This paper defends the acts/omissions distinction which underpins the present law on euthanasia, from various criticisms (including from within the judiciary itself), and aims to show that it is supported by fundamental principles. After rejecting arguments that deny the coherence and/or legal relevance of the distinction, the discussion proceeds to focus on the causal relationship between the doctor and the patient's death in each case. Although previous analyses, challenging the causal efficacy of omissions generally, are shown to be deficient, it is argued that in certain cases of causing death by omission the causal authorship of the doctor lapses. The final part of the paper examines why this should be morally significant and proposes an answer in terms of the principle of equality. Assuming all other factors are equal, the infringement of this principle provides an additional reason against actively killing a patient, which is not present in cases of passively letting die.

When senior house officers were observed to be resistant to an intern support group, they were surveyed in order to identify the sources of their resistance. Sixty-nine percent of house officers in postgraduate year two (PGY-2) and PGY-3 responded to an anonymous seven-item survey. Although their attitudes toward supportive programs were generally favorable, a minority of the house officers felt that residents expressing the need for support were less competent than other residents or needed to change to a less rigorous specialty. A majority felt that it was unfair to require senior house officers to provide coverage for interns attending a support group. They felt that support should be made available to all house officers rather than interns only and that stress would be reduced by eliminating the sources of stress as well as by providing supportive programs. Training program directors need to be aware of and anticipate these attitudes before designing supportive programs.

Teaching by residents has long been recognized as essential to the education of interns and medical students, but how residents view their role as educators has not been examined in great detail. For this purpose a questionnaire was constructed and administered to 55 internal medicine residents at the McGaw Medical Center of Northwestern University. Responses indicate that the residents enjoyed teaching and considered it a critical component of their own experience and education. These residents' views appear unrelated to their previous teaching or academic backgrounds or to plans for an academic career. A number of variables correlated with teaching satisfaction. The teaching experience can be improved, the survey suggests, by lessening distractions and interruptions that occur during teaching sessions, freeing residents of some other obligations so that more time may be devoted to teaching, increasing faculty members' observation and guidance of teaching, and carefully structuring the content of the residents' teaching sessions.

Numerous medical schools are beginning to plan single courses, separate curricular tracks, or entire curricula using problem-based, small-group methods. The use of these methods places a high demand on faculty members' time and support. In the present study, the authors examined the characteristics and beliefs of those faculty members who volunteered as tutors for problem-based teaching during the first two years of the New Pathway Project at Harvard Medical School. The results confirm several major conclusions of innovation research: that an individual's adoption of an innovation is heavily influenced by his or her perceived need for change and the benefits that might result from becoming involved in this change; that initial adopters tend to be oriented toward institutional colleagueship; and that personal contacts with colleagues play an essential role in their decision to participate. In addition, the desire to improve medical education emerged as a major motive for involvement in the problem-based curriculum.

Psychometric aspects of multiple-choice tests were investigated using a confidence-weighted scoring technique. The contributions of two indices, overconfidence and underconfidence, in the prediction of subsequent academic performance of examinees were studied. A total of 444 sophomore students (entering classes of 1982 and 1983) in one medical school were asked to indicate their confidence, on a 5-point scale (100, 75, 50, 25, and 0), in the correctness of their responses to each multiple-choice item on an Introduction to Clinical Medicine examination. Examinations were scored in two ways: in the conventional way, using the total number of correct responses, and by a confidence-weighted technique based on the level of certainty indicated for each response by the examinee. Only the conventional score determined the grade; the confidence-weighted score was calculated for the purely experimental purposes of this study. Overconfidence and underconfidence indices were also calculated by using the indicated levels of certainty. Improvements in the psychometrics of the examinations were observed when confidence-weighted scoring was used. In multiple-regression models, the confidence-weighted scores and indices of over- and underconfidence contributed significantly to predicting scores of the students studied on Parts I and II of the National Board of Medical Examiners examinations, whereas the conventional score did not contribute to the prediction of Part II scores. Significant differences on junior clerkship examinations and ratings were observed between those who were highly overconfident and those who were slightly overconfident. The highly overconfident students also estimated higher future incomes than did those who were slightly overconfident.