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Better clinical skills needed for better diagnosis

Yale Medicine Magazine, 2010 - Autumn


Basic clinical skills provide crucial information: one study showed that the patient interview provided conclusive diagnostic information for 73 percent of patients, while information from imaging proved conclusive for only 35 percent.

But training programs are haphazard in monitoring residents as they learn the basic skills of history taking, physical examination, and decision making, argued Eric S. Holmboe, M.D., HS ’93, chief medical officer of the American Board of Internal Medicine. Without supervision, practice does not necessarily make perfect. “If you do something 100 times and you do it wrong, it’s still wrong,” said Holmboe, speaking at May’s Program for Humanities in Medicine. The program honored G. Morris Dillard, Ph.D., M.D., founder of the Wednesday Evening Clinic, a service that has provided primary care to the New Haven community for over 30 years while allowing medical students opportunities to practice long-term medicine with the clinic’s patients.

The remedies, says Holmboe, are closer supervision and systematic evaluation.

In fields other than medicine, such virtuosos and champions as Yo-Yo Ma and Tiger Woods routinely seek immediate feedback while training, Holmboe said, citing the work of Anders Ericsson, an expert on how individuals develop expertise. In medicine, “It’s something we don’t do for each other. It’s not part of our culture.” It’s time for that to change, said Holmboe.