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History of Medical Education


C. Taradejna, 5/07


Most doctors were educated through apprenticeships as many did not attend medical school. There were about 30 medical schools existing in the US at this time; seven located in New York. The quality of medical schools, medical education, and the practice of medicine was questionable.


New York physician, Nathan Davis, introduced to the New York Medical Society a resolution calling for American physicians to establish a nationwide professional association to help regulate the practice of medicine.


The American Medical Association (AMA) was created with primary tasks to raise ethical standards in the medical field.


The AMA Council on Ethical and Judicial Affairs was created to write and implement an ethics code for American medical professionals.


Association of American Medical Colleges (AAMC) founded to reform medical education (originally represented only medical schools).


Johns Hopkins Hospital opens and offers the first “residency” program in the US.


AMA played an influential role during this time in establishing standards for medical schools, medical boards, hospital internship programs, medical specialty training, and other areas of health care. AMA begins a process by which to rate medical schools.


Abraham Flexner, an educator working for the Carnegie Foundation, published the Flexner Report, which assessed the quality of education in medical schools in the United States. As a result of his report, 12 of 168 medical schools in the US either closed or merged due to a “bad grade” from Flexner and another 28 were affected by this report.


The Federation of State Medical Boards (FSMB) is created as a national organization to strengthen cooperation among and collaboration with independent medical boards springing up to set standards for physician licensor. The FSMB accepts AMA’s rating of medical schools as authoritative.


AMA Council on Medical Education and Hospitals institutes a program of internship approval and publishes a list of hospitals approved for the education of physician internships. In 1914, 603 hospitals were approved to educate a total of 3,095 interns. The hospitals included in this list were located in the US, Canada, the Canal Zone, the Philippines, and in Peking and Shanghai, China. 


During this twenty-year period, medical specialty boards were being recognized to assure the public that a physician claiming to be a specialist was indeed qualified. The boards were to define specialty qualifications and issue credentials assuring a specialist’s qualifications. In 1916, the first medical specialty board was formed by Ophthalmology. This was followed by the American Board of Otolaryngology in 1924, the American Board of Obstetrics and Gynecology in 1930, and the American Board of Dermatology and Syphiliology in 1932. 


AMA publishes the “Essentials of Approved Residencies and Fellowships.” It set the early standards for residency programs.


The American Board of Medical Specialties (ABMS) is established as the preeminent entity to oversee the certification of physician specialists in the US.


The American Hospital Association (AHA) begins organizing to represent and serve hospital and other related organizations committed to health improvement.

The American College of Surgeons published its own standards for surgical education programs called the “Fundamental Requirements for Graduate Training in Surgery.”


The American College of Surgeons was the first specialty society to publish its list of hospitals which were approved for residency education in surgery.


The AMA Council on Medical Education, American Board of Internal Medicine, and American College of Physicians collaborated to form the Conference Committee in Graduate Training in Internal Medicine, a precursor to the Residency Review Committee for Internal Medicine.


The AMA joined with the Association of American Medical Colleges to establish the Liaison Committee on Medical Education LCME to maintain standards for undergraduate medical programs and to accredit medical schools in the US and Canada.


With the assistance of the American College of Surgeons and the American Board of Surgery, the AMA formed the next Conference Committee which was for graduate training in surgery.


With the assistance of the American College of Surgeons and the American Board of Surgery, the AMA formed the next Conference Committee which was for graduate training in surgery


The Council on Medical Specialty Societies (CMSS) creates an organization for medical specialty societies and a forum for medical specialists.

Congress approves the Medicare Bill. With the creation of public (Medicare) support, graduate medical education (GME) was raised to the level of public policy. The medical education community realized that the multiple RRCs in existence at the time, each with its own standards and policies, did not give the appearance of coordinated standards or a coordinated effort that could assure quality of residency programs across the board. The need for focused oversight was seen as compelling by both governmental and medical groups other than the AMA.


Five organizations in medicine and medical education came together, under the direction of the AMA, to create the Coordinating Council on Medical Education (CCME). These five organizations were the American Medical Association, the American Board of Medical Specialties, the American Hospital Association, the Association of American Medical Colleges, and the Council of Medical Specialty Societies. Its charge was to approve and coordinate all areas of medical education.

To help them with this daunting task, the CCME, as its first order of business, created the Liaison Committee for Graduate Medical Education (LCGME) to begin to coordinate and oversee the review activities of the several independent RRCs in existence.


The structure in place to coordinate GME ultimately failed to achieve its goals due to the cumbersome reporting and approval processes in place to accomplish tasks and establish policy. There were three layers of bureaucracy. The unhappy RRCs, who were slowly losing their independence, were at the bottom. The new LCGME was over the RRCs. Upon the LCGME was the weight of five eminent member organizations. Sitting atop this whole construct was the CCMEl composed of the same five member organizations as the LCGME.


The need for streamlining led to reorganization. The Coordinating Council was abolished. The LCGME was restructured under new bylaws and renamed the Accreditation Council for Graduate Medical Education (ACGME), a name that would more clearly reflect its responsibility for accreditation of GME.


The ACGME becomes a separately incorporated organization with new bylaws.


ACGME identifies and endorses six general competencies to assess resident competence; the American Board of Medical Specialties endorsed the same competencies for continuing assessment of competence in practicing physicians.


ACGME institutes common duty-hour standards for residents.

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