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Continuing medical education in the 21st century

BMJ 2008; 337 doi: (Published 22 August 2008) Cite this as: BMJ 2008;337:a119
  1. Robert F Woollard, Royal Canadian Legion professor and head
  1. 1UBC Department of Family Practice, Vancouver, BC, Canada V6T 1Z3
  1. woollard{at}

    Needs to recapture professionalism in lifelong learning

    The relations between large bodies of money and the healing professions have often been ambiguous. Commercial interests have sought to influence the course and content of doctors’ education. On the other hand, foundations established through personal wealth have funded some of the principal reports and reflections that have shaped professional education. For example, the Carnegie Foundation supported Abraham Flexner’s 1910 report on the state of medical education in North America. This changed medical schools dramatically in terms of scientific education and commercial influence. As a result, more than 100 schools based on commercial interests closed in subsequent years. Over the following decades, the medical professional and academic communities established accreditation systems of setting standards and mutual site visits with audit, and later quality improvement.

    The interlinked Committee on the Accreditation of Canadian Medical Schools and Liaison Committee on Medical Education currently accredit approximately 150 undergraduate programmes in North America. These committees have profoundly affected undergraduate and postgraduate education by stimulating effective pedagogy devoted to producing dedicated, ethical, and skilled doctors for the future.

    In Canada and the United States, respectively, the Committee on the Accreditation of Continuing Medical Education and the Accreditation Council for Continuing Medical Education attempt to do the same for continuing professional development in an environment more akin to the “wild west” that Abraham Flexner observed and excoriated 100 years ago.

    The US based Josiah Macy Foundation recently sponsored a conference exploring the state of continuing education.1 The conference was attended by some of the leading developers of continuing education in the US. The resulting report’s reflections on the questionable scientific basis for the practices and content of much continuing education, emphasis on the welfare of doctors …

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