Excerpt from Hospital Bulletin, 1911 Third, lead him to practice it under your own direction until Fourth, he is capable of doing it himself under your personal supervision. These four methods embrace, each one of them, the three processes of gaining clinical knowledge, namely: (1) Observation. (2) Recording what has been observed. (3) Interpreting the recorded data. The first thing the student has to learn is how to observe and study the patient. Then he must become practiced in making precise records of all his facts, and, thirdly, he must learn to reason with these recorded clinical data. In order to acquire this ability, clinical introductory lectures cannot be dispensed with. Whenever a new subject or a new method is taken up, or whenever a patient that illustrates a new condition presents himself, then the teacher should be ready to explain how that particular method, subject or patient is to be studied. The teacher should, if possible, furnish the student with a schedule or schema which he may use himself in the out-patient department whenever the teacher is not present. It is also necessary that the amount and kind of work to be devoted to each subject, each method and each patient should be described by the teacher, as well as the correlation and dovetailing of the subject and methods that may have to be taught by different instructors and professors. Some professors of medicine, like Dr. C.S. Minot, would like to do away with lectures altogether (See his address at the Yale medical commencement, published in Science, July 7, 1899), but to me it seems impossible to dispense with the lecture absolutely in clinical teaching, especially where the ground plan of the whole course has to be gone over, and where the correlation and dovetailing of subjects has to be explained. Such things cannot be demonstrated nor practiced by the student; they must be explained by the teacher. After such a clinical lecture, which should not exceed 40 minutes, the student should be encouraged to ask questions. Large Amphitheater Clinics. As Dr. S. Weir Mitchell has correctly said, the best lecturing does not so much think for you as invite you to think along suggested lines of inquiry. Therefore, in the large amphitheater clinic there should be not so much lecturing, but it should be utilized mainly to get the following purposes: First - Teaching the student how to get a subjective and objective history from the patient by a kindly, thorough, yet tactful questioning. Yes, the student should even be led to attribute importance to listening with consideration to the complaints the patient has to make, provided they are not spun out too long, which is especially the case with such as are not very sick. Then, as the teacher percusses, auscultates, palpates and inspects, he should not presume too much of an already-existing knowledge of these methods in the student. Second - The exemplifying good record keeping is an important lesson for the large clinic, for it is in my experience impossible for the student to learn record keeping without any previous acquaintance with good models. After that comes the personal practice in accordance with the observed models. Third - The large clinic is the proper place for the demonstration of all technique, whether purely manual or instrumental. The technique of the clinical laboratory is only in rare instances to be transferred or repeated in the clinic. It is generally presupposed in the listener of a clinic. Fourth - Interpretation and reasoning from records supposed to be correct. There are two ways of gaining information concerning the nature of human illness and its management. One is from a personal and direct study of the sick individual himself or herself. Naturally, this way of study depends upon the actual cases that happen to be available, and as these vary greatly in quality and quantity, we are likely to get a he.