Purpose: To determine whether the medical knowledge of candidates from different types of medical schools changed between 1983 and 1988. Subjects: Candidates for certification who took the 1983 to 1988 examinations in internal medicine were divided into five groups according to the type and location of the medical school they had attended and, in some instances, their citizenship: graduates of U.S. medical schools, of Canadian medical schools, and of osteopathic medical schools as well as U.S. citizens who graduated from foreign medical schools and non-U.S. citizens who graduated from foreign medical schools. Design: Performance on items that were common to four pairs of the 1983 to 1988 certifying examinations (1983 and 1985, 1984 and 1986, 1985 and 1987, and 1986 and 1988) was analyzed. Results: The scores of graduates of U.S. medical schools decreased, and the scores of non-U.S. citizens who graduated from foreign medical schools increased. Trends in the performance of graduates of Canadian and osteopathic medical schools and of U.S. citizens who graduated from foreign medical schools were not discernible. Conclusions: The cumulative decline in the performance of graduates from U.S. medical schools and the progressive improvement in the performance of non-U.S. citizens who graduated from foreign medical schools may ultimately manifest itself in patient care.
