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Examinations and Competence

S. Mouchly Small, MD
JAMA. 1981;246(18):2030. doi:10.1001/jama.1981.03320180022012.
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To the Editor.—  The letter by Jack R. Harnes, MD (1981;245:342), entitled "Seventy Percent Physicians" sets up an untenable dichotomy of competence vs incompetence. Attempts to define physician competence show its complexity. We usually deal with varying degrees of competence dependent on the patient, the illness, and the context in which the interaction occurs.Neither licensure nor certification attests to life-long, unvarying competence of an absolute nature. These credentials should provide some assurance to patients of an expectable degree of relevant knowledge, skills, and judgment, essential for the safe practice of medicine. By no means can we rightfully expect perfection.The letter further confuses the issue by not recognizing the function of a written, objective, multiplechoice type of examination. No one has ever demonstrated a near-perfect degree of correlation between scores on such examinations and actual clinical performance. However, poor grades that reflect a pervasive lack of knowledge across the


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