Continuing education and the quality of care: Hopes and fears in the USA

Abstract

During the last decade the continuing education of physicians in the United States has commanded more attention from a larger number of individuals and institutions than at any time in the relatively short history of formal medical education on the North American continent. Yet even as long ago as the end of the nineteenth century one of the great leaders in American medicine made a stirring plea for the profession to recognise that “medical education is not completed at medical school, it is only begun.” And the echo of that charge had been heard many times in the ensuing years. Fulfilment of the implied responsibility for continuing study, however, was left largely to the sense of personal obligation felt by individual practitioners, many of whom did not feel it very keenly. During the middle years of the twentieth century the array of opportunities for self-improvement through postgraduate courses, professional society meetings, hospital conferences, and other wholesome activities grew steadily: by 1962, for example, 208 sponsors offered 1,146 formal courses of instruction lasting from a few hours to a few months. But it was the dawning consumer movement in the 1970s which stimulated the vigorous and varied expansion that led to an annual total of 8,938 courses being sponsored by 966 organisations in 1981. During