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AMA against NBME's clinical skills test

The Association tells the National Board of Medical Examiners not to go forward with mandatory exam for medical students.

By Myrle Croasdale, amednews staff. July 7, 2003.

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Chicago -- Doctors are opposed to the National Board of Medical Examiners' plan to test medical students' clinical skills, and they're willing to go to court to stop it.

The new policy made during the AMA 2003 Annual Meeting opens the door for legal action to halt the implementation of the controversial exam.

But AMA Trustee Peter Carmel, MD, said it was unlikely the AMA actually would sue. "It would be a no-win legal tangle," he said. "This just demonstrates how deeply we feel about this."

Most third-year U.S. medical students will take the test in 2004. The graduating class of 2005 will be the first complete class to take the exam.

Practicing physicians fear it will become a requirement for relicensure once testing centers are available across the United States.

The test, which is sponsored by the Federation of State Medical Boards as well as the NBME, is part of the U.S. Medical Licensing Examination. It mirrors a physician's typical day, with students seeing 10 standardized patients for 15 minutes each. After each patient, the student writes up the patient's history, physical exam, diagnosis and treatment plan.

The AMA has several concerns about the test.

"There's no verification that the test will predict who will be a good doctor," Dr. Carmel said.

But Tom Kirksey, MD, a member of the Texas State Board of Medical Examiners, pointed out that there is strong evidence that the test is a valid audit of medical students' skills.

"I'm here as an anti-Christ," Dr. Kirksey quipped. "We have this test to assure the public that doctors going into residency have the basic skills to enter practice."

Dr. Carmel questioned the NBME's ability to handle an influx of 16,000 students at its testing facilities and lamented the distances many students would have to travel to take the test.

But James Thompson, MD, executive vice president of the FSMB, assured the AMA that centers would be capable of handling 30,000 students and that the five sites would be within a two- to three-hour drive for the majority of students.

The $950 cost of the test and the estimated $1,000 for travel and accommodations also were an issue. If a mandatory test moves forward, and there's no indication it won't, the AMA encouraged schools to find ways to help offset the cost.

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