© 2015 the College of Radiographers. Background: Peer to peer support programmes involve students supporting each other in either an educational, social and/or pastoral way. This is now common place in higher education institutes and has been proven to decrease student attrition and improve grades. Aim: to evaluate a peer assisted learning scheme (PALS) within the University of Exeter undergraduate programme, where final year (stage 3) students held extra-curricular teaching sessions in an on-campus X-ray room throughout the academic term to support a first year (stage 1) module introducing basic projectional radiographic examinations, radiation safety, patient care and radiographic equipment. PALS sessions were unstructured and as such could involve roleplaying radiographic examinations, revisiting lecture material and/or discussing hospital placement or pastoral issues. Methods: Brookfield's four lenses of critical reflection were used. 16 of 63 stage 1 students and 9 of 29 stage 3 students were electronically surveyed upon completion of the PALS sessions. Relevant colleagues and educational specialists were also informally interviewed. These were put in context with autobiographical reflections and the existing literature base on PALS. Results: all agreed that the sessions provided a good environment for stage 1 students to improve their practical skills, revise lecture content, and gain confidence for upcoming clinical placements. Stage 3 students gained experience teaching students, an essential role of a graduate radiographer's job. Improvements around recruiting stage 3 peer leaders, sustainability, timetabling and session structure were explored. Conclusion: the PALS proved to be a successful initiative within the undergraduate programme and will be continued into the future.

The primary association of both type 2 diabetes mellitus (T2DM) and fragility fractures with age has become cause for concern in the developed world, with T2DM now considered an independent risk factor for an increased risk of fragility fracture. The increased susceptibility to fragility fracture associated with T2DM has wide ranging and increasing socioeconomic, morbidity and mortality effects. As the incidence of T2DM increases, understanding the mechanisms behind why T2DM is a causative risk factor to decreased bone health is an important step. These may be split into two broad categories: those that involve an increased risk of falling, and those mechanisms that make fragility fracture after falling more likely due to detrimental changes to bone strength. The latter is not definitively understood making diagnosis in T2DM populations difficult. Current diagnostic methods do not sufficiently account for the unique endocrinological effects of T2DM on bone. New markers for identifying fragility fracture risk in patients with T2DM are required to overcome the paradoxical increase in bone mineral density (BMD) in these populations, and the shortcomings of predictive algorithms and dual energy X-ray absorptiometry (DXA) in identifying fracture risk in T2DM populations. Earlier identification of patients with T2DM who are at risk of fragility fracture is important, as these patients are not as responsive to current preventative medical interventions as those without T2DM, although there are also adoptive lifestyle changes that can help.