The contemporary challenge to the practicing physician is to maintain clinical competence by serial updating of relevant medical knowledge. Such learning is best accomplished when it relates to a specific problem identified in the course of patient care. This concept has guided the cognitive component of my teaching during medical ward rounds in a university teaching hospital.

Our ward team includes a third-year medical student, two first-year residents (or a subintern, or both), and the supervising second- or third-year ward resident. In addition to the traditional case presentation of each patient discussed at teaching rounds, the junior medical student reviews a major presenting sign or symptom exhibited by the patient, deriving the information from a textbook on clinical methods and physical diagnosis. The definition of the sign or symptom, its clinical description, and its differential diagnosis are emphasized. The subintern or first-year resident reviews a circumscribed component of the patient's diagnosis or a relevant differential diagnosis such as the definition, description, associated physical findings, evaluation, or management strategy. The ward resident addresses comparable data, but, based on a report in a recent peer-review journal, a comprehensive review paper (if available) can be cited.

Succinct 3- to 5-minute presentations are supplemented by a brief summary handout or photocopy of the citation for all team members. By the middle of the month, so many common signs and symptoms have been addressed or discussed that the junior student often must select for presentation a sign or symptom of a minor or comorbid problem. Excellent summary or state-of-the-art reports are often noted to have been previously reviewed. Anecdotally, students and residents often use these brief reviews to give reports on subsequent clinical rotations.

I learn a great deal from these presentations each time I serve as ward attending physician. Office-based physicians can readily access the same information through various computer-based retrieval services or, more simply, from standard textbook or library reference sources. The attractiveness of this approach is its potential to improve the care of the specific patient being evaluated, as well as to enhance the care of similar patients.

We learn best when information retrieval answers a current question. We remember best when the information is applied in clinical practice.