Reflections of a Maverick Measurement Maven

Christine H. McGuire, MA
JAMA. 1995;274(9):735-740. doi:10.1001/jama.1995.03530090067024.
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All living physicians who have ever practiced medicine in the United States share memories of a common ordeal—designed, most of us believe, to protect the public or, as some cynics would have it, to preserve a profitable monopoly—namely, the examination for licensure and/or specialty certification. Herewith, a very personal view of the alleged horrors of"how it used to be" and an account of the changes (progress?) I have witnessed over the past third of a century in the philosophy, procedures, and techniques of assessing physician competence.

For editorial comment see p 741.

When I entered the field of medical testing 35 years ago, no one had ever heard the word "simulation" applied to examinations in medicine, nor had anyone read a book or seen a test printed in invisible ink. The few existing computers occupied entire floors of large university buildings; litigation against a testing authority for unwelcome results was


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