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218 Robert Woollard chapter 19 A History of the Committee on the Accreditation of Continuing Medical Education—Canada One reasonable reading of the last one hundred years of medical education in North America would indicate that the medical profession is readily committed to visiting educational rigor and surveillance on those who presume to enter the profession but most reluctant to apply the same standards to itself once basic education is complete. While speaking fulsomely about the continuum of lifelong learning, the profession has applied the most intense scrutiny to the first two stages— undergraduate and postgraduate—while leaving the third and longest phase—continuing medical education (CME) or continuing professional development (CPD)—to fend for itself. The development of the Committee on the Accreditation of Continuing Medical Education (CACME) represents an instructive chapter in the evolution of the medical profession’s seriousness in addressing the quality of education required of and for its members. Long dedicated to the quality and nature of education for those entering the profession, organized medicine in Canada (and in the United States) has been much more tentative in giving serious, sustained, and critical attention to those already practicing the profession.∞ Flexner Then and Now Exactly a century ago, the organized professions in the United States and Canada participated in the development of the Flexner Report. This involved an educational assessment of the many medical schools then extant in North America. Many of these were disturbingly commercialized and unscientific. Abraham Flexner eloquently and bitingly described the situation: First and last, the United States and Canada have in little more than a century produced four hundred and fifty seven medical schools, many, of course, short-lived and perhaps fifty still-born. One hundred and fifty-five survive today. . . . These enterprises—for the most part they can be called schools or institutions only by courtesy—were frequently preempted. Wherever and whenever a roster of untitled practitioners rose above half a dozen, a medical school was likely at any moment to be precipitated. Nothing was really essential but professors. . . . The teaching was, except for a little anatomy, wholly didactic. The schools were essentially private ventures, money-making in spirit and object. . . . Income was simply divided among the lecturer, who reaped a rich harvest, besides, through the consultations which the loyalty of their former students threw into their hands.≤ Well into the last quarter of the twentieth century , one could substitute CME for medical school, add in the largess of grateful pharmaceutical companies to fees and grateful students, and have a reasonably representative picture of much The Committee on the Accreditation of CME / Woollard 219 of the state of a√airs in educational o√erings for active practitioners. Even today, as much as half of all such o√erings in the United States derive from industry support.≥ It is unlikely that the situation is dramatically di√erent in Canada. While significant advances have been made in the academic CME/ CPD community, this has not been the result of substantial commitment or resource support from the medical schools themselves. Until quite recently, virtually all CME units were expected to be cost neutral or profit centers. The situation is aggravated in many schools where successful CMEeventsdevelopedatsignificantcostarespun o√ to hospital-based and other entities where income is not provided for further research and development of new CME innovations. This lack of serious commitment is frequently excused on the basis of inadequate resources on the part of the medical school. This can be usefully compared to the following, somewhat plaintive, observation by Flexner: There are in the United States and Canada 56 schools whose total annual available resources are below $10,000 each—so small a sum that the endeavor to do anything substantial with it is of course absurdly futile, a fact that is usually made an excuse for doing nothing at all, not even washing the windows, sweeping the floor, or providing a disinfectant for the dissecting room.∂ While CME/CPD events now frequently take place in luxurious surroundings, this can often be attributed to the largess (and attendant influence ) of industry and not to the seriousness of support from medical schools or even the profession itself. To a great extent the Canadian Forum on CME was animated to change this situation—to define and develop resources such that academic units for CME/CPD would not remain in this situation but might become centers of excellence helping to build the envisioned system dedicated to the best...

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