Ethical and professional conduct of medical students: review of current assessment measures and controversies

As medical education increasingly acknowledges the importance of the ethical and professional conduct of practitioners, and moves towards more formal assessment of these issues, it is important to consider the evidence base which exists in this area. This article discusses literature about the health needs and problems experienced by medical practitioners as a background to a review of the current efforts in medical education to promote ethical conduct and develop mechanisms for the detection and remediation of problems.

La Mettrie and charlatanism: The dynamics of recognition and denunciation

This paper contributes to a genealogy of charlatanism by tracing two figures which eventually come to overlap: the street charlatan or operator, known for his eloquence and deceptive skill, and the comically incompetent doctor, represented classically in France in the theatre of Molière. The paper argues that eighteenth-century France gives the term 'charlatan' new moral weight while extending it to fields outside medicine, most notably to philosophy. Some examples of the denunciation of charlatans are examined, and it is suggested that denunciation was usually both extensible and reversible. La Mettrie appears in this regard as the very type of the denouncer denounced. He was a doctor-philosopher who vigorously decried the Paris Faculty of Medicine as a group of charlatans, even though his own medical qualifications were anything but impressive, and he was in turn reviled by Diderot as the most charlatanic and unworthy of philosophers.

Pattern-based phylogenetic distance estimation and tree reconstruction

We have developed an alignment-free method that calculates phylogenetic distances using a maximum-likelihood approach for a model of sequence change on patterns that are discovered in unaligned sequences. To evaluate the phylogenetic accuracy of our method, and to conduct a comprehensive comparison of existing alignment-free methods (freely available as Python package decaf+py at http://www.bioinformatics.org.au), we have created a data set of reference trees covering a wide range of phylogenetic distances. Amino acid sequences were evolved along the trees and input to the tested methods; from their calculated distances we infered trees whose topologies we compared to the reference trees. We find our pattern-based method statistically superior to all other tested alignment-free methods. We also demonstrate the general advantage of alignment-free methods over an approach based on automated alignments when sequences violate the assumption of collinearity. Similarly, we compare methods on empirical data from an existing alignment benchmark set that we used to derive reference distances and trees. Our pattern-based approach yields distances that show a linear relationship to reference distances over a substantially longer range than other alignment-free methods. The pattern-based approach outperforms alignment-free methods and its phylogenetic accuracy is statistically indistinguishable from alignment-based distances.

Adolescence: A useful concept for this millennium

‘Adolescence’ has become increasingly recognised as a nebulous concept. Previous conceptualisations of adolescence have adopted a ‘deficit’ view, regarding teenagers as ‘unfinished’ adults. The deficit view of adolescence is highly problematic in an era where adulthood itself is difficult to define. The terms ‘kidult’ or ‘adultescent’ have emerged to describe adult-age people whose interests and priorities match those of their teenage counterparts. Rather than relying on ‘lock-step’ models of physical, cognitive and social growth put forward by developmental psychology, adolescence can be more usefully defined by looking at the common experiences of people in their teenage years. Common experiences arise at an institutional level; for example, all adolescents are treated as the same by legal and education systems. The transition from primary to secondary schooling is a milestone for all children, exposing them to a new type of educational environment. Shared experiences also arise from generational factors. Today’s adolescents belong to the millennial generation, characterised by technological competence, global perspectives, high susceptibility to media influence, individualisation and rapid interactions. This generation focuses on teamwork, achievement, modesty and good conduct, and has great potential for significant collective accomplishments. These generational factors challenge educators to provide relevant learning experiences for today’s students. Many classrooms still utilise textbook-based pedagogy more suited to previous generations, resulting in disengagement among millennial students. Curriculum content must also be tailored to generational needs. The rapid pace of change, as well as the fluidity of identity created by dissolving geographical and vocational boundaries, mean that the millennial generation will need more than a fixed set of skills and knowledge to enter adulthood. Teachers must enable their students to think like ‘expert novices’, adept at assimilating new concepts in depth and prepared to engage in lifelong learning.

Dual paths to performance: the impact of global pressures on MNC subsidiary conduct and performance

Over the last decade, the international business literature has placed ever-greater emphasis on the role that learning and innovation play in determining multinational and multinational subsidiary performance. The present research seeks to understand the organizational paths leading to such desirable outcomes as greater learning, increased innovation and improved performance. Using a model tested with data collected through a survey of managers in subsidiaries of multinational firms, we find dual, independent paths to improved performance - one through networking and inter-unit learning and the other through subsidiary autonomy and innovation. A particular feature of these findings is that they can be shown to be robust after controlling for a wide range of environmental pressures and firm and industry factors. However, in the absence of environmental controls the dual path finding is rejected. These conflicting findings support the imperative to test models that include a diverse range of environmental pressures so that the true effects of organizational factors on learning, innovation and performance can be identified.