The oral examination: awesome or awful?

Medical and surgical specialty boards are constantly striving to insure that those seeking certification in their specialty are adequately trained and sufficiently evaluated to guarantee the highest quality of patient care. One traditional component of the evaluation process, the oral examination, has been discontinued by some specialty boards but is still retained by most. A review of the history of the oral examination, combined with personal experiences of the author, suggests that this particular rite of passage may have outlived its usefulness in all but a few areas of medical specialization. Addressing the most pressing problems of patient mismanagement in the most visible area of practice, the hospital environment, requires that major emphasis be on the improvement of hospital practices rather than on doctors' qualifications. Only in this way can we ensure patient safety and restore patients' confidence in the care they receive and in the doctors responsible for administering it.