Editorial: Medical exam needed

Two national organizations in charge of the medical licensing exam are going ahead with plans to establish a standardized, national medical licensing exam to test the clinical skills of newly-minted doctors. Obviously, the medical profession requires that doctors have good clinical skills and there needs to be accountability for these skills in order to protect patients and ensure the quality of medical care in this country.

Thus, a national standard of clinical skills is a good idea. Although the goal of ensuring standards for clinical skills is noble, there are certain problems with the system as it is set up.The plan would establish five national testing centers to evaluate doctors' clinical skills. Two of these centers have already been built in Atlanta and Philadelphia. But because there are only five centers, medical students will be forced to travel to the centers to be tested, at great expense. The exams themselves will cost students $950, with additional travel and lodging expenses. The national organizations should try to minimize these cost wherever possible.

The School of Medicine - one of the best medical schools in the country - already has its own version of the clinical skills test in place as part of its curriculum, as do several other medical schools around the country. Perhaps the ideal way to ensure that doctors are both well-trained clinically while minimizing the cost and bother to students is to have every medical school institute a similar, standardized test that could be administrated locally. Ultimately, however, such a system would likely prove infeasible because of a lack of standardization.

There also may be deeper problems with these kinds of tests, since they attempt to objectively evaluate human interaction - something that is inherently subjective and difficult to quantify. The importance of ensuring that doctors have good clinical skills makes some sort of test necessary, but the test must be carefully designed and monitored to ensure that it is applied effectively and uniformly throughout the country.

Working together, medical schools, the national certification organization and medical students can come up with a plan for ensuring the quality of clinical skills among doctors that satisfies all parties. The importance of providing quality care to all patients makes a system necessary, despite the difficulties inherent in trying to set up an evaluative metric of this complexity.