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Are Medical Schools Neglecting Clinical Skills?

George L. Engel, MD
JAMA. 1976;236(7):861-863. doi:10.1001/jama.1976.03270080043032.
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Wiener and Nathanson report in this issue of The Journal on the large number of errors in interviewing and physical examination committed by medical house officers at a first-rank hospital.1 It would be easy to dismiss such charges as unreliable and inconsequential; unreliable because they do not conform with some readers' personal impressions, inconsequential because some may consider clinical observation to have been rendered obsolete by the availability of modern diagnostic technology. Actually, this communication should provoke sober soul-searching among the medical profession. Is our much vaunted American medical educational system failing in its responsibility to prepare physicians in the most fundamental of all medical skills: clinical observation and clinical reasoning?2

Unfortunately, the answer appears to be in the affirmative. Physicians reading this who have graduated in the last two decades need only recollect their own personal instruction as students in this area. In informal inquiries of medical


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