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June 13, 1990

Internal Medicine Certification: Scores Slip; Spirochete Survives-Reply

JAMA. 1990;263(22):3023. doi:10.1001/jama.1990.03440220045020

In Reply.—  Dr Cary should consider himself extraordinarily fortunate that he managed to pass the certifying examination given by the American Board of Internal Medicine, because if he tried his outlandish theory on cognitive functioning on our colleagues in neurology, he surely would have been sent back for another year of residency.Contrary to his assertion that internal medicine residents can only acquire new information about diseases at the expense of others, the brain does not have a fixed capacity for learning. We would live in a bizarre world indeed if for each new fact learned an older memory had to be cast out. You do not forget how to balance your checkbook as a result of learning a new recipe for chili, and your ability to diagnose and care for a patient with rheumatoid arthritis is not compromised by being able to recognize and treat Lyme disease.The trends in the