Medical Teacher

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Discovering professionalism through guided

reflection

Dr Patsy Stark, Chris Roberts, David Newble & Nigel Bax

To cite this article: Dr Patsy Stark, Chris Roberts, David Newble & Nigel Bax (2006)
Discovering professionalism through guided reflection, Medical Teacher, 28:1, e25-e31, DOI:
10.1080/01421590600568520

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Medical Teacher, Vol. 28, No. 1, 2006, pp. e25–e31
WEB PAPER
Discovering professionalism through guided reflection
PATSY STARK, CHRIS ROBERTS, DAVID NEWBLE & NIGEL BAX
Northern General Hospital, Sheffield, UK
ABSTRACT Doctors need to identify and understand the pro-
fessional behaviours of both themselves and others. In order for
students to think critically about these issues we encouraged
them to use the tenets of the General Medical Council’s Duties of
a Doctor as a framework in which to reflect on the actions
of healthcare professionals at work. Although the critical incident
technique is a well-known process for encouraging reflection,
little is known about its usefulness for assessment purposes in this
setting. We aimed to discover the validity, feasibility and
educational impact of the critical incident as an assessment
method for first year students undertaking guided reflection in
the context of their first exposure to multi-professional health
and social care experiences. First year medical students submitted
two critical incidents they had observed during multi-professional
health and social care attachments and an evaluation of their
experiences. Students engaged in the reflective cycle on the
professional behaviours of others providing evidence of a varied
range of situations. With adequate preparation, junior students
are able to reflect on social and healthcare experiences using the
Duties of a Doctor as a framework. Critical incidents are a valid
and feasible method for assessing students’ reflections on profes-
sionalism, with good educational impact.
Introduction
Doctors need to understand their duties as professionals
and to be able to reflect on their own performance and that
of other practitioners (GMC, 2001) to meet the expectations
of the medical profession and the public. Until recently,
many medical schools had focussed their assessment strate-
gies on knowledge and skills objectives. However, there
is increasing evidence (Sox, 2002; Papadakis et al., 2004;
ABIM, 2003) that unsatisfactory performance in practice is
more likely to be due to unprofessional behaviour, rather than
knowledge or clinical skills. Consequently, there is a growing
consensus that professionalism can and should be specifi-
cally addressed during undergraduate studies (Cruess &
Creuss, 1997; Swick et al., 1999; Stephenson et al., 2001;
AAMC, 2002; Whitcomb, 2002). This has been made
explicit in the UK by the General Medical Council (GMC,
1993; 2002) which recommends that attitudinal learning
objectives should be given equal importance in the curricu-
lum to knowledge and skills objectives.
Professionalism has been defined as:
‘the extended set of responsibilities that include the
respectful, sensitive focus on individual patient
needs that transcends the physician’s self-interest,
ISSN 0142–159X print/ISSN 1466–187X online/06/010e25–7 ß 2006 Taylor & Francis
DOI: 10.1080/01421590600568520
the understanding and use of the cultural dimension
in clinical care, the support of colleagues, and the
sustained commitment to the broader, societal goals
of medicine as a profession’ (Hatem, 2003).
Some aspects of professionalism, e.g. communication
skills, ethics and confidentiality may be taught didactically.
However, students need opportunities to participate in
appropriate activities from which they may analyse what
they see and do, consider the impact that those activities
have on them and devise a learning plan to develop their
own professionalism. Reflection helps students to integrate
theory and their understandings gained from experience,
whilst developing future practice (Boud et al., 1985; Schon,
1991). Embedding reflection in real multi-professional
health and social care experiences early in the undergradu-
ate course may encourage students to use the tool through-
out their studies and career as part of work-based learning.
At the University of Sheffield, such an opportunity for
reflection on professional behaviours arose in the Intensive
Clinical Experience (ICE) within the first year of the course.
Curriculum development
The new curriculum, commenced in 2003, is outcome
focussed, highly integrated and organized around body
systems. Outcomes of the course are based around clinical
skills, interpersonal skills, professional behaviours, practical
skills, and the appropriate underpinning basic medical
sciences (Newble et al., 2005). We validated our professional
behaviours outcomes by mapping them against the princi-
ples of Duties of a Doctor (GMC, 2001) (Figure 1), and
the existing Professional Ethical Code for Sheffield medical
students and found close agreement. ICE was initially intro-
duced into year one of the old curriculum in 2000, in order
to enhance vertical integration between basic clinical com-
petence and basic sciences. Students spent three weeks
with doctors, nurses and social services staff, observing
them perform in practice. The ICE programme was modified
in the light of previous evaluations (Bax et al., 2001) as part
of the new curriculum in order to provide more guidance
for students to engage in reflection on professionals at work
as participant observers, in the context of Duties of a Doctor.
Correspondence: Dr Patsy Stark, Academic Unit of Medical Education,
University of Sheffield, Coleridge House, Northern General Hospital,
Sheffield S5 7AU, UK. Tel: 0114 226 6784; fax: 0114 242 4896; email:
p.stark@sheffield.ac.uk
e25
P. Stark et al.

• Make the care of your patient your first concern;

• Treat every patient politely and considerately;
• Respect patients’ dignity and privacy;
• Listen to patients and respect their views;
• Give patients information in a way they can understand;
• Respect the right of patients to be fully involved in decisions about their care;
• Keep your professional knowledge and skills up to date;
• Recognize the limits of your professional competence;
• Be honest and trustworthy;
• Respect and protect confidential information;
• Make sure that your personal beliefs do not prejudice you patients’ care;
• Act quickly to protect patients from risk if you have good reason to believe that
you or a colleague may not be fit to practice;
• Avoid abusing your position as a doctor;
• Work with colleagues in the ways that best serve patients’ interests
Figure 1. Duties of a Doctor (from Good Medical Practice GMC, 2001).

Assessing professionalism The Intensive Clinical Experience (ICE)

Whilst it is difficult to assess attitudes to professionalism, it
is possible to observe and assess their expression in the form
of professional behaviours (ABIM, 2003) but there were few
published methods of assessing professional behaviours
to guide us.
The 15 tenets of Duties of a Doctor (Figure 1) offer a
set of learning objectives for developing teaching and
learning activities, which might be appropriately assessed to
encourage the development of professionalism in students.
Alternative approaches have been used. Within the postgrad-
uate arena, the tenets of Good Medical Practice have been
used to create a multi-source feedback tool to assess a range
of generic skills, which cover aspects of professionalism
in the workplace (Archer et al., 2005). Some medical schools
are beginning to use this approach (Rees & Shepherd, 2004)
in relation to professionalism. However, there are potential
resource implications in collecting and analysing up to
12 ratings per student on potentially two or three occasions.
We wished to use the portfolio approach with the purpose
of marshalling evidence about the progress of students
towards the specific professionalism outcomes of our course
(Challis, 1999). This raised the question of how we might
develop a valid and feasible assessment of the understanding
professionalism within an integrated curriculum, which could
be part of a portfolio but avoided the tick box approach of
multi-source feedback.
Methods
This study aimed to discover the educational impact,
validity, and feasibility of the critical incident as an
assessment method for a class of students undertaking
guided reflection in the context of their first exposure
to health and social care professionals at work. In order to
do this, we needed to decide whether the evidence of
reflection presented in the critical incidents (Challis, 1999)
was valid (showed what it claimed to show), was sufficient
(detailed enough for the assessor to be able to infer that
appropriate learning had taken place) and could be inte-
grated into the school assessment strategy for professional
behaviours.
First year medical students (n ¼ 250) were randomly assigned
to a nurse, a hospital consultant, and a member of social
services staff for a single three-day attachment, in each
of three consecutive weeks.
The learning objectives of ICE were:
. To encourage students to develop effective communica-
tion skills with patients/clients
. To enable students to meet, talk with and question
professionals involved in health and social care
. To reinforce the Professional Ethical Code for Medical
Students (University of Sheffield)
. To understand the Duties of a Doctor
. To enable students to reflect on experiences gained in ICE
Guidance on reflection
The ‘guided reflection’ method (Johns, 1994; Wilkinson,
1999) was adapted to prepare students to engage in reflective
practice (Figure 2). This approach provides a series of
prompts to help students develop reflective thinking.
At a whole class briefing, prior to their attachments, we
defined a ‘critical incident’ (Flanaghan, 1953) as any event
that challenged them within the context of Duties of a Doctor.
They practised the critical incident technique using a video
taped nurse-patient and doctor-patient consultation as
a trigger for small group discussion and reflection. Students
were encouraged to develop personal learning goals from the
simulated learning experience, which they would research,
to add to their understandings of the issues raised. The
results of the small group discussions were shared with the
year group. Supporting materials about reflection, the Duties
of a Doctor, the assessment, and the evaluation were made
available on Minerva, the school’s managed learning
environment.
Outcome measures
We used two outcome measures to provide data for our
study. These were:
(1) The quality of student reflections. Students were
required to submit reflections on two critical incidents.

e26
 Discovering professionalism through guided reflection

1. List the Duties of the Doctor (as listed in Good Medical Practice) to which your
incident related
2. Describe the incident in your own words
3. Illustrate the ways in which the incident challenged your values, beliefs or
understanding.
4. Describe which learning resources you used to increase your understanding of the
issues you described. Which were useful and which were not?
5. Describe how the situation may have been handled differently.
6. What did you learn personally from this incident?
7. What future learning do you plan to do around this incident?

Figure 2. The guided reflection template showing the steps the students had to follow.

They were asked to choose meaningful but contrast-
ing episodes from any of the attachments, which
illustrated the principles within Duties of the Doctor
and to reflect upon them using the template, illus-
trated in Figure 2. Assessment criteria for reflective
learning outcomes have been suggested by a number of
authors (Hatton & Smith, 1995; Richardson &
Maltby, 1995; Pee et al., 2002) In this formative
exercise the assessment criteria were largely task
focussed: Were the two reflections submitted on time?
Were the two reflections complete? Did both submis-
sions demonstrate a degree of reflection (i.e. consid-
ered challenges to values, beliefs, understanding;
consideration of alternative approaches; identification
of personal learning) rather than being purely
descriptive?
One author (PS who is experienced in teaching and
assessing reflective practice in undergraduate and
postgraduate contexts) marked all the submissions
according to the criteria (i.e. the work was submitted
on time, in the correct format and showed at least
a moderate level of reflection). A global rating of
either satisfactory or unsatisfactory was given.
Students with an unsatisfactory grade were seen by
the Director of Teaching (NB) to discuss their under-
performance and to receive guidance on how to
resubmit work to a satisfactory standard. Those who
failed to submit by the deadline were reminded
within 72 hours, also by email.
(2) Student evaluation of ICE. As part of an on-line
evaluation, students were asked for free text comments
to evaluate the students’ perceptions of the quality
of their learning and teaching experiences. They were
asked what worked well, what did not work well,
and what could be improved in the ICE programme.
Additionally, students listed the learning resources
used to support their reflections.
Qualitative data analysis
a conceptual framework could emerge in relation to our
research questions (Strauss & Corbin, 1998). Each reflection
was given a single code. Codes were merged into sub-themes
and then condensed into themes. The coding process
considered all elements of the Duties of a Doctor. Evidence
of reflective learning was recorded where students used
expressions like ‘As a result of . . . Now I understand’
(Mathers et al., 1999). Validity was assured by iterative
consideration of the emerging explanations for the data.
A second experienced qualitative researcher (CR) indepen-
dently undertook the coding process on a sample of reflec-
tions, with >80% agreement. The number of times each
code was evidenced in the full data set (Table 1) is given,
allowing a relative comparison of different data (Miles &
Huberman, 1994).
Results
The reflections were analysed and 40 codes assigned.
The codes were merged into 11 sub-themes (Table 2) and
from those, five themes were identified: communication;
professionalism; team working; organisation of care; and
student learning issues. The data presented are illustrative
of the analysis undertaken.
Communication
The most frequent reflection was about communication
(n ¼ 175). Students reflected on examples of good and poor
communication displayed by all three professional groups.
Many described how professional communication affected
not only the patients but also how they felt observing
such interactions. Some students were able to move from
being merely observers of practice by connecting the issues
raised in the critical incident to events in their own lives,
thus demonstrating ways in which they attended to their own
feelings, in the line of duty, a key component of reflection
(Bolton, 2001).

The analysis was carried out anonymously within an ethical
framework of research, which met the University guidelines
on evaluations of curriculum development.
The text of all students’ critical incidents and their
qualitative comments from the ICE evaluation was archived
electronically in a database to which only the researchers
had access. A content analysis using a constant compara-
tive approach was used to provide a basis from which
‘. . . This is the first time that I have ever listened to
bad news like this being broken, I was impressed by
the way it was done. However, I did begin to feel
upset myself and I was surprised to see that the
doctor wasn’t, even though he was sympathetic . . . I
related this experience to when I was told that my
Grandad had cancer and so I felt sympathetic
towards her daughter as well as the patient herself.’

e27
P. Stark et al.
Table 1. Frequency of codes.
Codes
Dr positive communication
Dr negative communication
Teamwork positive
NHS/Social Services resources
Patient beliefs/autonomy/dignity resources
Dr/senior student limit of competence
Social Services respect
Social Services positive care
Confidentiality negative
Dr negative professionalism/quality of care
Nurse positive communication
Nurse negative care/behaviour/knowledge
Nurses positive care/behaviour
Respect (all professions) for
patients & students negative
Student overcoming/acknowledging prejudice
Hospital negative communication
Dr interest of patient positive
Dr interest of patient negative
Dr positive professionalism/quality of care
Respect (all professions) for
patients & students positive
Patient or family decision?
IP communication
Culture/religion
Nurse negative communication
Social Services negative communication
Social Services negative care
Racism
Teamwork negative
Power of doctors
Students positive communication
Dr positive behaviour
Social Services ethics
Student unease
Institutional prejudice
Social Services positive communication
Dr up to date
Communication problems language
Student coping with death
Sexism
Student too much responsibility
Table 2. Sub-themes.
Communication
Teamwork
Resources
Beliefs
Autonomy
Respect
Care
Competence
Confidentiality
Behaviour
Prejudice
e28
Professionalism
Number of This theme encompassed the greatest number of sub-themes
times evidenced and included reflections on the behaviour, professionalism
and the quality of care given by all three professional groups.
76 The most frequent code was ‘dignity, autonomy and patients’
61 beliefs’ (n ¼ 30).
44 Students moved from being aware of the importance
33 of maintaining patients’ dignity, to understanding
30 it within a real context. The student who said, ‘Maintaining
12 patient’s dignity and self respect is something I hope
12 I will continue to be conscious of’ had reflected upon a
12 patient’s colostomy bag bursting in distressing
12 circumstances.
11 There were reflections on all aspects of professionalism
10 contained within Duties of a Doctor. For example keeping
10 up to date with advancing medical knowledge, acknowledg-
9 ing the limits of competence, and ensuring the patient is the
9 first concern of the professional and is involved in decisions
about care, avoiding gossip about patients and negatively
9 commenting on colleagues.
8 By reflecting on these aspects of being a healthcare
8 professional, students identified for themselves what will
7 be important to them as practising doctors.
7 They were able to do this by recognizing inappropriate
7 behaviour and using reflection to think about how they
might behave in a similar context.
7 Some students found that expectations of patient
6 care challenged their own cultural and religious beliefs.
6 However, through reflection they were able to deconstruct
5 the incident in order to find a rationale or a solution to
5 such personal conflict. For example, a male student from
4 an ethnic minority said:
4
3 ‘Then she [the patient] started taking her clothes
3 off . . . I was confused on how to deal with this situ-
3 ation, and whether it was appropriate for me to stay
2 and help. The patient was talking to me. I had no
2 choice but replying and stayed and helped. When
2 we went outside, the nurse then explained that I am
2 on a duty to help people rather than feeling
1 embarrassed. Then I explained about my cultural
1 beliefs which left me embarrassed at the time when
1 the patient took her clothes off, from my point of
1 view, it would have been impolite to stay there.
1 However, the situation made me feel that there was
1 a duty which was beyond all that’.
Students were able to recognize stereotypical
behaviours in professionals, and develop possible strategies
for changing practice, whilst shaping their own future
practice. There were examples of students from ethnic
minority backgrounds reflecting on examples of unprofes-
sional behaviours such as racism, where many students
and doctors have just accepted the stereotyping (Kai
et al., 2001) without reflecting on such issues.
‘The midwife announced that one of the patients
had a particularly troublesome baby who cried a lot
and that this was due to the fact that the baby was of
mixed race. The other nurses burst out in
laughter . . . I was frankly mortified at what I had
witnessed and felt that these people were acting in a
most unprofessional and insensitive manner . . .

I learnt that blatant racism and ignorance in the
work place is not a thing of the past and also felt that
there was a big flaw in the way which professionals
can report such incidences. I being an Asian am
unfortunately having to accept that I will be
subjected to racial remarks and should prepare
myself accordingly. I have to learn that not every-
one has the same views about racism as me and will
have to tolerate other peoples’ views without
compromising my level of care towards them’.
Other incidents, which students identified, included
examples of discrimination against patients with mental
health problems, and recognition of the role of training in
shaping professionals’ behaviours.
‘. . . it made me realise the shortcomings of my
understanding of mental health conditions and the
lack of understanding I had . . . If I felt like that, then
surely I couldn’t be the only one, which means that
these individuals quite probably are discriminated
against for these reasons, not only by the general
public, but also possibly by medical personnel not
equipped with the adequate training or life
experience’.
Team working
Harden (1998) has drawn attention to ways in which
effective working relationships in healthcare might develop
through multi-disciplinary learning. In the context of ICE,
whilst some students reflected on examples of poor practice,
largely they observed good team working both between
staff in the same and between professions.
Some of the reflections indicated the power of role
modelling, in multi-professional working. In particular
students were able to consider ‘a willingness to share, and
indeed devolve, specialised knowledge and authority . . . if
the needs of clients can be met more efficiently by others’
(Carrier & Kendall, 1995).
‘It was positive to see a doctor getting involved
in the social side of a patient’s care rather than
merely concentrating on the medical management
of the patient. The communication between all
members of the team involved in the clinic was also
very good and it provided a positive outcome for the
patient’.
Organization of care
In addition to reflecting on the behaviour of individual
professionals, students also considered how organizational
and institutional issues impacted on the care of patients
or clients, and the responsibilities of professionals in main-
taining best practice:
Patients who had suffered from mental ill-
ness . . . had their case notes placed in a blue file,
whilst [others] had theirs in buff files . . .. When
these patients were admitted to general wards,
nursing staff would recognise the patient’s files as
those with mental health problems, and as such
would have a degree of scepticism regarding any
Discovering professionalism through guided reflection
information or complaints received from the
patient . . . I have learnt that prejudice and labelling
can occur in any area of patient care, unless staff
and carers make efforts to prevent it’.
Students reflected on how workload and resource issues
within the NHS, might account for behaviours, but recog-
nized that professionalism should be maintained.
‘this should never develop into the situation that
occurred where this frustration affected the care of
the patient’.
Student learning issues
Students provided good evidence of their learning.
Some revealed how they linked the situation they were
observing to past experience and how this understanding
would change future practice. Other students demonstrated
how the learning resources, which included patients, families
and staff, as well as reading materials from patient informa-
tion leaflets, textbooks and the Internet, had increased
their understanding. Few were able to offer learning plans
in sufficient detail as to how they might achieve their learning
needs in a way typical of portfolio learning (Challis, 1999).
For example one student said:
‘I would like to learn more about the process of
[mental health] sectioning and when it is appropri-
ate to section a patient. I am going to look into
patients’ rights and medical ethics related to this
incident’.
There were several useful suggestions for making
sure students were better prepared for engaging with patients
and clients as other than passive observers. For example
by ensuring all students had undertaken a moving and
handling course, so they could be of direct help in the
workplace.
Some students observed situations, e.g. involving
drug abuse and abortion which many students ‘had previ-
ously [been] unaware of except from on the television’.
‘a young man . . . was dirty, unkempt and had
a history of drug abuse . . . Suddenly his condition
deteriorated . . . Perhaps it was seeing the medical
team quietly but efficiently working to save his life
with no-one uttering sounds of disdain or objection
that made me realise that personal feelings and
prejudices have no place in medical treatment and
care. Minutes later the young man died and the
reaction of the staff was of overwhelming sadness
that his life had been lost . . . It was a very powerful
lesson and one which illustrated perfectly the point
in the duties of a doctor’.
In this instance, little was said about the degree of debrief-
ing (Pearson & Smith, 1985) the student received from staff
in such a challenging situation.
All 250 students in the year undertook the reflec-
tive critical incident component of ICE. Of those, 236
students’ reflections were regarded as satisfactory. The
remaining 14 were unsatisfactory by virtue of non-
submission (n ¼ 10), submission of only one critical incident
e29
P. Stark et al.
(n ¼ 2) or failure to demonstrate reflection (n ¼ 2).
All students with an unsatisfactory grade subsequently
submitted satisfactory work. The on-line evaluation was
completed by 75% (n ¼ 188).
Discussion
Guided reflection has a valuable educational impact
on our students in the exploration of professionalism in a
real work-based multi-professional setting. Our findings
illustrate how the ICE programme provided a rich learn-
ing experience in which students were able to engage in a
number of powerful learning activities in a diverse range
of health and social care situations. All of the students were
able to demonstrate engagement with the reflective cycle,
with most students showing some reflective capacity
(Boud et al., 1985; Schon, 1991). Reflecting on critical
incidents encouraged students to understand and analyse
professionalism, and recognize what it means to be a
professional in the context of Duties of a Doctor. Students
were able to demonstrate how they had engaged with
and reflected on the real daily activities of health and social
care professionals in a to create personal learning needs.
They had related these to a variety of learning resources
further enriching their experience. Although most students
were able to identify future learning needs that emanated
from their reflected experiences, their plans to fulfil them
needed refining, suggesting the need for some additional
support or changes in the guidance on reflection (Challis,
1999).
The assessment of the understanding of professional
behaviours has undoubted face validity. We were satisfied
that the evidence presented in the critical incidents by
students was valid (Challis, 1999) as they consistently
met the claims of the appropriate tenet from Duties of a
Doctor. We had demonstrated through the broad range
of material that was available that the critical incidents
were sufficiently detailed enough for the assessor to be able to
infer that appropriate learning had taken place (Challis,
1999). Some students witnessed things that were upsetting,
challenging and even exposed them to a degree of risk.
We accept that debriefing and feedback as part of closer
supervision of students would be desirable (Pearson & Smith,
1985; Baernstein & Fryer-Edwards, 2003; Gordon, 2003)
but this would require the investigation of additional
resource.
Limitations of the study
This was on a pilot study exploring an educational innova-
tion in the context of a major curriculum reform. Effects
of particular educational innovations can be difficult to
isolate from each other.
Implications of the study
How might this work contribute to an integrated strategy
for the assessment of professional behaviours? The ability
to understand professional behaviours is one of the expected
e30
learning outcomes of a medical course (GMC, 2002) and
we have shown this can be assessed in a valid, feasible way,
with good educational impact. The critical incidents were
capable of being assessed more rigorously (Johns, 1994;
Hatton et al., 1995, Richardson & Maltby, 1995) using more
explicit measurement characteristics. Content validity can
be assured by sampling widely across the range of expected
professional behaviours. The reliability of the assessment
has not been considered in this study. Additional assessors
would have provided inter-rater reliability. However,
we believe that the construct of professionalism is a part
of clinical competence, the measurement characteristics of
which have been studied for many years. An important
finding is that an attribute has to be tested across a large
sample of cases before a reliable generalization about com-
petence can be made (Van der Vleuten, 1996). In relation
to professionalism the reliability of the assessment can only
be guaranteed through the use of multiple raters on multiple
occasions.
The measurement construct we were most interested
in ICE was reflection on the professionalism of others.
Whilst ICE was sufficient to demonstrate this capability,
it was insufficient to make judgements on students’ own
professionalism.
Curricular impact
The curriculum management committee used a range
of evaluation data, not just this study, in deciding to
include guided reflection as part of the student selected
component (SSC) programme in the new curriculum. The
eventual format of ICE was as a component of the SSC
programme. The ICE programme provided the first oppor-
tunity to collect some evidence about students’ capacity to
reflect as a component of a portfolio of in-course assessments
For the assessment of the student’s own professional
behaviours, we adopted the strategy of collecting and
collating evidence about students’ professionalism at multiple
points throughout the course using the global ratings of
multiple observers, including those from ICE. Students are
able to view their progress both of their professional
behaviour grades and their in course assessments via their
electronic portfolios, where their assessments were posted.
Further work would be required to determine what educa-
tional impact this model of assessing professional behaviours
had and whether it is an effective and sustainable curricular
innovation.
Notes on contributors
PATSY STARK is the Senior Lecturer in Medical Education and
Co-ordinator of the SSC programme at the University of Sheffield. She
has an interest in developing professionalism in medical students and,
with Dr Chris Roberts, developed the reflection template used in ICE.
CHRIS ROBERTS is Associate Professor in Medical Education at the
University of Sydney.
DAVID NEWBLE is Emeritus Professor of Medical Education at the
University of Sheffield. He returned to Australia in 2004 where he has
appointments as Professorial Fellow at Flinders University, Honorary
Professor at the new University of Wollongong Medical School and
Educational Consultant to the National University of Singapore.

NIGEL BAX is Professor of Medical Education at the Academic Unit of
Medical Education, and Director of Teaching, University of Sheffield.
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