1) I would never, ever, ever suggest that there is any substitute for clinical experience; no artificial resource can come close to duplicating the cognitive resonance you get from actual clinical experience. I'm just saying that, at least for me (and several other people I've asked), the closest second comes from comprehensive case presentations that include the full HPI, PMH, data from all labs and diagnostic studies, means of eventual definitive diagnosis utilized and, importantly, information gained from subsequent patient follow-up.
2) Case presentations in morning reports are not always Zebras, but [in my admittedly limited experience] they tend to be aimed at achieving one of the following three goals: 1) presenting very infrequently encountered disease entities, 2) serving as a springboard for reviewing comprehensive differential diagnoses of a clinical sign or symptom (e.g. melena) or 3) presenting common disease entities that presented with one or more red herring signs or symptoms. This third group tends to end up being centered around something other than the disease entity itself. In my experience their complexity ends up being iatrogenic in nature (ex. 32 year old female had melena for 1 month and every test had been run except for colonoscopy because GI didn't want to come in on the weekend, and when they finally did, they didn't want to do a colonscopy because there was "active inflammation" or something). Each of these types of presentation is extremely valuable... no doubt about it... but what I am arguing is that straightforward, comprehensive presentations of typical or near-typical presentations of common diseases are extremely valuable as well, and they are much harder to come by than I feel they should be.
3) The creators of CLIPP and SIMPLE cases really missed the mark. I believe they had the right idea at the outset - they wanted to educate students on the presentation and workup of common clinical entities. Unfortunately, they ended up making these huge time-intensive online modules that include way too many questions [the questions are generally poorly designed and lack personalized feedback to answers - they really just add time, without effectively reinforcing key points], and, worst of all, WAY too much fluff (e.g. "Mrs. Garcia appreciated the time that Dr. Winston took to explain her diagnosis with her. As she exited the exam room, she sincerely thanked him and his team."). If they cut a lot of this extra crap out, I think they could actually be a decent resource.
Anyway, this discussion has further bolstered my belief that a repository of case presentations (with comprehensive details on HPI, PMH, all labs and other data, definitive diagnosis and any relevant follow-up) a) would be quite valuable and b) is currently not readily available. I've decided I'm going to create my own such website during residency.
I really appreciate all of your thoughtful responses. They mean a lot.
