BULLETIN OF THE American Academy of Medicine. VOLUME X. 1909. EASTON, PA.: 1909. THE AMERICAN ACADEMY OF MEDICINE is not responsible for the sentiments expressed in any paper or article published in the BULLETIN. LEADING ARTICLE. THE QUESTIONS USED BY THE MEDICAL EXAMINING BOARDS. No discussion of this subject should be attempted without endeavoring to realize the purpose of a license examination and the limitations produced by circumstances entirely beyond the control of the boards themselves. Medical examining boards are not faultless, neither are medical practice acts without flaws, and these enable the captious critic and the disgruntled to tincture his vituperations with enough of truth to make his assertions seem plausible. It also permits a fair, though severe, adverse criticism; the former is not the view to be taken in a discussion like the present. We must acknowledge an effort in the right direction in all the laws, and, for the most part, an honest attempt to do what is right by the examiners. Medical practice acts are, ostensibly, an exercise of the police power of the state to protect the people from the dangers of improperly educated physicians. In reality, the purpose is not quite so simple. The demand for physicians examined and licensed by the state has not come from the people seeking for protection, but from an effort on the part of the more publicspirited physicians to make use of this police power to relieve the United States of the odium of its medical profession. Unfortunately, no chain is stronger than its weakest link, and the medical profession of the United States was like the feet of the image in the dream of the ancient king of Babylon: part iron and part clay. And the clay was very earthy. This effort runs counter to the interests of a class of men who are not willing to sacrifice their personal desires for the common good. Seeing the source of their gains disappearing under the administration of these laws, they are ready to stir up the people by any and every method that will play upon their emotions. No one receives as much popular sympathy as those who appear as the weak persecuted by the strong. The failure of the students of an individual school would be heralded as caused by personal bias on the part of the examiners, were not the questions and answers a matter of record to be appealed to at any time. Hence, at the present, there is the necessity for written examinations and written examinations solely. Let us hope that the time is near at hand when those who are most concerned in a medical practice act, will awake to their dangers and demand an act, not compromised by the desires of this or the other medical college, nor adjusted to cater to the vagaries of this or the other theory of the nature of disease or the treatment thereof. When such time comes, much that now cumbers a medical practice act can be pruned out. A written examination is at once the fairest and the most imperfect of examinations. Its excellencies and faults should be carefully studied by every board of examiners. There is just as much technical skill required to set a paper for a written examination as there is to operate for stone. Many of the members of our boards of examiners would think it no reflection upon their skill to ask a surgeon to operate for them, yet calmly prepare a set of questions for which they are no more qualified. This assertion does not imply that they are not able to mark the papers properly after the answers have been written, any more than that they could not look after the patient after the operation. It might be remarked, in passing, that the assertion is frequently made that when all medical schools become what they should be, then there will be no need for a state examination. This does not seem to be the experience in Europe. Even in Germany, the medical faculties which are so often held up to us as models because they are under state control and not private adventures, are said to grant the M.D. degree to those who afterwards fail in the license examination. And it is not an unheard accusation that some of these M.D.'s who fail in the Staats Examen hie them to the Land of the Free to practise. One of the great objections to a written examination is the possibility of cramming for it, and cramming of a most vicious sort. A few months ago the writer was thrown in company with a young man newly graduated from one of the medical schools classed with the best, and he had the curiosity to examine the book that the doctor was studying. It was a large volume with no suggestion of the compend about it, but proved to be a compilation of the questions propounded by a number of medical examining boards; the candidate for license was deeply engaged in an effort to be familiar with the character of the questions that he might pole to prepare answers for similar questions. The writer has taken the pains to examine some of the answers given to these questions, and many of them show a memorized reply to a possible question. Another objection to the written examination is that but a small portion of any subject can be presented, and the chance of testing only the weak side of a candidate. It is not to be supposed that any one applying for examination is fully prepared on every phase of any one of the subjects. After all, if a written examination can be conducted fairly, it becomes all the test that is necessary under most of the laws regulating the practice of medicine. For the most part these laws require a definite amount of opportunity for medical education with the assurance that this opportunity has been improved as evidenced by the diploma of the medical school. The examination of the individual is in a measure to put a check on the character of the college granting the M.D. degree while it is ascertaining the fitness of the applicant to practise. For, if the proper check be put upon the product of the medical schools, these, with their facilities, will see that their graduates are given the opportunity to be fitted to begin practice. |