JOURNAL OF GENERAL INTERNAL MEDICINE, Volume 0 (November), 1994 621

t u r i n g t h e i r i n v e s t i g a t i o n s a l o n g t h e s e l ines . Th i s is re-

f l e c t e d in t h e i r i n v e s t i g a t i v e s c o r e s .

T h e r e f o r e , g i v e n tha t th is s t u d y w a s d e s i g n e d to

m a x i m i z e t h e b e n e f i t o f Q M R a n d t h e e f fo r t i n v o l v e d in

t r a i n i n g t h e i n t e r n s , t h e o b s e r v e d i m p r o v e m e n t in t e s t

s c o r e s d o e s n o t s u p p o r t t h e w i d e s p r e a d u s e o f Q M R as

an a d j u n c t to s t a n d a r d e d u c a t i o n a l t o o l s at th i s l eve l o f

t ra ining.

Q u i c k M e d i c a l R e f e r e n c e has t h e p o t e n t i a l to p r o -

v ide va luab le d i a g n o s t i c a s s i s t a n c e to p h y s i c i a n s . H o w -

ever , f u r t h e r s t u d i e s a re r e q u i r e d to a s se s s t h e app l ica -

t ion o f QMR us ing sub j ec t s w i t h d i f fe ren t levels o f me d i c a l

t r a i n i n g w h o a re t e s t e d o n rea l c l in ica l c a s e s w i t h a w i d e r

r a n g e o f m e d i c a l p r o b l e m s to d e t e r m i n e Q M R ' s r o l e in

m e d i c a l e d u c a t i o n .

The authors thank the fi)llowing individuals h)r their valuable assis- tance in developing the cases, gold standard answers, and marking scheme: Drs. M. Baiter, A. Bookman, E. Cohen, M. Crump, A. Dhanani, J. Eisenstat, W. Francombe, D. Goldman, G. Hawker, N. Lazar, T. Mazulli, D. McCarthy, P. O'Cnnnor, D. Panisko, K. Robb, J. Ross, M. Schreiber, J. G. Scott, M. Sherman, F. Silver, H. Steinhart, H. Vellend, G. Webb, T. Wnng, and J. Zahman.

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clinical and research evidence by medical practitioners. Arch In- tern Med. 1984;143:1971-5.

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3. Shortliffe EH. Medical expert systems--knowledge tools for phy- sicians. West J Med. 1986;145:830-9.

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5. BIomqvist N. On the relation between change and initial value. J Am Star Assoc. 1977;72:746-7.

6. Yates F, Cochran WG. The analysis of groups of experiments. J Agricult Sci. 1938;28:556-80.

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8. Ott L. An Introduction to Statistical Methods and Data Analysis. Boston: Duxbury Press, 1984;132.

9. Covell DG, Uman GC, Manning PR. Information needs in office practice: are they being met? Ann Intern Med. 1985;103:596-9.

10. Jones TV, Gcrrity MS, Earp J. Written case simulations: do they predict physician's behaviour?J Clin Epidemiol. 1990;43:805-12.

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REFLECTIONS

Cat and Mouse

I SENSED SOMEOME at the bedside. I opened one eye and peeked over the top of the covers. It was barely dawn. My son, who is 8, was standing there with a small red cardboard box po in ted at me. He looked miserable.

"What 's wrong?" I asked. "Sidney died." he said as he broke into sobs. Sidney was a mouse, 3 mon ths old, my son's

first pet of his own. His death was not unexpec ted . Three days earlier one of our cats had stolen into my son's room and s o m e h o w managed not only to free Sidney, but also to maul him. She didn ' t kill thc mouse immediately, though, preferr ing to "play" with him. We in tervened before the final pounce. The mouse had lost one eye and was limping after the attack but initially looked sur- prisingly well. When I first heard about the attack, I told my sou to expec t the worse, but he would have none of that.

Over the next days Sidney seemed weaker, not

eating. We tried ent ic ing him wi th fruit, cheese , and bananas, to no avail. Eventually, we were at- tempt ing to give him water wi th an eyedropper . There was much irrepressible hope from my son. A slow, one-eyed mouse was be t te r than no mouse at all. Hope was not enough. The mouse got a lot of at tent ion and love in those last few days, how- ever, and his passing was very peaceful. Now he had lovingly been put in the box for burial in the back yard.

It would be too much to expec t realistic ex- pecta t ions from an 8-year-old. But desp i te the out- come, my son is not in the least bitter. Ills mem- ories of the mouse are fond. Is the care w e give many of our hopelessly ill pat ients as res trained and compassionate as that given the mouse?

Ka:,t'rH Wrv:nn, MD Vanderbilt University Nashville; Tennessee