learning to stay vigilant about conditions that are rare but important

doi:10.1136/bmj.327.7420.919

BMJ 2003;327:919 (18 October), doi:10.1136/bmj.327.7420.919

Commentary

learning to stay vigilant about conditions that are rare but important

Ed Peile, associate director of clinical studies¹

¹ Division of Public Health and Primary Health Care, University of Oxford, Oxford OX3 7LF ed.peile@dphpc.ox.ac.uk

The first 150 words of the full text of this article appear below.

All doctors who look after children need to recognise the presentationof Kawasaki disease: the consequences of missing it are potentiallydrastic for the affected child. The question is how we reinforceour undergraduate learning about rare but important conditions.Many years in practice without seeing a case may erode the vigilanceof the generalist who has many common and important conditionsjostling for priority as learning needs in continuing medicaleducation.

In the rapid responses, Christopher Martin draws attention tocontext, rightly drawing on Loong's recent paper¹ to remindus that, in practice, even cardinal symptoms have low predictivevalues if the incidence of the condition is very low. Martindraws attention to the tendency for case reports to focus onrarities. Is this a bad thing? Is there a place for an educationalcounterbalance to the everyday experience that "common thingsoccur commonly" and to any implicit assumption . . . [Full text of this article]

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