- Email: [email protected]
Creation of the American Board of Ophthalmology
Creation of the American Board of Ophthalmology The Role of the American Ophthalmological Society Thomas J. Liesegang, MD1,2 The American Ophthalmological Society (AOS) is 1 of the 3 founding organizations of the American Board of Ophthalmology (ABO), in addition to the Section on Ophthalmology of the American Medical Association and the American Academy of Ophthalmology and Otolaryngology. The early history of the AOS and its role in the founding of the ABO are addressed in this article. Ophthalmology 2016;123:S6-S7 ª 2016 by the American Academy of Ophthalmology.
Formation of the American Ophthalmological Society By 1864, ophthalmology was becoming a popular specialty, but there were no standards regarding training, qualifications, or competency. An early detailed history of the American Ophthalmological Society (AOS) was recorded by Wheeler,1 later enhanced by Newell,2 and most recently reported by Albert and Atzen.3 In January 1864, 7 prominent ophthalmologists from New York City and 1 from Boston met to consider how to counteract a controversial German immigrant who signed himself “Dr. Julius Homberger, Oculist.” Homberger was judged guilty of both advertising and promoting a “magazine” entitled the American Journal of Ophthalmology. He had been schooled in advertising directly under the tutelage of Albrecht von Graefe of Berlin. However, the conversation at the January 1864 meeting shifted to establishing a society. Pointed specifically at Homberger, this new AOS amended their constitution in 1868 to indicate that one could not declare himself an oculist or advertise in print; the AOS even expelled a member and some members resigned, but this amendment was enforced until 1929. Homberger continued to advertise in many cities and became an itinerant and outcast ophthalmologist, expelled from the American Medical Association (AMA). His journal was published from 1862 through 1864 and criticized most oculists of the day. The first meeting of the AOS was in June 1864 in association with the AMA meeting. This was the first specialist medical society in the United States and second in the world after the German Ophthalmological Society, founded in 1857. The AOS had only 19 members invited to join at the first meeting, but would grow to 199 members by the time the specialty was established by the American Board of Ophthalmology (ABO) in 1916. The AOS has met continuously over the past 151 years with additional requirements for admission, including ABO
S6
2016 by the American Academy of Ophthalmology Published by Elsevier Inc.
certification as early as 1920, and later an invitation, a thesis, and guidelines for meeting attendance. The transactions of the AOS have been published continuously since 1865, providing a rich record of the articles and of accurately recorded discussions of each annual meeting. Predating the major ophthalmic societies in the United States, the AOS was active in the formation of the American Academy of Ophthalmology and Otolaryngology (AAOO), the ABO, the Association of Vision Research and Ophthalmology, and the Ophthalmology Section of the AMA. The AOS worked with these organizations over the decades, with many leaders having positions in each organization as well as the ABO. Today, the approximately 360 AOS members play prominent roles in the legislative, political, and medical activities of several organizations. By 1962, there were 65 members of the ABO; all but 3 were AOS members.1
Role of the American Ophthalmological Society in Establishing the American Board of Ophthalmology American Ophthalmological Society member Judd Beach4 provided an oral and written perspective of the founding of the ABO at the 1938 AOS meeting. Prior minutes either were disappointingly discreet or lacking by the AOS, AAOO, or the AMA, whereas Beach had a contemporary perspective. The AMA frowned on specialization at the turn of the century; however, the burgeoning information about medical disease, the concentration of large populations in cities, and the development of new surgeries or medical treatments permitted or warranted a specialized practice.5 In the fall of 1908, there were 4 presentations at the AAOO meeting that addressed the need for cooperation in Statement of Potential Conflict of Interest and Funding/Support: See page S7. http://dx.doi.org/10.1016/j.ophtha.2016.06.012 ISSN 0161-6420/16
Liesegang
The Role of AOS
the specialty, including Derrick Vail’s president’s address suggesting formal ophthalmic training of sufficient duration in the United States or abroad. He and others suggested state legal registration. As pointed out by O’Day and Ladden,5 Vail may have been motivated more by a desire to protect ophthalmology from encroachment. Edward Jackson of Denver, a most prominent ophthalmologist and a leading member of AOS, AAOO, and AMA, formulated and directed more than anyone else the concrete plans for a specialization in ophthalmology. Education was always the central theme of Jackson’s crusade, including medical school and postgraduate training, culminating in a voluntary examination to confirm and prove to the public one’s competence. He believed that ophthalmology specialization should take place in university-associated training programs immediately after medical school, which in essence is the present-day model. There were 3 movements in ophthalmology in the early 1900s. The first was a movement for training family physicians in refraction. The second was the Committee on Optometry that published a report expressing disapproval of ophthalmologists who worked with optometrists as well as restricting use of the word doctor. The only successful movement was the training of ophthalmologists. In a 1911 lecture, Edward Jackson acknowledged that the failure to provide adequate teaching for ophthalmology was “responsible for the Optometry issue.”4 Based on successful experiments in Oxford and Liverpool, Jackson developed the Degree in Ophthalmology program at the University of Colorado in 1912, followed shortly by programs at the University of Pennsylvania and the University of Minnesota. However, there was no impetus for students to pursue this education. In 1913, the AOS formed a committee comprising George de Schweinitz of Philadelphia, Edward Jackson of Denver, Myles Standish of Boston, Samuel Risley of Philadelphia, and John Weeks of New York to formulate standards for the Degree in Ophthalmology.4 They also provided for a thesis and an examination. In 1913, the 3 national organizations formed a joint committee to explore the issue of postgraduate training and certification in ophthalmology. Edward Jackson was appointed from the AMA, George de Schweinitz from the AOS, and Wendell Reber from the AAOO, along with additional members from the 3 organizations. The joint
committee assessed 3 needs: proper facilities for graduate training, testing the qualifications, and inducing candidates to take an examination. Edward Jackson, Walter Lancaster, and Wendell Reber carried out continuous communications as the primary movers of the committee. Jackson was Chair of the Section, so in June 1914, the committee presented the concept of a board to the AMA. The Royal College of Surgeons and the Royal College of Physicians in London already were conducting certification examinations. There was the anticipated discussion, but the report of the committee was accepted by the AMA, the AOS, and the AAOO in 1915 and resulted in the organization of what is now the ABO. This then compelled universities to formulate a curriculum. Initially, some individuals (almost all AOS members) were granted a board certificate without an actual examination on the basis of their merits or record, which obviously disturbed some. By 1920, all new AOS members were required to have board certification, and by 1921, all new AAOO members had to have certification. The AMA required certification of all who held leadership positions in the AMA.
References 1. Wheeler MC. The American Ophthalmological Society: the first hundred years. Toronto, Canada: University of Toronto Press; 1964. Available at: http://www.aosonline.org/history/wheeler/ wheeler_links.html. Accessed January 25, 2016. 2. Newell FW. The American Ophthalmological Society 1864e1989: a continuation of Wheeler’s first hundred years. Rochester, MN: Johnson Printing Company; 1989. Available at: http://www.aosonline.org/history/newell/newell_links.html. Accessed January 25, 2016. 3. Albert DM, Atzen SL. The sesquicentennial of the American Ophthalmological Society: our mission continues. San Francisco, CA: The American Ophthalmological Society; 2014. Available at: http://aosonline.org/history/AOS_Sesquicentennial_Book. pdf. Accessed January 25, 2016. 4. Beach SJ. American ophthalmology grows up: turbulent years from 1908e1915. Trans Am Ophthalmol Soc 1938;35:221–6. 5. O’Day DM, Ladden MR. The influence of Derrick T. Vail Sr., MD, and Edward M. Jackson, MD, on the creation of the American Board of Ophthalmology and the specialist board system in the United States. Arch Ophthalmol 2012;130:224–32.
Footnotes and Financial Disclosures Originally received: April 18, 2016. Final revision: June 3, 2016. Accepted: June 3, 2016.
Analysis and interpretation: Liesegang Manuscript no. 2016-799.
1
American Ophthalmological Society, San Francisco, California.
2
Department of Ophthalmology Mayo Clinic, Jacksonville, Florida.
Presented at: American Board of Ophthalmology 100th Anniversary Symposium, March 2016, San Francisco, California. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Author Contributions:
Data collection: Liesegang Obtained funding: none Overall responsibility: Liesegang Abbreviations and Acronyms: AAOO ¼ American Academy of Ophthalmology and Otolaryngology; ABO ¼ American Board of Ophthalmology; AMA ¼ American Medical Association; AOS ¼ American Ophthalmological Society. Correspondence: Thomas J. Liesegang, MD, 24517 Deer Trace Dr, Ponte Vedra, FL 32082. E-mail: [email protected].
Conception and design: Liesegang
S7
Formation of the American Ophthalmological Society By 1864, ophthalmology was becoming a popular specialty, but there were no standards regarding training, qualifications, or competency. An early detailed history of the American Ophthalmological Society (AOS) was recorded by Wheeler,1 later enhanced by Newell,2 and most recently reported by Albert and Atzen.3 In January 1864, 7 prominent ophthalmologists from New York City and 1 from Boston met to consider how to counteract a controversial German immigrant who signed himself “Dr. Julius Homberger, Oculist.” Homberger was judged guilty of both advertising and promoting a “magazine” entitled the American Journal of Ophthalmology. He had been schooled in advertising directly under the tutelage of Albrecht von Graefe of Berlin. However, the conversation at the January 1864 meeting shifted to establishing a society. Pointed specifically at Homberger, this new AOS amended their constitution in 1868 to indicate that one could not declare himself an oculist or advertise in print; the AOS even expelled a member and some members resigned, but this amendment was enforced until 1929. Homberger continued to advertise in many cities and became an itinerant and outcast ophthalmologist, expelled from the American Medical Association (AMA). His journal was published from 1862 through 1864 and criticized most oculists of the day. The first meeting of the AOS was in June 1864 in association with the AMA meeting. This was the first specialist medical society in the United States and second in the world after the German Ophthalmological Society, founded in 1857. The AOS had only 19 members invited to join at the first meeting, but would grow to 199 members by the time the specialty was established by the American Board of Ophthalmology (ABO) in 1916. The AOS has met continuously over the past 151 years with additional requirements for admission, including ABO
S6
2016 by the American Academy of Ophthalmology Published by Elsevier Inc.
certification as early as 1920, and later an invitation, a thesis, and guidelines for meeting attendance. The transactions of the AOS have been published continuously since 1865, providing a rich record of the articles and of accurately recorded discussions of each annual meeting. Predating the major ophthalmic societies in the United States, the AOS was active in the formation of the American Academy of Ophthalmology and Otolaryngology (AAOO), the ABO, the Association of Vision Research and Ophthalmology, and the Ophthalmology Section of the AMA. The AOS worked with these organizations over the decades, with many leaders having positions in each organization as well as the ABO. Today, the approximately 360 AOS members play prominent roles in the legislative, political, and medical activities of several organizations. By 1962, there were 65 members of the ABO; all but 3 were AOS members.1
Role of the American Ophthalmological Society in Establishing the American Board of Ophthalmology American Ophthalmological Society member Judd Beach4 provided an oral and written perspective of the founding of the ABO at the 1938 AOS meeting. Prior minutes either were disappointingly discreet or lacking by the AOS, AAOO, or the AMA, whereas Beach had a contemporary perspective. The AMA frowned on specialization at the turn of the century; however, the burgeoning information about medical disease, the concentration of large populations in cities, and the development of new surgeries or medical treatments permitted or warranted a specialized practice.5 In the fall of 1908, there were 4 presentations at the AAOO meeting that addressed the need for cooperation in Statement of Potential Conflict of Interest and Funding/Support: See page S7. http://dx.doi.org/10.1016/j.ophtha.2016.06.012 ISSN 0161-6420/16
Liesegang
The Role of AOS
the specialty, including Derrick Vail’s president’s address suggesting formal ophthalmic training of sufficient duration in the United States or abroad. He and others suggested state legal registration. As pointed out by O’Day and Ladden,5 Vail may have been motivated more by a desire to protect ophthalmology from encroachment. Edward Jackson of Denver, a most prominent ophthalmologist and a leading member of AOS, AAOO, and AMA, formulated and directed more than anyone else the concrete plans for a specialization in ophthalmology. Education was always the central theme of Jackson’s crusade, including medical school and postgraduate training, culminating in a voluntary examination to confirm and prove to the public one’s competence. He believed that ophthalmology specialization should take place in university-associated training programs immediately after medical school, which in essence is the present-day model. There were 3 movements in ophthalmology in the early 1900s. The first was a movement for training family physicians in refraction. The second was the Committee on Optometry that published a report expressing disapproval of ophthalmologists who worked with optometrists as well as restricting use of the word doctor. The only successful movement was the training of ophthalmologists. In a 1911 lecture, Edward Jackson acknowledged that the failure to provide adequate teaching for ophthalmology was “responsible for the Optometry issue.”4 Based on successful experiments in Oxford and Liverpool, Jackson developed the Degree in Ophthalmology program at the University of Colorado in 1912, followed shortly by programs at the University of Pennsylvania and the University of Minnesota. However, there was no impetus for students to pursue this education. In 1913, the AOS formed a committee comprising George de Schweinitz of Philadelphia, Edward Jackson of Denver, Myles Standish of Boston, Samuel Risley of Philadelphia, and John Weeks of New York to formulate standards for the Degree in Ophthalmology.4 They also provided for a thesis and an examination. In 1913, the 3 national organizations formed a joint committee to explore the issue of postgraduate training and certification in ophthalmology. Edward Jackson was appointed from the AMA, George de Schweinitz from the AOS, and Wendell Reber from the AAOO, along with additional members from the 3 organizations. The joint
committee assessed 3 needs: proper facilities for graduate training, testing the qualifications, and inducing candidates to take an examination. Edward Jackson, Walter Lancaster, and Wendell Reber carried out continuous communications as the primary movers of the committee. Jackson was Chair of the Section, so in June 1914, the committee presented the concept of a board to the AMA. The Royal College of Surgeons and the Royal College of Physicians in London already were conducting certification examinations. There was the anticipated discussion, but the report of the committee was accepted by the AMA, the AOS, and the AAOO in 1915 and resulted in the organization of what is now the ABO. This then compelled universities to formulate a curriculum. Initially, some individuals (almost all AOS members) were granted a board certificate without an actual examination on the basis of their merits or record, which obviously disturbed some. By 1920, all new AOS members were required to have board certification, and by 1921, all new AAOO members had to have certification. The AMA required certification of all who held leadership positions in the AMA.
References 1. Wheeler MC. The American Ophthalmological Society: the first hundred years. Toronto, Canada: University of Toronto Press; 1964. Available at: http://www.aosonline.org/history/wheeler/ wheeler_links.html. Accessed January 25, 2016. 2. Newell FW. The American Ophthalmological Society 1864e1989: a continuation of Wheeler’s first hundred years. Rochester, MN: Johnson Printing Company; 1989. Available at: http://www.aosonline.org/history/newell/newell_links.html. Accessed January 25, 2016. 3. Albert DM, Atzen SL. The sesquicentennial of the American Ophthalmological Society: our mission continues. San Francisco, CA: The American Ophthalmological Society; 2014. Available at: http://aosonline.org/history/AOS_Sesquicentennial_Book. pdf. Accessed January 25, 2016. 4. Beach SJ. American ophthalmology grows up: turbulent years from 1908e1915. Trans Am Ophthalmol Soc 1938;35:221–6. 5. O’Day DM, Ladden MR. The influence of Derrick T. Vail Sr., MD, and Edward M. Jackson, MD, on the creation of the American Board of Ophthalmology and the specialist board system in the United States. Arch Ophthalmol 2012;130:224–32.
Footnotes and Financial Disclosures Originally received: April 18, 2016. Final revision: June 3, 2016. Accepted: June 3, 2016.
Analysis and interpretation: Liesegang Manuscript no. 2016-799.
1
American Ophthalmological Society, San Francisco, California.
2
Department of Ophthalmology Mayo Clinic, Jacksonville, Florida.
Presented at: American Board of Ophthalmology 100th Anniversary Symposium, March 2016, San Francisco, California. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Author Contributions:
Data collection: Liesegang Obtained funding: none Overall responsibility: Liesegang Abbreviations and Acronyms: AAOO ¼ American Academy of Ophthalmology and Otolaryngology; ABO ¼ American Board of Ophthalmology; AMA ¼ American Medical Association; AOS ¼ American Ophthalmological Society. Correspondence: Thomas J. Liesegang, MD, 24517 Deer Trace Dr, Ponte Vedra, FL 32082. E-mail: [email protected].
Conception and design: Liesegang
S7