AMA takes aim at skills exam

Chicago -- No clinical skills testing for practicing physicians. That's the verdict from AMA members, who voted at their Annual Meeting in June to oppose any clinical skills test tied to relicensure.

Representatives of the National Board of Medical Examiners testified there were no plans to make the clinical skills assessment exam into a relicensing requirement.

However, now that the test is a component of the U.S. Medical Licensing Examination, AMA members did not want to see it expanded to include practicing physicians.

AMA Trustee Peter W. Carmel, MD, said the NBME and the Federation of State Medical Boards, co-sponsors of the USMLE, spent a great deal of money building the clinical skills exam centers -- sites that U.S. medical students are expected to keep busy the first half of the academic year, leaving them relatively quiet the second half.

"These clinical exam centers are expensive," Dr. Carmel said. "I don't think it's premature to go on the record on this. The Federation of State Medical Boards will be looking to recoup its investment. Rest assured they will want to fill those rooms. They will need to find more customers."

Physicians testified they were not against testing clinical skills in principle but that there is no evidence that this test accurately predicts a physician's clinical competence.

Patrice Burgess, MD, an Idaho family physician and past chair of the AMA Young Physicians Section, testified against the clinical skills exam.

"Our competency is already being tested and evaluated by our hospitals and specialty boards," she said. "A test with no proven validity should not be used."

Susan Rudd Wynn, MD, a Texas pediatrician and allergist, also opposed such a test.

"This is simply a test looking for payers," she said.

Dr. Carmel said the sponsors of the clinical skills exam, the FSMB and the NBME, had assured the AMA only that no plans were in the works this year for a clinical skills component for relicensure. If and when the FSMB and the NBME revisit the topic, now there is AMA policy clearly against such a move.

U.S. medical graduates must take the clinical skills exam as part of the USMLE, a new requirement as of this year. The exam was widely panned by the AMA, which contended such testing should be done as part of medical school, not as a separate licensing requirement.