Evidence doesn't support push for clinical skills exam

AMA Leader Commentary. By William G. Plested III, MD, Dec. 1, 2003.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from William G. Plested III, MD, chair of the AMA Board of Trustees.

Today in the United States our profession of medicine is under siege from every direction. It seems like everyone knows more about medicine and its practice than physicians -- and all are doing their best to impose their views on the men and women who do the daily work of caring for patients.

We have insurers braying that they will pay for "quality," which they will define -- without bothering to share that definition with us. This is nothing more than a pitiful excuse to underpay a majority of physicians and stuff even more millions of dollars into the pockets of third-party payers. On the other extreme, we have business people forming groups designed to bring "business practices and ethics" to medicine.

That's all we need: to have the Enron-Global Crossing bunch teach physicians about ethics!

In the midst of this frenzy, we have our own institutions leaping on the bandwagon with new schemes to "ensure" physician competence. One of these schemes is the clinical skills examination, scheduled for implementation next summer.

For years the National Board of Medical Examiners and the Federation of State Medical Boards have administered the U.S. Medical Licensing Examination. This examination is given in three parts for U.S. graduates. Step 1 is usually given during the second year of medical school, Step 2 in the fourth year, and Step 3 in the first or second year of residency training. Successful completion of all three steps is a requirement for licensure in all 50 states.

Some have clamored that someone must ensure that physicians possess "basic clinical skills" before being allowed to practice medicine. At first glance, that doesn't sound unreasonable. In fact, the AMA has a spectacular record of achievement in this arena. As the prime motivational force behind the Flexner Report, the AMA was pivotal in the development and maintenance of the greatest medical education system in history.