The World Federation for Medical Education, too, has a well-established history of involvement in
improving the quality of medical education, marked by the International Collaborative Programme for
the Reorientation of Medical Education of 1984, cornerstones of which were the Edinburgh
Declaration of 1988 and the recommendations of the World Summit on Medical Education,
Edinburgh, in 1993.
James Parkinson described Parkinson’s disease in his memorable Essay on the Shaking Palsy in 1817. Since then,
and particularly in recent years, there has been tremendous progress in our understanding of this complex and fascinating
neurological disorder. Briefly, we have learned that it is not only manifest by motor symptoms but also
that there is a whole range of non-motor features, including autonomic, psychiatric, cognitive and sensory impairments.
We now know how to distinguish better clinically between Parkinson’s disease and the various parkinsonian
The advantages which have been derived from the caution with which hypothetical statements are admitted,
are in no instance more obvious than in those sciences which more particularly belong to the healing art. It
therefore is necessary, that some conciliatory explanation should be offered for the present publication: in
which, it is acknowledged, that mere conjecture takes the place of experiment; and, that analogy is the
substitute for anatomical examination, the only sure foundation for pathological knowledge.
Pearson and Heywood (2004) studied reﬂection through a survey of attitudes toward and
reported use of reﬂective portfolios in learning among UK GP registrars (postgraduate
students). Sixty-ﬁve percent of 92 responders used the portfolio regularly for recording,
and 42% used it in reﬂective learning. Three categories emerged in relation to the portfolio:
reﬂectors, those who recorded data in the portfolio, reﬂected on that information and/or
discussed it; recorders, those who used the portfolio to record data; and, non-users, those
who did not record data in the portfolio.
Abbreviations: LSD, lysergic acid diethylamide; GHB, γ-hydroxybutyrate; PCP, phencyclidine; CNS, central nervous systemPrescribed, over-the-counter, and herbal medications are common precipitants of delirium. Drugs with anticholinergic properties, narcotics, and benzodiazepines are especially frequent offenders, but nearly any compound can lead to cognitive dysfunction in a predisposed patient.