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May 12, 2010

Quantitative Decision Tools in Medical Education—Reply

JAMA. 2010;303(18):1812. doi:10.1001/jama.2010.546

In Reply: In response to Dr Alguire, I first need to apologize to the editors and readers of JAMA for a typographic error stating that I reviewed MKSAP 14, when it really was MKSAP 15. I agree with all of the comments made by Alguire, and I am pleased that, especially in cardiology, MKSAP 15 included some of the rules that have been developed by clinical and health services research scientists.

The first edition of the clinical epidemiology book by Sackett et al,1 which was published in 1985, included a simple ruler that used pretest probability and likelihood ratios to calculate a posttest probability. I imagined that 10 years later, but certainly within the next quarter of a century, physicians would actually use those concepts, and perhaps even that ruler, in their day-to-day practice. Among the questions at the end of the cardiovascular medicine section of MKSAP 15,2 it is hard to find one that requires such a calculation. It will be great if MKSAP 16 extends the work done in MKSAP 15 and requires the use of quantitative techniques to eliminate guessing and arrive at the correct answer.