By Karen Hebert Bristol

The American Medical Association (AMA) has threatened to go to court in an attempt to stop the implementation of a national clinical skills test for medical students.

The National Board of Medical Examiners (NBME) is hoping to implement the clinical skills test in 2004 for some graduating students, and it will become a national requirement for all graduating medical students in 2005.

The test has been designed as a simulated typical doctor's day. A student will see 10 standardised patients for 15 minutes each and will then be expected to write up each patient's history, examination, diagnosis, and proposed treatment plan.

It is expected that 5-7% of students will fail the test, with 1-2% failing the retake.

The test was first designed in 1999 in response to patients' demands for an improvement in doctors' communication skills and the NBME claim that the test will increase patients' confidence in newly qualified doctors, thereby reducing medical lawsuits.

Medical students have been strongly opposed to the test since it was first suggested, arguing that the responsibility of clinical skills testing should lie with the individual medical school and not a national body. Concern about the associated costs of the test has also been raised with students expected to subsidise the $950 (£590; a840) to sit the exam, plus an extra estimated $1000 for travel and accommodation.

Moreover, students feel that the test will not achieve its aims and it is unproved in its ability to assess communication skills or to reduce medical errors. Joshua Cohen, chair of the AMA medical students' section, told the delegates: "The public is trusting the licencing boards to screen out bad doctors, but this test could also be screening out good doctors."

However, some members of the AMA support the need for standardised clinical skills testing. Thomas D Kirsey, a member of the Texas Board of Medical Examiners, defended the test to the AMA. "The overriding issue is the inability to communicate by physicians. Patients most respect a doctor who talks and listens to them. We have this test to assure the public that doctors going into residency have the basic skills to enter practice," he said.

Despite the threat, it is unlikely that the AMA will actually pursue the matter to court. AMA trustee Peter Carmel said in a statement: "It would be a no-win legal tangle. This policy just demonstrated how deeply we feel about this."