Continuing Medical Education: Looking Back, Planning Ahead

3. Is There a Continuum of Medical Education? Fact versus Fiction

31 M. Roy Schwarz chapter 3 Is There a Continuum of Medical Education? Fact versus Fiction Over the past decade, it has become increasingly clear that we live in an era of global health. In late 2008, a joint Sino-US conference was held at Johns Hopkins University that focused largely on the components of global health. Many themes emerged from this conference, with the most important being that for the world to e√ectively face the global health challenges of the future, there must be a seamless continuum from the laboratory benches of biomedical science to the bedsides of patients and populations of people. Many examples were given, but the most compelling was the natural history of vaccines. Vaccines begin with breakthroughs in the laboratory and continue until patients are immunized and the threat of the infectious disease has been significantly attenuated at both the individual patient and the population of people levels. In light of the emergence of global health and the global village of which it is a part, the question of whether a continuum of medical education covering medical school, residency training, and continuing medical education (CME) exists takes on new meaning and is both timely and important. The short answer to this question is no, a continuum does not exist at this point in history. While lip service is paid to such a continuum , scant evidence supports its existence. To understand why it does not exist, one must begin with a brief history of medical education in the United States. History of Medical Education In the early 1900s, medical education leading to the MD degree was largely in disarray. Many medical schools served as nothing more than forpro fit diploma mills. There was little or no planning for medical education, poorly defined and non-uniform curricula, limited buildings, and the core needs of medical education were wanting at best. In addition, the faculty varied greatly in their quality and credentials, and admissions to medical school, the educational experience, and the requirements for graduation lacked quality control. Not surprisingly, educational programs received little, if any, evaluation. In short, educational chaos reigned largely unchallenged in the medical education system. Exploited for profit and personal gain and not for improving patients’ welfare, medical education was, to a large extent, a national disgrace. Change came about because the Flexner Report of 1910 challenged the status quo. It established new quality standards to define proper medical education. The report created a revolution that purified medical school education (undergraduate medical education or UGME), which in turn spawned residency education programs (graduate medical education or GME) using, to a large degree, the same standards as used in UGME. After the closure of many, if not all, poor- 32 reflections at the beginning quality schools, the remaining medical schools and the American Medical Association (AMA) became responsible for advancing and applying the Flexnerian standards. From the moment of its original formation in 1876 to its closing in 1880 and then after its second initiation in 1890, the Association of American Medical Colleges (AAMC) joined the fray. With the establishment of these quality standards came public acceptance of medical education, prestige, money, buildings, highly trained faculty, schools, prizes, promotions in academia based upon e√ectiveness as educators , reviews, reforms, research in medical education , journals containing scholarly research articles, conferences, professional societies, and great pride in the educational institutions. As a result, in the century since publication of the Flexner Report, American UGME and GME have become world standards for developing countries and have been in total, or in large part, reproduced around the globe. Pre-Flexner State of Continuing Medical Education Comparing the status of CME to UGME and GME brings the realization that the di√erence between(1)medicalschoolandresidencytraining and (2) CME is vast. CME is largely fragmented and lacking an integrated structure. Some have observed that ‘‘there is a CME enterprise on every street corner.’’ Continuity of CME planning and experiences is limited. The definition of educational needs lags behind UGME and GME. CME contains a large, for-profit element to the enterprise . CME has no dedicated faculty, i.e., those whose primary educational job is CME. CME has limited funds except what it can raise. Except at Meharry Medical College, no CME buildings or schools exist. CME has limited prestige in the public eye, and no CME prizes for excellence are widely applauded. Academic promotions for creativity and excellent achievement in CME are rare...