Redesigning rounds: towards a more purposeful approach to inpatient teaching and learning.

Problem: Inpatient rotations remain a central component in residency training, particularly in specialties such as internal medicine. However, maintaining the quality of this important learning experience has become a challenge. Recent approaches to redesigning the inpatient rounding experience have included reductions in the number of admissions and in patient census, which may not be feasible or desirable for many programs.

Overcoming poor attendance to first scheduled colonoscopy: a randomized trial of peer coach or brochure support.

Objectives: Among patients unlikely to attend a scheduled colonoscopy, we examined the impact of peer coach versus educational brochure support and compared these with concurrent patients who did not receive support.

Methods: From health system data, we identified 275 consecutive patients aged >50 who kept <75% of visits to 4 primary care practices and scheduled for a first colonoscopy from February 1, 2005 to August 31, 2006. Using block randomization, we assigned consenting patients to a phone call by a peer coach trained to address barriers to attendance or to a mailed colonoscopy brochure.

Clinical examination: still a tool for our times?

Physical diagnosis, as an integral part of the diagnostic process and as a central component of the physician-patient relationship, is at a crossroad. Technology offers a more sophisticated and, in many instances, more accurate solution to diagnostic problems, while evidence mounts suggesting that students' and residents' physical diagnosis skills are inadequate. For several reasons, however, physical diagnosis must remain a core skill for clinicians, particularly for those who practice in outpatient settings.