Discusses three caveats to the evidence-based paradigm in medical education: (1) detection of abnormalities that may not ever be overtly expressed inflates apparent diagnostic test performance; (2) probability revision is valuable primarily as an exercise to gain qualitative insights; and (3) patients are likely to be interested in more than just…

This study examining whether certain textbooks emphasize a semantic presentation of their contents arose from the results of a previous study conducted by the authors. It was hypothesized that certain textbooks would organize their contents by comparing and contrasting symptoms, signs, and disorders rather than simply listing them. (MLW)

In July 1989 the American Board of Emergency Medicine conducted a field test of the oral recertification examination process. Sixteen examiners and 25 examinees participated in the field test. The examination included 3 chart-stimulated recall and 3 simulated-patient encounter cases. (MLW)

The study examined how 3 medical information-gathering processes (history-taking, physical examination, and diagnostic studies) influenced 175 second-year medical students' formulations of the differential and the principal diagnoses of 14 simulated patient management problems in comparison with experienced clinicians. Students emphasized…

A study of 195,165 patient visits at the University of Illinois hospital's 5 clinics investigated the mix of ambulatory care diagnosis clusters for diversity. It concluded that, to create an appropriate patient mix for training medical students and residents in ambulatory care, supplementation with other clinics is necessary. (Author/MSE)

The University of North Carolina at Chapel Hill medical school uses an objective structured clinical examination as the final exam in physical diagnosis. Since 1987, students and evaluators have shown overwhelming acceptance and support of the test, partly because it is structured for teaching as well as assessment. (Author/MSE)

Students (n=107) at the University of Michigan Medical School self-assessed diagnostic skills in 14 clinical areas before and after the clerkship and reported the relative amounts of time spent learning during the clerkship. Though self-assessed strengths and weaknesses typically did not correlate with study time allocation, time allocation was…

A program at an inner-city community health center involving 20 family practice residents provided an educational intervention concerning the use of laboratory tests based on quality of care, not cost containment. During the program, the use of thyroid stimulating hormone test declined, while complete blood counts ordered did not. (MSE)

An innovative internal medicine clerkship provides a one-month ambulatory care component followed by two months of traditional inpatient experience. Assessment of the changes in student ability to diagnose in a variety of brief cases found knowledge gains in the shorter ambulatory care segment were double those in the longer segment. (MSE)

Describes an electronic database of clinical questions (CQs) and medical evidence, the Critical Appraisal Resource (CAR). Evaluation of ten months of use found that medical residents did engage the medical literature on behalf of their patients, which influenced approximately half of their patient-care decisions. (EV)

A total of 200 patients were interviewed at 2 out-patient settings to quantify the patients' perspectives on their illness by measuring their requests for help. Results showed specific requests were made by most patients that focused either on the problem and/or the treatment. (GLR)

The article describes an elective course, part of the required psychiatry clerkship, at Dartmouth Medical School (New Hampshire), which stresses development of critical thinking skills in the diagnosis and management of patients with substance abuse and related medical and psychiatric complications. (Author/DB)

A group of medical students at Wright State University School of Medicine developed and participated in a one-month elective on selecting and interpreting diagnostic tests. Tests and diseases were reviewed, recorded and published by the students as a reference manual for their later use during clinical rotations. (MLW)

The study compared the diagnoses determined by 200 adult autopsies performed in 1968 and 200 autopsies 20 years later. Analysis indicated few changes in variety of case material despite declining autopsy rates and a changing racial mix of patients. Recommendations for maximizing the teaching impact of each autopsy are offered. (Author/DB)

Discusses clinical problem analysis (CPA) in medical education, an approach to solving complex clinical problems. Outlines the five step CPA model and examines the value of CPA's content-independent (methodical) approach. Argues that teaching students to use CPA will enable them to avoid common diagnostic reasoning errors and pitfalls. Compares…