Guilds, boards, and hobgoblins.

Abstract

The American specialty board system is viewed in the historical perspective of a quest for quality assessment of surgical trainees. Beginning with the American Board for Ophthalmic Examinations in 1916, a system of 22 boards has developed which, by their training requirements and examinations, essentially dictate the length and content of all postgraduate educational programs. The time has come for the boards, as a powerful force in postgraduate education and in organized medicine, to reassess their position and to be sensitive to the responsibilities they have for the future. The events of history suggest six changes that might be profitable. (1) Recognize their purpose to be broader than the administration of certifying examinations. (2) Recognize that the certificate is now a license, and deal squarely with this issue. (3) Initiate and support needed medical reforms while the private sector can still do so. (4) Assume a leadership role in the shaping and future direction of graduate medical education. (5) Relinquish a degree of autonomy in order to strengthen the American Board of Medical Specialties. (6) Define their place in the medical scene and reorganize their board structures accordingly. The primary responsibility of the boards should be to make certain all aspects of resident training in approved programs are sound. Long-range goals should be the elimination of the certifying examination, and public recognition and approval of specialty status attainment.