosis was confirmed by one of the molecular markers. The application of the molecular markers increased the diagnostic accuracy of cytology in this small study from 76 to 89%. Conclusions-The study indicates that assessment of alterations in the K-ras and p53 genes may be a valuable adjunct to diagnostic cytopathology of the head region of the pancreas, although there are some difficulties which will overcome.(J7 Clin Pathol 1995;48:218-222) have to be

Three patterns in the growth in skills were distinguished: (i) low baseline, relatively high follow-up, (ii) moderate baseline, moderate growth and (iii) high baseline, hardly any growth. Patient-oriented skills follow either pattern (i) or (iii), whereas task-oriented skills follow pattern (ii). These findings may help to define where the focus should lie in the training of doctor-patient communication skills.

Background: General practice (GP) trainers play a key role GP trainees' education. To stimulate development of trainer competencies a Personal Development Plan (PDP) can be helpful, especially when feedback is incorporated. Aims: To investigate to what extent GP trainers use feedback in PDPs. Methods: GP trainers were provided with three feedback sources: trainees' rating scores, trainees' narrative comments, and selfassessment scores. Trainers were instructed to use these while drawing up PDP goals. With quantitative analyses the extent to feedback sources were used was determined. Results: Of the trainers 93% submitted a PDP. More than 75% of goals were based on provided feedback. Multiple sources addressing the same issue increased feedback use. If two sources pointed in the same direction, feedback was used more often if one of them concerned ''narrative comments''. Ratings were lowest for GP-related Expertise and Teaching Skills. Most goals defined concerned these domains. Fewer goals regarded Personal Functioning. Proportion of feedback used concerning Personal functioning was lowest. Conclusions: GP trainers use most feedback and address issues most commented upon. Narrative comments deserve a profound place when eliciting feedback. Research into the quality with which feedback is used in PDP goals should complement these results.

Background: It has been reported that appraisal by peers can be effective. Aim: To investigate whether feedback from a peer group (PG) compared to that by a staff member during a practice visit (PV) is as effective in improving the quality of action plans. Methods: Seventy-three general practitioner (GP) trainers randomized into either a PG or PV were instructed to draw up action plans using the SMART criteria to realize the goals set in their personal development plans (PDPs). To improve action plans, feedback was given in either PG or PV. Quality of baseline and follow-up action plans, operationalized as the SMARTness with which plans were formulated, was assessed using a study-specific instrument. Results: Response rate for submitting both baseline and follow-up action plans was 89% in the PG versus 79% in the PV. It was feasible to determine scores on all SMART criteria, except for the criterion 'Acceptability'. Significant improvement was made on the remaining four criteria irrespective of the feedback setting. Conclusions: PGs cost less and seem equally effective in improving the SMARTness of the action plans. Moreover, they also seem to stimulate GP trainers more to write a PDP. Therefore, they may be favoured over PVs.