Internal Medicine Certification: Scores Slip; Spirochete Survives-Reply

John J. Norcini, PhD; Susan C. Day, MD, MPH; John A. Benson Jr, MD
JAMA. 1990;263(22):3023. doi:10.1001/jama.1990.03440220044019.
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In Reply. —  Dr Cary makes several good points about our article and Dr Dan's editorial, but we differ with his conclusion. He is correct that the Medical College Admission Test scores and grades of medical students have not fallen. It is further true that any 2-year decrement in candidate performance is small in absolute numbers of questions, although these differences are considerable in a statistical sense (as a proportion of the SD). In any event, the decline is cumulative, and during the 6 years of the study it almost certainly reflects a decrease in the medical knowledge of the reference-group candidates.More importantly, Dr Cary cites several areas of new medical knowledge and argues that residents must learn them at the expense of others. This argument fails to acknowledge that some informaltion becomes outdated during that same period and no longer needs to be retained (in fact should be


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