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56 Dennis K. Wentz and Alejandro Aparicio chapter 5 Continuing Medical Education and the American Medical Association: An Educational Journey This is the story of the American Medical Association (AMA) and its role in continuing medical education (CME) and continuing physician professional development (CPPD) during its 163 years of existence. The AMA has been a major force in American medical education while serving its historic mission of representing US physicians . These historical struggles of the AMA around basic medical education allow us to better understand the AMA role in CME today. The Beginnings The AMA was founded at an evening meeting on May 7, 1847, in the hall of the Museum of Natural Sciences in Philadelphia, Pennsylvania. Approximately 200 delegates from 28 state medical societies gathered to establish a national association that would have more authority than any state society had singly and would represent all physicians to a growing national government. Nathaniel Chapman, MD, was elected the first AMA president, though most historians cite Nathan S. Davis, MD, as founder of the AMA. A 30-year-old New York physician, Davis had introduced successfully a resolution at the 1845 annual meeting of the New York Medical Association that led to the Philadelphia gathering. The resolution began : ‘‘It is believed that a national convention would be conducive to the elevation of the standard of medical education in the United States.’’∞ That May 1847 meeting also saw the adoption of the original AMA constitution, which charged the AMA: to give frequent, united and emphatic expression to the views of the medical profession in this country, must at all times have a beneficial influence, and supply more e≈cient means than have hitherto been available here for cultivating and advancing medical knowledge; for elevating the standard of medical education ; for promoting the usefulness, honor and interests of the medical profession, for enlightening and directing public opinion in regard to the duties, responsibilities , and requirements of medical men; for exciting and encouraging emulation and concert of action in the profession, and fostering friendly intercourse between those who are engaged in it.≤ By agreement, only two committees were formed at the first meeting: one on ethics and one on medical education. Prior to the AMA founding , state medical societies were proactive on behalf of the postgraduate education of the profession for many years. And so it was that the first focus of the Committee on Medical Education was on the basic education of doctors. Many of the decisions made by the committee over the next 50 years proved controversial. Numerous resolu- American Medical Association / Wentz & Aparicio 57 tions were introduced at the annual meetings— with none passed—that challenged the direction of the Committee on Medical Education. Some examples of these resolutions include the following: 1. The Association had not the power to control medical education. 2. The great objects of the Association were the advancement of medical science and the promotion of harmony in the profession. 3. The attempt on the part of the Association to regulate medical education had significantly failed in its object and had introduced elements of discord, and . . . any further interference on the subject would be useless and calculated to disturb the deliberations of the Association.≥ Thus preoccupied by such challenges, the committee for the next 57 years focused on the issues of basic medical education and on the quality of the existing US medical schools. Early recommendations included a graded curriculum, some high school preparation for students before their admission to medical school, careful selection of medical students, and separation of education from licensure. Because the quality of medical schools and their graduates varied greatly, the AMA defended the right of states to require examinations for licensure of medical school graduates and to not rely on the medical school. The committee persuaded the Journal of the American Medical Association ( JAMA) to publish statistics on licensure examination failures of graduates by school. Such an act by the AMA led to its key role in the 1912 founding of the Federation of State Medical Boards of the United States, a voluntary organization of legally constituted licensing bodies.∂ Until 1900, the AMA did not focus on continuation or postgraduate medical education though the committee recognized that many practicing physicians were graduates of inadequate medical schools. But several important events occurred around this time that began to change the medical education scene. In 1901, AMA reorganized to include the House of Delegates and a board of trustees with executive...

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