While I greatly applaud the long-overdue decision to eliminate the oral part of the certification exam of the American Board of Psychiatry and Neurology, for all the reasons given, I don't think a computerized exam is the answer. Sure, it will be easier, cheaper, and can assess some reasoning. However, the real life of most clinicians is about our longitudinal care of patients. It is a long stretch to see how a computerized exam will correlate with that.

What I think we really need in the future is an accurate way to assess how we do with our own patients. That cannot come from a computer exam. It cannot come from our subjective analysis of our own patients. As flawed as it is, a refinement of what managed care has done might do it. An outside, expert review of random patients, which would also include feedback about the psychiatrist, might be much more accurate. In the article “A Call for 'Qualitists' in Psychiatry” in the August Clinical Psychiatry News, I discussed how we can develop such expert reviewers, where this would be part of their routine jobs. Let's not be seduced by the ease of technology.