We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
A Piece of My Mind |

Trust Worthy

Dianne P. Wagner, MD1
[+] Author Affiliations
1Department of Internal Medicine, Michigan State University College of Human Medicine, East Lansing
JAMA. 2014;312(24):2621-2622. doi:10.1001/jama.2014.10438.
Text Size: A A A
Published online


It took me several years as a clinical skills course director before I realized that my students didn’t trust me. Looking back it makes sense: our time together was limited to lectures and logistics. But I didn’t understand why for a long time. When I described what I felt would be the most successful approach to mastering the physical examination, students were more likely to ask a peer. When I promised to fix a glitch—in the schedule or the manual or on the examination, their expressions often informed me it was too little, too late. When I suggested that studying from shadowy, student-generated answers that lurk in the hidden curriculum rather than reading their textbook would be cheating themselves, they responded that First Aid had it covered. And always, the concern about the grade, often out of proportion to the probability that it would not be favorable. Faculty has placed its trust in multiple-choice examinations, and for our students, those examinations and the resulting grades trump all. At some point, I figured it out; it occurred to me in a sudden rush of understanding, as these truths sometimes do. Rather than seeing me as someone with knowledge to impart and students’ best interests at heart, many students saw a potential adversary in control of their grade. A lot of behavior was easier to explain, but I had to wrestle with a new conceptual model for what it meant to be a teacher/administrator in a medical school.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Related Collections