© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 493 493493

In brief

Improving approaches, understanding and outcomes Philip Cotton , General Practice, University of Glasgow , Scotland , UK

Twenty-nine self-selected and highly motivated students from six countries who undertook electives in Malawi, Tanzania and Zambia experienced differences in levels of supervision between ur-ban and rural settings. Although they did not feel that they had practised beyond their level of competence, they did offer sev-eral examples of being left with little option but to undertake tasks that they would not have undertaken in the UK. Although not forgetting the responsibility of the hosts to brief students, the study reminds us of the responsi-bility of home institutions to pre-pare students for work in settings where the ethical frameworks presented in the senders’ curricula are sometimes stretched.

Kumwenda B , Royan D , Ringsell P , Dowell J . Western medical students’ experiences on clinical electives in sub-Saharan Africa . Med Educ 2014 ; 48 : 593 - 60 3.

Doctors and medical students who have trained to a high level in sport and music share their expe-riences of the impact of feedback on their development. Feedback

has to be specifi c, credible and actionable, and so learner and teacher must agree performance goals, and trust and value feed-back. Building a learning culture in medicine requires not only at-tention to the physical and social setting, but to a shared apprecia-tion of feedback that is a core professional attribute of clinician teachers and learners.

Watling C , Driessen E , van der Vleuten CPM , Lingard L . Learning culture and feedback: an international study of medical athletes and musicians . Med Educ 2014 ; 48 : 713 – 723 .

This US-based study highlights that as early as year 2 of medical school imperatives such as future job security, debt from tuition and eventual social status, perceived to be associated with location and specialty, are more important than idealistic motiva-tions. The desire to work with underserved populations appar-ent at selection declines within a few years at school, leaving a potential gap in services. Medical schools have work to do in mak-ing sense of policy and health

service delivery in planning learning. Mader EM , Roseamelia C , Morley CP . The temporal decline of idealism in two cohorts of medical students at one institution . BMC Med Educ 2014 ; 14 – 58 .

Nurses and doctors from sub-Saharan Africa working in Europe were interviewed to explore their reasons for migration. They were united by having moved away from working in primary care set-tings in their countries. Poor con-ditions in which to work and be employed, low income, personal insecurity, and lack of opportuni-ties for their families in often remote and rural settings are cited as reasons why they make the choice to leave their communities. The authors call for approaches that train and then sustain health care workers to serve the commu-nities that need them most.

Moosa S , Wojczewski S , Hoffmann K , Poppe A , Nkomazana O , Peersman W , Willcox M , Derese A , Mant D . The inverse primary care law in sub-Saharan Africa: a qualitative study of the views of migrant health work-ers . Br J Gen Pract 2014 ; 66 : 281 – 282 .

doi: 10.1111/tct.12308

Philip Cotton reads the latest journals

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