Actors are widely used in medical education as simulated patients. In this session, the role of actors was extended to 'simulated students' and facilitators in an introductory communication session. After an initial activity with the entire cohort of first-year students, groups of 20 students worked with either an actor or medical teacher in three activities. The activities aimed to raise students' awareness of the range of communication challenges in medical education and practice. After the session, students completed evaluation forms based on their experiences in the session. The results revealed no difference between students who were facilitated by actors or medical teachers in relation to meeting the learning objectives and their ratings of the usefulness of the activities to support learning. The actors who participated in this session were experienced in working with medical students. Their enhanced role provides students with an opportunity to identify with and reflect on the expertise of a lay teacher and to consider extending their definition of a learning opportunity to more informal encounters.

Nurses are under more pressure than ever before in a fast-changing NHS. Staff shortages and spiralling workload have led to escalating levels of stress in community care, while managers look to minimize the cost of sickness absence. However, the causes of sickness absence are complex and poorly understood. The authors report on a small-scale qualitative research study on the attitudes of primary care nurses to sickness absence. In-depth interviews were conducted with a small sample of volunteer nurses working in a west London primary care organization. Interviews were transcribed, coded and analysed into six main themes. It was found that psychological issues and values are very important but good management and the role of the team are also key factors in the decision to take sick leave. Workplace characteristics, personal issues, and local factors also play a very significant role.

(i) This study was rapid and sustained a high level of energy and purpose among stakeholders. Action research is an appropriate method to apply to transformational change in the modernization of health-care systems; (ii) Modelling of system dynamics is a critical dimension to the success of whole system change; (iii) Primary care commissioning power is an under-used, but influential, lever for change. At a point when the PCT commissioning structure is under threat, this project exemplifies primary care's ability to engineer change in acute hospital services.

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