Recent Accreditation Council for Graduate Medical Education Initiatives Have Not Been Shown to Improve the Education of Cardiology Fellows

The best lad schemes o’ mice an’ men Gang aft agley, An’ lea’e us nought but grief an’ pain, For promis’d joy! — —Robert Burns Before formal training programs in medicine, physician trainees learned at the feet of established physicians. Although formal training programs in internal medicine and surgery had been around for many years, the Flexner report in 1910 fundamentally changed how training was performed.1,2 Flexner described the mediocre quality of medical education at the turn of the century, noting the poor facilities, the profit motives, and the inadequate curricula. To reform medical education, he envisioned academically oriented hospitals where clinical observations drove research questions and advancements in patient care. Postgraduate trainees were indeed “residents”; they lived at the hospital, allowing the closest observation of their patients and a continuity of inpatient care that was unmatched. Indeed, in this setting, a night off duty was characterized, without a lack of sarcasm, as a lost opportunity to learn.Response by Kuvin p 537 In the 1950s, Residency Review committees were created for many specialties to set standards for and to evaluate residency programs in those specialties. In contrast to specialty boards that examined trainees at the completion of residency training, the review committees evaluated and accredited programs within individual specialties. In 1965, with the US Congress approval of the Medicare Bill and public support for graduate medical education (GME), the door was opened for GME policies to be subject to public policy. In 1972, the Coordinating Council on Medical Education (CCME), charged with approving and coordinating all areas of medical education, was born from 5 organizations: the American Medical Association, the American Board of Medical Specialties, the American Hospital Association, the Association of American Medical Colleges, and the Council of Medical Specialty Societies. The goals of the CCME were …