This study demonstrates that in consultations where doctors use computers, the computer can legitimately be regarded as part of a triadic relationship. Routine use of computers in the consultation changes the doctor-patient relationship, and is altering the distribution of power and authority between doctor and patient.

This study throws light on to the uncertain path of the novice clinical learner illuminating both the intractable aspects of hospital environments and opportunities for pedagogical and affective supports that can compensate. The processes and conditions for self-directed learning time need attention in order to provide for a safe, efficient or successful clerkship experience for all students. Particular effort is needed to sensitively identify those individuals who struggle and suffer on the journey, and provide appropriate support.

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CONTEXT The seemingly obvious claim that people prefer to keep mum about undesirable messagestermed 'the MUM effect'was initially reported in the psychology literature in the 1970s. More recently, it has been discussed in contexts including performance appraisals and the reporting of unsuccessful projects in workplace settings, but only sparsely in educational ones. We wished to review the published literature on the MUM effect in order to understand the implications for clinical assessment.METHODS We performed a narrative literature review on the MUM effect and clustered findings together into three themes: those that describe what MUM behaviours look like, those that explore potential reasons for the MUM effect and those that consider factors that can influence MUM behaviours.RESULTS This paper summarises the extensive literature on the MUM effect, including its manifestations and modifiers and discusses how the effect may be used to consider issues faced by many clinical supervisors faced with delivering 'negative' assessment messages to trainees.DISCUSSION We suggest, that as a pervasive phenomenon, the MUM effect can both help to explain the difficulties that some assessors face when delivering undesirable messages (including feedback or ratings) and offer new insights in how to deal with such issues.

Purpose -The purpose of this paper is to examine changes in patients' satisfaction after their doctor has participated in a brief educational intervention on medicolegal risk management. Design/methodology/approach -Questionnaire completed by ambulatory patients, measuring satisfaction with their doctor's communication skills before and three months after the doctor participated in a three hour workshop on medicolegal risk management. 75 obstetrician/gynaecologists (O&Gs) and 99 general practitioners (GPs) were each rated by 60 of their patients following a consultation in their clinical rooms. Findings -Patient satisfaction as evidenced by change to "complete satisfaction" with doctor's communication skills and overall satisfaction with the clinical encounter. Practical implications -Participants had high initial patient satisfaction ratings and these were found to have improved across all parameters three months after the educational intervention. Originality/value -The educational intervention was successful in improving doctors' communication skills as evidenced by enhanced patient satisfaction in all key areas, including those most frequently associated with patient complaint, litigation and adverse outcome.