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This is the fourth edition of Harrison's Self-Assessment and Board Review that we have had the honor of working on. We thank the editors of the 19th edition of Harrison's Principles of Internal Medicine for their continued confidence in our ability to produce a worthwhile companion to their exceptional textbook. It is truly inspirational to remind ourselves why we love medicine broadly, and internal medicine specifically.

The care of patients is a privilege. As physicians, we owe it to our patients to be intelligent, contemporary, and curious. Continuing education takes many forms; many of us enjoy the intellectual stimulation and active learning challenge of the question-and-answer format. It is in that spirit that we offer the 19th edition of the Self-Assessment and Board Review to students, housestaff, and practitioners. We hope that from it you will learn, read, investigate, and question. The questions and answers are particularly conducive to collaboration and discussion with colleagues.

This edition contains over 1100 questions and comprehensive explanations. The questions, whenever possible, use realistic patient scenarios, including radiographic or pathologic images. Our answers attempt to explain the correct or best choice, often supported with figures from the 19th edition of Harrison's Principles of Internal Medicine to stimulate learning.

Readers will note important changes in this new edition. We have replaced more than 60% of questions from the prior edition, thus hundreds of brand new questions and explanations are included herein. The format of the book has also changed, allowing for the more effective use of color images throughout. Readers will appreciate the convenience of having color images next to their citations in the text. This new edition is tied directly to all the great and updated content in the 19th edition of Harrison's Principles of Internal Medicine, assuring readers that the content of the Self Assessment and Board Review reflects the latest knowledge and developments in the field.

The content of this book is available in a variety of delivery formats. In addition to the print edition, an "app" will be available that offers adaptive learning features so that users can focus their studies on areas of greatest need. Several eBook formats are available, and as before the content is available on the widely used www.accessmedicine.com resource, where users can easily toggle over the Harrison's content for greater explanation and context of all the Q&A in this book.

Even though two of the authors (C.D.B., B.H.) have physically left the Osler Medical Service at Johns Hopkins Hospital, they will never leave spiritually. Our experiences with colleagues and patients at Johns Hopkins have defined our professional lives. In the words of William Osler, "We are here to add what we can to life, not to get what we can from life." We hope this addition to your life stimulates your mind, challenges your thinking, and translates benefit to your patients.

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