In lieu of an abstract, here is a brief excerpt of the content:

205 W. Dale Dauphinee chapter 18 The Evolution of Continuing Medical Education in Canada The story of continuing medical education (CME) in Canada traces the origins of concepts and ideas, the evolution of processes and structures, and the assessment of impacts, all of which influenced and directed the development of CME in Canada. While physicians and healers long preceded the development of Canada as a nation,∞ the identification of critical background influences , both social and educational, define the purpose of the chapter and, thus, direct the writing plan. The story begins in colonial times and sets the stage for the gradual emergence of medical institutions and the improvement of educational processes and practices. Phase 1: From Colonial Times to Osler In colonial times, the first physicians came to Canada after being educated in Europe, and later the United States. The early history has been well described by Heargerty in his book Four Hundred Years of Medicine in Canada.≤ Formal medical education in Canada began in Montreal where the Montreal Medical Institution was founded in 1823 by physicians from Edinburgh, Scotland, who worked at the recently opened Montreal General Hospital.≥ By 1829, the institution transformed into a faculty at McGill University where, ironically, the new university needed to have an established program to meet the terms of the James McGill will and its o√er of his estate (in the countyside near Mount Royal) for a campus. Thus, the first faculty at McGill was in medicine, and it was the first Faculty of Medicine in Canada. Schools quickly followed in Toronto and at the Université de Montréal (1843), at Laval in Quebec City (1852), in Kingston, Ontario, with Queens (1854), and Halifax (1867).∂ Preceding the development of schools of medicine, often by decades, was the development of hospitals, although the direct link between hospitals and universities as joint teaching sites was yet to be made in many cases. By the turn of the 20th century, with the addition of the schools at London in western Ontario , and in Manitoba, there were eight medical schools of ‘‘varying quality’’ in Canada, as Flexner was to later describe them in his report to the Carnegie Foundation in 1910.∑ Meanwhile in the United States, emerging from the time of Andrew Jackson’s presidency when deregulation had been widely promoted, was the appearance of many proprietary medical schoolsofquestionablequality.Itwasaphenomenon that, over time, attracted considerable attention . The outcome was the Flexner Report of 1910.∏ Flexner’s influence was as important in Canada as in the United States. The key point is that with the coming of improvement of medical schools and hospitals, there existed structures for promoting better quality educational practices. Thus, with the emergence of new philanthropic bodies such as the Carnegie Foundation from the preceding economic boom, came a new concern with the quality of medical education and the phy- 206 cme and cpd in canada sicians so produced. The Flexner Report focused support for the review of educational processes and the possibility of adopting criteria to guide and improve the quality of medical education. But the ferment of that era, as reflected in Flexner’s analyses, was not focused strictly on laboratorybased research, as is often erroneously asserted. Also at that time, the first signs of interest in assessing and improving the outcomes of care in surgery were seen in Codman’s work from the Massachusetts General Hospital in 1910. They were the first signs of another influence that would slowly emerge over the next decades: the issue of quality of medical care. These events set the stage for the recognition of what was to emerge over the next years: the need for structures to assess quality. Two of the earliest examples were the creation of the Medical Council of Canada in 1912 and the National Board of Medical Examiners in the United States in 1914.π They signaled the coming of standards by which medical licensure would be granted and potentially portable in North America.∫ To re-emphasize the theme and assumptions behind this analysis, the message is that the history of CME and its evolution has to be seen in terms of what was going on in society, in medicine, and in academia on both sides of the Canadian-US border. The impacts from ideas flowing back and forth across the USCanadian border will be repeated throughout the examination of the history of CME in Canada. Around the time of Canada’s emergence as a...

Share