Opinion

Physicians are both lifelong learners and teachers

A message to all physicians from AMA President John C. Nelson, MD, MPH.

By By John C. Nelson MD, MPH amednews correspondent— Posted Feb. 21, 2005.

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The AMA's Principles of Medical Ethics make it clear that physicians should "continue to study" and have a "commitment to medical education." These expectations are not new.

Teaching the next generation of physicians is in the Hippocratic Oath, and lifelong learning is a core part of many definitions of professionalism.

The concepts of the physician as learner and teacher have profound implications for what we do every day. They commit us to a lifetime of effort. But these activities are not ends in themselves. They are not just for us. They are important because they benefit our patients.

Supporting the physician as learner always has been a core value of the American Medical Association.

While some activity occurred during the first part of the 20th century, the commitment to continuing physician professional development took concrete form with the 1952-55 Council on Medical Education survey of "Postgraduate (Continuing) Medical Education in the United States." It was the first national look at the CME enterprise.

The 1955 Vollan report that resulted from the survey called for accreditation of continuing education programs. A formal continuing medical education advisory committee was formed at the AMA soon after and began the process of developing a workable accreditation system.

After a period of pilot-testing, the Council on Medical Education began to approve providers of continuing medical education in 1967. Eventually, the AMA joined with other organizations to form what is now the Accreditation Council for Continuing Medical Education,

To complement the accreditation system, the AMA introduced the Physician's Recognition Award in 1968. The PRA recognizes a physician's participation in continuing medical education and is used by 28 state licensing boards and many hospitals as evidence of CME participation.

The PRA certificate displayed in the office demonstrates to patients a physician's commitment to ongoing learning.

The PRA category 1 credit system, a national standard, currently is undergoing a change to award credit for new ways that physicians learn. For example, pilot projects are nearing completion to award credit for "just-in-time, " patient-based learning using the Internet, and for quality assurance activities in the physician's practice. These changes recognize that lifelong learning needs a system that fits with the busy and complex lives of physicians.

Many physicians participate in educating medical students and resident physicians. It is gratifying to know that more than 285,000 physicians are full-time, part-time or volunteer faculty members in U.S. medical schools.

Again, the AMA helps medical school faculty and their institutions educate young doctors to be knowledgeable, skillful and compassionate. When I hear people say, "Medical education in America is the best in the world," I am proud that the AMA has played a large part in this success.

What has the AMA done to make me proud?

Through its Council on Medical Education, the AMA has been involved in medical school accreditation since 1906 and residency program accreditation since 1927. Accreditation ensures that educational programs meet high standards and prepare their students well.

A major benefit for both schools and students is a system of medical school accreditation by the Liaison Committee on Medical Education, jointly sponsored by the AMA Council on Medical Education and the Assn. of American Medical Colleges.

Since 1901, the Journal of the American Medical Association has published an annual issue on medical education. It contains facts and figures, and commentary on U.S. medical schools and residency programs.

JAMA's medical education issues are used nationwide and worldwide by policy-makers, faculty and researchers. Review the 2004 edition (JAMA, Sept. 1, 2004) to learn what is new in medical education this year.

The AMA also produces a number of products related to medical education that have important benefits. For example, the Web-based AMA Fellowship and Residency Electronic Interactive Database (FREIDA) Online is used without charge by thousands of medical students and resident physicians each day to get information about residency training programs and medical specialties.

If you are an academic physician, you have a special opportunity to have a voice in the AMA. In 1976, the AMA created the Section on Medical Schools. Each medical school has a number of representatives. They meet in June and December in conjunction with the AMA House of Delegates. The section serves as a means for the academic community to influence AMA policy.

To make the section and the AMA more effective, we need more academic physicians to become AMA members. Remind your colleagues of the many benefits you receive from the AMA (accreditation, representation and useful products, for example).

If you are not associated with a medical school or residency program, the AMA's activities in medical education still are important to you. The young physicians going through training are your future colleagues. It is important to have the AMA, as the voice of the profession, involved in ensuring that they are receiving the best possible education.

The AMA does many things that benefit you as a practicing physician. It is working very hard to bring about reform of our broken liability system and to ensure that all Americans have access to care. I wanted you to know about the AMA's role in improving medical education, which has been a major goal since it was founded in 1847. This role directly benefits you, as both a learner and a teacher.

John C. Nelson MD, MPH amednews correspondent—

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