Medical education: 100 years of progress

When the American Medical Association created the Council on Medical Education 100 years ago, there were no uniform standards for medical schools, and it was widely believed that the principal issue facing these institutions was the reform of medical education.

But consensus on the fact that reform was the principal issue in medical education by no means ensured that reforms were the next step.

At the time, many medical schools were privately owned and operated by the faculty. They were self-supporting, with student fees being most schools' main source of income. Most faculty members were afraid that raising standards would result in decreased enrollment, which would, in turn, lead to less income. As a result, they were largely resistant to change.

It was into this environment that the Council on Medical Education was created in 1904. The council's general goal at that time was to improve medical education in the United States. It had its work cut out for it.

Undaunted, it hit the ground running, issuing its first version of minimum and ideal standards for a medical school in 1904, conducting its first inspection of medical schools in 1906 and its first survey of hospitals for training interns in 1912. In 1910, it supported the Flexner Report, which articulated new standards for medical schools and catalyzed a significant change in medical education in this country. The report is still considered a landmark in the history of medical education.

The council also had a hand in creating many of the institutions that are instrumental to medical education to this day, including specialty boards.

Yet the council has never rested on its early laurels. Its 2002 report on resident physician working conditions recommended implementing an 80-hour work week, in effect stimulating the Accreditation Council for Graduate Medical Education plan to set work rules. And in late 2003, the council, after a significant study of physician supply in this country, recommended that the AMA abandon its policy that an oversupply of physicians exists, weighing in at the early stages of what is likely to be a significant debate about how many and what types of physicians the country will need.

In fashioning the council's centennial celebration, now winding down, the AMA has struck a perfect balance between saluting the council's past accomplishments and setting the stage for its coming work. For although great strides have been made in medical education and many groups now oversee and evaluate the process, the council still has an important role to play in defining medical education.

Today, its responsibilities include recommending educational policies to the AMA House of Delegates, studying and evaluating medical education, and ensuring that there is an adequate continuing supply of well-qualified physicians and that the AMA remains an accredited sponsor of continuing medical education.

One hundred years is a true milestone, and the council has accomplished much to be proud of. With the many challenges facing medical education today, including student debt and physician supply, it continues to have its work cut out for it. No doubt it will tackle those issues with the vigor it has demonstrated in the past, continuing to be a driving force in the betterment of the medical profession.