A study was conducted to determine whether the attitudes of medical students to death and caring changed during the 3 months following exposure to cadaver dissection. All first-year students were invited to complete a questionnaire immediately before their initial cadaver dissection experience, after 6 weeks, and after a further 3 months. The questionnaire reflected attitudes to death, violent death, death of someone known to the respondent and caring when someone known to the respondent is seriously injured. Ethnicity and previous exposure to dying has no effect on responses, but overall men students' reactions were significantly less than for women (P < 0.001). The responses given on the final part of the questionnaire after 3 months were significantly lower than those to most questions in the first part of the questionnaire. The exceptions were those questions where the subject in the given scenario was known to the respondent, where reactions were rated significantly greater (P < 0.001) in the follow-up questionnaire and can be explained on the basis that they were a personal referent. Students rapidly develop a coping mechanism which enables them to view cadaver dissection as an occupation quite divorced from living human beings. During these early months of training solicitude decreases for those who die who are unknown to them, but concern for personal referents increases. Educators should be aware of the dramatic change of attitudes among students and the process of professionalization which might influence their caring of future patients.

To ascertain the perceived skills of students at U.K. medical schools in palliative medicine. Design: A validated questionnaire survey. Participants: Newly qualified U.K. pre-registration house officers (PRHOs). Measures: A Likert scale from 0 to 5 for respondents to rate their perceived skills in four clinical scenarios, and their anxiety in caring for the dying. Results: Mean confidence rating in breaking bad news was 2.9, in ability to empathize was 3.2, in discussing prognosis was 3.3, and in providing symptom control was 2.8. Mean anxiety rating in caring for a dying patient was 2.9. Of the comments, 24% wished for more "hands on" experience and 23% suggested further curriculum recommendations. Conclusion: Teaching of palliative medicine is still inadequate for the needs of recently qualified doctors. Although PRHOs have identified a need for further instruction there is also acknowledgment that it is a difficult subject to teach. Recommendations are made for coordination of current interdepartmental teaching programs. medecins nouvellement recus, Meme s'ils ont identifie la necessite d'avoir plus de cours sur Ie sujet, ils ont d'autre part reconnu que c'est un sujet difficile a enseigner. On recommande done, entre autre, de COordonner au niveau lnterdeparternental les programmes d'enseignement couramment dispenses.

In order to determine the views of General Practice attenders on death and dying, a survey was conducted using a questionnaire with nine questions on aspects of death and dying. There were 4117 respondents with an average age of 36.4 years, who attended 10 general practices. A control group of 100 patients was employed. There was a stated preference for management by the General Practitioner and a wish to die in the home. An honest approach by doctors was called for and the greatest fear concerning death was that of leaving the family. A subgroup of people who stated that they had close personal experience of death or dying, amplified most of these findings.

Teaching of communication skills in Palliative Medicine can be achieved using a three hour exercise involving role-plays, a time of feedback and discussion, a teaching video and a reading list. Using this teaching method self-ratings of perceived skills recorded on a questionnaire before and four weeks after the exercises showed a significant increase in both undergraduates and postgraduates. The validity of these self-ratings as a tool to measure communication skills was assessed by correlating the self-ratings with the ratings given by the participant and the observers after the clinical scenarios from the questionnaire were simulated in role-plays.

Uganda has been engaged for a number of years in an ambitious programme of political and financial decentralization involving significantly expanded expenditure and service delivery responsibilities for local governments in what are now forty-five districts. Fiscal decentralization has involved allocation of block grants from the centre to complement increased local tax revenueraising efforts by districts and municipalities. This article is concerned with the financial side of decentralization and in particular with an examination of district government efforts to raise revenue with the tax instruments which have been assigned to them. These are found to be deficient in a number of ways and their tax raising potential not to be commensurate with the responsibilities being devolved. Achievement of the decentralization aims laid down, therefore, must depend either on the identification of new or modified methods of raising revenue locally, or increased commitment to transfer of financial resources from the centre, or both.