Dr Aring's commentary on page 1849 brings to mind a sobering thought for the Bicentennial. In recent times, the traditional American values, namely, self-reliance, self-assessment, and emphasis on individual standards of excellence, appear to have given way to a greater and greater concern for appearances, for the opinions of others, and the approval of peers. A psychologist might say that America, once largely inner-directed, has become more and more outer-directed. Moreover, there are indications that our preoccupation with credentials, with setting standards for everyone, may have blunted the aspirations of the few. Alan Gregg pointed out many years ago that credentials do not necessarily equate with competence. In his address to the American College of Physicians, he reminded his colleagues that the board examinations were not finding out what the candidates could do. They were not really ascertaining what the candidates knew, but only whether or not they knew the
Wolf S. Specialty Board Examinations: Credentials vs Competence. JAMA. 1976;235(17):1883. doi:10.1001/jama.1976.03260430053030
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