NEJM â Collection Updates for Medical Education and Training

PERSPECTIVE: Cottage Industry to Postindustrial Care â The Revolution in Health Care Delivery

Thu, 04Â FebÂ 2010 00:00:00 -05:00

U.S. health care is broken. Although other industries have transformed themselves using tools such as standardization of value-generating processes, performance measurement, and transparent reporting of quality, the application of these...

PERSPECTIVE: Launching HITECH

Thu, 04Â FebÂ 2010 00:00:00 -05:00

Information is the lifeblood of modern medicine. Health information technology (HIT) is destined to be its circulatory system. Without that system, neither individual physicians nor health care institutions can perform...

PERSPECTIVE: Withholding Information from Patients â When Less Is More

Thu, 04Â FebÂ 2010 00:00:00 -05:00

As clinicians who strongly value truth telling and active patient involvement in medical decision making,1 we have lately been reflecting on the circumstances in which physicians consciously (and sometimes unconsciously)...

PERSPECTIVE: Patient-Centered Medical Homes in Ontario

Thu, 21Â JanÂ 2010 00:00:00 -05:00

As the United States debates health care reform, the concept of âpatient-centered medical homesâ is receiving increasing attention.1 Many experts believe that medical homes with multidisciplinary teams and financial incentives...

PERSPECTIVE: Googling Ourselves â What Physicians Can Learn from Online Rating Sites

Thu, 07Â JanÂ 2010 00:00:00 -05:00

I open the Google search page on my laptop, type in my name, and click âsearch.â In the 0.22 second it takes for the 1540 results to appear, I have...

IMAGES IN CLINICAL MEDICINE: Coughing and Masks

Julian Wei-Tze Tang, M.D. and Gary Settles, Ph.D. — Thu, 24Â DecÂ 2009 00:00:00 -05:00

Coughing can transmit infectious agents, such as influenza virus, and it has been assumed that wearing a mask limits transmission of these agents. Schlieren optics can effectively visualize the dispersion...

SOUNDING BOARD: The Agenda for Continuing Medical Education â Limiting Industry's Influence

Lewis Morris, J.D., and Julie K. Taitsman, M.D., J.D. — Thu, 17Â DecÂ 2009 00:00:00 -05:00

Most physicians must complete accredited continuing medical education (CME) programs to maintain their medical licenses, hospital privileges, and specialty board certifications. Data from the Accreditation Council for Continuing Medical Education...

PERSPECTIVE: The Breadth of Hopes

Thu, 10Â DecÂ 2009 00:00:00 -05:00

Hoping is a fundamental human activity. As a pediatrician who cares for children with life-threatening, complex chronic conditions, I hear the word âhopeâ on a daily basis: âI hope we...

PERSPECTIVE: The Service

Thu, 12Â NovÂ 2009 00:00:00 -05:00

This morning, I came upon an intern engrossed at the computer.

âI am looking up the diseases Mr. Crosby died of,â she explained.

The octogenarian had been on our unit for 4...

VIDEOS IN CLINICAL MEDICINE: AnkleâBrachial Index for Assessment of Peripheral Arterial Disease

S. Marlene Grenon, M.D.C.M., Joel Gagnon, M.D., and York Hsiang, M.D. — Thu, 05Â NovÂ 2009 00:00:00 -05:00

...

PERSPECTIVE: Reform and the Health Care Workforce â Current Capacity, Future Demand

Thu, 05Â NovÂ 2009 00:00:00 -05:00

As Democrats press to enact health care reform legislation, they have emphasized their commitment to greatly expanding coverage, slowing the growth of medical spending, and more tightly regulating private insurers,...

INTERACTIVE MEDICAL CASE: A Bloody Mystery

Thu, 15Â OctÂ 2009 00:00:00 -05:00

A 62-year-old woman presented to the urgent care clinic with gingival bleeding after periodontal scaling of her lower right second molar. She had undergone the procedure 5 hours before presentation,...

VIDEOS IN CLINICAL MEDICINE: Bone Marrow Aspiration and Biopsy

Thu, 08Â OctÂ 2009 00:00:00 -05:00

...

INTERACTIVE MEDICAL CASE: The Writing on the Wall

Thu, 10Â SepÂ 2009 00:00:00 -05:00

A 52-year-old man with diabetes mellitus was admitted to the hospital after presenting to the emergency department with abdominal discomfort. His symptoms began 5 weeks earlier, when epigastric discomfort developed...

EDITORIAL: Interactive Medical Cases â A New Feature

Thu, 10Â SepÂ 2009 00:00:00 -05:00

Educators have long recognized that learning is enhanced and retention improves when the educational material is relevant and engaging and includes interaction. Building on the increasing capacity of the online...

CORRESPONDENCE: Residents' Duty Hours and Professionalism

John D. Rybock, M.D. — Thu, 27Â AugÂ 2009 00:00:00 -05:00

To the Editor: The Accreditation Council for Graduate Medical Education (ACGME) is currently reevaluating its 2003 rules1 regarding duty hours, in light of the recent recommendations2 from the Institute of...

PERSPECTIVE: Dr. Holmes at 200 â The Spirit of Skepticism

Thu, 27Â AugÂ 2009 00:00:00 -05:00

This week marks the bicentennial of the birth of Oliver Wendell Holmes (August 29, 1809âOctober 7, 1894), who at various times during the 19th century was America's best-known physician and...

PERSPECTIVE: What Would Osler Do? Learning from âDifficultâ Patients

Thu, 30Â JulÂ 2009 00:00:00 -05:00

âMy intern can't stand Ms. Andrews and refuses to meet with her. He says I'll do all the communicating for the team and that I shouldn't be too nice to...

PERSPECTIVE: Who Has Capacity?

Thu, 16Â JulÂ 2009 00:00:00 -05:00

âSomeone else should get the liver,â the patient told me, âsomebody with kids or a family.â Mr. D. was lying in his hospital bed with his hands folded atop his...

PERSPECTIVE: Easing the Shortage in Adult Primary Care â Is It All about Money?

Thu, 25Â JunÂ 2009 00:00:00 -05:00

As Americans debate health care reform, it is easy to forget that success may depend as much on the availability of primary care physicians for adults as on the specifics...

PERSPECTIVE: A Lifeline for Primary Care

Thu, 25Â JunÂ 2009 00:00:00 -05:00

Primary care in the United States needs a lifeline. In 2009, for the 12th straight year, the number of graduating U.S. medical students choosing primary care residencies reached dismally low...

BOOK REVIEW:

Thu, 11Â JunÂ 2009 00:00:00 -05:00

One of the oft-heard adages in medical education is that professional values are âcaught and not taught,â which implies that learners integrate important values in a way that resists formal...

BOOK REVIEW:

Thu, 21Â MayÂ 2009 00:00:00 -05:00

The drama in the lives of physicians in training, as it is depicted in television shows and in films, has long fascinated the public. There have also been many firsthand...

EDITORIAL: To Nap or Not to Nap? Residents' Work Hours Revisited

Thu, 21Â MayÂ 2009 00:00:00 -05:00

The medical profession must provide quality, cost-effective care and seek high standards of patient safety. To improve patient safety in our teaching hospitals, a committee of the Institute of Medicine...

SPECIAL ARTICLE: Cost Implications of Reduced Work Hours and Workloads for Resident Physicians

Thu, 21Â MayÂ 2009 00:00:00 -05:00

Background: Although the Accreditation Council for Graduate Medical Education (ACGME) limits the work hours of residents, concerns about fatigue persist. A new Institute of Medicine (IOM) report recommends, among other...

CLINICAL DECISIONS: Management of Incidental Hepatitis C Virus Infection

Thu, 30Â AprÂ 2009 00:00:00 -05:00

A 25-year-old black woman is referred to your clinic for management of an incidental positive result on a hepatitis C virus (HCV) antibody test. She had decided to donate blood...

BOOK REVIEW:

Thu, 23Â AprÂ 2009 00:00:00 -05:00

The number of women entering medical school and residency and practicing medicine in the United States has grown steadily over the past four decades. The Changing Face of Medicine is...

PERSPECTIVE: The Future of Research Funding in Academic Medicine

Thu, 09Â AprÂ 2009 00:00:00 -05:00

Medical schools and teaching hospitals in the United States are essential producers of basic scientific and clinical knowledge that drives our supply of new medicines, devices, and other health care...

BOOK REVIEW:

Thu, 19Â MarÂ 2009 00:00:00 -05:00

In 1858, a new book appeared. It had the lackluster title Anatomy Descriptive and Surgical and it boasted no original discoveries, but compared with other textbooks on the market, it...

PERSPECTIVE: Denial

Thu, 19Â MarÂ 2009 00:00:00 -05:00

The medical student is watching closely. In an overfilled clinic, time is scarce and the teaching staccato. I point out a malignant lymph node here, an enlarged liver there. She...

CLINICAL DECISIONS: Care of an Unresponsive Patient with a Poor Prognosis â Polling Results

Thu, 05Â MarÂ 2009 00:00:00 -05:00

In late January, we presented the case of an unresponsive, 56-year-old homeless patient who had a ruptured aneurysm, a high probability of cancer, and a best prognosis of severe disability...

VIDEOS IN CLINICAL MEDICINE: Blood-Pressure Measurement

Thu, 29Â JanÂ 2009 00:00:00 -05:00

...

CLINICAL DECISIONS: Care of an Unresponsive Patient with a Poor Prognosis

Thu, 29Â JanÂ 2009 00:00:00 -05:00

A 56-year-old homeless man was found having a seizure and was transported to the hospital. He was found to have a subarachnoid hemorrhage and acute hydrocephalus. He underwent intubation, and...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Constipation

Ioannis Karakis, M.D. and Christos Kosmas, M.D. — Thu, 22Â JanÂ 2009 00:00:00 -05:00

A 56-year-old woman with a medical history notable for epilepsy, scoliosis, and chronic constipation presented with shortness of breath and cough, which she reported having had for the past 10...

CLINICAL DECISIONS: Management of Prostate Cancer â Polling Results

Robert S. Schwartz, M.D. — Thu, 15Â JanÂ 2009 00:00:00 -05:00

In early December, we presented the case of a 63-year-old man with a rising prostate-specific antigen (PSA) level in Clinical Decisions,1 an interactive feature designed to assess how readers would...

BOOK REVIEW:

Thu, 08Â JanÂ 2009 00:00:00 -05:00

This concise, lively, and sometimes humorous history will interest women and men of all ages. Author Toni Martin includes the experiences of herself and four others in her book â...

VIDEOS IN CLINICAL MEDICINE: Basic Splinting Techniques

Thu, 25Â DecÂ 2008 00:00:00 -05:00

...

PERSPECTIVE: Culture Shock â Patient as Icon, Icon as Patient

Thu, 25Â DecÂ 2008 00:00:00 -05:00

On my first day as an attending physician in a new hospital, I found my house staff and students in the team room, a snug bunker filled with glowing monitors....

PERSPECTIVE: The Future of Primary Care â The Community Responds

Thu, 18Â DecÂ 2008 00:00:00 -05:00

In a collection of Perspective articles published in the November 13 issue of the Journal and a videotaped roundtable discussion posted online, experts in the field discussed the current crisis...

PERSPECTIVE: Revisiting Duty-Hour Limits â IOM Recommendations for Patient Safety and Resident Education

Thu, 18Â DecÂ 2008 00:00:00 -05:00

Has the 80-hour workweek been good for patients and residents?...

PERSPECTIVE: Medical Student Debt â Is There a Limit?

Thu, 18Â DecÂ 2008 00:00:00 -05:00

In 2008, medical schools in the United States enrolled 18,036 first-year students, a record number. On average, more than two people applied for every slot; the overall applicant pool was...

CLINICAL DECISIONS: Management of Prostate Cancer

Thu, 11Â DecÂ 2008 00:00:00 -05:00

A 63-year-old man who has been under your care for the past 3 years undergoes an annual check-up. He believes he is in excellent health, and he has no medical...

VIDEOS IN CLINICAL MEDICINE: Peripheral Intravenous Cannulation

Thu, 20Â NovÂ 2008 00:00:00 -05:00

...

PERSPECTIVE: Sustaining Relationships

Thu, 13Â NovÂ 2008 00:00:00 -05:00

Redesigning Primary Care...

PERSPECTIVE: The Need for Reinvention

Thu, 13Â NovÂ 2008 00:00:00 -05:00

Redesigning Primary Care...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â A 71-Year-Old Man with Pancytopenia

Julia M. Braza, M.D. and Parul Bhargava, M.D. — Thu, 30Â OctÂ 2008 00:00:00 -05:00

A 71-year-old-man presented to the emergency department with dizziness, progressive lethargy, and confusion, which he reported having had for the past 10 days. A complete blood count showed pancytopenia. A...

PERSPECTIVE: Living Unlabeled â Diagnosis and Disorder

Thu, 16Â OctÂ 2008 00:00:00 -05:00

I'm at the end of my second year of residency, and for 2 years I have had a pain in my left hip. I've convinced myself that this pain is...

CLINICAL DECISIONS: Management of Skin and Soft-Tissue Infection â Polling Results

Sarah P. Hammond, M.D., and Lindsey R. Baden, M.D. — Thu, 09Â OctÂ 2008 00:00:00 -05:00

In early September, we presented a case of a college athlete with a skin and soft-tissue infection in Clinical Decisions,1 an interactive feature designed to assess how readers would manage...

VIDEOS IN CLINICAL MEDICINE: Umbilical Vascular Catheterization

Thu, 09Â OctÂ 2008 00:00:00 -05:00

...

BOOK REVIEW:

Thu, 02Â OctÂ 2008 00:00:00 -05:00

Intern is an excellent, well-written book in which Sandeep Jauhar describes his first 2 years of internship and residency in internal medicine at New York Hospital (now New YorkâPresbyterian Hospital),...

PERSPECTIVE: Close Calls

Thu, 04Â SepÂ 2008 00:00:00 -05:00

I didn't realize I was on call that night until we were at Fenway Park and the ball game was well under way. Call started at 9 p.m., and frankly,...

CLINICAL DECISIONS: Management of Skin and Soft-Tissue Infection

Thu, 04Â SepÂ 2008 00:00:00 -05:00

A 20-year-old college basketball player presents to the emergency department with a 2-day history of a red, painful area on his right buttock. He reports that there was no specific...

BOOK REVIEW:

Thu, 28Â AugÂ 2008 00:00:00 -05:00

The Oxford Textbook of Clinical Research Ethics is a resource suitable for a course in research ethics and would also be helpful for those starting a career in clinical research....

HEALTH POLICY REPORT: Medicare, Graduate Medical Education, and New Policy Directions

John K. Iglehart — Thu, 07Â AugÂ 2008 00:00:00 -05:00

It has been more than a decade since Congress enacted legislation that significantly altered the policies under which Medicare supports graduate medical education (GME). Now, the political ground under this...

PERSPECTIVE: From All Walks of Life â Nontraditional Medical Students and the Future of Medicine

Thu, 17Â JulÂ 2008 00:00:00 -05:00

When I was growing up, my parents wanted me to become a doctor, but I had other ideas. I wanted to be a television journalist, or perhaps a trial lawyer...

PERSPECTIVE: Relevance and Rigor in Premedical Education

Thu, 17Â JulÂ 2008 00:00:00 -05:00

In recent decades, scientific knowledge has changed dramatically, once-settled scientific principles have been replaced by more sophisticated concepts and entirely new disciplines, and parallel changes have occurred in medical practice...

BOOK REVIEW:

Thu, 10Â JulÂ 2008 00:00:00 -05:00

The relentless âscientificationâ of medical training during the past century has laudably taken medicine far from its roots in hucksterism. Each generation of physicians is steeped in an ever-expanding universe...

VIDEOS IN CLINICAL MEDICINE: Placement of a Femoral Venous Catheter

Thu, 26Â JunÂ 2008 00:00:00 -05:00

...

VIDEOS IN CLINICAL MEDICINE: Cricothyroidotomy

James Hsiao, M.D., and Victor Pacheco-Fowler, M.D. — Thu, 29Â MayÂ 2008 00:00:00 -05:00

...

PERSPECTIVE: The Moral of the Story

Thu, 29Â MayÂ 2008 00:00:00 -05:00

I came home the other night clutching a scrap of paper towel with a mother's cell-phone number scribbled on it. I had been precepting in the residents' pediatric primary care...

EDITORIAL: Peer Review in the Balance

Thu, 22Â MayÂ 2008 00:00:00 -05:00

For many years, the editors of the Journal have relied on peer review to ensure the scientific quality of the articles that we publish. Of the thousands of manuscripts submitted...

CLINICAL DECISIONS: Management of Carotid Stenosis â Polling Results

Thu, 15Â MayÂ 2008 00:00:00 -05:00

In early April, we presented the case of a 67-year-old man with asymptomatic carotid disease in Clinical Decisions,1 an interactive feature designed to assess how readers would manage a clinical...

PERSPECTIVE: Physician Workforce Crisis? Wrong Diagnosis, Wrong Prescription

Thu, 17Â AprÂ 2008 00:00:00 -05:00

Despite the fact that there are now more physicians per capita in the United States than there have been for at least 50 years, the Council on Graduate Medical Education...

CLINICAL DECISIONS: Management of Carotid Stenosis

Thu, 10Â AprÂ 2008 00:00:00 -05:00

A 67-year-old man with a history of hypertension and hyperlipidemia is seen for a routine examination. His medications include hydrochlorothiazide (25 mg daily), simvastatin (20 mg daily), and aspirin (81...

VIDEOS IN CLINICAL MEDICINE: Female Urethral Catheterization

Rafael Ortega, M.D., Linda Ng, M.D., Pavan Sekhar, B.S., and Michael Song, M.A. — Thu, 03Â AprÂ 2008 00:00:00 -05:00

...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery: Epigastric Pain

Rangan Murali, M.D. and Bashar M. Attar, M.D., Ph.D. — Thu, 06Â MarÂ 2008 00:00:00 -05:00

An 82-year-old woman presented with respiratory symptoms, and a chest film was obtained. Six years later, she presented with epigastric pain, nausea, and vomiting. What is the diagnosis?...

PERSPECTIVE: The Vanishing Nonforensic Autopsy

Thu, 28Â FebÂ 2008 00:00:00 -05:00

We've all heard about cases in which a patient presumed to have died from acute myocardial infarction was discovered at autopsy to have had an aortic dissection, or a patient...

VIDEOS IN CLINICAL MEDICINE: Examination of the Larynx and Pharynx

Thu, 17Â JanÂ 2008 00:00:00 -05:00

...

CLINICAL DECISIONS: Management of Type 2 Diabetes

Thu, 17Â JanÂ 2008 00:00:00 -05:00

A 55-year-old woman with type 2 diabetes, obesity, and hypertension has been under your care for the past 2 years. She has no history of microalbuminuria, retinopathy, or neuropathy. She...

PERSPECTIVE: A Bridge to Nowhere â The Troubled Trek of Foreign Medical Graduates

Thu, 17Â JanÂ 2008 00:00:00 -05:00

It is a typical day in my Melbourne clinic, with missing files, scans gone astray, and patients overwhelmed by their diagnoses. Though a mountain of dictation remains, the day's end...

IMAGES IN CLINICAL MEDICINE: Medical Mystery: Cloud Surrounding the Optic Disks

Sandeep Randhawa, M.D. and Andrew G. Lee, M.D. — Thu, 03Â JanÂ 2008 00:00:00 -05:00

A 42-year-old man presented for a routine eye examination. His best corrected visual acuity was 20/20 in both eyes, and examination of the anterior segment of each eye showed no...

CLINICAL DECISIONS: Management of Stable Coronary Disease â Polling Results

Susan Cheng, M.D., and John Jarcho, M.D. — Thu, 13Â DecÂ 2007 00:00:00 -05:00

In late October, we presented the case of a patient with stable coronary artery disease in Clinical Decisions,1 an interactive feature designed to assess how readers would manage a clinical...

VIDEOS IN CLINICAL MEDICINE: Central Venous Catheterization â Subclavian Vein

Thu, 13Â DecÂ 2007 00:00:00 -05:00

...

SPECIAL ARTICLE: The Anatomy of Medical School Patenting

Pierre Azoulay, Ph.D., Ryan Michigan, M.Phil., and Bhaven N. Sampat, Ph.D. — Thu, 15Â NovÂ 2007 00:00:00 -05:00

Background: Although issues related to patenting by faculty at academic medical centers have been the source of much controversy, there is little systematic evidence of the growth of these activities,...

VIDEOS IN CLINICAL MEDICINE: Abscess Incision and Drainage

Thu, 08Â NovÂ 2007 00:00:00 -05:00

...

PERSPECTIVE: Becoming a Doctor, Starting a Family â Leaves of Absence from Graduate Medical Education

Thu, 08Â NovÂ 2007 00:00:00 -05:00

Colleagues offered congratulations when Mike and Anya announced that they were expecting a baby â due a few months before their expected graduation from residency programs in radiology and family...

PERSPECTIVE: Climbing through Medicine's Glass Ceiling

Thu, 08Â NovÂ 2007 00:00:00 -05:00

Earlier this year, I was named the first female dean of the Duke University School of Medicine, an event that National Public Radio summed up in the headline: âAndrews Makes...

CLINICAL DECISIONS: Management of Stable Coronary Disease

Thu, 25Â OctÂ 2007 00:00:00 -05:00

This interactive feature allows readers to decide on the diagnosis or management of a clinical case. A case vignette is followed by specific clinical options, none of which can be...

PERSPECTIVE: Guilty, Afraid, and Alone â Struggling with Medical Error

Thu, 25Â OctÂ 2007 00:00:00 -05:00

Since 1999, health care professionals have been focusing on To Err Is Human, the Institute of Medicine report that sounded alarms about medical error. As we have strived to reduce...

VIDEOS IN CLINICAL MEDICINE: Chest-Tube Insertion

Thu, 11Â OctÂ 2007 00:00:00 -05:00

...

PERSPECTIVE: The Code

Thu, 27Â SepÂ 2007 00:00:00 -05:00

How do you deal with the emotionally challenging aspects of clinical care?...

PERSPECTIVE: Terra Firma â A Journey from Migrant Farm Labor to Neurosurgery

Thu, 09Â AugÂ 2007 00:00:00 -05:00

âYou will spend the rest of your life working in the fields,â my cousin told me when I arrived in the United States in the mid-1980s. This fate indeed appeared...

VIDEOS IN CLINICAL MEDICINE: Positive-Pressure Ventilation with a Face Mask and a Bag-Valve Device

Thu, 26Â JulÂ 2007 00:00:00 -05:00

...

PERSPECTIVE: Leaving against Medical Advice

Thu, 19Â JulÂ 2007 00:00:00 -05:00

It was the first day of my cardiology subinternship, and I was trying to catch details of the 29-year-old patient's complex history. Juan Perez, a heroin addict who had undergone...

CLINICAL DECISIONS: Mild Persistent Asthma â Polling Results

Laura E. Fredenburgh, M.D., Edward W. Campion, M.D., and Jeffrey M. Drazen, M.D. — Thu, 12Â JulÂ 2007 00:00:00 -05:00

In mid-May, we introduced Clinical Decisions â a new interactive feature designed to help us understand how our readers would manage a given clinical case. Our opening case1 involved how...

PERSPECTIVE: The Art of Letting Go

Thu, 05Â JulÂ 2007 00:00:00 -05:00

âIs there any money we need to pay? Is that why you won't treat him?â

Her face wears a hunted expression; her slender frame is weighed down by fatigue and untold...

VIDEOS IN CLINICAL MEDICINE: Pelvic Examination

Thu, 28Â JunÂ 2007 00:00:00 -05:00

...

ORIGINAL ARTICLE: Needlestick Injuries among Surgeons in Training

Thu, 28Â JunÂ 2007 00:00:00 -05:00

Background: Surgeons in training are at high risk for needlestick injuries. The reporting of such injuries is a critical step in initiating early prophylaxis or treatment.

Methods: We surveyed surgeons in...

PERSPECTIVE: Adapting to Duty-Hour Limits â Four Years On

Thu, 28Â JunÂ 2007 00:00:00 -05:00

On July 1, 2003, prompted by the medical profession's concerns about patient safety and the working conditions and education of resident physicians, the Accreditation Council for Graduate Medical Education (ACGME)...

PERSPECTIVE: An Elusive Balance â Residents' Work Hours and the Continuity of Care

Thu, 28Â JunÂ 2007 00:00:00 -05:00

Four years after national limits on duty hours for medical residents took effect â and nearly two decades after similar limits were enacted by New York State â conversations with...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â High Blood Pressure

Raul Quiros-Lopez, M.D. and Javier Garcia-Alegria, M.D. — Thu, 21Â JunÂ 2007 00:00:00 -05:00

A healthy 28-year-old woman presented with a 1-year history of high blood pressure, which had been diagnosed during her first pregnancy and treated with amiloride and hydrochlorothiazide. Physical examination revealed...

VIDEOS IN CLINICAL MEDICINE: Central Venous Catheterization

Thu, 24Â MayÂ 2007 00:00:00 -05:00

...

CLINICAL DECISIONS: Treatment of Mild Persistent Asthma

Thu, 17Â MayÂ 2007 00:00:00 -05:00

You are consulted by a 30-year-old white woman, who holds an administrative position in an office and has a lifelong history of asthma, about the treatment of her condition. In...

EDITORIAL: Clinical Decisions

Thu, 17Â MayÂ 2007 00:00:00 -05:00

In this issue of the Journal, we begin an experiment in understanding the therapeutic decisions that physicians make every day at the bedside and in the office. At the foundation...

VIDEOS IN CLINICAL MEDICINE: Orotracheal Intubation

Thu, 26Â AprÂ 2007 00:00:00 -05:00

...

PERSPECTIVE: The Patient as Ally â Learning the Pelvic Examination

Thu, 01Â MarÂ 2007 00:00:00 -05:00

The gynecology clinic is often a discouraging learning environment for medical students. Although those who complete a third-year clerkship in obstetrics and gynecology may take histories from plenty of women,...

SOUNDING BOARD: âContinuityâ as an Organizing Principle for Clinical Education Reform

Thu, 22Â FebÂ 2007 00:00:00 -05:00

If the ultimate purpose of medical education â to meet the health needs of society â is to be achieved, the primary goal of undergraduate medical education should be to...

EDITORIAL: Educational Continuity in Clinical Clerkships

David M. Irby, Ph.D. — Thu, 22Â FebÂ 2007 00:00:00 -05:00

Continuity in medical-student clerkships is becoming a thing of the past. There is little continuity between students and teachers, between students and patients, and between specialty-based components of the curriculum....

IMAGES IN CLINICAL MEDICINE: A Medical Mystery: Dilated Bowel

Jason Handwerker, M.D. and Vassilios D. Raptopoulos, M.D. — Thu, 01Â FebÂ 2007 00:00:00 -05:00

A 70-year-old man presented with a history of increasing abdominal distention. On physical examination, the patient was afebrile and his abdomen was soft and nontender. An abdominal radiograph raised concern...

PERSPECTIVE: Pakistani Physicians and the Repatriation Equation

Thu, 01Â FebÂ 2007 00:00:00 -05:00

In Pakistan, students who are accepted into medical school are congratulated â only half-jokingly â on three counts: that they will become doctors, that they will become certified by the...

PERSPECTIVE: Doctors and Soccer Players â African Professionals on the Move

Thu, 01Â FebÂ 2007 00:00:00 -05:00

On June 22, 2006, the nation of Ghana erupted. SUVs flew through the streets of Accra with flag-waving celebrants jammed through sunroofs. Crowds led by shirtless drummers banging garbage-can tops...

EDITORIAL: Assessing Doctors at Work â Progress and Challenges

Daniel Klass, M.D., C.M. — Thu, 25Â JanÂ 2007 00:00:00 -05:00

A fair amount of scrutiny has been given recently to the assessment of medical students' competence before they enter practice. In this issue of the Journal, Epstein provides a timely...

REVIEW ARTICLE: Assessment in Medical Education

Ronald M. Epstein, M.D. — Thu, 25Â JanÂ 2007 00:00:00 -05:00

As an attending physician working with a student for a week, you receive a form that asks you to evaluate the student's fund of knowledge, procedural skills, professionalism, interest in...

EDITORIAL: Technical-Skills Training in the 21st Century

Rajesh Aggarwal, M.R.C.S., and Ara Darzi, M.D. — Thu, 21Â DecÂ 2006 00:00:00 -05:00

Medical education is undergoing a paradigm shift, from the traditional experience-based model to a program that requires documentation of proficiency.1 Technological advances in health care, the development of day-case surgery,...

REVIEW ARTICLE: Teaching Surgical Skills â Changes in the Wind

Richard K. Reznick, M.D., M.Ed., and Helen MacRae, M.D. — Thu, 21Â DecÂ 2006 00:00:00 -05:00

Sir William Halsted introduced a German-style residency training system with an emphasis on graded responsibility at Johns Hopkins Hospital in 1889.1 This system remains the cornerstone of surgical training in...

EDITORIAL: Building on Experience â The Development of Clinical Reasoning

Geoffrey Norman, Ph.D. — Thu, 23Â NovÂ 2006 00:00:00 -05:00

As medical students become physicians, they need to learn to diagnose and manage clinical problems â a process often referred to as developing clinical reasoning skills. Researchers have been exploring...

REVIEW ARTICLE: Educational Strategies to Promote Clinical Diagnostic Reasoning

Judith L. Bowen, M.D. — Thu, 23Â NovÂ 2006 00:00:00 -05:00

Clinical 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...

EDITORIAL: Professionalism â The Next Wave

Thu, 16Â NovÂ 2006 00:00:00 -05:00

In their Medical Education article in the October 26 issue of the Journal, Stern and Papadakis make a number of observations about professionalism and the learning environments in which medical...

PERSPECTIVE: Murder or Mercy? Hurricane Katrina and the Need for Disaster Training

Thu, 16Â NovÂ 2006 00:00:00 -05:00

In July 2006, a New Orleans physician, Anna Pou, and two nurses, Lori Budo and Cheri Landry, were arrested and accused of the second-degree murder of four patients at Memorial...

VIDEOS IN CLINICAL MEDICINE: Paracentesis

Thu, 09Â NovÂ 2006 00:00:00 -05:00

...

VIDEOS IN CLINICAL MEDICINE: Basic Laceration Repair

Todd W. Thomsen, M.D., Derek A. Barclay, M.D., and Gary S. Setnik, M.D. — Thu, 26Â OctÂ 2006 00:00:00 -05:00

...

REVIEW ARTICLE: The Developing Physician â Becoming a Professional

David T. Stern, M.D., Ph.D., and Maxine Papadakis, M.D. — Thu, 26Â OctÂ 2006 00:00:00 -05:00

We all reflect on our formal training in medicine and know that somehow we made the transition from being a student in a classroom to being a seasoned clinician caring...

VIDEOS IN CLINICAL MEDICINE: Thoracentesis

Todd W. Thomsen, M.D., Jennifer DeLaPena, M.D., and Gary S. Setnik, M.D. — Thu, 12Â OctÂ 2006 00:00:00 -05:00

...

PERSPECTIVE: An Aging Un-American

Thu, 05Â OctÂ 2006 00:00:00 -05:00

My new patient barely returned my handshake. Instead, she hurried to the cramped center of the exam room and knelt on the yoga mat she had placed on the floor....

PERSPECTIVE: Tracing Atrial Fibrillation â 100 Years

Thu, 05Â OctÂ 2006 00:00:00 -05:00

Today, there is talk about an epidemic of atrial fibrillation, and physicians caring for patients with this common arrhythmia face a bewildering array of treatment options. Contrast this situation with...

VIDEOS IN CLINICAL MEDICINE: Lumbar Puncture

Thu, 28Â SepÂ 2006 00:00:00 -05:00

...

EDITORIAL: A New Series on Medical Education

Malcolm Cox, M.D., and David M. Irby, Ph.D. — Thu, 28Â SepÂ 2006 00:00:00 -05:00

Providing the ârightâ physician for the health care of the future will require substantial changes in the way doctors are educated. This view was voiced in a report from the...

EDITORIAL: A Good Teacher

Jeffrey M. Drazen, M.D. — Thu, 28Â SepÂ 2006 00:00:00 -05:00

Earlier this year, I learned that my high school chemistry teacher had died. This was not surprising, since he had been my teacher in 1961. What was rather astounding was...

REVIEW ARTICLE: American Medical Education 100 Years after the Flexner Report

Thu, 28Â SepÂ 2006 00:00:00 -05:00

Medical education seems to be in a perpetual state of unrest. From the early 1900s to the present, more than a score of reports from foundations, educational bodies, and professional...

PERSPECTIVE: The Script

Thu, 07Â SepÂ 2006 00:00:00 -05:00

âWhat happened?â the patient asked. She was coming out of anesthesia after six hours of surgery. A weary resident cleaned dried blood and iodine from the skin around the surgical...

PERSPECTIVE: Going beyond Disease to Address Disability

Thu, 07Â SepÂ 2006 00:00:00 -05:00

One summer day about 10 years ago, a young woman flagged me down as I was rolling back to my hospital on my scooter wheelchair. An inpatient taking a sunshine...

PERSPECTIVE: Primary Care â The Best Job in Medicine?

Thu, 31Â AugÂ 2006 00:00:00 -05:00

I first met Mr. B. during my internship, when he was a 29-year-old musician who had been admitted to the hospital with atypical pneumonia. After he was discharged, he kept...

PERSPECTIVE: Primary Care â Will It Survive?

Thu, 31Â AugÂ 2006 00:00:00 -05:00

The American College of Physicians recently warned that âprimary care, the backbone of the nation's health care system, is at grave risk of collapse.â1 And indeed, primary care is facing...

PERSPECTIVE: Turning the Page at the CMAJ

Thu, 10Â AugÂ 2006 00:00:00 -05:00

Since the editor-in-chief and senior deputy editor of the Canadian Medical Association Journal (CMAJ) were fired in February 2006, there has been passionate public debate about editorial independence and the...

PERSPECTIVE: The Silent Epidemic â The Health Effects of Illiteracy

Thu, 27Â JulÂ 2006 00:00:00 -05:00

He came in for a âtune-up.â He was 64 years old, with a âhistory of noncompliance,â according to the resident, and he hadn't taken his diabetes or cardiac medications for...

EDITORIAL: Women in Academic Medicine â Progress and Challenges

Thu, 20Â JulÂ 2006 00:00:00 -05:00

In 1960, only about 5 percent of medical students in the United States were women; today, the numbers of women and men in medical school are approximately equal. This apparent...

SPECIAL ARTICLE: The âGender Gapâ in Authorship of Academic Medical Literature â A 35-Year Perspective

Thu, 20Â JulÂ 2006 00:00:00 -05:00

Background: Participation of women in the medical profession has increased during the past four decades, but issues of concern persist regarding disparities between the sexes in academic medicine. Advancement is...

HEALTH POLICY REPORT: The New Era of Medical Imaging â Progress and Pitfalls

John K. Iglehart — Thu, 29Â JunÂ 2006 00:00:00 -05:00

Rapid advances in biomedical imaging have greatly enhanced the ability of physicians to diagnose and treat a variety of diseases. This enhanced ability often leads to improved outcomes for patients....

PERSPECTIVE: Incidentalomas â Clinical Correlation and Translational Science Required

Thu, 29Â JunÂ 2006 00:00:00 -05:00

It should have been a moment of huge relief. The biopsy specimen of the temporal artery was positive. We had answered the riddle of the patient's year-long fatigue, limb pain,...

EDITORIAL: Introduction to Clinical Therapeutics

Thu, 22Â JunÂ 2006 00:00:00 -05:00

Five years ago, the Journal introduced Clinical Practice, a series of review articles intended to provide practical guidance in the diagnosis, evaluation, and management of clinical problems at the interface...

VIDEOS IN CLINICAL MEDICINE: Male Urethral Catheterization

Todd W. Thomsen, M.D., and Gary S. Setnik, M.D. — Thu, 25Â MayÂ 2006 00:00:00 -05:00

...

LEGAL ISSUES IN MEDICINE: Intelligent Judging â Evolution in the Classroom and the Courtroom

George J. Annas, J.D., M.P.H. — Thu, 25Â MayÂ 2006 00:00:00 -05:00

Religious arguments have permeated debates on the role of the law in medical practice at the beginning and the end of life. But nowhere has religion played so prominent a...

VIDEOS IN CLINICAL MEDICINE: Arthrocentesis of the Knee

Thu, 11Â MayÂ 2006 00:00:00 -05:00

...

PERSPECTIVE: Editorial Independence and the

Thu, 11Â MayÂ 2006 00:00:00 -05:00

On February 20, after almost 10 years as editor-in-chief of the Canadian Medical Association Journal (CMAJ), I was fired without cause. I packed up my few personal belongings and left...

SPECIAL ARTICLE: The Family Business â To Educate

Ronald A. Arky, M.D. — Thu, 04Â MayÂ 2006 00:00:00 -05:00

When the Massachusetts Medical Society (MMS) was established in 1781, cofounder John Warren explained its purpose to the public. âThe design of the above institution,â he wrote, âis to promote...

VIDEOS IN CLINICAL MEDICINE: Nasogastric Intubation

Todd W. Thomsen, M.D., Robert W. Shaffer, M.D., and Gary S. Setnik, M.D. — Thu, 27Â AprÂ 2006 00:00:00 -05:00

...

PERSPECTIVE: The New Medical âMissionariesâ â Grooming the Next Generation of Global Health Workers

Thu, 27Â AprÂ 2006 00:00:00 -05:00

Noelle Benzekri is a first-year medical student with a mission. Even before the 27-year-old New York native spent a year as a clinic assistant and polio vaccinateur in Senegal, she...

PERSPECTIVE: The Challenge of Subgroup Analyses â Reporting without Distorting

Thu, 20Â AprÂ 2006 00:00:00 -05:00

Subgroup analyses are an important part of the analysis of a comparative clinical trial. However, they are commonly overinterpreted1234 and can lead to further research that is misguided or, worse,...

PERSPECTIVE: The NIH Budget and the Future of Biomedical Research

Thu, 20Â AprÂ 2006 00:00:00 -05:00

Federal funding for biomedical research in the United States has fueled discoveries that have advanced our understanding of human disease, led to novel and effective diagnostic tools and therapies, and...

VIDEOS IN CLINICAL MEDICINE: Placement of an Arterial Line

Thu, 13Â AprÂ 2006 00:00:00 -05:00

...

EDITORIAL: Videos in Clinical Medicine â A New Feature

Graham T. McMahon, M.D., Julie R. Ingelfinger, M.D., and Edward W. Campion, M.D. — Thu, 13Â AprÂ 2006 00:00:00 -05:00

This week, the Journal's table of contents includes a new type of article, Videos in Clinical Medicine. Innovative technology affords us the opportunity to offer peer-reviewed educational videos that capitalize...

PERSPECTIVE: Access to the Scientific Literature â A Difficult Balance

Thu, 13Â AprÂ 2006 00:00:00 -05:00

During the past decade, scientific publications have increasingly become available on the Internet, where they can be used by far more readers than print journals have ever reached. In The...

PERSPECTIVE: Politics and Independence â The Collapse of the

Thu, 30Â MarÂ 2006 00:00:00 -05:00

On February 20, 2006, when John Hoey, editor-in-chief of the Canadian Medical Association Journal (CMAJ), returned to the Ottawa headquarters of the Canadian Medical Association (CMA) after a vacation, his...

PERSPECTIVE: Does Laughter Make Good Medicine?

Thu, 16Â MarÂ 2006 00:00:00 -05:00

The medical teams convened for a ritual snack break at 10:45 on a recent call night. We ate our ice cream in the far corner of the Moffiteria â as...

PERSPECTIVE: Heart Sounds

Thu, 16Â MarÂ 2006 00:00:00 -05:00

The second-year students are learning about the cardiac exam today. They file into a large classroom, where they will first learn about heart murmurs â their location, quality, and meaning....

PERSPECTIVE: The Words Count â Radiology and Medical Linguistics

Thu, 16Â FebÂ 2006 00:00:00 -05:00

Thanks to European Union (EU) regulations, I, an Irishman, was recently permitted to pursue a radiology fellowship in France. Though free movement of labor within the EU is legal, it...

PERSPECTIVE: The Stethoscope and the Art of Listening

Thu, 09Â FebÂ 2006 00:00:00 -05:00

Many physicians cling to Asclepios's staff as the quintessential insignia of our craft, no doubt debating endlessly whether it should have one or two ascending snakes. Some doctors cherish instead...

PERSPECTIVE: The Demise of the Physical Exam

Thu, 09Â FebÂ 2006 00:00:00 -05:00

One afternoon, at the beginning of my first clinical clerkship in internal medicine, my team was called to the intensive care unit. A patient, whom I'll call Mr. Abbott, had...

PERSPECTIVE: The Physical Exam and the Sense of Smell

Thu, 26Â JanÂ 2006 00:00:00 -05:00

Throughout medical school, I heard one attending physician after another bemoan the death of the physical examination. âI can read the echo report myself,â a cardiologist once chided me when...

PERSPECTIVE: Searching for the Right Search â Reaching the Medical Literature

Thu, 05Â JanÂ 2006 00:00:00 -05:00

Web-based search engines are transforming our use of the medical literature. Although we continue to read the print issues of journals and to browse current issues online, we are now...

EDITORIAL: Professional Behavior â A Learner's Permit for Licensure

Lynne M. Kirk, M.D., and Linda L. Blank — Thu, 22Â DecÂ 2005 00:00:00 -05:00

At probably no point in the history of modern medicine have physicians and medical educators been pulled by so many demands of accountability from such diverse constituencies. Although these demands...

SPECIAL ARTICLE: Disciplinary Action by Medical Boards and Prior Behavior in Medical School

Thu, 22Â DecÂ 2005 00:00:00 -05:00

Background: Evidence supporting professionalism as a critical measure of competence in medical education is limited. In this caseâcontrol study, we investigated the association of disciplinary action against practicing physicians with...

PERSPECTIVE: Robert Koch, the Nobel Prize, and the Ongoing Threat of Tuberculosis

Stefan H.E. Kaufmann, Ph.D. — Thu, 08Â DecÂ 2005 00:00:00 -05:00

âDuring my wandering through medicine, I encountered sites where gold was lying around. It needs a lot of serendipity to distinguish gold from ignobility; this however is not a particular...

PERSPECTIVE: So Where's My Medal?

Perri Klass, M.D. — Thu, 17Â NovÂ 2005 00:00:00 -05:00

I accepted an invitation to give a talk in Michigan on a Tuesday in April, though the date rang some distant bell. A day or two later, I recognized the...

PERSPECTIVE: Renewing Board Certification

Robert Steinbrook, M.D. — Thu, 10Â NovÂ 2005 00:00:00 -05:00

Like gross anatomy class and the first night on call as an intern, the medical specialty board examination is a rite of passage for physicians. The first specialty board, the...

PERSPECTIVE: Personal Metrics for Practice â How'm I Doing?

Richard J. Baron, M.D. — Thu, 10Â NovÂ 2005 00:00:00 -05:00

Part of the challenge of being happy in medical practice arises from the difficulty of ascertaining whether we are truly succeeding as doctors. In primary care, we take on complex...

PERSPECTIVE: Recertification for Internists â One âGrandfather'sâ Experience

Troyen A. Brennan, M.D., J.D., M.P.H. — Thu, 10Â NovÂ 2005 00:00:00 -05:00

Practicing internal medicine can be isolating: lacking the clear-cut outcomes of one-time interventions like surgery, internists work from day to day essentially without signposts indicating success or failure. Without performance...

PERSPECTIVE: Paving the Way â Providing Opportunities for Native American Students

Thomas D. Sequist, M.D., M.P.H. — Thu, 03Â NovÂ 2005 00:00:00 -05:00

As a member of the Pauma Band of LuiseÃ±o Indians, Dan Calac grew up on the Pauma Indian reservation in southern California. His medical visits during childhood took place at...

EDITORIAL: Fatal Flows â Doctors on the Move

Lincoln C. Chen, M.D., and Jo Ivey Boufford, M.D. — Thu, 27Â OctÂ 2005 00:00:00 -05:00

The movement of physicians from poor to rich countries is a growing obstacle to global health. Ghana, with 0.09 physician per thousand population, sends doctors to the United Kingdom, which...

SPECIAL ARTICLE: The Metrics of the Physician Brain Drain

Fitzhugh Mullan, M.D. — Thu, 27Â OctÂ 2005 00:00:00 -05:00

Background: There has been substantial immigration of physicians to developed countries, much of it coming from lower-income countries. Although the recipient nations and the immigrating physicians benefit from this migration,...

PERSPECTIVE: Aiding and Abetting â Nursing Crises at Home and Abroad

Sreekanth Chaguturu, M.D., and Snigdha Vallabhaneni, B.A. — Thu, 27Â OctÂ 2005 00:00:00 -05:00

After what seemed like years of teleconferencing, protocol revisions, international travel, and training sessions, the staff at the HIV clinical care and research site in India, where we had worked...

SOUNDING BOARD: Translational and Clinical Science â Time for a New Vision

Elias A. Zerhouni, M.D. — Thu, 13Â OctÂ 2005 00:00:00 -05:00

It is the responsibility of those of us involved in today's biomedical research enterprise to translate the remarkable scientific innovations we are witnessing into health gains for the nation. In...

PERSPECTIVE: Faith Healers and Physicians â Teaching Pseudoscience by Mandate

Robert S. Schwartz, M.D. — Thu, 06Â OctÂ 2005 00:00:00 -05:00

In the 1939 movie The Wizard of Oz, Frank Morgan plays five roles. In one of them, he is a flimflam hawker of trivia traveling across the plains of Kansas...

PERSPECTIVE: Cultural Competence and the Culture of Medicine

RenÃ©e C. Fox, Ph.D. — Thu, 29Â SepÂ 2005 00:00:00 -05:00

The phrase âcultural competenceâ arises often in discussions about improving medical education and health care in the United States. It is usually used to refer to a body of knowledge,...

PERSPECTIVE: Learning from the Dying

Susan D. Block, M.D., and J. Andrew Billings, M.D. — Thu, 29Â SepÂ 2005 00:00:00 -05:00

âI thought I would find out what death actually is. I thought I would learn the proper words to speak. . . . I thought I would leave with answers...

PERSPECTIVE: White Coat, Mood Indigo â Depression in Medical School

Julie M. Rosenthal and Susan Okie, M.D. — Thu, 15Â SepÂ 2005 00:00:00 -05:00

As the head of student government at Duke University School of Medicine in Durham, North Carolina, Sujay Kansagra had witnessed several of his fellow students dealing with depression. âI knew...

PERSPECTIVE: Occupational Hazards

Ted Louie, M.D. — Thu, 25Â AugÂ 2005 00:00:00 -05:00

It was a gray Sunday in late February 1993, no longer cold enough for skiing or ice-skating but still chilly and windy enough to be oppressive. As a senior medical...

PERSPECTIVE: Naked

Atul Gawande, M.D., M.P.H. — Thu, 18Â AugÂ 2005 00:00:00 -05:00

There is an exquisite and fascinating scene in Kandahar, a movie set in Afghanistan under the Taliban regime, in which a male physician is asked to examine a female patient....

PERSPECTIVE: On Needless Words

Stephen E. Goldfinger, M.D. — Thu, 12Â MayÂ 2005 00:00:00 -05:00

The presentation began. She described a 62-year-old male with a UGIB whose history included CAD S/P CABG x 2, NAFLD, DM, HT, PUD, and BPH. I looked around as the...

PERSPECTIVE: MSL â Medicine as a Second Language

Rachel K. Sobel — Thu, 12Â MayÂ 2005 00:00:00 -05:00

We were practicing in the nurses' room, with a few minutes to go before the big performance. My classmate Julie and I ran through our lines and critiqued each other....

PERSPECTIVE: Notes to the Class â First Day

Katharine Treadway, M.D. — Thu, 12Â MayÂ 2005 00:00:00 -05:00

I watch the second-year students file into the Ether Dome for their first day of my âPatientâDoctor 2â course. For me, this course marks their true entry into medical school....

PERSPECTIVE: The Calling

Abraham Verghese, M.D. — Thu, 05Â MayÂ 2005 00:00:00 -05:00

I grew up in Africa, the younger of two sons of Indian parents who taught college physics. Around the time that my brother's precocious ability with numbers was revealing itself,...

PERSPECTIVE: Quiet in the Library

Thomas H. Lee, M.D. — Thu, 17Â MarÂ 2005 00:00:00 -05:00

The library at my medical school has never been a better place to work. The journals are shelved in perfect order. The copying machines have no lines. Quiet, comfortable places...

PERSPECTIVE: 2015 â The Future of Medical Libraries

Donald A.B. Lindberg, M.D., and Betsy L. Humphreys, M.L.S. — Thu, 17Â MarÂ 2005 00:00:00 -05:00

The past 20 years have witnessed computer and communications revolutions, rapid progress in genetics research, increasing public interest in personal health decisions, and corresponding expansions in the services provided by...

PERSPECTIVE: The Accidental Addict

Howard Markel, M.D., Ph.D. — Thu, 10Â MarÂ 2005 00:00:00 -05:00

All stories of addiction are tragic. Some addictions are so well concealed that, when discovered, they initially appear to be inconceivable. One of the most remarkable tales of a concealed...

PERSPECTIVE: Personal Digital Educators

James J. Cimino, M.D., and Suzanne Bakken, R.N., D.N.Sc. — Thu, 03Â MarÂ 2005 00:00:00 -05:00

âWhat's his infection sensitive to?â In 1995, getting the answer to this question required a house officer to find an unoccupied computer at the nursing station, sign on, and traverse...

PERSPECTIVE: Bearing Witness â Sontag and the Body

Rita Charon, M.D., Ph.D. — Thu, 24Â FebÂ 2005 00:00:00 -05:00

It is the rare book in social medicine that does not cite Susan Sontag's opening sentence in Illness as Metaphor: âIllness is the night-side of life, a more onerous citizenship.â1...

PERSPECTIVE: Geriatrics in the United States â Baby Boomers' Boon?

Leslie S. Libow, M.D. — Thu, 24Â FebÂ 2005 00:00:00 -05:00

The graying of America, a triumph of medical and cultural advances, has caught us unprepared. Our economic system, burdened with Social Security, Medicare, and extended retirement years, is shaking. Our...

PERSPECTIVE: Commercial Support and Continuing Medical Education

Robert Steinbrook, M.D. — Thu, 10Â FebÂ 2005 00:00:00 -05:00

The majority of the financial support for continuing medical education (CME) in the United States comes from drug companies and other commercial entities (see graph).1 Total commercial support more than...

PERSPECTIVE: Consent or Obedience? Power and Authority in Medicine

Eric J. Cassell, M.D. — Thu, 27Â JanÂ 2005 00:00:00 -05:00

A recent biography of the social psychologist Stanley Milgram (The Man Who Shocked the World, by Thomas Blass) details the âobedience experimentsâ that made Milgram famous. These studies demonstrated that...

EDITORIAL: Sleep, Science, and Policy Change

C. Dennis Wylie, B.A. — Thu, 13Â JanÂ 2005 00:00:00 -05:00

Policies can be very difficult to change, and advocates of change who claim a logical or scientific foundation need valid, reliable, and convincing data. An example of the process is...

ORIGINAL ARTICLE: Extended Work Shifts and the Risk of Motor Vehicle Crashes among Interns

Thu, 13Â JanÂ 2005 00:00:00 -05:00

Background: Long work hours and work shifts of an extended duration (â¥24 hours) remain a hallmark of medical education in the United States. Yet their effect on health and safety...

PERSPECTIVE: Mortgaging Our Future â The Cost of Medical Education

Gail Morrison, M.D. — Thu, 13Â JanÂ 2005 00:00:00 -05:00

The cost of obtaining a medical education has been spiraling upward for the past 20 years. Despite a lot of rhetoric in articles12 and at meetings of the Association of...

PERSPECTIVE: âWho's on First?â â Medical Discoveries and Scientific Priority

Howard Markel, M.D., Ph.D. — Thu, 30Â DecÂ 2004 00:00:00 -05:00

One afternoon, a brilliant medical investigator unveiled before an eager crowd of physicians a stunning series of experiments that would revolutionize how they understood the human body. Realizing that he...

PERSPECTIVE: Affirmative Action, Cuban Style

Fitzhugh Mullan, M.D. — Thu, 23Â DecÂ 2004 00:00:00 -05:00

âI feel as if I'm standing on the backs of all my ancestors. This is a huge opportunity for me,â Teresa Glover, a 27-year-old medical student, told me during a...

SOUNDING BOARD: The Family History â More Important Than Ever

Thu, 25Â NovÂ 2004 00:00:00 -05:00

For many observers, the term âgenomic medicineâ conjures up space-age images of microarray chips, bioinformatics, and designer drugs. Today, with medicine poised at the dawn of the genomic era, it...

PERSPECTIVE: House Calls

Sandeep Jauhar, M.D., Ph.D. — Thu, 18Â NovÂ 2004 00:00:00 -05:00

In 1930, 40 percent of all doctorâpatient visits were house calls. By 1980, the proportion had dwindled to less than 1 percent. Even in the 1990s, in the midst of...

PERSPECTIVE: A Great Case

Jerome Groopman, M.D. — Thu, 11Â NovÂ 2004 00:00:00 -05:00

âIt's a really great case,â the neurology resident said. âGerstmann's syndrome.â I was a third-year medical student, and neurology was my first clinical rotation. The resident listed the four findings...

PERSPECTIVE: Minimal Intervention â Nurse-Midwives in the United States

Mona T. Lydon-Rochelle, C.N.M., Ph.D. — Thu, 04Â NovÂ 2004 00:00:00 -05:00

I first observed childbirth in 1973 during a rotation at the Boston Lying-In Hospital, where I witnessed many women in labor screaming in a scopolamine stupor. What I remember most...

EDITORIAL: Awake and Informed

Jeffrey M. Drazen, M.D. — Thu, 28Â OctÂ 2004 00:00:00 -05:00

I grew up with the one-doctorâone-patient paradigm. When I admitted a patient, I took the case as my personal responsibility. I did my best to get to know the patient...

ORIGINAL ARTICLE: Effect of Reducing Interns' Work Hours on Serious Medical Errors in Intensive Care Units

Thu, 28Â OctÂ 2004 00:00:00 -05:00

Background: Although sleep deprivation has been shown to impair neurobehavioral performance, few studies have measured its effects on medical errors.

Methods: We conducted a prospective, randomized study comparing the rates of...

ORIGINAL ARTICLE: Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures

Thu, 28Â OctÂ 2004 00:00:00 -05:00

Background: Knowledge of the physiological effects of extended (24 hours or more) work shifts in postgraduate medical training is limited. We aimed to quantify work hours, sleep, and attentional failures...

PERSPECTIVE: Residency Regulations â Resisting Our Reflexes

Danielle Ofri, M.D., Ph.D. — Thu, 28Â OctÂ 2004 00:00:00 -05:00

It's Friday on the medical wards . . . and once again, I am the utterly confused ward attending.

The âbadâ weekend is coming up: the pre-call resident is off today,...

PERSPECTIVE: A Precarious Exchange

Siddhartha Mukherjee, M.D., Ph.D. — Thu, 28Â OctÂ 2004 00:00:00 -05:00

If an anthropologist were to stumble into this room between 6 and 8 p.m. this evening, he might find the telltale signs of a ritual: a group of residents and...

PERSPECTIVE: From Culture to Vaccine â Salk and Sabin

Samuel L. Katz, M.D. — Thu, 07Â OctÂ 2004 00:00:00 -05:00

The Nobel Prizeâwinning demonstration by John Enders, Frederick Robbins, and Thomas Weller that polioviruses could be propagated successfully in nonneural cell cultures paved the way for two brilliant, ambitious scientists...

PERSPECTIVE: Advances in Virology â Weller and Robbins

Martha L. Lepow, M.D. — Thu, 07Â OctÂ 2004 00:00:00 -05:00

Book Review: This article reviews the book Growing Pathogens in Tissue Culture: Fifty Years in Academic Tropical Medicine, Pediatrics, and Virology, by Thomas H. Weller, published by Science History Publishers,...

PERSPECTIVE: Isolation of Poliovirus â John Enders and the Nobel Prize

Fred S. Rosen, M.D. — Thu, 07Â OctÂ 2004 00:00:00 -05:00

When John Enders was informed, 50 years ago this month, that he was the sole recipient of the Nobel Prize in Medicine or Physiology for 1954, he declined the honor....

PERSPECTIVE: Mistakes in the Operating Room â Error and Responsibility

Sherwin B. Nuland, M.D. — Thu, 23Â SepÂ 2004 00:00:00 -05:00

It happened a very long time ago, when I was a third-year medical student in my first week on the surgical service of a large university hospital. One of the...

PERSPECTIVE: Teaching Anatomy in the Digital World

Kitt Shaffer, M.D. — Thu, 23Â SepÂ 2004 00:00:00 -05:00

Anatomy has a long and checkered past as a scientific discipline. In ancient Egypt, dissection was a religious ritual. During the Renaissance, it was considered an artistic and spiritual exploration...

PERSPECTIVE: Just the Facts

Rafael Campo, M.D. — Thu, 16Â SepÂ 2004 00:00:00 -05:00

A patient of mine died recently, and as I dutifully filled out his death certificate beneath a sputtering fluorescent light in my hospital's admitting office, I wondered about the tales...

PERSPECTIVE: Match Point?

Alexi A. Wright, M.D., and Ingrid T. Katz, M.D., M.H.S. — Thu, 16Â SepÂ 2004 00:00:00 -05:00

Last month, a federal district judge in Washington, D.C., dismissed the first antitrust lawsuit filed by medical residents. In an unusual twist, Congress retroactively granted residency programs and hospitals immunity...

PERSPECTIVE: Learner-Centered Medical Education

Kenneth M. Ludmerer, M.D. — Thu, 16Â SepÂ 2004 00:00:00 -05:00

Medical students occupy a curious position in the history of the American medical school. Before World War II, the education of medical students was the central mission of medical schools,...

PERSPECTIVE: A View from the Periphery â Health Care in Rural America

Roger A. Rosenblatt, M.D., M.P.H. — Thu, 09Â SepÂ 2004 00:00:00 -05:00

Urban Americans tend to view the rural United States as a larder, a playground, or a place to retire. But although agriculture now employs less than 3 percent of the...

PERSPECTIVE: Cultural Competence â Marginal or Mainstream Movement?

Joseph R. Betancourt, M.D., M.P.H. — Thu, 02Â SepÂ 2004 00:00:00 -05:00

As the United States becomes increasingly diverse, physicians will see patients from a variety of sociocultural backgrounds on a daily basis. Culture plays a large role in shaping health-related values,...

SOUNDING BOARD: The Future of Primary Care Medicine

Michael E. Whitcomb, M.D., and Jordan J. Cohen, M.D. — Thu, 12Â AugÂ 2004 00:00:00 -05:00

During the early and mid-1990s, a consensus emerged among physicians and health care policymakers that the United States would have a substantial surplus of physicians by the end of the...

PERSPECTIVE: The Road Less Traveled â Attracting Students to Primary Care

Ruth-Marie E. Fincher, M.D. — Thu, 12Â AugÂ 2004 00:00:00 -05:00

At the turn of the 20th century, most physicians in the United States were general practitioners; by the turn of the 21st century, most were subspecialists. Yet primary care continues...

EDITORIAL: Health Care in America â Still Too Separate, Not Yet Equal

Arnold M. Epstein, M.D. — Thu, 05Â AugÂ 2004 00:00:00 -05:00

In the 50 years since the civil-rights movement began we have seen growth in the racial and ethnic diversity of the American people, as well as encouraging evidence that members...

SPECIAL ARTICLE: Primary Care Physicians Who Treat Blacks and Whites

Thu, 05Â AugÂ 2004 00:00:00 -05:00

Background: In the United States, black patients generally receive lower-quality health care than white patients. Black patients may receive their care from a subgroup of physicians whose qualifications or resources...

PERSPECTIVE: Mind Reading

Elissa Ely, M.D. — Thu, 29Â JulÂ 2004 00:00:00 -05:00

I was called in to see a man I did not know. No one knew him. His usual doctor was on vacation, and the social worker who paged me was...

PERSPECTIVE: Coming to America â International Medical Graduates in the United States

Graham T. McMahon, M.B., B.Ch. — Thu, 10Â JunÂ 2004 00:00:00 -05:00

They can't believe that I round at 6:30 a.m., that I am available to my patients 24 hours a day, or that I don't get paid overtime for long hours....

PERSPECTIVE: Dying and Decision Making â Evolution of End-of-Life Options

Timothy E. Quill, M.D. — Thu, 13Â MayÂ 2004 00:00:00 -05:00

I recently helped my father to die. He was an engineer, independent, always on the go and in charge. He began to deteriorate rapidly from an ill-defined dementing illness, and...

PERSPECTIVE: âI Swear by Apolloâ â On Taking the Hippocratic Oath

Howard Markel, M.D., Ph.D. — Thu, 13Â MayÂ 2004 00:00:00 -05:00

Every spring for almost 20 years, I have happily donned a rented robe, hood, and mortarboard to attend medical school commencement exercises. The purpose of this annual foray into pomp...

PERSPECTIVE: Index Case

Perri Klass, M.D. — Thu, 13Â MayÂ 2004 00:00:00 -05:00

Because of my extensive training â four years of medical school, three years of pediatric residency, a two-year fellowship in pediatric infectious diseases â and because of my years of...

HEALTH POLICY REPORT: New Steam from an Old Cauldron â The Physician-Supply Debate

David Blumenthal, M.D., M.P.P. — Thu, 22Â AprÂ 2004 00:00:00 -05:00

The debate about the physician workforce is back. Just yesterday, it seems, the conventional wisdom was a confident prediction that we faced a worrisome surplus of physicians.123 But today, a...

PERSPECTIVE: Electrons in Flight â E-Mail between Doctors and Patients

Tom Delbanco, M.D., and Daniel Z. Sands, M.D., M.P.H. — Thu, 22Â AprÂ 2004 00:00:00 -05:00

Alexander Graham Bell invented the telephone in 1876, and within decades it was impossible to imagine society without it. E-mail emerged in the early 1970s, and today about 100 million...

PERSPECTIVE: The Step 2 Clinical-Skills Examination

Maxine A. Papadakis, M.D. — Thu, 22Â AprÂ 2004 00:00:00 -05:00

Editor's note: This is the first in a series of occasional articles on the education of physicians.

From their introduction in the late 1800s, medical licensing examinations in the United States...

PERSPECTIVE: On Washing Hands

Atul Gawande, M.D., M.P.H. — Thu, 25Â MarÂ 2004 00:00:00 -05:00

One afternoon last December, I took a tour of my hospital with Deborah Yokoe, an infectious-disease specialist, and Susan Marino, a medical technologist by training. They work in our infection-control...

PERSPECTIVE: God at the Bedside

Jerome Groopman, M.D. — Thu, 18Â MarÂ 2004 00:00:00 -05:00

Not long ago, in the oncology clinic where I work, my patient Anna Angelo asked me to pray to God. At the time, prayer was far from the forefront of...

PERSPECTIVE: Tools of the Trade

Danielle Ofri, M.D., Ph.D. — Thu, 30Â OctÂ 2003 00:00:00 -05:00

I grasped the list of patients, fingering the crispness of the sheet that represented my first day of service on the medical wards. I knew that the sheet would soon...

LEGAL ISSUES IN MEDICINE: HIPAA Regulations â A New Era of Medical-Record Privacy?

George J. Annas, J.D., M.P.H. — Thu, 10Â AprÂ 2003 00:00:00 -05:00

Although the regulations under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regarding the privacy of medical records are new,1 the concept of using federal law to protect...

PERSPECTIVE: The Cost of HIPAA Compliance

Peter Kilbridge, M.D. — Thu, 10Â AprÂ 2003 00:00:00 -05:00

The deadline for compliance with the regulations for patient privacy in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) is now upon us, and hospitals and physician groups...

SOUNDING BOARD: The Importance of Race and Ethnic Background in Biomedical Research and Clinical Practice

Thu, 20Â MarÂ 2003 00:00:00 -05:00

A debate has recently arisen over the use of racial classification in medicine and biomedical research. In particular, with the completion of a rough draft of the human genome, some...

REVIEW ARTICLE: Preventing Complications of Central Venous Catheterization

David C. McGee, M.D., and Michael K. Gould, M.D. — Thu, 20Â MarÂ 2003 00:00:00 -05:00

In the United States, physicians insert more than 5 million central venous catheters every year.1 Central venous catheters allow measurement of hemodynamic variables that cannot be measured accurately by noninvasive...

HEALTH POLICY REPORT: Understanding and Responding to Adverse Events

Charles Vincent, Ph.D. — Thu, 13Â MarÂ 2003 00:00:00 -05:00

An adverse outcome for a patient is difficult, sometimes traumatic, for all concerned. Such incidents pose considerable challenges to an organization, both in terms of the need to respond intelligently...

SOUNDING BOARD: Residents' Suggestions for Reducing Errors in Teaching Hospitals

Kevin G.M. Volpp, M.D., Ph.D., and David Grande, M.D. — Thu, 27Â FebÂ 2003 00:00:00 -05:00

The Institute of Medicine's 2000 report To Err Is Human precipitated a firestorm of publicity on the issue of medical errors.1 On the basis of the Harvard Medical Practice Study2...

CLINICAL PRACTICE: Occupational Exposure to HIV in Health Care Settings

Julie Louise Gerberding, M.D., M.P.H. — Thu, 27Â FebÂ 2003 00:00:00 -05:00

While obtaining a peripheral venous blood sample from a patient with the acquired immunodeficiency syndrome (AIDS), a 35-year-old phlebotomist is injured by a bloody 18-gauge needle attached to a syringe....

SPECIAL ARTICLE: Readability Standards for Informed-Consent Forms as Compared with Actual Readability

Thu, 20Â FebÂ 2003 00:00:00 -05:00

Background: Institutional review boards (IRBs) are charged with safeguarding potential research subjects with limited literacy but may have an inadvertent role in promulgating unreadable consent forms. We hypothesized that text...

HEALTH POLICY REPORT: Infection Control â A Problem for Patient Safety

John P. Burke, M.D. — Thu, 13Â FebÂ 2003 00:00:00 -05:00

Nosocomial, or hospital-acquired, infections (more appropriately called health careâassociated infections) are today by far the most common complications affecting hospitalized patients. Indeed, the Harvard Medical Practice Study II found that...

SOUNDING BOARD: Is the Match Illegal?

Sanders H. Chae, M.D., J.D. — Thu, 23Â JanÂ 2003 00:00:00 -05:00

The recent announcement that a class-action lawsuit has been filed against the Accreditation Council for Graduate Medical Education (ACGME) and several teaching hospitals on the grounds that âthe Match,â or...

SPECIAL ARTICLE: Risk Factors for Retained Instruments and Sponges after Surgery

Thu, 16Â JanÂ 2003 00:00:00 -05:00

Background: Risk factors for medical errors remain poorly understood. We performed a caseâcontrol study of retained foreign bodies in surgical patients in order to identify risk factors for this type...

EDITORIAL: Achieving an Interdisciplinary Workforce in Health Care

Linda H. Aiken, Ph.D., R.N. — Thu, 09Â JanÂ 2003 00:00:00 -05:00

In recent decades, fundamental changes in the organization and financing of medical services in the United States, combined with social and demographic changes, have set the stage for a substantially...

SPECIAL ARTICLE: Trends in Care by Nonphysician Clinicians in the United States

Thu, 09Â JanÂ 2003 00:00:00 -05:00

Background: The 1990s saw rising numbers of graduates of training programs for nonphysician clinicians, passage of legislation expanding their scope of practice, and a proliferation of managed-care models that emphasized...

EDITORIAL: A Broader Concept of Medical Errors

Thu, 12Â DecÂ 2002 00:00:00 -05:00

No one disputes the goal â a health care system that can reliably provide high-quality care with minimal waste to all in need. Disagreement begins with the question of which...

SPECIAL ARTICLE: Views of Practicing Physicians and the Public on Medical Errors

Thu, 12Â DecÂ 2002 00:00:00 -05:00

Background: In response to the report by the Institute of Medicine on medical errors, national groups have recommended actions to reduce the occurrence of preventable medical errors. What is not...

HEALTH POLICY REPORT: Reporting of Adverse Events

Lucian L. Leape, M.D. — Thu, 14Â NovÂ 2002 00:00:00 -05:00

When the Institute of Medicine (IOM) issued To Err Is Human,1 the recommendation to expand reporting of serious adverse events and medical errors, particularly mandatory reporting, received the most attention...

SOUNDING BOARD: Collaborating with Industry â Choices for the Academic Medical Center

Thu, 24Â OctÂ 2002 00:00:00 -05:00

The relationships between academic institutions and private companies are strengthening. The decision of several large pharmaceutical companies, and many biotechnology companies, to build major new laboratories near U.S., European, and...

SOUNDING BOARD: Academic Freedom in Clinical Research

Thu, 24Â OctÂ 2002 00:00:00 -05:00

âIs the universityâindustrial complex out of control?â The editorial that appeared under this eye-catching title in Nature in January 2001 came to the conclusion that links between academia and industry...

EDITORIAL: Institutions, Contracts, and Academic Freedom

Thu, 24Â OctÂ 2002 00:00:00 -05:00

Clinical research in the United States is commonly performed under contracts between institutions and commercial sponsors. Often the investigator who actually does the research is not a direct party to...

SPECIAL ARTICLE: A National Survey of Provisions in Clinical-Trial Agreements between Medical Schools and Industry Sponsors

Thu, 24Â OctÂ 2002 00:00:00 -05:00

Background: Concerned about threats to the integrity of clinical trials in a research environment increasingly controlled by private interests, the International Committee of Medical Journal Editors (ICMJE) has issued revised...

HEALTH POLICY REPORT: The Debate over Residents' Work Hours

Robert Steinbrook, M.D. — Thu, 17Â OctÂ 2002 00:00:00 -05:00

After years of discussion, the system of training resident physicians in the United States is about to undergo substantial changes. As of July 1, 2003, more â but not all...

SOUNDING BOARD: Duty Hours for Resident Physicians â Tough Choices for Teaching Hospitals

Thu, 17Â OctÂ 2002 00:00:00 -05:00

Those involved in graduate medical education have long struggled with competing priorities that surround the issue of residents' work hours: providing each trainee with an adequate amount of clinical experience;...

EDITORIAL: A Series on Patient Safety

Thu, 17Â OctÂ 2002 00:00:00 -05:00

When the Institute of Medicine (IOM) released its report, To Err Is Human,1 the speed and intensity with which it captured media, public, political, and professional attention surprised everyone. Neither...

EDITORIAL: Rethinking Medical Training â The Critical Work Ahead

Thu, 17Â OctÂ 2002 00:00:00 -05:00

What physicians do on a daily basis has evolved considerably in the past quarter-century, but the format of postgraduate medical training has changed relatively little. When we trained in internal...

SPECIAL ARTICLE: Fatigue among Clinicians and the Safety of Patients

David M. Gaba, M.D., and Steven K. Howard, M.D. — Thu, 17Â OctÂ 2002 00:00:00 -05:00

Sleep deprivation due to extended work hours and circadian disruption has long been a concern in medicine.1 It has been called the Achilles' heel of the medical profession.2 The levels...

PERSPECTIVE: The New Federal Medical-Privacy Rule

Thu, 10Â OctÂ 2002 00:00:00 -05:00

On August 9, 2002, the Department of Health and Human Services released the final version of the federal medical-privacy rule (Federal Register 67: 53182â53273, 2002). The release ended a tortuous...

NEJM â Collection Updates for Medical Education and Training

PERSPECTIVE: Cottage Industry to Postindustrial Care â The Revolution in Health Care Delivery

PERSPECTIVE: Launching HITECH

PERSPECTIVE: Withholding Information from Patients â When Less Is More

PERSPECTIVE: Patient-Centered Medical Homes in Ontario

PERSPECTIVE: Googling Ourselves â What Physicians Can Learn from Online Rating Sites

IMAGES IN CLINICAL MEDICINE: Coughing and Masks

SOUNDING BOARD: The Agenda for Continuing Medical Education â Limiting Industry's Influence

PERSPECTIVE: The Breadth of Hopes

PERSPECTIVE: The Service

VIDEOS IN CLINICAL MEDICINE: AnkleâBrachial Index for Assessment of Peripheral Arterial Disease

PERSPECTIVE: Reform and the Health Care Workforce â Current Capacity, Future Demand

INTERACTIVE MEDICAL CASE: A Bloody Mystery

VIDEOS IN CLINICAL MEDICINE: Bone Marrow Aspiration and Biopsy

INTERACTIVE MEDICAL CASE: The Writing on the Wall

EDITORIAL: Interactive Medical Cases â A New Feature

CORRESPONDENCE: Residents' Duty Hours and Professionalism

PERSPECTIVE: Dr. Holmes at 200 â The Spirit of Skepticism

PERSPECTIVE: What Would Osler Do? Learning from âDifficultâ Patients

PERSPECTIVE: Who Has Capacity?

PERSPECTIVE: Easing the Shortage in Adult Primary Care â Is It All about Money?

PERSPECTIVE: A Lifeline for Primary Care

BOOK REVIEW:

BOOK REVIEW:

EDITORIAL: To Nap or Not to Nap? Residents' Work Hours Revisited

SPECIAL ARTICLE: Cost Implications of Reduced Work Hours and Workloads for Resident Physicians

CLINICAL DECISIONS: Management of Incidental Hepatitis C Virus Infection

BOOK REVIEW:

PERSPECTIVE: The Future of Research Funding in Academic Medicine

BOOK REVIEW:

PERSPECTIVE: Denial

CLINICAL DECISIONS: Care of an Unresponsive Patient with a Poor Prognosis â Polling Results

VIDEOS IN CLINICAL MEDICINE: Blood-Pressure Measurement

CLINICAL DECISIONS: Care of an Unresponsive Patient with a Poor Prognosis

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Constipation

CLINICAL DECISIONS: Management of Prostate Cancer â Polling Results

BOOK REVIEW:

VIDEOS IN CLINICAL MEDICINE: Basic Splinting Techniques

PERSPECTIVE: Culture Shock â Patient as Icon, Icon as Patient

PERSPECTIVE: The Future of Primary Care â The Community Responds

PERSPECTIVE: Revisiting Duty-Hour Limits â IOM Recommendations for Patient Safety and Resident Education

PERSPECTIVE: Medical Student Debt â Is There a Limit?

CLINICAL DECISIONS: Management of Prostate Cancer

VIDEOS IN CLINICAL MEDICINE: Peripheral Intravenous Cannulation

PERSPECTIVE: Sustaining Relationships

PERSPECTIVE: The Need for Reinvention

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â A 71-Year-Old Man with Pancytopenia

PERSPECTIVE: Living Unlabeled â Diagnosis and Disorder

CLINICAL DECISIONS: Management of Skin and Soft-Tissue Infection â Polling Results

VIDEOS IN CLINICAL MEDICINE: Umbilical Vascular Catheterization

BOOK REVIEW:

PERSPECTIVE: Close Calls

CLINICAL DECISIONS: Management of Skin and Soft-Tissue Infection

BOOK REVIEW:

HEALTH POLICY REPORT: Medicare, Graduate Medical Education, and New Policy Directions

PERSPECTIVE: From All Walks of Life â Nontraditional Medical Students and the Future of Medicine

PERSPECTIVE: Relevance and Rigor in Premedical Education

BOOK REVIEW:

VIDEOS IN CLINICAL MEDICINE: Placement of a Femoral Venous Catheter

VIDEOS IN CLINICAL MEDICINE: Cricothyroidotomy

PERSPECTIVE: The Moral of the Story

EDITORIAL: Peer Review in the Balance

CLINICAL DECISIONS: Management of Carotid Stenosis â Polling Results

PERSPECTIVE: Physician Workforce Crisis? Wrong Diagnosis, Wrong Prescription

CLINICAL DECISIONS: Management of Carotid Stenosis

VIDEOS IN CLINICAL MEDICINE: Female Urethral Catheterization

IMAGES IN CLINICAL MEDICINE: A Medical Mystery: Epigastric Pain

PERSPECTIVE: The Vanishing Nonforensic Autopsy

VIDEOS IN CLINICAL MEDICINE: Examination of the Larynx and Pharynx

CLINICAL DECISIONS: Management of Type 2 Diabetes

PERSPECTIVE: A Bridge to Nowhere â The Troubled Trek of Foreign Medical Graduates

IMAGES IN CLINICAL MEDICINE: Medical Mystery: Cloud Surrounding the Optic Disks

CLINICAL DECISIONS: Management of Stable Coronary Disease â Polling Results

VIDEOS IN CLINICAL MEDICINE: Central Venous Catheterization â Subclavian Vein

SPECIAL ARTICLE: The Anatomy of Medical School Patenting

VIDEOS IN CLINICAL MEDICINE: Abscess Incision and Drainage

PERSPECTIVE: Becoming a Doctor, Starting a Family â Leaves of Absence from Graduate Medical Education

PERSPECTIVE: Climbing through Medicine's Glass Ceiling

CLINICAL DECISIONS: Management of Stable Coronary Disease

PERSPECTIVE: Guilty, Afraid, and Alone â Struggling with Medical Error

NEJM â Collection Updates for Medical Education and Training

PERSPECTIVE: Cottage Industry to Postindustrial Care â The Revolution in Health Care Delivery

PERSPECTIVE: Withholding Information from Patients â When Less Is More

PERSPECTIVE: Googling Ourselves â What Physicians Can Learn from Online Rating Sites

SOUNDING BOARD: The Agenda for Continuing Medical Education â Limiting Industry's Influence

VIDEOS IN CLINICAL MEDICINE: AnkleâBrachial Index for Assessment of Peripheral Arterial Disease

PERSPECTIVE: Reform and the Health Care Workforce â Current Capacity, Future Demand

EDITORIAL: Interactive Medical Cases â A New Feature

PERSPECTIVE: Dr. Holmes at 200 â The Spirit of Skepticism

PERSPECTIVE: What Would Osler Do? Learning from âDifficultâ Patients

PERSPECTIVE: Easing the Shortage in Adult Primary Care â Is It All about Money?

CLINICAL DECISIONS: Care of an Unresponsive Patient with a Poor Prognosis â Polling Results

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Constipation

CLINICAL DECISIONS: Management of Prostate Cancer â Polling Results

PERSPECTIVE: Culture Shock â Patient as Icon, Icon as Patient

PERSPECTIVE: The Future of Primary Care â The Community Responds

PERSPECTIVE: Revisiting Duty-Hour Limits â IOM Recommendations for Patient Safety and Resident Education

PERSPECTIVE: Medical Student Debt â Is There a Limit?

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â A 71-Year-Old Man with Pancytopenia

PERSPECTIVE: Living Unlabeled â Diagnosis and Disorder

CLINICAL DECISIONS: Management of Skin and Soft-Tissue Infection â Polling Results

PERSPECTIVE: From All Walks of Life â Nontraditional Medical Students and the Future of Medicine

CLINICAL DECISIONS: Management of Carotid Stenosis â Polling Results

PERSPECTIVE: A Bridge to Nowhere â The Troubled Trek of Foreign Medical Graduates

CLINICAL DECISIONS: Management of Stable Coronary Disease â Polling Results

VIDEOS IN CLINICAL MEDICINE: Central Venous Catheterization â Subclavian Vein

PERSPECTIVE: Becoming a Doctor, Starting a Family â Leaves of Absence from Graduate Medical Education

PERSPECTIVE: Guilty, Afraid, and Alone â Struggling with Medical Error

PERSPECTIVE: Terra Firma â A Journey from Migrant Farm Labor to Neurosurgery

CLINICAL DECISIONS: Mild Persistent Asthma â Polling Results

PERSPECTIVE: Adapting to Duty-Hour Limits â Four Years On

PERSPECTIVE: An Elusive Balance â Residents' Work Hours and the Continuity of Care

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â High Blood Pressure

PERSPECTIVE: The Patient as Ally â Learning the Pelvic Examination

SOUNDING BOARD: âContinuityâ as an Organizing Principle for Clinical Education Reform

PERSPECTIVE: Doctors and Soccer Players â African Professionals on the Move

EDITORIAL: Assessing Doctors at Work â Progress and Challenges

REVIEW ARTICLE: Teaching Surgical Skills â Changes in the Wind

EDITORIAL: Building on Experience â The Development of Clinical Reasoning

EDITORIAL: Professionalism â The Next Wave

REVIEW ARTICLE: The Developing Physician â Becoming a Professional

PERSPECTIVE: Tracing Atrial Fibrillation â 100 Years

PERSPECTIVE: Primary Care â The Best Job in Medicine?

PERSPECTIVE: Primary Care â Will It Survive?

PERSPECTIVE: The Silent Epidemic â The Health Effects of Illiteracy

EDITORIAL: Women in Academic Medicine â Progress and Challenges

SPECIAL ARTICLE: The âGender Gapâ in Authorship of Academic Medical Literature â A 35-Year Perspective

HEALTH POLICY REPORT: The New Era of Medical Imaging â Progress and Pitfalls

PERSPECTIVE: Incidentalomas â Clinical Correlation and Translational Science Required

LEGAL ISSUES IN MEDICINE: Intelligent Judging â Evolution in the Classroom and the Courtroom

SPECIAL ARTICLE: The Family Business â To Educate

PERSPECTIVE: The New Medical âMissionariesâ â Grooming the Next Generation of Global Health Workers

PERSPECTIVE: The Challenge of Subgroup Analyses â Reporting without Distorting

EDITORIAL: Videos in Clinical Medicine â A New Feature

PERSPECTIVE: Access to the Scientific Literature â A Difficult Balance

PERSPECTIVE: Politics and Independence â The Collapse of the

PERSPECTIVE: The Words Count â Radiology and Medical Linguistics