A dinosaur roars

In this issue of Neurology®, Schuh et al.¹ report on internal bias and interrater reliability of the residency-based neurology clinical skills evaluation (NEX).

I began training in the pre-MRI era and that qualifies me as a dinosaur. Forces combine to erode the quality of bedside clinical skills that serve as the backbone of our profession and define us as neurologists. Residents are consumed by duty hours restrictions, patient handoffs, electronic medical records, diagnostic antibody panels, high-tech imaging, and systems-based practice, and their faculty members are strapped for time as never before. Bedside clinical skills may become extinct.

BACKGROUND

For many years, the American Board of Psychiatry and Neurology (ABPN) and others have recognized the problems associated with testing fundamental clinical skills 1-2 years following completion of training and view the residency as the most logical and appropriate time for evaluating such skills. It seems most fair to the trainee and their patients to have deficiencies recognized in a timeframe that allows for improvement and remediation. The Accreditation Council for Graduate Medical Education (ACGME) requires our training programs to evaluate clinical skills during residency and the program director (PD) signs a letter upon completion of residency testifying that the graduate is competent …