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Arch Pediatr Adolesc Med. 1999;153:893-894.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The commentary by Cunningham et al,¹ as an example of "out of the box" thinking as an alternative way to teach in the ambulatory setting in this era of managed care, was interesting and entertaining, and the authors are to be commended. I do, however, have reservations about adopting this technique either personally or for instructing others as a faculty development teaching tool for the following reasons:

1. An innovation such as this needs to be examined and studied as a randomized controlled trial or through qualitative analysis to be certain that learner behavior and outcome is at least as effective as that resulting from traditional teaching.
   
2. In a recent article, Irby² states that "physicians develop an exhaustive knowledge base of medicine" through experiencing a variety of clinical cases, and knowledge then develops into tighter connections and is retained in memory as "illness scripts." Irby goes on to state that effective . . . [Full Text of this Article]