Editorial: Health informatics

context in which we carry out our task has changed dramatically and there is little reason to suppose that changes will not continue to happen. Not all change is necessarily bad and some may even provide new incentives and new means to improvements in clinicalpractice and in the quality of services received by patients and their carers. One important cultural change throughout health services is a greater emphasis on the consumer and the service user perspective. With this has come growing demands for greater professional accountability and a growing expect ation of patient participation in clinical decisionmaking. These changes impinging on medical practice from the outside have their counterparts from within the profession. They can be seen throughout the spectrum of medical education from undergraduate to postgraduate and contin uing professional development (CPD). One example is the new emphasis placed on a critical approach to evidence, a fundamental principle in the General Medical Council guidelines (1993)for undergraduate medical education, Tomorrow's Doctors'. Another is the new Research and