I am a psychiatrist trained rather traditionally in the 1970s and certified
in 1977 in general psychiatry by the American Board of Psychiatry and
Neurology (ABPN). I am astonished by the plan to eliminate the oral exam in
psychiatry boards as described in the September 5 issue. I was aghast and
dumbfounded to read that the reasons were the relatively low pass rate and the
impact of language or cultural barriers and that "the crippling effect
of anxiety" is suspected to be a "predominant reason" for
the relatively low pass rate.
It is astounding that we would shift, to residency directors, the decision
about whether the resident has "the ability to examine a patient [and]
establish and maintain a relationship with the patient..." before
I cannot believe that this is occurring in a field where the relationship
with a patient and communication in a clinical setting are so fundamental.
I had no problems with Part II of the ABPN examination, but knew some
people who did. As I recall, most passed the second time. A few failed many
times, some because they were in the wrong field. Some failed because their
own issues, including anxiety, got in the way of the exam and their
To compare a psychiatrist with a neurologist in this regard is not a good
comparison, given the distinct differences in their roles and practices.
Perhaps we should do away with examinations altogether and just ask the
applicant if he or she is competent.