Clinical data gathering is central to clinical competence. Although research has demonstrated the value to experienced clinicians of information obtained from the history, little is known of how medical students use this information. In the present study, two case simulations (in rheumatoid arthritis and systemic lupus erythematosis) were developed to assess medical student information gathering and utilization. The results indicate that most of the students were already considering the correct diagnosis as a possibility after the presenting complaint and patient description. However, the medical history exerted the strongest influence on transforming the correct diagnosis from just another diagnostic possibility into the favored diagnostic candidate. Students who failed to list the correct diagnosis in the differential diagnosis after obtaining the history were significantly less likely to reach the correct diagnosis at the end of the case. These results confirm the critical importance of the history in medical problem solving.

Using a broad range of written patient management problems (PMPs), this study examined (1) how each of three medical information-gathering processes (history-taking, physical examination, and diagnostic studies) influenced 175 second-year medical students' formulations of the differential (i.e., plausible) and the principal (i.e., most probable) diagnoses for each of 14 PMPs, and (2) the extent to which these results paralleled the emphases that experienced clinicians placed on these same information-gathering processes regarding each of the same PMPs. The results suggest that in ten of the 14 PMPs the students appeared to rely on specific information-gathering strategies in formulating their diagnoses, and that both similarities and differences existed between the levels of emphasis placed by the students and physicians on each of the three processes. In general, the physicians placed greater emphasis on the importance of the history, whereas the students relied more on diagnostic studies. These variations have implications for selecting medical problems for purposes of instruction and evaluation of students.

Student evaluations of teaching effectiveness in a large multi-instructor human anatomy course for students from four professionalprograms (nursing, dental hygiene, pharmacy, and physical education) were examined over a three-year period to assess the influence of professional program on student ratings of instruction. In spite of wide differences in mean achievement, students in the four professional groups were relatively consistent in their differential evaluations of the three course instructors and in their evaluations of learner motivational and course performance dimensions of instruction. Results supportedpreviousfindings regarding both (a) the internal consistency and interrater reliability of student evaluations of instruction in a course format increasingly being used in health professional education and (b) the needfor multiple assessments of instruction over time before generalizations can be made about an individual instructor's teaching skill.

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