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The Graduate Education of Physicians Dr. Millis

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The Graduate Education of Physicians Dr. Millis ffi ,'# ,#.þ The Graduate Education of Physicians THE REPORT OF THE CITIZENS COMMISSION ffi ON GRADUATE ii# MEDICAT EDUCATION t'ti,) Commissioned by the American Medical Association Þtr :'ùï i.'rN'r ..:: . itìi MEMBERS OF THE CITIZENS COMMISSION ON a -'! GRADUATE MEDICAL EDUCATION Chairman John S. Millis, Ph.D., President 'rî¡ .,Ji **"ä.åT:iJi8i,i'""' i:t.. ;.r. Frrncis Boyer, D.Sc. (Hon.) LL.D. (Hon.), D.H.L. (Hon.), Director Smirh Kline & French Laboratories Philaclelphia, Pennsylvania Nçrvspapers and magazines, wirhouc making in<Jiviclual request, may copy portions for use in reviews or discussions W*rren H.. Cole, M.D., Professor and of this repoft. Universities, hospirals, and medical societies ì. He¡d of Department of Surgery may reproduce rhe enrire reporr or porrions of ir for their University of Illinois own use. College of Medicine Chica.go, Illinois Copies may be secured from rhe Council on lvfedical Educarion llverert C. Hughes, Ph.D. American Medical Associarion, Professor of Sociology 535 Norrh Dearborn Srreec, Brrrndeis Universirv Clricrrgo, Illinois 60(110 \\'alrham, Massachusetrs Leonard \V. Larson, M.D. [Jismirrck, North Dakora Past Presidenr American Medical Assoçiation E,,.lrvard H. Levi, J.S.D., Provgst University of Chicago Chicago, Illinois. ' Charles E. Odegdard, Ph.D., President University of tWashington Prinred tn U.S.r\. Seatrle; Vashington' :;r!, Joseph T. Wearn, M.D. Yernassee, South Carolina i.$t Professor of Medicine Emeritus and "+.! Preface .:¡; Dean Emeritus, Western Reserve University School of Medicine fhe Honorable Charles E. \ùühittaker, LL,B. Kansas City, Missouri Former Jusrice Unired Srates Suprerne Court .4, principal ¡notive for the founding of the ,tmerican Dael Volfle, Ph.D., Executive Officer Medical .Association was a concern for the character and American Association for the medical edt¡cation and thus for the qualifi' .Advancernent of Science standards of Washington, D.C. cations of the future members of the profession. Twice in the twentieth century the Association has requested an B. Young, Ph.D.,J.D., President George external examination of the state of medical education Field Enrerprises, Inc. Chicago, Illinois and has sought reco¡nmendations for changes to ensure an increasing excellence. In the first decade of the century the A.ssociation took advantage of the interest in educa- Secretary tion for the learned professions of Mr. Henry Pritchett, President the Carnegie Foundation for the Âdvance- Edgar S. Bowerfind, Jr., M.D. of Assis¡ant Professor of Medicine ment of Teaching, to obtain a study of the medical schools Western Reserve Universiry of the nation. The report of this study, known universally School of Medicine was rvholeheartedly supported in Cleveland, Ohio as the Flexner Report, its implementatio¡r by the ,tmerican Medical ,tssociation. It had profound effect upon the development of American Consultant medical education and, tlrerefore, uPon the medical care our citizens. Walrer S. Wiggins, M.D., Secrerary of Council on Medical Education In the seventh decade the Association has again ex' American Medical,{ssociasion pressed its continuing concern by requesting an external Illinois Chicago, examination of the intenrship and the residency, the con- ili ll¡ stituent parts of graduate medical education. In the frve Iii Douglas M. Whiraker, Ph.D., Vice-President of Rockefeller ...,i., and a half decades rvhich have passed since the Flexner Inscirure (now Rockefeller University), was a member of che .iit: Ripori, the'sysiem of graduate medical education has be- Commission but resigned for health reasons on 23 May L964 , ,il. come established and now'constitutes the larget half of before preparation of rhis reporr had begun. !.iê.' '.i i: the formal education'of the physìciair. In this develop- li' 1,, ili,i lll ,:.; ment a process of specialization and consequent frag- ensuing report represents the conclusions fornied by the mentation has occurred so that responsibility is diftused members. It is not a staff report in which a committee has and authority divided. Once again, the A.merican Medical concurred. In its attempt to uhderstand the changes which .A,ssociation sought external exanri¡ration and asked for have occurred in medical education, the Commission has the formation of the Citizens Commission on Graduate endcavore<l to delineate the forces which are operating Medical Education to make recomnrendations for the im- at present an<l to take account of those which may operate provement of this phase of medical education. In request- in the foreseeable future. The recommendations, we be- ing this study, as in supporting the Flexner study, the lieve, rvill make it possible for graduate medical education Âmerican Medical Âssociation has demonstrated its deep to enjoy an orderly adaptation to the changes required by concern not only for the profession which it represents, a burgeoning science and an evolving society. 'S(/'olfle, but also for the public good. Special thanks must be given to Dr. Dael the For any learned profession there are but two alterna' Commission member who served as draftsman of the re- tives for establishing standards of practice and education. port. Credit for the lucid presentation of the report belongs Responsibility can be assumed by society as a rvhole, op- to him. The Cornmission is grateful for the constant in- erating through governnnent, or can be assumed by the terest and helpful counsel of Dr. Walter S. \Øiggins, who organized profession through a voluntarily accepted self- served as consultant. Further, the Commission is grateful discipline. There are no other alternatives, for, if the pro- to the many people representing all parts of medical edu- fession does not take responsibility, society rvill surely cation and practice rvho shared their knowledge and demand that the vacuum be filled and the government experience with us. assume the responsibility. It is the conviction of the Com- John S. Millis, Chairman mission that the profession of medicine should assume 1 August 1966 the responsibility for its standards of education and should have a mechanism adequate to the full discharge of these responsibilities. The reconrmendations of the Comnrission set forth in the follou,ing pages are designed to provide such a mechanism. The nrechanism, s'e believe, is capable of assuming clearly and effectively the necessary responsi- bilities, and is of such indepcndence that it can be free of special interests a¡rd servc both the interests of the profession and the public u'elfare. The Citizens Commissiorì on Graduate Medical Edu- cation has operated as a committee of the rvhole ànd has not emploied a staff. D.ata, opinions, and.relevant evidence have been presented to the enfire Commission. Thus,'the vi v¡l ..t68 .\Y¿¿.. 'crTrzE¡!q ,ox$ S. lllùLrs, Pr.D., cócrraa '_ï,$, coMM¡sstoN oN lcrrctn Rcsirvc UnivcaiilY 'itr, ... Clcvcl.nd 6. Oh¡o ¡ I. L. fw¡'ø"r, r¡.D. GRADUATE EDUCAT¡ON ' Association .t...it. d(. î..¡!¿.t HEDICÂL v^Lrrr S. 9tcrctrs, M.D., Scoctay .irh American Medical trrrr 8. Hot¡.!, l¡.¡r. trt N, D..rboñ Ssc.i sdta..l Sponso¡ed by American Mcdicat Associa¡ion Ch¡c.ro 10. ¡lliN¡t s35 NORTH OEARE ORN STRttT. CHICAGO. ILLINOIS 606lO ..aæ,ìù. ti.a t.at.añr aRq cooEg¿7.r5æ 3r2 .: ¿' August 5, f966 August 8, 1966 Dr. Wesley W. Hall , Cbaiman j.. ' Board of Trustees í¡¡' Dr. John S. Millis, Cbairman American Medlcal Association '¡ì;È.: Citizens Commission on 535 North Dearborn Street "i..! Graduate l[edical Education Western Beserve University Cbicago, Illinois 60610 2109 Adelbert Road Dear Doctor Hall: Cleveland, Ohio 44LO6 I am pleased to lnforrn you that tbe Cltlzens Dear Doctor Millis: Comnission on Graduate Medlcal Education has fin- ished its assigned task. With the work of the Citizens Coûunission completed, I know the Board of Trustees of the AlvfA would Like to In studying tbe problems 1n record its gratitude and respect for the initiative the lnternship which you and your colleagues under- and residency years of medical educatlon, my and industry with col- and residency training. leagues and I bave found many occasions to recog- took the study of internship nize and value tbe freedom whicb we were granted We aware thj.s distinguj.shed group of cj.tizens from the outset to pursue this study in the ¡nanner are that which seened most appropriate to us. devoted rnany weeks of their busy schedules over the past three years to a conscientious and statesnanlike phase AlI of us bave found tbis assignment an in- probing of problems in this important of medical education. As medicine now gives attention to the re- triguing and ricbly rewarding experience. I'Ve are your rnay be grateful for tbe opportunlty afforded tbe port of findings and recommendationsr Vou us by sure that we shall give it the consideration that its Board of Trustees to serve the cause of medicine in its faithful endeavor to do all possible to eminent authorsbip and historic nature demand. ¡I assure the public of continuing irnprovements in it S incere ly yours, t,t the graduate training of young physicians. It is t.l our most earnest wisb that the report of our find.- /t-:^.' ings and recom¡nendations will contrlbute directly æ&4>.,à- i¡ii to this end. w"trcvlw. HalI, M.D. Chairman Sincerely lours¡' AIvfA Board of Trustees i;il llr: .-¿"e/61{74/U^ '.!, ir; John S!'nruri", Ph.D. !r: ChaÍrman tii lill .ì.,.:.']..:....¡-,¡:,'.:l.]}'r:r|¡r.¡rïill9ry.wn'È!.i.'ñ..*q'.r: liit Contents Preface. John S. Millis, Ph.D., Chairman Citizens Commission on Graduate Medical Educadon 1. Introduction 2. The Organization and Control of Medical Education 9 Schoolsof Medicine ......10 Internships. ........11 Residencies .....,..14 3. Major Trends in Medical Educadon andPractice ........19 IncreasingKnowledge .....20 Rising Expectations and Demands. ... 22 UrbanizationandMobility.
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