Internal Medicine Certification: Scores Slip; Spirochete Survives

To the Editor.—  Norcini et al¹ determined that medical knowledge of recent graduates taking the internal medicine boards is declining by comparing scores on identical questions from year to year. Dr Dan² points out that the number of questions involved is small (one to three questions in a 2-day test). Both make statements that are questionable.To base the measurement of knowledge only on identical questions is unfair to the later candidates. In the 2 years since I took the boards, tissue plasminogen activator, cefixime, selegiline (L-deprenyl), pergolide mesylate, zidovudine, ganciclovir, inhaled pentamidine, esmolol, misoprostol, and lisinopril have become available. Ehrlichiosis, Lyme disease, chronic Epstein-Barr virus infection, and numerous manifestations of acquired immunodeficiency syndrome have all been first described in the recent past. Whether questions concerning these new topics were on the boards is irrelevant; today's residents learn about these diseases at the expense of others. No doubt