Complex medical case histories as portals to medical practice and integrative, scientific thought.

Complex clinicopathological conferences from the New England Journal of Medicine are used to introduce first-year medical and graduate students to scientific reasoning at the level of the whole organism and to help them mobilize and integrate the knowledge obtained in their previous studies. The approach involves outlining the etiology of the case history. This becomes a framework for thought allowing students to easily cope with the profusion of data. The method is cost effective: a single professor can interact with a large class, yet engage students on a one-to-one basis. It is a powerful adjunct to, but does not replace, lecture or small group activities such as problem-based learning. An annotated case history involving diabetes mellitus is provided.