AMERICAN JOURNAL OF OPHTHALMOLOGY FRANK
W.
NEWELL,
Editor-in-Chief
233 East Ontario St., Chicago, Illinois 60611 EDITORIAL BOARD Mathea R. Allansmith, Boston Douglas R. Anderson, Miami Crowell Beard, San Jose Bernard Becker, St. Louis Benjamin F. Boyd, Panama Charles J. Campbell, New York Ronald E. Carr, New York Thomas Chalkley, Chicago Claes H. Dohlman, Boston Fred Ederer, Bethesda DuPont Guerry III, Richmond
G. Richard O'Connor, San Francisco Paul Henkind, Bronx Robert W. Hollenhorst, Rochester Arnall Patz, Baltimore Herbert E. Kaufman, New Orleans Steven M. Podos, New York Albert M. Potts, Louisville Arthur H. Keeney, Louisville Algernon B. Reese, New York Bertha A. Klien, Tucson Robert D. Reinecke, Albany Carl Kupfer, Bethesda Marvin L. Sears, New Haven James E. Lebensohn, Chicago David Shoch, Chicago Irving H. Leopold, Irvine A. Edward Maumenee, Baltimore Bruce E. Spivey, San Francisco Bradley R. Straatsma, Los Angeles Irene H. Maumenee, Baltimore Gunter K. von Noorden, Houston Edward W. D. Norton, Miami
Published monthly by the Ophthalmic
Publishing
Company
233 East Ontario St., Chicago, Illinois 60611 Directors: A. EDWARD MAUMENEE, President; DAVID SHOCH, Vice President; FRANK W. NEWELL, Secretary and Treasurer; EDWARD W. D. NORTON, BRUCE E. SPIVEY, BRADLEY R. STRAATSMA
CONTINUING O P H T H A L M I C MEDICAL EDUCATION In December 1977, Allergan Pharma ceuticals, Inc., surveyed ophthalmolo gists to learn their attitudes about contin uing medical education (CME). Bill Isaacs, Group Marketing Director of Allergan, and Bert Winograd, an indepen dent marketing consultant, recently shared the survey's findings with THE JOURNAL. The results indicated a wide spread frustration concerning various as pects of continuing education. At the out set, it should be noted that ophthalmolo gists purchase more medical and ophthal mic books than any other specialty group; the number of new ophthalmic titles pub lished annually is exceptionally large. The Allergan respondents averaged more than an hour a day in continuing medical education activities. Considering the plethora of journals, educational re leases from manufacturers, a n d similar material that arrives daily, this is not surprising. We combine reading of jour nals and books, listening to tape cassettes with attending conferences and meetings.
Our Academy pioneered in providing in struction courses in addition to the annu al scientific program. A glance through the advertising pages of T H E J O U R N A L indicates hundreds of ophthalmologists teaching and thousands attending special courses. T h e five-year cumulative index lists over 300 books reviewed in T H E J O U R N A L between 1973 a n d 1977. Oph thalmologists are indeed a studious group. Then what are the causes of dissatisfac tion with continuing medical education? The ophthalmic clinician interested in providing the best possible care to his pa tients has specialized in delicate surgery and exact medical diagnosis, yet there is no credit for continuing medical educa tion unless the specific experience is veri fied and documented. There is no way the scholar can receive credit for retiring to his study to learn all he can concerning a particular disorder or the management of a specific patient. He may spend hours reading textbooks a n d standard journals, and thus become an expert in a particular aspect of ophthalmology, but credit is not
576
VOL. 86, NO. 4 available. Indeed, we are all frustrated by not knowing exactly what credits are. Educational credits originated with the American Medical Association and its Physicians Recognition Award (PRA). They are divided into categories from 1 to 5. Category 1 credits are awarded by institutions varying from hospitals to uni versities to medical societies. Categories 2 through 5 are awarded for activities that involve mainly individual effort. Most licensing groups recognize only Category 1 credits. Many physicians responding to the Allergan questionnaire resented excessive fees for conferences. High tuition com bined with travel costs, housing, and the loss of practice income makes awayfrom-home instruction extremely expen sive. It is, however, possible to fulfill most state relicensure requirements through various, inexpensive methods available for use in the office or at home. One cannot escape though the costs re quired to maintain permanent records, provide educational objectives, interpret results, provide pre-tests and post-tests and tabulate credits. Ophthalmologists who responded to the Allergan survey strongly resent the mandatory aspects of the continuing edu cation program. Many fear that they have devoted their lives to developing skills in a particular aspect of ophthalmology only to find themselves being tested about un related topics. This resentment is un derstandable because ophthalmologists maintain skills in the areas for which they accept responsibility. There may be the rare individual who doesn't keep abreast of current information unless prodded by threats of loss of recertification. I suspect, however, that such practitioners limit themselves in practice to doing what they know best, and that they do not pose a threat to life and limb, as our legislators might have us believe. Stross and Harlan 1 of the University of Michigan reviewed the impact of com
EDITORIAL
577
pulsory mandatory continuing medical education after the first re-registration cycle and compared the results to those of a similar survey of Michigan physicians performed in 1970 before implementation of the Michigan law. They emphasized the undeveloped nature of the C M E sys tem and the need for research into learn ing how a practicing physician learns. They emphasized that CME must be evaluated as to its effect on the practice of medicine. The mere cataloging of hours of attendance at meetings has no impor tance if the care provided to patients does not improve. As indicated by the growing number of states passing relicensure laws, mandato ry continuing medical education is with us permanently. Whether or not it will improve medical practice depends upon methods of evaluation that are either not available or have not been studied. None theless, the CME movement is gaining momentum. The wise ophthalmologist will make certain that those activities providing CME credit are properly veri fied. Additionally, he will be certain that he is not wasting time on activities la belled educational, which offer credit without increasing knowledge or skill. F R A N K W.
NEWELL
REFERENCE
1. Stross, J. K., and Harlan, W. R.: The impact of mandatory continuing medical education. J.A.M.A. 239:2663, 1978. CORRESPONDENCE Letters to the Editor must be typed double-spaced on 8V2 x 11-inch bond paper, with lV2-inch margins on all four sides, and limited in length to two man uscript pages. Aniridia, Cataracts, and Wilms Tumor Editor: The article, "Aniridia, cataracts and Wilms tumor in monozygous twins,"
W.
NEWELL,
Editor-in-Chief
233 East Ontario St., Chicago, Illinois 60611 EDITORIAL BOARD Mathea R. Allansmith, Boston Douglas R. Anderson, Miami Crowell Beard, San Jose Bernard Becker, St. Louis Benjamin F. Boyd, Panama Charles J. Campbell, New York Ronald E. Carr, New York Thomas Chalkley, Chicago Claes H. Dohlman, Boston Fred Ederer, Bethesda DuPont Guerry III, Richmond
G. Richard O'Connor, San Francisco Paul Henkind, Bronx Robert W. Hollenhorst, Rochester Arnall Patz, Baltimore Herbert E. Kaufman, New Orleans Steven M. Podos, New York Albert M. Potts, Louisville Arthur H. Keeney, Louisville Algernon B. Reese, New York Bertha A. Klien, Tucson Robert D. Reinecke, Albany Carl Kupfer, Bethesda Marvin L. Sears, New Haven James E. Lebensohn, Chicago David Shoch, Chicago Irving H. Leopold, Irvine A. Edward Maumenee, Baltimore Bruce E. Spivey, San Francisco Bradley R. Straatsma, Los Angeles Irene H. Maumenee, Baltimore Gunter K. von Noorden, Houston Edward W. D. Norton, Miami
Published monthly by the Ophthalmic
Publishing
Company
233 East Ontario St., Chicago, Illinois 60611 Directors: A. EDWARD MAUMENEE, President; DAVID SHOCH, Vice President; FRANK W. NEWELL, Secretary and Treasurer; EDWARD W. D. NORTON, BRUCE E. SPIVEY, BRADLEY R. STRAATSMA
CONTINUING O P H T H A L M I C MEDICAL EDUCATION In December 1977, Allergan Pharma ceuticals, Inc., surveyed ophthalmolo gists to learn their attitudes about contin uing medical education (CME). Bill Isaacs, Group Marketing Director of Allergan, and Bert Winograd, an indepen dent marketing consultant, recently shared the survey's findings with THE JOURNAL. The results indicated a wide spread frustration concerning various as pects of continuing education. At the out set, it should be noted that ophthalmolo gists purchase more medical and ophthal mic books than any other specialty group; the number of new ophthalmic titles pub lished annually is exceptionally large. The Allergan respondents averaged more than an hour a day in continuing medical education activities. Considering the plethora of journals, educational re leases from manufacturers, a n d similar material that arrives daily, this is not surprising. We combine reading of jour nals and books, listening to tape cassettes with attending conferences and meetings.
Our Academy pioneered in providing in struction courses in addition to the annu al scientific program. A glance through the advertising pages of T H E J O U R N A L indicates hundreds of ophthalmologists teaching and thousands attending special courses. T h e five-year cumulative index lists over 300 books reviewed in T H E J O U R N A L between 1973 a n d 1977. Oph thalmologists are indeed a studious group. Then what are the causes of dissatisfac tion with continuing medical education? The ophthalmic clinician interested in providing the best possible care to his pa tients has specialized in delicate surgery and exact medical diagnosis, yet there is no credit for continuing medical educa tion unless the specific experience is veri fied and documented. There is no way the scholar can receive credit for retiring to his study to learn all he can concerning a particular disorder or the management of a specific patient. He may spend hours reading textbooks a n d standard journals, and thus become an expert in a particular aspect of ophthalmology, but credit is not
576
VOL. 86, NO. 4 available. Indeed, we are all frustrated by not knowing exactly what credits are. Educational credits originated with the American Medical Association and its Physicians Recognition Award (PRA). They are divided into categories from 1 to 5. Category 1 credits are awarded by institutions varying from hospitals to uni versities to medical societies. Categories 2 through 5 are awarded for activities that involve mainly individual effort. Most licensing groups recognize only Category 1 credits. Many physicians responding to the Allergan questionnaire resented excessive fees for conferences. High tuition com bined with travel costs, housing, and the loss of practice income makes awayfrom-home instruction extremely expen sive. It is, however, possible to fulfill most state relicensure requirements through various, inexpensive methods available for use in the office or at home. One cannot escape though the costs re quired to maintain permanent records, provide educational objectives, interpret results, provide pre-tests and post-tests and tabulate credits. Ophthalmologists who responded to the Allergan survey strongly resent the mandatory aspects of the continuing edu cation program. Many fear that they have devoted their lives to developing skills in a particular aspect of ophthalmology only to find themselves being tested about un related topics. This resentment is un derstandable because ophthalmologists maintain skills in the areas for which they accept responsibility. There may be the rare individual who doesn't keep abreast of current information unless prodded by threats of loss of recertification. I suspect, however, that such practitioners limit themselves in practice to doing what they know best, and that they do not pose a threat to life and limb, as our legislators might have us believe. Stross and Harlan 1 of the University of Michigan reviewed the impact of com
EDITORIAL
577
pulsory mandatory continuing medical education after the first re-registration cycle and compared the results to those of a similar survey of Michigan physicians performed in 1970 before implementation of the Michigan law. They emphasized the undeveloped nature of the C M E sys tem and the need for research into learn ing how a practicing physician learns. They emphasized that CME must be evaluated as to its effect on the practice of medicine. The mere cataloging of hours of attendance at meetings has no impor tance if the care provided to patients does not improve. As indicated by the growing number of states passing relicensure laws, mandato ry continuing medical education is with us permanently. Whether or not it will improve medical practice depends upon methods of evaluation that are either not available or have not been studied. None theless, the CME movement is gaining momentum. The wise ophthalmologist will make certain that those activities providing CME credit are properly veri fied. Additionally, he will be certain that he is not wasting time on activities la belled educational, which offer credit without increasing knowledge or skill. F R A N K W.
NEWELL
REFERENCE
1. Stross, J. K., and Harlan, W. R.: The impact of mandatory continuing medical education. J.A.M.A. 239:2663, 1978. CORRESPONDENCE Letters to the Editor must be typed double-spaced on 8V2 x 11-inch bond paper, with lV2-inch margins on all four sides, and limited in length to two man uscript pages. Aniridia, Cataracts, and Wilms Tumor Editor: The article, "Aniridia, cataracts and Wilms tumor in monozygous twins,"
