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Life Is Short, the Art Long, Opportunity Fleeting, Experience Treacherous, Judgment Difficult-Reply FREE

Diane L. Elliott, MD; David H. Hickam, MD, MPH
JAMA. 1988;259(17):2543-2543. doi:10.1001/jama.1988.03720170018014
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In Reply.  —Dr Conner raises timely issues concerning the value of the history and physical examination for diagnostic decision making. We studied methods for evaluating medical students' mastery of skills for acquiring physical examination information. Another important goal of clinical teaching is to help students use findings to assess alternative diagnoses. Other investigators have developed tools to aid in teaching these skills in data synthesis.1Ms Mueller has emphasized that an effective breast examination is thorough, which has been confirmed by experimental studies.2,3 Patient instructors have been trained to teach the breast examination.4 And, as Drs Stillman, Regan, and Swanson point out, patient instructors may be logically suited to evaluate these skills. The teaching and assessment of the breast examination are often components of instruction in pelvic examination, which is a use of patient instructors provided by most medical schools.5We agree with Drs Stillman, Regan,

REFERENCES

Wasson JH, Sox HC Jr, Sox CH:  The diagnosis of abdominal pain in ambulatory male patients. Med Decis Making 1981;;1:215-224.
Hall DC, Adams CK, Stein GH, et al:  Improved detection of human breast lesions following experimental training. Cancer 1980;;46:408-411.
Saunders KJ, Pilgrim CA, Pennypacker HS:  Increased proficiency of search in breast self-examination. Cancer 1986;;58:2531-2537.
Sanfilippo JS, Berman B, Spratt JS, et al:  Establishment of a clinical teaching associates breast examination program for medical students. J ReprodMed 1986;;31:245-248.
Beckmann DRB, Spellacy WN, Yonke A, et al:  Initial instruction in the pelvic examination in the United States and Canada, 1983. Am J Obstet Gynecol 1985;;151:58-60.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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Wasson JH, Sox HC Jr, Sox CH:  The diagnosis of abdominal pain in ambulatory male patients. Med Decis Making 1981;;1:215-224.
Hall DC, Adams CK, Stein GH, et al:  Improved detection of human breast lesions following experimental training. Cancer 1980;;46:408-411.
Saunders KJ, Pilgrim CA, Pennypacker HS:  Increased proficiency of search in breast self-examination. Cancer 1986;;58:2531-2537.
Sanfilippo JS, Berman B, Spratt JS, et al:  Establishment of a clinical teaching associates breast examination program for medical students. J ReprodMed 1986;;31:245-248.
Beckmann DRB, Spellacy WN, Yonke A, et al:  Initial instruction in the pelvic examination in the United States and Canada, 1983. Am J Obstet Gynecol 1985;;151:58-60.
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To understand the clinical management of acute heart failure syndromes.
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