Questions ( Table I ). CONCLUSION: Conclusions : Clinical data and physical exams are essential for ID. However complementary tests are important to determine FD. Among the tests, it's important to highlight the importance of CT scan , although we must re-evaluate others like Chest X-ray and Electrocardiograms which were taken to all patients but they were of poor value in patients without specific symptoms. We need to rationalize others like biochemistry tests and consults to others specialist. The biopsies and therapy tests were very useful. These results reflect what has happened with Medicine in the last two decades, in which the technological progress allowed a better diagnosis, although it was initially established by physicians at the patient's bedside. (sixth) year medical students while they were rotating through general medical outpatient clinic for 2 weeks. Faculty internists evaluated student's clinical competence observing student's ability to assemble clinical information gathered through medical history taking and physical examination and to formulate working diagnosis. Students were rated as follows; A, able to integrate pertinent information for initial assessment, B, able to gather pertinent information, C, information gathering is passive and superficial, and D, detrimental to patient. A, B and C were further divided into three subgroups according to individual performances to develop a 10 point Competence Score. Patient satisfaction ratings for students were also obtained at the same time by using a modified Japanese version of Patient Satisfaction Questionnaire developed by the American Board of Internal Medicine (m-PSQ). Multiple regression analysis was used for statistical comparison. RESULTS: A total of 77 medical students were evaluated by 9 staff physicians and by 229 patients. The m-PSQ consisted of single factor with Cronbach's a coefficient of 0.90. Multiple regression test revealed that competence scores of students were strongly associated with the m-PSQ ratings (p < 0.001), but not with student's age and gender, Objective Structured Clinical Examination (OSCE) scores, patients' demographic characteristics such as age, sex, occupation status. CONCLUSION: Patient satisfaction ratings of medical students in outpatient clinics were strongly associated with student's ability to gather and integrate clinical information obtained through history taking and physical examination in a university hospital outpatient clinic. The use of Palm Pilots is rapidly expanding among residents and some training programs are even providing them for their housestaff. However, little is known about how residents view their utility. The purpose of this study is to determine 1) residents' perception of the utility of Palm, 2) potential obstacles toward their use, and 3) the influence of providing Palms to medical residents. METHODS: We conducted a survey of all medicine residents at two hospitals. One of the hospitals heavily subsidized and encouraged residents' purchase of Palms. The survey included questions regarding perceptions toward the benefits of using Palms to help them record patient data (record) and improve the quality of their signouts (signout). We also surveyed for potential obstacles to their use: cost, difficulty in learning how to use (learning), fragility and effort required to enter data (enter). A Likert scale (1=strongly disagree to 5=strongly agree) was used. The survey was piloted for reliability at a third hospital. RESULTS: 65 of 81 residents (80 %) in the hospital that did not subsidize the purchase of Palms (unsubsidized group) and 25 of 29 (86%) in the hospital that subsidized their purchase (subsidized group) returned the survey. 21 residents in the unsubsidized group (32%) and 24 residents in the subsidized group (96%) owned a Palm. The unsubsidized group rated questions on the utility to record patient data and signout higher than the subsidized group (table 1) . Regarding potential obstacles the unsubsidized group felt that cost was a greater obstacle while the subsidized group felt that the fragility of the device and the effort to enter data was a greater obstacle than the control group. Analysis by ownership of a Palm independent of the site also failed to reveal any significant results with exception to cost and learning (less of an obstacle to Palm users). CONCLUSION: Our study demonstrates that in a training program that subsidized the purchase of Palms, residents perceived them to be less useful and felt that the fragility of the device and the effort to enter data were greater obstacles to their use. These results imply that simply providing housestaff with Palms may not be beneficial. Studies are needed to see if providing medical software and additional training will increase their utility and decrease perceived obstacles. inquired about the most common uses in patient care as well as the use of any medical programs. Information on training level and whether they owned a Palm Pilot was also obtained. The survey was piloted for test ± retest reliability at a third hospital. Mann ± Whitney U tests were performed to compare groups and logistic regression was performed to adjust for resident genre, level of training, and program site. RESULTS: The survey was sent to 81 residents in the hospital that did not subsidize the purchase of Palm (unsubsidized group) and 29 residents in the hospital that subsidized their purchase (subsidized group). 65 residents (80 %) in the unsubsidized group and 25 (86%) in the subsidized group responded to the survey. 21 residents in the unsubsidized group (32%) and 24 residents in the subsidized group (96%) owned a Palm device. Palm owners in both groups responded that they used these devices to organize patient records (23%) and phone numbers used in patient care (82%), keep patient``to do'' lists (39%), schedule events and appointments (75%), and as an aid for clinical calculations (86%). The most frequently used programs were pharmacopoeias (93%), medical reference (44%), and clinical calculators (18%). Ownership of Palm and training sites were not independent predictors of using clinical prediction rules more frequently on logistic regression. CONCLUSION: Our study demonstrates that medical residents use Palms for a variety of purposes relating to patient care. However, owning Palm Pilots did not increase the likelihood of using clinical prediction rules and very few residents used them to organize patient records.