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This paper outlines a case for a new approach to the education of future professionals. The magnitude and potential seriousness of changes to be anticipated in the first half of the new century challenge institutions of higher education to prepare their students to become able to adapt themselves to change and to participate in the management of change--not only in relation to their own profession, but more widely for the benefit of society at large. The Network of Community-Oriented Educational Institutions for Health Sciences is planning three major programs which are designed to help meet this challenge in the 21st century. The first of these programs will set out to identify generic competencies that are needed for adapting to change and for participating in managing change. This is to include not only profession-specific changes, but also changes that affect the well-being of society as a whole. The second program will address the related need to develop educational interventions that are designed to foster competencies for interprofessional and intersectoral collaboration. The third of these programs accepts that serious attention to effective education for the professions will require institutionalization of recognition and reward of creativity and commitment in education.

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Multisectoral planning can yield major benefits for health, especially in the case of water resource development projects. A two-week course, designed to involve mid-level officers from at least six government ministries in the planning and implementation of such projects, has been tested in Ghana, the United Republic of Tanzania, and Zimbabwe.

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A distance learning programme for medical officers and their assistants at the district level has produced some valuable lessons for future activities in continuing education. Besides correspondence and study materials, face-to-face contact between students and their tutors is a particularly important ingredient, as it provides the guidance, flexibility and motivation that are essential for an effective programme.

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The Wellcome Tropical Institute has assisted countries in the tropics to establish viable systems of continuing medical education, particularly for young doctors practising in rural areas. As part of this strategy the Institute has developed material for use in distance learning. The first attempt to apply the problem-based learning approach to written material for use by an individual learner in the absence of a tutor led to a trial in Ghana, Kenya and Pakistan to compare a conventionally designed module with a problem-based learning module on the same topic for their respective acceptability, effectiveness and efficiency. The design, implementation and results of these three comparative trials are presented.

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Problem-based learning is now a well-established approach to the design and implementation of undergraduate, postgraduate and continuing medical education. This article describes how it functions and examines how it contributes to more enjoyable and effective professional development.

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The Wellcome Tropical Institute has assisted countries in the tropics to establish viable systems of continuing medical education; particularly for young doctors practising in rural areas. As part of this strategy the Institute has developed material for use in distance learning. The first attempt to apply the problem-based learning approach to written material for use by an individual learner in the absence of a tutor led to a trial in Ghana; Kenya and Pakistan to compare a conventionally designed module with a problem-based learning module on the same topic for their respective acceptability; effectiveness and efficiency. The design; implementation and results of these three comparative trials are presented

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Between 1984 and 1986, 888 final-year medical students from The Universities of Sydney, Western Australia and Newcastle took part in trial examinations that comprised multiple-choice questions, modified essay questions and a patient management problem. Differences in student performance among the schools were small. In 1984 and 1985, Newcastle students performed less well than did Sydney students on multiple-choice questions that were prepared by The University of Sydney, but there was no difference between the schools in 1986. Sydney students performed better than did Newcastle students on the multiple-choice question paper that was prepared by The University of New South Wales in 1984, but in the last two years no differences have been detected between the schools in performance on this paper. The performance on modified essay questions in 1984 suggested that Newcastle students were stronger in behavioural sciences and weaker in pathological sciences than were Sydney students. Sydney students performed less well than did Newcastle students in the patient management problem in 1985, particularly in the area of the use of clinical investigations. On the one occasion of testing that involved students from The University of Western Australia (in 1985), these students performed best of the three schools in the patient management problem, and roughly equally with students from Sydney and Newcastle in the multiple-choice question papers. Differences among the schools usually amounted to less than 10% and might have been accounted for by differences in familiarity with test instruments. We conclude that medical students are likely to graduate from The University of Sydney, Western Australia and Newcastle with similar levels of knowledge of internal medicine. Possible differences in problem-solving ability require further study, particularly in the clinical setting.

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Students' perceptions of their learning environment in the Faculty of Medicine of the University of Newcastle were tested in 1979, in the second year of the school's existence, when the first two cohorts of students were surveyed. It was thought important to re-test those same cohorts in 1982, when they were in the later years of the curriculum, to see whether their perceptions had changed, and also to test the perceptions of subsequent cohorts of students (still in the earlier years of the course) to examine whether the favourable perceptions of the earlier cohorts were being maintained. Accordingly, this paper reports the results of a cross-sectional study undertaken on all five years of Newcastle medical students in 1982, and it compares their perceptions with those obtained 3 years earlier.

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In this series, we print evaluation instruments, questionnaires, rating scales and similar resource materials useful to teachers, evaluators and planners. You may wish to adapt such instruments for your own purposes. The feature in this issue has been prepared by Grahame I. Feletti, Nicholas A. Saunders, Anthony J. Smith and Charles E. Engel. Further information is available from Charles E. Engel.

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In this series, we print evaluation instruments, questionnaires, rating scales and similar resource materials useful to teachers, evaluators and planners. You may wish to adapt such instruments for your own purposes. The feature in this issue has been prepared by Nicholas A. Saunders, Charles E. Engel, and Grahame I. Feletti from whom further information is available.

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