I was stunned by the decision of the American Board of Psychiatry and Neurology (ABPN) to eliminate the oral part of the board certification exam, as announced in the November 21, 2008, issue.

I took and passed the oral part in 2002, in New York. I agree that it is a complicated and expensive event, and I was impressed by the organizational effort required.

Among the reasons for eliminating the exam are cultural and language barriers. I am a foreign medical graduate. Before I decided to train in psychiatry, I wondered if my command of English was adequate enough for the complexity and nuances required to communicate emotions, thoughts, and feelings. The burden to prove that we have the mastery of communication as well as the theoretical knowledge is on us. Choosing psychiatry instead of computer science or radiology is a personal choice.

I also suffer from significant social anxiety. Preparing for and taking the oral boards were very stressful. But so is meeting a patient in the office for the first time and having 30 to 45 minutes to obtain a history and formulate a diagnosis and a treatment plan. Sure, the oral board examination introduces a degree of subjectivity, but I firmly believe that it replicates fairly closely what we are required to do in real life in our chosen profession.

When we enter the examination room, as well as our offices where we practice, we bring not just our knowledge, but our own cultural experience, our personality, our communication skills—good or imperfect—and our own anxiety. There is no computer test or paper-and-pencil test that will adequately assess all the skills that a well-rounded psychiatrist should possess.