Can students learn comparable clinical skills in general practice and hospital settings?

A randomised crossover trial to study the acquisition of clinical skills in general practice shows that medical students are discriminating consumers of educational experience and will seek out teaching that meets their learning needs.

Abstract

Majority view of climate scientists is that global warming is indeed happeningEditor-Gardner states that the scientific basis of climate change is uncertain and that there are major differences of opinion among climatologists about whether climate change is likely to occur and its potential magnitude. 1 Inevitably, with an issue of such complexity there is bound to be scientific debate, but the Intergovernmental Panel on Climate Change, which we quoted in our articles, is a major international collaboration: it has involved the participation of over 2500 scientists from around the world.Many of the most vociferous sceptics have received funding from fossil fuel industries, which clearly have a vested interest in opposing changes in policy that might result in shifts away from fossil fuels. 2 The evidence that Gardner quoted against climate change-that satellite data have shown 0.13°C global cooling between 1979 and 1994 and that the Arctic has been cooling-is mistaken.Satellite measurements are in good agreement with records of surface temperature for 1979-94. 3 Once the transient effects of volcanoes and the El Niño-southern oscillation are removed, upward global trends of 0.09°C per decade from satellite data and 0.17°C per decade from surface data are obtained. 4 This is reasonable agreement, especially when one realises that the satellite measurement is a weighted average over the atmosphere column from the surface to 7 km altitude and temperature changes in the midtroposphere may well differ from those at the surface.Furthermore, although temperatures have fallen in Greenland, they have risen by similar amounts over much of the remaining Arctic, notably in Siberia, northern Canada, and Alaska. 5 There is compelling evidence that the average global temperature has increased by about 0.6°C since the industrial revolution.Indeed, nine of the 11 hottest years this century have occurred since 1985.More importantly, climate models suggest that substantial global warming (1.0-3.5°C) will have occurred by the end of the next century with projected increases in use of fossil fuels.This underlines the need for a precautionary approach to limit emissions of greenhouse gases as well as increased investment in research on climate change and its potential impacts.Finally, we must emphasise that the prospect of large scale climate and environ-mental changes necessitates the contingent assessment of future risks.Epidemiologists (like agricultural scientists, hydrologists, urban planners, and others) cannot reasonably dispute the majority view of climate scientists.Rather, they must base their risk assessment on the climate change scenarios projected by those experts.