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the counter balancing assessment, would be the actual clinical assessment of individual resident. so it be up to residency programs, and perhaps the reason why some are famed, it is because they are strict in assessment of their residents. those that passes actually mean they are superb residents and be superb attendings. so when we hear of an attending trained in this or that place, automatically we know that this is one of the best. so expectation would be at that level. it is how things are anyway. so assessment of physicians in training is another factor that be counter balancing
one other point about the mcqs, it is more like scenarios of actual happenings in clinics and hospitals, and those are what the residents would most likely encounter. hence although it be memorizing, it be what the residents be facing. so as said, mcqs are to have counter balancing assessment, and so be matched with the strict clinical assessment. lagging in clinical practice would mean failure
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clinical assessment in training is a factor be counter balancing rather, i have used another yet haven't stated any other reasoning
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5pani is right, and this is the current practice. the examination for usmle and all such exams even for the residency board exams have question bank. it is a pool of questions gathered from here and there from about everyone that sets the exams. so each examiner submits in the mcq with the answers and explanation, and forward it to the examination center usmle or boards. this is stored in the qbank pool. to make an exam for one, questions are picked from these question pool and so that be the exam for a person. these questions have been reviewed by the board and are deemed to be of equal in difficulty, except for some pilot questions that are specialist level or so.
so, to make an exam for an applicant, the questions are picked from the question pool. say 300 questions, those are picked from a pool of who knows perhaps 1000 questions. so this be the exam questions for the resident or usmle taker.
now that's another thing, to write as many questions and submit in, and so exams not entirely be alike. however, for the usmle step 3 exam, the whole trial paper on the usmle website were in the actual exam. this goes to say, that they have not rewritten questions or the question pool is limited so that they even use the trial questions.
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so the fsmb have been lazy in writing new questions, but good thing though because i would have failed usmle step 3 if it wasn't for those trial questions hahahahahahahahahahaha
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because i never bothered to read the trial questions since i have read it before, so just click on the answers and turn to the next question as soon as i get to realize that the question is of familiarity as that i have read it in the trial question. it also goes to say that fsmb are not really putting emphasis on usmle step 3. only step 2ck and step 1 kept having changes in questions. besides these are the areas as in clinical science and basic science with vast medical stuff to ask question on. step 3 is management and about the common things seen are about the same. rule of questions is that most common conditions are asked, so it be asthma, it be diarrhea and so management for those
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this is according to our last meeting with the fsmb executive members
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@categorical --- lol man i am from India ... and i can say that u have absolutely no idea of wat the indian system is like ..... well unlike in the u.s the indian exams are extremely difficult .. i got 240's in both usmle steps but could not get a residency seat in India because i could not get good enuf marks .... our entrance exam for residency which is like usmle for india ... is MCQ based questions "no essays" ..... and like i said ... it's not being used to essays or mcq's the .... there is alwayz advantages and disadvantages ... for example if u take the Poiseuille equation ... to test it in MCQ basis u can only give it as a mathematical problem ... but if u had it in a essay u can write pages about it .. provided u have memorized the equation from which u can write about it's application ...... so the only reason MCQs are preferred is because not because it is superior it is because it can be STANDARDIZED ...
Secondly, this problem though i don't know about other countries has been looked into in India ... and that is why .. exams before u enter medical school included essays, short answer as 1 exam and mcq based 2nd exam .... so u can see the extent indian education is advanced 
Lol and as for thank you letters ... not to mock but shows shortsightedness ...we are from a different culture ... for heavens sake we drive in a different direction ..... did u know it's rude in india to write to a facult member as " Dear Dr.Xyz" ... ur supposed to say "Respected Dr.Xyz" .... and u ask why they ask for a sample .... iam pretty sure with the reverse brain drain happening in the IT industry where american people coming to india looking for jobs ... they are learning to write from similar forums "Respected sir" instead of "Dear Sir"
and finally Sir osler's aphorisms are the best i agree ... but dear friend medicine is'nt an uncertainity anymore ... if u treat it like an ART people SUE you ... which is unfortunate actually .... it would be real nice to diagnose by clinical examination ... but instead it's all mostly investigation based ,,, and experience based medicine has given way to evidence based medicine ....... Favourite osler quote "If it were not for the great variability among individuals, medicine might as well be a science, not an art" .... unfortunately with SNP typing and tailored medications iam sure variability is going to be accounted for!
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The only "art" that is left is your investigative technique. Some (esp young doctors) may be more inclined to the shotgun approach to narrow down the diagnosis, but with experience and confidence your investigations should be quick and precise from the beginning.
Once your investigation lands you a diagnosis, I agree with the above poster, you basically follow protocol in evidence-based medicine for the best treatment modality. If you fail to do so: lawsuit.
Too many doctors who have practiced for 30+ years harp about 'experience' and the 'art' of medicine. This all applied when medicine was allowed to be more subjective and research could not explain many of the things we know now.
Art in medicine? Think plastic surgery.
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Interesting contributions from doc.12345. Perhaps my statements were misunderstood, I am advocating for the over reliance on history taking and anecdotes- that is 18th century medicine. What I mean to say is that medicine is an art AND a science.
@5pani: ''The only "art" that is left is your investigative technique.'' Hmmm..interesting statement, and may I ask, what informs your investigative technique? I think it's your history & physical examination- which are art forms. History taking and PEs are art forms whose importance cannot be overemphasized. It involves clear and concise communication with a patient in a manner that informs what investigations to request. Not everyone is skilled at that and I think that is part of what residency is all about. Learning to elicit a good history. As you rightfully noted among us younger doctors, we tend to adopt the 'shotgun' approach because we are yet to perfect the art form. Ordering a battery of tests for every complaint is a sign of not knowing what you're doing, and is not consistent with good clinical practice guidelines.
Therefore relegating H&PE (art forms) to the status as a relic of the past is not doing justice to the role it plays in contemporary medicine. Another one from Sir William Osler: "Listen to the patient. He is telling you the diagnosis." It is for this reason that we are urged to 'treat the patient and not the disease i.e. Laboratory numbers.
I agree with you 100 percent that treatment should be informed by the best evidence rather than anecdotes; however this constitutes the easier part of the process- once a correct diagnosis is made, all one needs to do is just follow standard guidelines and you will not have to worry about lawsuits. Making the 'RIGHT' diagnosis however is the issue, and therein my friend lies the 'art' of medicine.
Also, your perception that the place of art in medicine is confined to plastic surgery, reflects a rather reductionist mindset which our colleagues in the specialty will not appreciate. Lol.
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