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By developing and delivering the session in-house, training materials specific to the new performance management system could be created, rather than relying on generic training materials. It was hoped that this would facilitate the transfer from training to the workplace. The training would be mandatory for all appraisers to ensure consistency. The trainer developed a plan for the two-hour session and included activities that would appeal to participants of various learning styles. Appropriate resources and handouts were designed. The trainer used the organization's generic training evaluation form (provided at the end of this workbook) to evaluate the program.

39 In children with abdominal pain and fever, does a white cell count help establish a diagnosis of appendicitis?

40 I have always been taught that ulcerative colitis only affects the large bowel with some associated proctitis. I read in your chapter on gastrointestinal disease that it can cause mouth ulcers and am now confused.

41 In pseudomembranous colitis, what is the first treatment of choice, metronidazole or vancomycin?

42 Is Crohn's disease considered as an autoimmune disease. If it is, are there other predisposing factors to it other than genetics? If it is not, what is its nature?

43 Why does carcinoma of the ascending colon cause more anaemia than obstruction, and carcinoma of the descending colon more obstruction features and less anaemia?

44 Can you explain why a patient with colorectal carcinoma might present with diarrhoea and abdominal pain?

45 What causes the blood to be altered in the presentation of melaena: is it intestinal juice?

46 What is the differential diagnosis of multiple rectal ulcers in an 18-year[1]old female?

47 What is the best surgical technique in a chronic (2-3 years) painful anal fissure that is located sagittally posteriorly?

48 Can I make a diagnosis of irritable bowel syndrome (IBS) in a 40-year-old female patient without doing gastrointestinal investigations?

49 What is the cause of abdominal bloating, which is often a symptom in patients with irritable bowel syndrome (IBS)?