Objectives: There are currently no guidelines on the most effective ways of supporting medical students to develop high standards of medical professionalism. The aim of this review is to summarise the evidence currently available on methods used by medical schools to promote medical professionalism.Methods: We performed a systematic search of electronic databases (Medline, PsychInfo, British Education Index, Educational Resources Information Centre, Sociological Abstracts and Topics in Medical Education) from January 1998 to October 2008. Outcomes studied were methods used to support and promote the development of professionalism in medical students.Results: We identified 134 papers and five main themes for supporting the development of professionalism in medical students: curriculum design, student selection, teaching and learning methods, role modelling and assessment methods. However, the level of empirical evidence supporting each of these methods is limited.Conclusions: Identification of these five areas helps medical schools to focus the emphasis of their approaches to developing professionalism and identifies future research areas. This review offers a preliminary guide to future discovery and progress in the area of medical professionalism.

ObjectiveTo evaluate the evidence on the transition process from child to adult services for young people with palliative care needs.DesignSystematic review.SettingChild and adult services and interface between healthcare providers.PatientsYoung people aged 13–24 years with palliative care conditions in the process of transition.Main outcome measuresYoung people and their families' experiences of transition, the process of transition between services and its impact on continuity of care and models of good practice.Results92 studies included. Papers on transition services were of variable quality when applied to palliative care contexts. Most focussed on common life-threatening and life-limiting conditions. No standardised transition program identified and most guidelines used to develop transition services were not evidence-based. Most studies on transition programs were predominantly condition-specific (eg, cystic fibrosis (CF), cancer) services. CF services offered high-quality transition with the most robust empirical evaluation. There were differing condition-dependent viewpoints on when transition should occur but agreement on major principles guiding transition planning and probable barriers. There was evidence of poor continuity between child and adult providers with most originating from within child settings.ConclusionsPalliative care was not, in itself, a useful concept for locating transition-related evidence. It is not possible to evaluate the merits of the various transition models for palliative care contexts, or their effects on continuity of care, as there are no long-term outcome data to measure their effectiveness. Use of validated outcome measures would facilitate research and service development.

Objective To evaluate the evidence on the transition process from child to adult services for young people with palliative care needs. Design Systematic review. Setting Child and adult services and interface between healthcare providers. Patients Young people aged 13-24 years with palliative care conditions in the process of transition. Main outcome measures Young people and their families' experiences of transition, the process of transition between services and its impact on continuity of care and models of good practice. Results 92 studies included. Papers on transition services were of variable quality when applied to palliative care contexts. Most focussed on common life-threatening and life-limiting conditions. No standardised transition program identifi ed and most guidelines used to develop transition services were not evidence-based. Most studies on transition programs were predominantly condition-specifi c (eg, cystic fi brosis (CF), cancer) services. CF services offered high-quality transition with the most robust empirical evaluation. There were differing condition-dependent viewpoints on when transition should occur but agreement on major principles guiding transition planning and probable barriers. There was evidence of poor continuity between child and adult providers with most originating from within child settings. Conclusions Palliative care was not, in itself, a useful concept for locating transition-related evidence. It is not possible to evaluate the merits of the various transition models for palliative care contexts, or their effects on continuity of care, as there are no long-term outcome data to measure their effectiveness. Use of validated outcome measures would facilitate research and service development.

This study sought to explore the early implementation of cluster-based learning (CBL) pilots in one part of the UK. A qualitative study using semi-structured one-to-one interviews was conducted with 10 key informants responsible for managing and delivering local training programmes across 14 general practice specialty training schemes. Data were analysed using thematic content analysis using the constant comparative method. Wide variation existed in the running of CBL pilots between different schemes. The principal reasons for trialling CBL were the high numbers of general practitioner trainees, resulting in extra pressure placed on postgraduate education facilities. Training programme directors (TPDs) managed and facilitated the current pilots. Effective facilitation of the groups was considered essential, along with good organisation and planning, and enthusiastic facilitators. Having a mixture of specialist trainees from different stages of training promoted shared learning in the group. The cluster-based approach was also judged to enable the targeting of training to meet the needs of learners and to address specific local needs. Responders considered that CBL should ultimately comprise learner-led sessions facilitated by educational supervisors, with TPDs being responsible for leading the improvement of the quality of educational and clinical supervision. The main reasons why CBL was not implemented were anxieties about the risks of losing the perceived benefits of the current training format in the absence of evidence of the added value of CBL. The reluctance of trainers to get involved was a major barrier - this resulted mainly from a lack of confidence with facilitating small groups and funding for their time.