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"They review some classics including: "The rational clinical examination. Is this patient having a myocardial infarction?" in JAMA 1998. "The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease" in JAMA 2000. "Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis" in NEJM 2003. "The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma" in NEJM 2003. "Computed tomography of the head before lumbar puncture in adults with suspected meningitis" in NEJM 2001."

"The NEJM Image Challenge app provides a great forum to keep one's diagnostic skills sharp, but has limitations in lack of robustness of explanations and inability to save particular images for later review."

NEJM- great images of imnpact of hand washing on MRSA

"linical teachers differ from clinicians in a fundamental way. They must simultaneously foster high-quality patient care and assess the clinical skills and reasoning of learners in order to promote their progress toward independence in the clinical setting.1 Clinical teachers must diagnose both the patient's clinical problem and the learner's ability and skill."

"The two major products of clinical decision making are diagnoses and treatment plans. If the first is correct, the second has a greater chance of being correct too. Surprisingly, we don't make correct diagnoses as often as we think: the diagnostic failure rate is estimated to be 10 to 15%. "

Key benefits of the NAS include the creation of a national framework for assessment that includes comparison data, reduction in the burden associated with the current process-based accreditation system, the opportunity for residents to learn in innovative programs, and enhanced resident education in quality, patient safety, and the new competencies. Over time, we envision that the NAS will allow the ACGME to create an accreditation system that focuses less on the identification of problems and more on the success of programs and institutions in addressing them.

shows that intensive lowering may increase mortality

"By offloading tasks from the 15-minute visit in order to prioritize the patient's agenda, adding group, telephone, and electronic encounters, and reorganizing services with the aim of maximizing the health of a practice's entire patient population, innovative primary care practices could lead primary care out of crisis into an era of renewal."

This article seems to advocate the trend in UK based primary care- but key questions remain unanswered, can trust be transferred from the individual doctor to the team? Does this dilute the 'doctor as drug' benefit?

"This case reinforces the importance of interpreting test results with caution and with attention to the clinical picture. Effective communication between the nurses and specialists caring for the patient led to the correct diagnosis and a good clinical outcome. This clinical scenario and clinical problem-solving exercise emphasize the importance of looking at the "hole" picture."

"Taking a comprehensive social history is time-consuming. It's easy to dismiss the task as outside the doctor's purview, especially when there's precious little time to get through a sea of investigations and treatment options. But every patient is a person, and illness occurs in the context of multifaceted lives. We need to listen to our patients with the recognition that the most important information they can give us about their illness often lies in the folds of their social circumstances. And it's our obligation to tailor our prescriptions to an illness in its full context."

Video interactive cases

"This report focuses on how clinical teachers can facilitate the learning process to help learners make the transition from being diagnostic novices to becoming expert clinicians"

"I think it is safe to say that no physician is optimistic about the future of medicine at this point," one participant wrote. Others seemed downright hopeless...the practice of medicine continually gets worse and worse, more intolerable, more onerous, with absolutely no hope or reason for any optimism either in the near or remote future."