Editorial
Editorial
The Challenge of Continuing Medical Education 1 Robert E. Wise, M.D. Continuing education is an important responsibility in the practice of radiology. The response to the growing demand for additional and new educational opportunities includes specialty societies and their programs of scientific paper presentations and refresher courses, audiovisual aids and seminars. Lacking, however, is organization of efforts leading toward programmed instruction, permitting renewal and expansion of knowledge on an organized and continuing basis. The Intersociety Educational Committee is attempting to coordinate educational efforts. A unified and effective educational process would eliminate much duplication of effort and increase efficiency. Education. Radiological Society of North America, presidential address • Radiology and radiologists
INDEX TERMS:
Radiology 114:741-743, March 1975
Members of the Radiological Society of North America and guests, it is an honor to appear before you on the occasion of the Sixtieth Scientific Assembly of our Society. As I considered the subject for the address, it appeared appropriate to review our charge as defined in our By-laws. The objects of the Radiological Society of North America shall be: 1. To promote the study and practical application of radiology in all of its aspects. 2. To provide meetings for the reading and discussion of papers and the dissemination of knowledge. 3. To maintain a journal. Thus are we charged by the By-laws of the Society. Without question, our predecessors, during the sixty years of our existence, have satisfied the responsibility with which we have been charged. Our Annual Scientific Assembly and the Journal RADIOLOGY are testimony to this. But what of the future? We are now on the brink of a new venture in education with our impending move to a convention center. Perhaps this should be the impetus to pause and reflect, to ponder our future, and move ahead with renewed determination to meet challenging education opportunities. Do we rest on our laurels and simply improve the quality of our previous product or do we examine our concepts with a view to responding to the requirements of modern society? Do we seek means of more efficient delivery of continuing education to all segments of the medical specialty of radiology?
The remarkable success of the Radiological Society of North America testifies to the desire of radiologists to accept our responsibility to study all of the days of our professional lives and to maintain, as well as improve, our skills in practice of the art and science of medicine. As in any field of human endeavor, all have not accepted this responsibility perhaps as well as they might have, but it may be said that with few exceptions it has been well accepted. Despite this, in our changing environment there is a growing demand for evidence of continuing competence. Additionally, society is seemingly demanding that we formalize our professional continuing education studies. This is amid threats, real and imagined, from governmental agencies, politicians, and those who fear governmental agencies, that recertification, relicensure, or recredentialing and possibly reexamination will be imposed by fiat. There are those who insist that, jf we do not assent and comply, others, very likely government agencies, will impose their will upon us. There are equally strong, and hopefully stronger, as well as more eloquent voices who vigorously oppose the involuntary imposition of a recertification by examination concept upon us. Those enunciating opposition to the concept of involuntary recertification by reexamination do not speak in opposition to continuing education nor do they, in principle, oppose formalization and documentation of the process. Despite the consensus which rejects the concept of involuntary reexamination and recertification, there is a recognition of a need for improved educational opportunities. This, I submit, is not born of fear, but rather of a
1 Presidential address delivered at the Sixtieth Scientific Assembly and Annual Meeting of the Radiological Society of North America, Chicadk go, III.,Dec. 1-6, 1974.
741
742
EDITORIAL
valid self-imposed determination to maintain and improve the quality of our professionalism. It is this intellectoal commitment to our professionalism which has been responsible for the development of the segment of medical practice which we know as radiology into a major aspect of medical care. All of these factors have resulted in an explosive demand for additional and new educational opportunities. Our response has been positive but, in our zeal to respond to the call for a greater educational effort, we have produced a relatively uncoordinated and sometimes chaotic educational process in radiology beyond the residency level. Uncoordinated and amorphous though it may be, we nevertheless have several rather well-defined segments emerging as educational entities. Numbered among these are our several radiological societies, each having viable programs of scientific paper presentations and refresher courses. Some have developed extension programs of audiovisual aids as well as extension lecture programs. The Radiological Society of North America, while not alone, is a prime example of this effort with its vast scientific program and its refresher course program which has no peer in radiological education. In addition, this year, we note the advent of the categorical course on the gastrointestinal tract pioneered by Dr. Sidney Nelson. It is to be hoped that this is a pattern for future development, for it is a rational approach to an orderly educational process. We have begun a program of extensive dissemination of information generated at our meetings in the scientific exhibit and refresher course areas through the development of our audiovisual aid programs utilizing slides and audio tapes. In a minor way we have sponsored extension of refresher courses by furnishing speakers to other societies. In a similar manner, the American Roentgen Ray Society has developed somewhat parallel programs. The American College of Radiology which has, as a part of its defined mission, the encouragement of contimJing education has entered the arena with the development of programs such as the teaching seminar and "black lung" programs. These have been highly successful. The financial cooperation of the American Roentgen Ray Society, the American College of Radiology and the Radiological Society of North America has permitted what hopefully will be a revitalized and valid educational effort for residents and practitioners through the Armed Forces Institute of Pathology. The universities and clinics of America have been in the forefront of continuing education, utilizing the "course" concept extending in time from one day to one week. In a sense, these have been of the categorica I type as they have tended to be confined to a single subject. One of the earliest and most successful of these was the course developed by the University of
March 1975
Minnesota. Today, a week does not go by that a formal nationally advertised course does not take place somewhere in this country. Seemingly each day we receive an announcement of another. We have a veritable plethora of these courses and still the market appears insatiable. Community hospitals have not been resistent to the lure and have, by drawing upon the resources of educational institutions, been able to mount creditable programs. It is interesting to note at this point that a change in venue to a resort area far removed from the parent institution has at times been a significant attendance factor or at least used as a lure. The self-evaluation program of the American College of Radiology is noteworthy in concept and effectiveness. Enterprising commercial houses, some physiciansponsored, have come forth with a shower of audiovisual teaching materials in the form of slides, audio tapes, video cassettes and so forth. They have been of varying and at times undependable quality. Drug companies have been willing to sponsor educational movies and other teaching media, and in fact have pioneered in the development of educational movie and television programs. Their efforts have been helpful to radiology, but have been mainly in the areas of medicine or surgery and their subspecialties. In this category, however, drug houses are probably the largest contributors, for few others can afford these particular media. While our motives have been altruistic, although at times admittedly self and institutionally oriented, the problem has been compounded by financial motivation. Quite properly there is a greater demand by the teachers for compensation. Institutions have found these courses to be quite remunerative, inherently creating a desire to expand these activities. The commercial houses engaged in producing audiovisual aids have scented the bait and are pursuing it with vigor. Regardless of the motivation, the by-product of our motives has been an enormous and fruitful output of educational material. The flood of material has become a Whirlpool in which we grasp for a semblance of order. Some progress has been made with the introduction in 1968 of the American Medical Association Physicians Achievement Award. This is a significant step forward but falls short due to lack of specificity. An element of quality control is embodied through certification of institutions and organizations but fails to control the quality of the end product except for the rather tenuous assumption that a certified institution will produce quality material. As a part of our search for order, several organizations, including radiological societies and the American Medical Association, have developed elaborate schemes including computer programs serving as bookkeeping devices to certify attendance. In addition, there are those who would demand pre-
VoL 114
EDITORIAL
and post-attendance examinations as certification of attendance as well as attention and learning. It is fortunate indeed that we have many who oppose this approach. The efforts of all of the foregoing are to be applauded, for they are significant contributions to our continuing educational effort. Despite these positive steps, it is still possible for the radiologist to achieve the American Medical Association award with a potpourri of educational experiences entirely unrelated to radiology as there is no demand that the educational experiences be specialty-related. It is only with great personal diligence, and frequently at considerable expense, that one is able to pursue a balanced continuing educational program. What is seriously lacking, however, is any organization leading toward programmed instruction which will permit the generalist or subspecialist in radiology to renew and expand his fund of knowledge on an organized and continuing basis. Currently an attempt is being made to unify our effort to some degree by the Intersociety Educational Committee. While this may bring some unity to the organized societies, there remains a void with respect to the other educational entities to which I have alluded. It has not yet been able to control the quality of the courses being offered by universities and clinics nor, in fact, the programs of the societies. Clearly there is a need for a more organized approach to our goal of effective continuing education. It should be possible to evolve, through proper organizational effort, a graduated system whereby in an orderly fashion the physician can renew and improve his fund of knowledge. An appropriate solution could conceivably be the formation of a Radiological Educational Council composed initially of representatives of all radiological educational societies, societies purporting to represent medical schools and those representing group practices. The Council, once formed, would not be responsible to any of the contributing organizations, but rather would be relatively freestanding. The contributing societies would be responsible to the Council rather than the reverse. Such a Council could be responsible for developing a coordinated program of educational programs which would permit an orderly approach by the radiologist to a
743
complete review and advancement program in a spec fied period of years, possibly three or more. The concept would include correlation of all of the e ements of our continuing educational process, includin refresher courses, seminars, freestanding courses, sel evaluation programs and all of our audiovisual pre grams, commercial and otherwise. Commercial house could participate by seeking approval by the parer Council of their offerings. The Council could serve t monitor quality of the end product rather than the spor soring institution. The net effect would be a unified effective proces and an efficiency of effort eliminating much of the dupl cation of effort with which many of us are faced today It is imperative, in the light of a restrictive economy de veloping in the world, that we eliminate as much dupli cation of effort as possible, and that we become as effi cient as possible in the implementation of our educa tionaI effort. To as great a degree as possible we mus deliver our material to the radiologist rather than the re verse. It is evident that there must be, if such a program is to be effective, some subjugation of our nationalistic and chauvinistic instincts to the common purpose. I submit that the price of success in this regard is not inappropriate. Let us' not bow to the threats of those who woulc control us. There are many forces engaged in the struggle for the control of medicine who would control n01 only our practice, but our education as well. As physicians, we have always recognized a need for change and have responded accordingly. We will continue to do so. Control of professional activities by fiat is doomed to failure. We will control our practice and our education ourselves, for they are too important to be left to anyone other than physicians. The ultimate control of the profession must come from within. Toward this end we must abandon the computer as the arbiter of who shall enter the profession. Rather, we must attract men and women of intellectual competence who· will progress by virtue of their philosophies and conscience, rather than by direction of politicians. Lahey Clinic Foundation 605 Commonwealth Avenue Boston, Mass. 02115
Editorial
The Challenge of Continuing Medical Education 1 Robert E. Wise, M.D. Continuing education is an important responsibility in the practice of radiology. The response to the growing demand for additional and new educational opportunities includes specialty societies and their programs of scientific paper presentations and refresher courses, audiovisual aids and seminars. Lacking, however, is organization of efforts leading toward programmed instruction, permitting renewal and expansion of knowledge on an organized and continuing basis. The Intersociety Educational Committee is attempting to coordinate educational efforts. A unified and effective educational process would eliminate much duplication of effort and increase efficiency. Education. Radiological Society of North America, presidential address • Radiology and radiologists
INDEX TERMS:
Radiology 114:741-743, March 1975
Members of the Radiological Society of North America and guests, it is an honor to appear before you on the occasion of the Sixtieth Scientific Assembly of our Society. As I considered the subject for the address, it appeared appropriate to review our charge as defined in our By-laws. The objects of the Radiological Society of North America shall be: 1. To promote the study and practical application of radiology in all of its aspects. 2. To provide meetings for the reading and discussion of papers and the dissemination of knowledge. 3. To maintain a journal. Thus are we charged by the By-laws of the Society. Without question, our predecessors, during the sixty years of our existence, have satisfied the responsibility with which we have been charged. Our Annual Scientific Assembly and the Journal RADIOLOGY are testimony to this. But what of the future? We are now on the brink of a new venture in education with our impending move to a convention center. Perhaps this should be the impetus to pause and reflect, to ponder our future, and move ahead with renewed determination to meet challenging education opportunities. Do we rest on our laurels and simply improve the quality of our previous product or do we examine our concepts with a view to responding to the requirements of modern society? Do we seek means of more efficient delivery of continuing education to all segments of the medical specialty of radiology?
The remarkable success of the Radiological Society of North America testifies to the desire of radiologists to accept our responsibility to study all of the days of our professional lives and to maintain, as well as improve, our skills in practice of the art and science of medicine. As in any field of human endeavor, all have not accepted this responsibility perhaps as well as they might have, but it may be said that with few exceptions it has been well accepted. Despite this, in our changing environment there is a growing demand for evidence of continuing competence. Additionally, society is seemingly demanding that we formalize our professional continuing education studies. This is amid threats, real and imagined, from governmental agencies, politicians, and those who fear governmental agencies, that recertification, relicensure, or recredentialing and possibly reexamination will be imposed by fiat. There are those who insist that, jf we do not assent and comply, others, very likely government agencies, will impose their will upon us. There are equally strong, and hopefully stronger, as well as more eloquent voices who vigorously oppose the involuntary imposition of a recertification by examination concept upon us. Those enunciating opposition to the concept of involuntary recertification by reexamination do not speak in opposition to continuing education nor do they, in principle, oppose formalization and documentation of the process. Despite the consensus which rejects the concept of involuntary reexamination and recertification, there is a recognition of a need for improved educational opportunities. This, I submit, is not born of fear, but rather of a
1 Presidential address delivered at the Sixtieth Scientific Assembly and Annual Meeting of the Radiological Society of North America, Chicadk go, III.,Dec. 1-6, 1974.
741
742
EDITORIAL
valid self-imposed determination to maintain and improve the quality of our professionalism. It is this intellectoal commitment to our professionalism which has been responsible for the development of the segment of medical practice which we know as radiology into a major aspect of medical care. All of these factors have resulted in an explosive demand for additional and new educational opportunities. Our response has been positive but, in our zeal to respond to the call for a greater educational effort, we have produced a relatively uncoordinated and sometimes chaotic educational process in radiology beyond the residency level. Uncoordinated and amorphous though it may be, we nevertheless have several rather well-defined segments emerging as educational entities. Numbered among these are our several radiological societies, each having viable programs of scientific paper presentations and refresher courses. Some have developed extension programs of audiovisual aids as well as extension lecture programs. The Radiological Society of North America, while not alone, is a prime example of this effort with its vast scientific program and its refresher course program which has no peer in radiological education. In addition, this year, we note the advent of the categorical course on the gastrointestinal tract pioneered by Dr. Sidney Nelson. It is to be hoped that this is a pattern for future development, for it is a rational approach to an orderly educational process. We have begun a program of extensive dissemination of information generated at our meetings in the scientific exhibit and refresher course areas through the development of our audiovisual aid programs utilizing slides and audio tapes. In a minor way we have sponsored extension of refresher courses by furnishing speakers to other societies. In a similar manner, the American Roentgen Ray Society has developed somewhat parallel programs. The American College of Radiology which has, as a part of its defined mission, the encouragement of contimJing education has entered the arena with the development of programs such as the teaching seminar and "black lung" programs. These have been highly successful. The financial cooperation of the American Roentgen Ray Society, the American College of Radiology and the Radiological Society of North America has permitted what hopefully will be a revitalized and valid educational effort for residents and practitioners through the Armed Forces Institute of Pathology. The universities and clinics of America have been in the forefront of continuing education, utilizing the "course" concept extending in time from one day to one week. In a sense, these have been of the categorica I type as they have tended to be confined to a single subject. One of the earliest and most successful of these was the course developed by the University of
March 1975
Minnesota. Today, a week does not go by that a formal nationally advertised course does not take place somewhere in this country. Seemingly each day we receive an announcement of another. We have a veritable plethora of these courses and still the market appears insatiable. Community hospitals have not been resistent to the lure and have, by drawing upon the resources of educational institutions, been able to mount creditable programs. It is interesting to note at this point that a change in venue to a resort area far removed from the parent institution has at times been a significant attendance factor or at least used as a lure. The self-evaluation program of the American College of Radiology is noteworthy in concept and effectiveness. Enterprising commercial houses, some physiciansponsored, have come forth with a shower of audiovisual teaching materials in the form of slides, audio tapes, video cassettes and so forth. They have been of varying and at times undependable quality. Drug companies have been willing to sponsor educational movies and other teaching media, and in fact have pioneered in the development of educational movie and television programs. Their efforts have been helpful to radiology, but have been mainly in the areas of medicine or surgery and their subspecialties. In this category, however, drug houses are probably the largest contributors, for few others can afford these particular media. While our motives have been altruistic, although at times admittedly self and institutionally oriented, the problem has been compounded by financial motivation. Quite properly there is a greater demand by the teachers for compensation. Institutions have found these courses to be quite remunerative, inherently creating a desire to expand these activities. The commercial houses engaged in producing audiovisual aids have scented the bait and are pursuing it with vigor. Regardless of the motivation, the by-product of our motives has been an enormous and fruitful output of educational material. The flood of material has become a Whirlpool in which we grasp for a semblance of order. Some progress has been made with the introduction in 1968 of the American Medical Association Physicians Achievement Award. This is a significant step forward but falls short due to lack of specificity. An element of quality control is embodied through certification of institutions and organizations but fails to control the quality of the end product except for the rather tenuous assumption that a certified institution will produce quality material. As a part of our search for order, several organizations, including radiological societies and the American Medical Association, have developed elaborate schemes including computer programs serving as bookkeeping devices to certify attendance. In addition, there are those who would demand pre-
VoL 114
EDITORIAL
and post-attendance examinations as certification of attendance as well as attention and learning. It is fortunate indeed that we have many who oppose this approach. The efforts of all of the foregoing are to be applauded, for they are significant contributions to our continuing educational effort. Despite these positive steps, it is still possible for the radiologist to achieve the American Medical Association award with a potpourri of educational experiences entirely unrelated to radiology as there is no demand that the educational experiences be specialty-related. It is only with great personal diligence, and frequently at considerable expense, that one is able to pursue a balanced continuing educational program. What is seriously lacking, however, is any organization leading toward programmed instruction which will permit the generalist or subspecialist in radiology to renew and expand his fund of knowledge on an organized and continuing basis. Currently an attempt is being made to unify our effort to some degree by the Intersociety Educational Committee. While this may bring some unity to the organized societies, there remains a void with respect to the other educational entities to which I have alluded. It has not yet been able to control the quality of the courses being offered by universities and clinics nor, in fact, the programs of the societies. Clearly there is a need for a more organized approach to our goal of effective continuing education. It should be possible to evolve, through proper organizational effort, a graduated system whereby in an orderly fashion the physician can renew and improve his fund of knowledge. An appropriate solution could conceivably be the formation of a Radiological Educational Council composed initially of representatives of all radiological educational societies, societies purporting to represent medical schools and those representing group practices. The Council, once formed, would not be responsible to any of the contributing organizations, but rather would be relatively freestanding. The contributing societies would be responsible to the Council rather than the reverse. Such a Council could be responsible for developing a coordinated program of educational programs which would permit an orderly approach by the radiologist to a
743
complete review and advancement program in a spec fied period of years, possibly three or more. The concept would include correlation of all of the e ements of our continuing educational process, includin refresher courses, seminars, freestanding courses, sel evaluation programs and all of our audiovisual pre grams, commercial and otherwise. Commercial house could participate by seeking approval by the parer Council of their offerings. The Council could serve t monitor quality of the end product rather than the spor soring institution. The net effect would be a unified effective proces and an efficiency of effort eliminating much of the dupl cation of effort with which many of us are faced today It is imperative, in the light of a restrictive economy de veloping in the world, that we eliminate as much dupli cation of effort as possible, and that we become as effi cient as possible in the implementation of our educa tionaI effort. To as great a degree as possible we mus deliver our material to the radiologist rather than the re verse. It is evident that there must be, if such a program is to be effective, some subjugation of our nationalistic and chauvinistic instincts to the common purpose. I submit that the price of success in this regard is not inappropriate. Let us' not bow to the threats of those who woulc control us. There are many forces engaged in the struggle for the control of medicine who would control n01 only our practice, but our education as well. As physicians, we have always recognized a need for change and have responded accordingly. We will continue to do so. Control of professional activities by fiat is doomed to failure. We will control our practice and our education ourselves, for they are too important to be left to anyone other than physicians. The ultimate control of the profession must come from within. Toward this end we must abandon the computer as the arbiter of who shall enter the profession. Rather, we must attract men and women of intellectual competence who· will progress by virtue of their philosophies and conscience, rather than by direction of politicians. Lahey Clinic Foundation 605 Commonwealth Avenue Boston, Mass. 02115
