Vocabulary for describing the structures, roles, and relationships characteristic of traditional, or 'offline', education has been seamlessly applied to the designs of 'online' education. One example is the lecture, delivered as a video recording. The purpose of this research is to consider the concept of 'lecture' as realised in both offline and online contexts. We explore how media differences entail different student experiences and how these differences relate to design decisions associated with each. We first identify five features of traditional lecturing that have been invoked to understand its impact. We then describe a taxonomy of online lecture design derived from digital artefacts published within web-based courses. Analysis of this taxonomy reveals six design features that configure differently the experience of lectures in the two presentational formats: classroom and video. Awareness of these differences is important for the practitioner who is now increasingly involved in developing network-based resources for learning.

Subcutaneous delivery of drugs using a syringe driver is common practice within specialist palliative care units. There is, however, little documented information regarding clinical practice. A survey performed in 1992 reported that at least 28 drugs were used in combination with others in a single syringe driver. The aim of the present study was to reassess practice in this field and to enquire more specifically about newer drugs. Postal questionnaires were sent to all adult specialist palliative care in-patient units in the UK and Eire (n = 208). One hundred and sixty-five units (79%) responded. The most common syringe driver in use was the Graseby 26 (61% of responding units). Most units delivered the contents of the syringe over 24 h, and water was usually used as the diluent in 90% of cases. The maximum number of drugs that respondents were prepared to mix in a single syringe was usually three (51%) or four (35%). In the UK, all units used diamorphine in doses from 2.5 mg/24 h upwards. All respondents also used haloperidol, in doses from 0.5 to 60 mg/24 h. A total of 28 different drugs were used in syringe drivers. The most common combinations were diamorphine and midazolam (37%), diamorphine and levomepromazine (35%), diamorphine and haloperidol (33%), and diamorphine and cyclizine (31%). In conclusion, there is much in common with regard to the way in which drugs are delivered in syringe drivers. However, a wide variety of drugs and drug combinations are still in use.

35 36 BACKGROUND The "Can't Intubate Can't Oxygenate" (CICO) emergency requires urgent front of neck 37 airway access to prevent death. In cases reported to the 4 th National Audit Project, the most 38 successful front of neck airway (FONA) was a surgical technique, almost all of which were performed 39 by surgeons. Subsequently, UK guidelines adopted surgical cricothyroidotomy as the preferred 40 emergency surgical FONA technique. Despite regular skills-based training, anaesthetists may still be 41 unwilling to perform an emergency surgical FONA. 42 AIM To compare consultant anaesthetists, head and neck surgeons and general surgeons in a high-43 fidelity simulated emergency. We hypothesised that head and neck surgeons would successfully 44 execute emergency surgical FONA faster than anaesthetists and general surgeons. 45 METHODS We recruited 15 consultants from each specialty (total 45). All agreed to participate in an 46 in-situ hi-fidelity simulation of an 'anaesthetic emergency'. Participants were not told in advance 47 that this would be a CICO scenario. 48 RESULTS There was no significant difference in total time to successful ventilation between the three 49 groups (median 86 vs. 98 vs. 126.5 seconds, p=0.078). However, anaesthetists completed the 50 emergency surgical FONA procedure significantly faster than general surgeons (median 50 vs. 86 51 seconds, p=0.018). Despite this strong performance, qualitative data suggested some anaesthetists 52 still believed 'surgeons' best placed to perform emergency surgical FONA in a genuine CICO 53 situation. 54 55 CONCLUSION Anaesthetists regularly trained in emergency emergency surgical FONA function at 56 levels comparable to head and neck surgeons and should feel empowered to lead this procedure in 57 the event of a CICO emergency.

In-situ' simulation or simulation 'in the original place' is gaining popularity as an educational modality. This article discusses the advantages and disadvantages of performing simulation in the clinical workplace drawing on the authors' experience, particularly for trauma teams and medical emergency teams. 'In-situ' simulation is a valuable tool for testing new guidelines and assessing for latent errors in the workplace.

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