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    Look for MOC changes in 2017, American Board of Urology says

    Gerald H. Jordan, MDGerald H. Jordan, MD Thomas GranatirThomas Granatir Michael L. Ritchey, MDMichael L. Ritchey, MD

    Dr. Jordan is executive secretary, American Board of Urology; Mr. Granatir is senior vice president, policy and external relations, American Board of Medical Specialties; and Dr. Ritchey is chairman, MOC committee, American Board of Urology.

     

    To understand certification and its origins, one must understand the evolution of medical education in the United States. In the late 1800s, U.S. medical education was uniformly deplorable. There were some university-affiliated medical colleges; however, the plethora of for-profit medical colleges produced physicians of questionable ability and ethics. Thus, medicine and surgery in the United States were dependent on Europe, England, France, and eventually Germany.

    Related - MOC: 84% of urologists are dissatisfied with current process

    While the American Medical Association (AMA) had been founded in 1847 and the American Association of Medical Colleges (AAMC) in 1890, much of medical education was really not affected by either organization’s efforts. In 1904, the AMA Council on Medical Education was created. In one of its reports, the council adopted what it termed the ideal standards for medical schools. Eventually the AMA Council on Medical Education joined forces with the Carnegie Foundation for the Advancement of Teaching. They conducted an inspection of all medical schools in the United States, based on these AMA standards, school by school.

    The report generated from this review, the Flexner Report, was published in 1910. It exposed medical schools by name and brought to the public’s attention the dismal state of much of medical education in the United States. Based on the significant reaction by the public and the government to that report, medical education was drastically reformed over the ensuing years.

    The product of medical education in the United States was markedly improved by that reorganization. However, what now remained in disarray was postgraduate medical school education for those physicians who desired subsequent training in more specialized areas of medicine. One must keep in mind that most medicine practiced in the United States at that time was almost exclusively by the “general practitioner.” Soon, with the standardization of medical education, the urge by physicians to pursue more narrow medical or surgical fields became apparent.

    Initially, post-graduate training was one of mentorships or apprenticeships, but a unified system of oversight of these programs was sought and achieved. Thus, those physicians who had achieved extra training and experience in designated specialty areas desired recognition for their expertise as well as recognition for being distinct from “general practice.”

    By this time, numerous medical and surgical specialty societies had evolved. In 1916, the American Board for Ophthalmic Examinations was established and was renamed the American Board of Ophthalmology in 1933. That board said its chief functions were “to establish standards of fitness to practice the specialty and to arrange, control, and conduct examinations to test qualifications and then confer certificates on the qualified.” The board emphasized that it was not attempting to control practice by license or legal regulation and that the standards were to be maintained on a voluntary basis.

    The American Board of Ophthalmology sought only to recognize its practitioners for their training and experience in the management of conditions of the eye. Their diploma was thus intended to indicate a reasonable, minimal standard of competence, not an advanced degree of skill. However, as it exists today, the nature of their organization meant that there would be those that chose to pursue certification and those that chose not to pursue it. Those who did not pursue certification were outside the board’s jurisdiction, and thus the Board then, nor any board now, can say categorically that those who are not certified are not safe specialists.

    Based on the experience of the American Board of Ophthalmology, other specialty boards were formed to identify those that had pursued extra training and had extra experience in a given specialty area of medicine or surgery. All of those boards were formed basically by the same tenets as the Board of Ophthalmology, and to this day are limited in many ways by the same factors as originally limited the Board of Ophthalmology. Three more boards were created in the next dozen years and in 1933 they together formed what would become the American Board of Medical Specialties (ABMS), then titled the Advisory Board of Medical Specialties.

    Next: American Board of Urology formed

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