Context Previous research has suggested that as medical students become more senior, they should increasingly take on the roles they will enact as newly qualified doctors by contributing to patient care. However, student contribution to patient care carries inherent risks to patient safety. This study aimed to provide students with a new opportunity to contribute to patient care and to use this as a platform from which to explore the influence of contributing to patient care on medical student learning. Methods This study took place in the context of final‐year medical student prescribing education at the University of Edinburgh, Edinburgh, UK. Students on attachment at a district general hospital were afforded a unique opportunity to learn prescribing by completing in‐patient drug charts in a process termed ‘pre‐prescribing’. All students were invited to participate in focus groups conducted by the principal researcher. Focus group discussions were audio‐recorded, transcribed verbatim and thematically analysed. Results Six focus groups, each lasting 20–50 minutes, were conducted with four to seven participants (33 students in total). The emerging themes took the form of developmental outcomes and learning processes. Developmental outcomes included ability to perform the task, modification of attitudes towards the task, formation of a professional identity, and development of relationships within the team. The central feature of the experience which influenced all developmental outcomes, was making mistakes. The themes interact in complex ways and all contribute towards development as a professional. Conclusions This study has demonstrated that contributing to patient care enhances students' development as professionals. Some of these developmental outcomes, such as improvements in knowledge and skills, may be achievable to some extent within the classroom. Other changes, such as developing relationships, forming a sense of professional identity and modifying attitudes, might arguably be achievable only within the context of contributing to patient care.

A ferric leghemoglobin reductase from the cytosol of soybean (Glyclne max) root nodules was purified to homogeneity and partlafly characterized. The enzyme is a flavoprotein with flavin adenine dinuclotide as the prosthetic group and consists of two identical subunits, each having a molecular mass of 54 kilodaltons. The pure enzyme shows a high activity for ferric leghemoglobin reduction with NADH as the reductant in the absence of any exogenous mediators. The enzyme also exhibits NADH-dependent 2,6-dichloroindophenol reductase activity. A sequence of the first 50 N-terminal amino acids of the purified protein was obtained. Comparisons with known protein sequences have shown that the sequence of the ferric leghemoglobin reductase is highly related to those of the flavin-nucleotide disulfide oxidoreductases, especially dihydrolipoamide dehydrogenase of the pyruvate dehydrogenase complex.proposed to be flavoproteins or metalloflavoproteins. All have low affinity for Lb"3, low Lb"3 reductase specific activity, and usually require for activity some exogenous electron carriers such as DCIP, methylene blue, or Cyt c. Their ability to catalyze Lb"3 reduction in vivo is doubtful. Klucas and colleagues (9,16,17) identified a protein with FLbR activity from soybean nodule cytosol. This enzyme showed a high activity for Lb"3 reduction with NAD(P)H as reductant in the absence of exogenous electron mediators. In this study the FLbR was purified to homogeneity. The enzyme was partially characterized and the sequence of N-terminal amino acids was determined. Based on the amount enzymatic activity and the apparent high affinity for Lb"3 of the purified enzyme, it seems likely that this enzyme may play a physiological role in maintaining Lb in the functional ferrous state in soybean nodules. MATERIALS AND METHODSLb3 plays an important role in symbiotic nitrogen fixation because it facilitates diffusion of02 to the N2-fixing bacteroids and buffers 02 concentration within the infected cells of nodules (2,

This study demonstrates the successful small-scale implementation of pre-prescribing. Initial data regarding the safety of the process is positive, but further evaluation is required to reassure all that the risk of adverse events is minimal. The project is to be expanded throughout South East Scotland with a view to all units providing the opportunity for pre-prescribing during the first student assistantships in March 2012. The longer-term goal is to set-up safe processes that will support medical students undertaking pre-prescribing throughout most of their final year.

Aims: This research investigated the effectiveness of an intervention for improving the prescribing and patient safety behaviour among Foundation Year doctors. The intervention consisted of simulated clinical encounters with subsequent personalised, structured, video-enhanced feedback and deliberate practice, undertaken at the start of four-month sub-specialty rotations. Methods: Three prospective, non-randomised control intervention studies were conducted, within two secondary care NHS Trusts in England. The primary outcome measure, error rate per prescriber, was calculated using daily prescribing data. Prescribers were grouped to enable a comparison between experimental and control conditions using regression analysis. A break-even analysis evaluated costeffectiveness.

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