Educational obstacles to learning diagnosis.

Formal teaching of the observational skills needed in diagnosing illness is a time honored part of medical education. The analytic skills which follow diagnostic observations, however, are often obscure and poorly taught. Much of this deficit may be due to the special character of the teaching context. The Flexnerian marriage of medical education to medical research and its substrate, the referral hospital, may have had consequences which confound the understanding and teaching of diagnosis. This paper explores four possibilities: inappropriate use of the inductive method; overemphasis on mechanistic paradigms; preoccupation with disease, the diagnostic end-point; and truncation of the analytic process occasioned by referral.