Rationalism and Empiricism in Modern Medicine

The roots of rationalism and empiricism in the Hippocratic tradition are explored. The triumph of the rationalists in the founding of modern medicine is emphasized. The development of clinical epidemiology and the evidence-based medicine over the last 30 years is described. The tension illuminates fundamental clinical and policy questions that doctors, the health care system, and the legal system confront today

The clinical epidemiology of hysteria: vanishingly rare, or just vanishing?

Vanish 1. intr. To disappear from sight or become invisible, esp. in a rapid and mysterious way (Shorter Oxford English Dictionary, 1972). There is a well-known view that hysteria has virtually disappeared in the Western world. There are two versions of this argument: one is that there was never a clinical disorder that coincided with the diagnosis, and hysteria has now been reconstructed as something else (e.g. Micale, 1993). The other is that hysteria did exist but has now become much rarer than it was (most famously, Veith, 1965). According to this view, hysteria is to be found in patients from developing countries, but in Western countries it is ‘virtually a historical curiosity’ (BMJ 1976). It is the latter view that is – in our experience – most commonly held by our colleagues in general psychiatry. Yet, this opinion is not shared by those who are involved in the clinical care of patients with neurological disorders: ‘to a psychiatrist who sees patients on the medical and surgical services of a general hospital, it appears that hysteria remains a rather common phenomenon’ (Brownsberger, 1966). A number of descriptions from liaison psychiatry services support this opinion (Akagi & House, 2001). There are good reasons why it might be difficult to judge just how common (or rare) hysteria really is. Epidemiology depends on reliable case definition, case ascertainment and selection of a suitable population to study (Neugebauer et al. 1980), and each of these poses problems in the study of hysterical disorders

Development of the Biostatistics and Clinical Epidemiology Skills Assessment for Medical Residents

This study developed the Biostatics and Clinical Epidemiology Skills (BACES) assessment, and established its preliminary item characteristics and validity evidence. Unlike previous instruments, the BACES assessment was developed and tested using an item response theory (IRT) approach to measurement to create a new, adaptive biostatistics and clinical epidemiology knowledge assessment for graduate medical professionals. Thirty multiple-choice questions were written to focus on interpreting relevant examples of clinical epidemiology and statistical methods. A four person expert panel reviewed these items for content validity. After this review, the BACES assessment was administered to 147 medical residents across three academic medical centers. Results of the IRT analysis produced a final instrument of 26 items with 13 devoted to statistical methods and 13 to clinical epidemiology, which successfully fit a 2-parameter IRT model. In contrast to previous assessment research, an IRT approach allowed for each BACES item’s difficulty, discrimination, and reliability to be estimated separately from the sample on which it was tested. As a result, this preliminary study has paved the road for a flexible yet psychometrically rigorous instrument for measuring the biostatistical and clinical epidemiologic knowledge of graduate medical students