In this paper I will be discussing the professional duties of psychiatrists. I will argue that there is an ethical tension at the heart of psychiatric practice – between the psychiatrist's professional duties to his or her patient, and what professional duties there might be to protect public safety. It may be of some comfort to clinicians to know that this tension has exercised the best minds for centuries, including thinkers such as Marcus Aurelius nearly 800 years ago (Spruit, 1998).

Trainees need to gain experience in the psychotherapies, but practical problems in implementing training programmes have made it difficult for many trainees to access the full range of experience.

Medication non-adherence is a major obstacle to translating treatment efficacy in research settings into effectiveness in clinical practice (Dickson & Kendall, 1986; Scott, 1995). Randomised controlled trials indicate that brief interventions such as cognitive-behavioural educational packages for depression, cognitive therapy for lithium clinic attenders and compliance therapy for people with schizophrenia may be beneficial (Cochran, 1984; Katon et al, 1995; Kemp et al, 1996). However, clinical psychiatry has been surprisingly slow to investigate individual risk factors for medication non-adherence or to use strategies to enhance adherence that have been used extensively in other chronic illness populations.

In the 1960s, most people with severe mental illness were treated in large mental hospitals, receiving all their care under one roof, ensuring its continuity and accountability. Deinstitutionalisation resulted in discharge into the community, where care was fragmented between many agencies, making continuity and accountability very difficult. Countless individual programs were developed with few links between them. Not surprisingly, deinstitutionalised patients, in an unfamiliar environment and with poor coping skills to navigate services, did not receive the care they needed.

The development of effective pharmacotherapy has revolutionised the treatment of obsessive–compulsive disorder (OCD), and has generated an explosion of interest in this previously poorly understood area of psychiatry. Once considered a rare, refractory form of learnt behaviour, we now recognise OCD to be a common, treatable illness, with a distinctive pathophysiology and pharmacology. Wide-ranging epidemiological surveys have demonstrated a surprisingly high lifetime prevalence amounting to 2–3% of the general population worldwide (Robins et al, 1984). Yet only a fraction of sufferers come forward for treatment and often the diagnosis is missed.

The purpose of this review is to familiarise the reader with the clinical utility of investigations in the diagnosis and management of alcohol use disorders (AUDs). Many biochemical and haematological tests are widely available, and can improve significantly the quality of diagnosis and management. However, there is no single test that can detect AUDs with complete accuracy. Further, the validity of a test will vary depending on the clinical application. Such tests should never be relied on in isolation. Adequate clinical evaluation also needs to include a combination of interview and examination of the patient, and interview of other informants (Cantwell & Chick, 1994; Edwards et al, 1997). In the research setting, self-report is generally a valid and reliable method of assessing alcohol consumption (Babor et al, 1987), particularly when it is elicited by a standardised method (e.g. Sobell et al, 1980) and the information is provided in confidence. In the clinical setting, however, the patient may report his or her version of past drinking subject to the demand characteristics of the situation, particularly if adverse consequences are likely to ensue (e.g. discharge from a treatment programme).

The aims of this article are to provide guidance on how to facilitate small group teaching and to address ways in which learners can be actively involved in the small group setting.

Medical undergraduate training is currently going through a momentous period of change (Tosteson, 1990). New methods of learning and evaluation are being introduced which will radically alter medical training over the next few years. These changes are in part a response to the way medicine itself is being transformed. Medical educators can no longer hope to equip medical students, upon qualification, with enough basic knowledge and skills to last them throughout their medical careers. Today's students are embarking upon a process of learning which will continue throughout their medical lives. Medical practice will be very different, when today's students become tomorrow's hospital consultants and general practitioners.

Since the 1970s, there has been a progressive increase in the use of computers as a teaching resource. The purpose of this article is to summarise the current uses of computer-based learning (CBL) packages and to highlight how to assess whether a particular multimedia package meets your own requirements for training.