North American screening programs appear to interpret a higher percentage of mammograms as abnormal than programs from other countries without evident benefit in the yield of cancers detected per 1000 screens, although an increase in DCIS detection was noted.

First-year medical students identified pain as a major concern in their early clinical experience. Students' perceptions of pain-related encounters can inform curriculum design and may ultimately benefit both physicians and the patients.

The concepts and tools clinicians use to understand disease and treat patients are the direct product of basic and applied scientific inquiry. To prepare physicians to participate in this tradition of medical science, the University of Washington School of Medicine (UWSOM) created a research requirement in 1981. The objective was to provide students, during their clinical years of medical school, with first-hand experience in hypothesis-driven inquiry and an understanding of the philosophies and methods of science integral to the practice of medicine. A comprehensive curriculum review in 1998-2000 identified several limitations of this requirement. Although many students completed it successfully, others struggled to find mentors, funding, or time as coursework became more demanding. Other students found they had no interest in or aptitude for the research process itself. Accordingly, UWSOM has reaffirmed its commitment to independent inquiry but expanded the ways in which students can meet the requirement. Three research options are now available under the Independent Investigative Inquiry (III) program, generally completed the summer after students' first year of medical school. These are the hypothesis-driven inquiry, a critical review of the literature, or an experience-driven inquiry in community medicine. The goal of UWSOM is to shape new physicians who can manage rapidly changing medical science, information technology, and patient expectations in clinical practice and/or laboratories. The role of III is to teach students to develop personal methods of acquiring new knowledge and integrate it into their professional lives. Faculty support, program oversight, and funding have been increased.

To assess predictors of reported performance of screening clinical breast examination (CBE) by internists, family physicians, and obstetrician/gynecologists, we surveyed members of these specialties in four counties of Washington State. We contacted all physicians in the counties and identified 334 providers who saw women ages 50-75 and provided primary care as their principal activity. Seventy-five percent (252 of 334) responded. Physicians were mailed a survey and contacted for telephone completion if they did not respond in writing. The survey inquired about their current performance of CBE and factors that might predispose, enable, or reinforce its use. Differences across specialties were assessed using the chi-square statistic. Factors associated with reported performance of screening CBE in > or =90% of women were evaluated using logistic regression. Fifty-one percent of physicians reported that they perform regular CBE on > or =90% of their patients, although the proportion varied across specialty type. Beliefs about the benefit of CBE were positive and similar across specialties. Twelve percent of male physicians, but no female physicians, reported that women's embarrassment affected their use of screening CBE. In a multivariate model, male gender, family practice specialty, and the perception of patient embarrassment were all associated with lower reported rates of performing regular CBE (p < 0.05). Work to increase the performance of CBE should consider the role of male physician embarrassment and family physician training. Ways to facilitate delivery of preventive care and factors influencing the women themselves may also be important to increased use of CBE.