The abyss: sinking scores in internal medicine

Article Abstract:

Taking 'boards', the certifying examinations for the American Board of Internal Medicine, is an experience not easily forgotten by any internist. Before 1986 this examination included one day of multiple-choice questions and one day of patient-management problems. The examination still takes two days, but now it requires answering over 600 true-false and 'multiple-guess' questions. The revised format was found to be as satisfactory as the older two-part test, and less time-consuming. A study by Norcini in the Journal of the American Medical Association analyzed certification examination scores achieved by physicians who had completed internal medicine residency training from 1983 to 1988. This study found a steady decline in scores and concluded that there had been a decline in the medical knowledge of the candidates taking the examinations during those six years. The lower scores actually represented a difference of one to three incorrect answers. During this same period of time the certification examination scores in general surgery increased; this was attributed to fewer foreign medical graduates taking the examination. Is the reverse true in internal medicine? The pool of candidates in medicine may have changed over the last decade. Physicians taking the 'boards' in the '70s were 'baby-boomers,' and may have been accustomed to more intense competition. Testing of the '70s versus the '80s high school students showed a similar trend of declining scores on the Scholastic Aptitude Tests. Although medical certification scores had decreased from 1983 to 1988, the clinical competence of internal medicine residents was seen to increase, as rated by their residency program directors. Perhaps the more recent graduates are not doing as well taking tests, but are more competent in providing good patient care.

Analysis, Medical education, American Board of Internal Medicine, editorial

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Promotion criteria for clinician-educators in the United States and Canada: a survey of promotion committee chairpersons

Article Abstract:

Most academic promotion committees in US medical schools rate teaching and mentoring skills very highly when considering physician faculty for promotion. Of 115 US medical schools surveyed, half had a promotion track specifically for physician educators. Teaching skills, clinical skills, mentoring and the ability to develop educational programs were rated more highly than research. Awards, peer reports, student evaluations and teaching portfolio were used to assess teaching ability. Physician educators were not expected to have as many publications as researchers.

College faculty, Appointments, resignations and dismissals, Medical colleges, Medical school faculty, Employee promotions, Educators

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National Survey of Internal Medicine Residency Program Directors Regarding Problem Residents

Article Abstract:

Practically all internal medicine resident training programs have residents who have difficulty fulfilling their role, according to a survey of 298 internal medicine program directors. The most common difficulties were insufficient medical knowledge, poor clinical judgment, inefficient use of time, stress, and depression.

Clinical competence

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