An estimable legacy

Article Abstract:

The status and conduct of medical education within the United States are reviewed yearly by the Council on Medical Education of the American Medical Association. The August 15, 1990 issue of the Journal of the American Medical Association is focused on the issues and statistical analysis of the committee. This article traces the history of efforts to explore the nature of American medical education from September 21, 1901, when the first special medical education issue of the Journal was published, until today. Before the 1847 organization of the American Medical association, there were no standards for evaluating medical education. One of the first steps that the Council undertook was the publishing of a set of standards in 1905, which included entrance requirements, curriculum, focus on clinical work, and a statement on licensure. In 1910 the Council published a set of standards or ''essentials'' that guided the development of medical education and support facilities such as laboratories and libraries. However, an independent review of medical education carried out by Abraham Flexner of the Carnegie Foundation in the 1909-1910 academic year was critical in evaluating all current medical schools and ushering in the current philosophic basis of medical education in the United States. The Flexner report (as it is usually referred to) also provided the basis of treating medicine as a scientific discipline that required extensive clinical training through at least a year of internship. By 1910 more than 70 percent of all medical students undertook internships and this led to an extension of the Council's work to include evaluation of residencies. Throughout the years the Council has been a strong participant in joint accreditation programs, which are required for the certification of medical training programs of all kinds and of hospitals. (Consumer Summary produced by Reliance Medical Information, Inc.)

Standards, History, Medical colleges, Medical schools, editorial

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Institutional responsibility in graduate medical education and highlights of historical data

Article Abstract:

Graduate medical education is quite homogeneous across the US according to the American Medical Association's (AMA) 1992 survey. The survey analyzed data from the AMA's Medical Education Research and Information database as well as information provided by the residency programs themselves. Non-profit, public, for-profit and government programs were compared. The student population remained similar to previous years with men making up 70% of the residents and with international medical graduates accounting for 20% of the population. Classes in medical ethics are offered by 60% of the programs and 26% offer instruction in end-of-life care. There were only slight differences in residents' workloads, benefits or pay in the different sectors. In 1992 there were 11 fewer programs in general surgery than in 1991. The number of programs in emergency medicine increased as did critical care, geriatrics, sports medicine and pediatric pulmonary programs.

Evaluation, Graduate medical education

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Medical workforce planning and medical education: attaining consensus

Article Abstract:

Accurate forecasting and planning to ensure an adequate supply of physicians will need to be built on consensus not mandates. Several proposals have been presented that aim to re-shape the medical workforce. The proposal by the Council on Graduate Medical Education would impose federal limitations on the number of residency positions and would also deny funding to programs that do not comply with the policy. The Physician Payment Review Commission has proposed that non-governmental sources be prohibited from funding residency positions that are not federally determined to be essential. In July 1993, Congress considered several bills that would mandate that 50% of all residents work be in primary care. The cooperation of the medical education community is essential to workforce planning. Without a consensus among the certification, licensure and accreditation sectors, federal workforce planning will fail.

Planning, Forecasts and trends, Physicians, Medical professions

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