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Clinical Examination 3rd Edition by Owen Epstein (Mosby) Becoming a physician involves the acquisition of both knowledge and skills. With the ever-increasing emphasis on the accumulation of facts, some may doubt that recent medical school graduates have adequate basic skills. In this era of high-technology diagnosis, the often-heard statement that "the patient's history and physical examination provide over 90 percent of the information needed to arrive at a correct diagnosis" may soon become obsolete. Would any intern risk diagnosing lobar pneumonia or ankylosing spondylitis solely on the basis of the history and physical examination? It is paradoxical, then, that high technology -- in the form of an interactive CD-ROM -- can now be used by physicians for assistance in the art of clinical examination.

After straightforward instructions on how to install the software, the main menu appears. Introductory chapters provide an overview of history taking, interviewing techniques, and the general examination. Then the various body systems are represented as icons on the main menu. Clicking on an icon produces a window of text next to a window containing figures, images, illustrations, animation, and video clips. For example, in the windows about heart sounds, a diagram indicates the sounds within the heart cycle and a very clear audio presentation reproduces each type of murmur. The same arrangement is available for auscultation of the lungs.

There are 86 interactive examples representing patients with conditions such as Reiter's syndrome, homonymous hemianopsia, and aneurysm of the posterior communicating artery. The user must choose from a predefined list of history questions, physical examinations, and auxiliary tests to reach the correct diagnosis. These stimulating and interesting cases cover a wide range of disorders. However, the requirement that one mark all relevant questions before proceeding is tedious.

This CD-ROM could be a most valuable addition to the teaching of physical examination. The interactive format of the cases demands a thorough and systematic approach, matching the new concept of the Observed Structured Clinical Examination. Integrating self-study sessions from this CD-ROM into courses that rely solely on textbooks and lectures would be of great value.

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