Forensic bitemark identification: weak foundations, exaggerated claims.

Several forensic sciences, especially of the pattern-matching kind, are increasingly seen to lack the scientific foundation needed to justify continuing admission as trial evidence. Indeed, several have been abolished in the recent past. A likely next candidate for elimination is bitemark identification.

Inadequacies of Physical Examination as a Cause of Medical Errors and Adverse Events: A Collection of Vignettes.

Background: Oversights in the physical examination are a type of medical error not easily studied by chart review. They may be a major contributor to missed or delayed diagnosis, unnecessary exposure to contrast and radiation, incorrect treatment, and other adverse consequences. Our purpose was to collect vignettes of physical examination oversights and to capture the diversity of their characteristics and consequences.

Guns, society, and medicine.

Given the 96 incidents of firearm violence on school campuses since Sandy Hook and the ongoing toll on lives and health, the lack of relevant data and a research pipeline in this area should be anathema to all physicians.

Internal medicine residency redesign: proposal of the Internal Medicine Working Group.

Concerned with the quality of internal medicine training, many leaders in the field assembled to assess the state of the residency, evaluate the decline in interest in the specialty, and create a framework for invigorating the discipline. Although many external factors are responsible, we also found ourselves culpable: allowing senior role models to opt out of important training activities, ignoring a progressive atrophy of bedside skills, and focusing on lock-step curricula, lectures, and compiled diagnostic and therapeutic strategies. The group affirmed its commitment to a vision of internal medicine rooted in science and learned with mentors at the bedside.

Comparative effectiveness research and the psychology of medical practice: the vicissitudes of knowledge implementation.

Comparative effectiveness research should provide much-needed information about the benefits and risks of different current treatment options in the community. Taking the perspective of medical care providers, we consider many of the psychological, social and behavioural hurdles to implementation of comparative effectiveness analyses and explain why these obstacles should not be ignored.

Teaching clinical reasoning: case-based and coached.

Optimal medical care is critically dependent on clinicians' skills to make the right diagnosis and to recommend the most appropriate therapy, and acquiring such reasoning skills is a key requirement at every level of medical education. Teaching clinical reasoning is grounded in several fundamental principles of educational theory. Adult learning theory posits that learning is best accomplished by repeated, deliberate exposure to real cases, that case examples should be selected for their reflection of multiple aspects of clinical reasoning, and that the participation of a coach augments the value of an educational experience.

Commentary: Disclosure's failings: what is the alternative?

Failure to disclose all sources of financial support in biomedical publications has been the focus of media critiques of authors, journals, and professional societies. In this issue, David Resnik properly calls attention to the need in many cases for an archaeological dig to discover all the companies that fund a particular research project. Disclosure is widely considered the best disinfectant for relationships between investigators and industry, but even though disclosure is necessary and all funding sources should be exposed, disclosure is not a real solution to dealing with conflicts of interest.

No more free drug samples?

Susan Chimonas and Jerome Kassirer argue that giving out "free" drug samples is not effective in improving drug access for the indigent, does not promote rational drug use, and raises the cost of care.