Don't hurt your hand from patting yourself so hard on the back there bud.
Sure, there's what's done in the real world and then there's what should be done/what there's evidence for. Just because everyone who walks into the ED who says the word "head" gets a head CT doesn't mean it's the right thing to do. There are also appropriate times to do four things at once though but, to be serious, a lot of what you see in the hospital is just "cover all our bases" kind of stuff. I think you're also forgetting that, in some cases where you would do multiple things at once, the shelves/CK have those options. Am I saying that every shelf question/CK question is super useful? No, but there are quite a few that are.
It's the same argument people have about the Iowa Basics, about the SAT, about the ACT, about the MCAT, about the LSAT, about Step 1/2/3, blah blah blah. "They don't actually test intelligence, they don't test what you need to be a good lawyer, doctor, whatever." The core argument seems to be whether rotation evals are a better "evaluation" of your clinical judgement than shelf exams. I personally (and I believe many students) would answer no. Disregarding all the ass kissing and random chance that your attending/resident likes you or not or is in a bad mood when they fill out your eval, even the parts which are actually related to clinical judgement can be stupidly subjective. Happen to read about pancreatitis the night before while studying for the shelf so you're able to pull Ranson's criteria out of your ass the next day when your team is on call and admit a patient with pancreatitis? Good "clinical judgement". Attending tells you to put more stuff in your differential but doesn't like the fourth diagnosis on your differential when you present the last morning? Bad "clinical judgement".
