Overwhelmingly, students enjoy CBL and think that it enhances their learning. The empirical data taken as a whole are inconclusive as to the effects on learning compared with other types of activity. Teachers enjoy CBL, partly because it engages, and is perceived to motivate, students. CBL seems to foster learning in small groups though whether this is the case delivery or the group learning effect is unclear.

Objective To explore the experience of non-UK-qualified doctors in working within the regulatory framework of the General Medical Council (GMC) document Good Medical Practice. Design Individual interviews and focus groups. Setting United Kingdom. Participants Non-UK-qualified doctors who had registered with the GMC between 1 April 2006 and 31 March 2008, doctors attending training/induction programmes for non-UK-qualified doctors, and key informants involved in training and support for non-UK-qualified doctors. Main outcome measures Themes identified from analysis of interview and focus group transcripts. Results Information and support for non-UK qualified doctors who apply to register to work in the UK has little reference to the ethical and professional standards required of doctors working in the UK. Recognition of the ethical, legal and cultural context of UK healthcare occurs once doctors are working in practice. Non-UK qualified doctors reported clear differences in the ethical and legal framework for practising medicine between the UK and their country of qualification, particularly in the model of the doctor–patient relationship. The degree of support for non-UK-qualified doctors in dealing with ethical concerns is related to the type of post they work in. European doctors describe similar difficulties with working in an unfamiliar regulatory framework to their non-European colleagues. Conclusions Non-UK-qualified doctors experience a number of difficulties related to practising within a different ethical and professional regulatory framework. Provision of information and educational resources before registration, together with in-practice support would help to develop a more effective understanding of GMP and its implications for practice in the UK.

National Blood Service (NBS) Tissue Services (TS) operates living donor and deceased donor tissue banking programmes. The living bone donor programme operates in collaboration with 91 orthopaedic departments across the country and collects bone donations, in the form of surgically removed femoral heads (FHs), from over 5,000 patients per annum undergoing total hip replacement. Bone donated via the living programme constitutes approximately 55% of the total bone donated to NBS. Non-NBS tissue banks, primarily in hospital orthopaedic departments, also bank donated bone for the UK. A survey of information received from 16 collaborating orthopaedic centres, between April 2003 and August 2004, identified 709 excluded donors. The total number of donations banked from these sites was 1,538. Donations can be excluded before collection if there are contraindications noted in a potential donor's medical history before their operation. Donors may also be excluded after collection of the FH, for instance because of reactive microbiology tests for blood borne viruses, or if the donation storage conditions or related documentation have not met stringent quality requirements. In this survey, bone or joint conditions were the major reasons for excluding potential donors before donation (154 of 709 exclusions, 22%), followed by a current or a past history of malignancy (139 of 709 exclusions, 20%). Local staffing and operational difficulties sometimes resulted in potential donors being missed, or specific reasons for exclusion not being reported (117 exclusions). These out numbered exclusions due to patient refusal (80 exclusions). A small number (< 5) appear to have been excluded erroneously. There was considerable local variation in the reasons given for exclusion and certainly under-reporting. A survey of donations discarded after collection in the same period highlighted that 43% were donor related; 110 of 370 did not provide a follow-up blood sample. More than 30% were due to delays in forwarding blood samples to the microbiological laboratory for testing, resulting in deterioration of the sample quality. Training to ensure that standards are complied with and a firm evidence base for exclusion criteria, applied uniformly, will help focus donor identification efforts on individuals meeting rational criteria so that fewer potential donations are lost.

More people die in hospital than at home (Department of Health (DH) 2008). Yet, many people do not want to die in hospital, which can be an inappropriate environment for end of life care. The government's end of life care strategy (DH 2008) and the NHS (2009) end of life care programme (EOLCP) state that people should be able to choose where they die. This article reports on the findings of a study on end of life care of decisions by patients, relatives and care professionals, and their perceptions of care pathways in the last 48 hours of life. It also highlights the challenges that must be overcome in acute and community settings for the aims of the EOLCP to be met.

This article discusses a six-day course designed to address the current gap in provision of structured, accredited training for service users wanting to contribute to Higher Education (HE) Health and Social Care Education through public involvement (PI). It discusses the views of the participants who completed the course on its perceived impact on their future practice and their opinions on formal accreditation in this context. The course was delivered by a team of service users and academics. It covered three domains of involvement in HE: teaching, research and governance. This article focuses particularly on involvement in teaching and learning activities, drawing on findings from a focus group with participants carried out after the completion of the course. Focus group participants discussed five main outcomes of the course: 'new knowledge', 'new skills', 'confidence', 'personal capability and gratification', and 'added value on CVs or when applying for jobs'. They recognised the 'challenges of accreditation' but also felt that they had gained from the experience in terms of personal development, and in relation to what they would be able to bring to improve engagement with learners. As public involvement becomes increasingly mandatory and common, their experiences illustrate the key role of training for involvement in HE teaching activities to ensure that a more diverse group of users feel able to actively contribute. However, reflections on the development and delivery of the course also highlight some of the challenges involved, particularly in relation to assessment, time and funding.