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The American Board of Obstetrics and Gynecology
THE AMERICAN
BOARD
Its Origin,
OF OBSTETRICS
AND GYNECOLOGY
Progress, and Accomplishments
WALTER T. DANNREUTHER,
M.D., F.A.C.S., NEW YORK, N. Y.
T
HE American Board of Obstetrics and Gynecology was organized with the intent of supervising, not controlling, the practice of obstetrics and gynecology by specialists, and will have functioned for a quarter of a century within the next few months. Prior to the formation of the specialty boards, there were numerous self-appointed specialists and the public was accustomed to ask who is a specialist rather than to inquire what a specialist is. There were no criteria whereby either t.he lay or medical public could distinguish between those who were well qualified and those who were not, and the justification for the establishment of standards to fix the requirements for legitimate specialization appeared to be self-evident. In September, 192’7, I introduced a resolution at the meeting of the American Association of Obstetricians, Gynecologists and Abdominal Surgeons in Asheville, North Carolina, providing for the appointment of a committee on standardization of requirements for specialists in obstetrics and gynecology and suggesting the designation of a similar committee by the American Gynecological Society. The primary function of these committees was to consider ways and means for the organization of a.n American Board of Obstetrics and Gynecology. In May, 1926, the American Gynecological Society appointed its committee and in September of that year the two committees met in Toronto, C’anada, and proposed the election of nine members; three by the American Association of Obstetricians, Gynecologists and Abdominal Surgeons, three by the American Gynecological Society, and three by the Section on Obstetrics, Gynecology, and Abdominal Surgery of the American Medical Association. The committee’s formal report included a st,atement of the objectives of the Board, the general requirements for a,pplicants, and a provision for the esamina.tion of voluntary candidates and the certification of those found qualified. In July, 1929, I introduced another resolution at the meeting of the Section on Obstetrics, Gynecology, and Abdominal Surgery of the American Medical Association in Portland, Oregon, committing the Section to rooperate in the establishment of the Board, which was unanimously adopted. Shortly therea,fter application was made to t,he State of Delaware for a Certificate of Incorporation which was granted and filed in the Secretary of State’s office on Sept. 12, 1930. The three original incorporators were Grace B. Little, Murray R. Spies, and Reed B. Dawson, all of New York. Mr. Dawson has served as the Board’s counsel throughout its entire existence. The R~ard held its organization meet,ing and a.dopted its By-Laws at the (General Brock Hotel in Niagara Falls, C!anada, on Sept. 14, 1930, with the 15
16
l)ANPL’REUTHEIt
\,t7 I. Oli\l. s G)llCl Icriv, 1’15i
01’ New J-ark, 1)~. following members present : I)r. Walter 1’. I)annreuther Paul Titus of Pittsburgh, and Dr. f?rfIndiStJIl 1). Koystoll of’ St. hk. ~flo (~:yrl(t,.ologists it rl(l represented the American Association of Ohstet’ricians, AbdorninaI Surgectns ; Ik. .Jennings f ‘. T,itzcnherg of Minneal)olis. 1)r. *l(~sc!l)h 1,. Baer of Chicago, and Dr. Edward A. Schurnnun of Philadelphia. M.ho reFsented the American Gynecological Hociet.y ; and Dr. Fred 1,. Aclwir OL’ (-‘hicw~. iIll(l I>r. ET’CYClt .I). PlilSS Of Dr. Robert 1). Mussey of Rochester. Minnesota, lowa City, who represented the Section on Obstetrics, (:~~c(~logy, :tu(l Abdominal Surgery of the Americ;ln RIedicdal Association, wit.h Mr. J)aws(lll present as legal adviser. 14t this mt*cxting, the Board voted to illvile SOIII(~ two hundred obstetricians and gynecologists who were I’ellows IJ~’ ow ()I’ the two National societies or held professorial tit,les in the medical schr)ols to :tppl? for certification wit.hout examinat,ion. This list was supplemented with atlditional names until December, 1931. since when all applicants hn.~c~ bt~n suljjetted to examination regardless of their 1)roEessioual position. Members of the Board automatically become Directors of the (!arporat,ion, each with the same rights, privileges, and rrsponsibilities. The sole reason Siuce the for electing officers is for the orderly transaction of business. foundation of the Board, all of the original n~r~~llww hut. one have retirc(l There have been twelve such or resigned and have been replaced by others. All Board members havt> hrld professoria.1 positions anIl changes to date. have served without compensation except for espcnses and a modest honorarium paid to the Secretary. Having been conceived in idealism and horn into the world as a result of hard labor, the Board’s further activities proceeded from the Articles 01’ T~Icorporation which st.ate that t,he chief purposes of the Board arc “To rncontSngcL the study, improve the practice, and advance t,hr cause of obstetrics ilntl gynecology, subjects which should be inseparably interwoven : allcl to grant and to issue to physicians, duly licensed by law, certificates or other eqniv:~lenl recognition of special knowledge of obstetrics and gynecology. ” The Board promptly instituted a survey of the existiug facilities for postgratluatr 1raitting in obstetrics and gynecology. undertook to persuade hospitals anal rlleclic*;11 schools to provide adequately for such training, outlined the qualificaticms that obstetricians and gynecologists should hal-c before announcing thenselves as speciadists, and endeavored by every means possible to irlc+ulcat,r the idea that obstetrics and gynecology are but two phases of the sattIc> specia.1t.v a,nd shoultl be cnmhinetl in a single departmeut, The Boartl has ;ll~~il.~s I*(‘quired that an applicn.nt be of high ethical and professional standillp, that hr have not less than three years of formal residency ill the sl)eci;l]ty aff-er the completion of a.n internship. a.t least minimal bilateral training. il~tt[ ;I, knowedge of the fundamentals of both obstetrics ant1 gynecology. fIe 1t1nst nlso have some experience in private pr;Ic’tic,c, IW acdcepted by his lo~+aI (.olleil~u(~s as a competent pra.ctitioner of the speGlt~*, allrl as~urc th(l lioi1r11 that h(a limits his practice and intends t,o continue to (10 SO. 111 some quarters the motives of’ the Board were viewed with suspicion and considerable skepticism and it.s personnel was mistaken for a se] f-ap~~oi~lt,~(l
\‘olume 68 Number
I
AMERICAN
BOARD
OF OBSTETRICS
AND GYNECOLOGY
17
autocratic group who presumed to dictate to the profession. Sporadic instances of adverse criticism and hostility had to be overcome, and in this campaign four stalwart characters, Dr. George W. Kosmak of New York, Dr. John 0. Polak of Brooklyn, Dr. C. Jeff Miller of ?Sew Orleans, and Dr. Frank ‘MT. Lynch of San Francisco were of tremendous help. Dr. Kosmak’s ent’husiastic support from the inception of the Board has been invaluable, as he was instrumental in having The C. V. ?rZosby Company assent to making the hERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY the official organ of the Board, and has always accepted its publicity for monthly publication in the JOURNAL.
The first written examination was held on March 13, 1931, and the first oral, clinical, and pathological examination was given in the Philadelphia General Hospital on May 6, 1931. There were 79 candidates, of whom 65 were successful, and it is interesting to note that one of the latter group is presently a member of the Board. With the addition of these to the 156 who had already accepted cert,ificates without examination, the Board had 221 diplomates in 1931, contrasted with the 3,908 it has now. In the early days of its operation the Board conducted its examinations in hospitals and utilized patients to test the candidates’ clinical ability, but this custom had to bc discontinued after the number of candidates became unwieldy. The hospitals were uniformly rourteous and cooperative, but it was obvious that the influx of so many people at one time was disrupting their routine work. Until recently the Board has met in various cities, usually at or near the time of the meeting of the American Medical Association, but it has now decided to meet each year in Chicago because that city is easily accessible from all parts of the country and because a permanent set of microscopic slides and gross pathological specimens can more conveniently be maintained in one place. It certainly is not unduly exacting to expect one who professes to be expert in the diseasesof a limited field to be familiar with the intrinsic pathologic alterations in the tissues involved, but there is no doubt that before the Board required a knowledge of the pathology of thi: common obstetric abnormalities and pelvic diseases and neoplasms many obstetricians and gynecologists were quite indifferent in this respect. As a result of the stressing of pathology in the examinations it is probable that, the specialists certified by this Board know as much of this subject pertaining to their specialty as any other clinical group in the country. In the beginning the oral, clinical, and pathological examinations were given by the nine Board members alone. As the member of applicants increased it became apparent that this was an impossible task, SO since 1938 an additional group of fifty-three different assistant examiners has been enlisted to participate. In 1953 sixteen additional examiners were needed for the grading of 357 candidates. This practice has served to broaden the Board members points of view as examiners and familiarized many of the leaders of our specialty with the Board’s procedures. The Board has repeatedly refused to sponsor or lend its support to extraneous activities in the field of obstetrics and gynecology, adhering strictly to the principle that its sole businessis to put the stamp of approval on qualified
18 It has aJs(j often Jxyij ititportlInrt1 lo waive its I’f~~lt~i1’(~I~i~~1~1 1’01, of practice, hut, has firtl~ly cwJlt~~JJtlcv1 that c’SJ)c’lTJlNs ill ;I specialty cannot. logicall,v bc combiiic*tl wit11 c*oniI)arati\-c> mc~tlio(~f4~ iri 0111(‘1. branches of medicine. It has consist.c~lly rcfnserl to lower its lW)lli IwlWl~ts cc)J’ eligibility so that its certificate might be accel)te(l as a rcliablc ~~J~i~c~t~iOll I’oJ’ 1 IIt* Not. Long &gl, tJ+r1ncmdo1ts ~‘l”‘“S”l”’ \VilS identification of a capable specialist. brought to boar to accept as eanditlatt1s a small number of skillful pelvic Slit’on the supur-radical treatment r~l’ pelvic: maliEh‘reons who wcrc c*onrentrating nancies but who were ineligible because thev la&cd ol)strtrica I t Viiining. It seems questionable that a pelvic SUJ~~WJI~ JIO JlGlttc’t’ IJow skillful, nho has Itilt II’) obstetrical expcriencc can have tlic ~)i’opt’r’ pclrspec.tive wlicn operatitrc on wJllN1 in the childbearing period. Alt,hough separate certification in obst.ctrics and ggnecolog,V was &bated ;I1 lengt.11 at the organization meeting in 1930 and has been under consideration from time to time since then, after a full discussion it had always hec~l rcj~+ctl until 1951. The Board then made a concession to those who had been graduated hefore 1939, who had confined their practice to obstetrics or gync~log,v for fivcl years immediately prior to application, and who would surrender and relinquish TO any certificate they might hold from one of the other specia1t.v boards. date only nine obstetricians and six ggneqologists hold unilateral ccrtificntes. The members of the Board have unanimously believed that Ihe intelligenl practice of gynecologJ7, which is 80 per cent. nonoperative, depends in a farg~x part upon a thorough knowledge of obstetrics, and vice versa. The final conclusion after many arguments in each instance has been that indiscriminate unilateral certification would compromise the Board’s efforts to encourage the t,raining of all residents in both branches and thus indireetlp Imtlcrntillc~ ifs other objectives.
specialists. strict
1iJJlitatioJJ
The progress made by the Board is exemplified in many ways. Not only has all hostility and antagonism to the Board’s purposes disappeared, but some seventy-five professors of obstetrics and gyneco1og.y have volunteered their timr and efforts t.o its work. Mushroom specialists are now practically nonexistent. There can be little doubt that the principles on which the Board functions have promoted the unification or at least the correlation of obstetrics and gynecology in a substantial additional number of medical schools and hospitals, and that the cumulative trend toward such a.malgamations is still gaining momentum. As a result of this transition, a const,antly growing percentage of potential specialist,s is being exposed to better basic training in both branches. Many pre-existing residencies have been lengthened and new ones careat.cd, 1~11 despite this amplification of educational facilities. the availahlc residencies, which are approved jointly by the Council on Medical Education and Hospitals of the American Medic.al Association and the Board’s Committee on (iraduate Education, arc still inadequate in number. Ttl 1931. there were X3 approved residencies in obstetrics and gynecology, including 170 positions; iI) 1953 ther(L were 414 residencies, including 1,728 positions. The Board thcret’orxr is empelled to continue making some provision for preceptorship training and lo
\~ol,,mcDR
AMERICAN
Pumber I
BOARD
OE‘ OBSTETRICS
AND
GYNECOT,OGY
19
accept postgraduate apprenticeship and clinical experience under approved supervision in lieu of part of the required formal training in some instances, much against its inclination. Aspirants for certification realize that they must prepare themselves thoroughly before presenting t,hemselves, which stimulates them to compile good obstetrical and gynecological records, to read and to study, to attend medical meetings, to take postgraduate courses, and otherwise to augment their qualifications so that they may pass their examinations, habit,s which are likely t,o persist throughout their professional lives. The Board also demands that a candidate must acquire sufficient experience in private practice before seeking recognition as a specialist, because unless he practices for a reasonable time on his own responsibility his integrity and ability as a practitioner cannot be determined. In 1931 there were 79 candidates for examination; in 1953 there were 357; and the diplomates to date* number 3,908. During World War II the Armed Forces adopted certification by one of the specialty boards as their standard for specialty qualification. It also seems quite natural that medical schools, hospitals, and special societies should evaluate for themselves the significance of certification and utilize it as they choose, but it should be distinctly understood that whatever a&ion has been taken in this respect has been entirely spontaneous and has originated outside the hoards. The definite reduction during the past twenty-five years in the previous inexcusably high mat,ernal mortalit,y rate has in all likelihood been due to the fact t.hat hospitals have t,ended to enforce more obstetrical consultations and to impose restrictions on inexperienced obstetricians. It wo~dcl be presumptuous and unwarranted to imply that, all of t,he advances in obstetrical education and pract,ice during the past twenty-five years have been due to the accomplishments of the Board, but that it has exerted a powerful influence for good and has had a salutary effect on the elevation of obstetrics and gynecology as a specialty must be conceded. The members of the Board have t,ricd to exercise their best judgrnent~ at all times, regardless of censure or applause.
References 1. ‘:. n. 1. 5. 6.
DallllrcYlthc~r, I)annrel~t,her, Dannreuther, Dannreuther, Dannreuther,
waltzer Walter Walter Walter IValter Walter
580
AVENUE
Dannreuther,
PARK
*Exclusive
of 1954
.T. OBST. & GYNEC. 1’. : ibf. T.: .T. A. M. A. 96: 797, 1031. Ahr. J. 0~~1’. & GYNEC. 25: T.: T.: ;r. A. M. A. 120: 169, 1942. AM. .T. OBST. Bc GYNEC. 61: T.: ARI. J. OBS~‘. & GYNEC. 64: T.:
diplomates.
18:
s!f5,
165,
1933.
465, 713,
1951. 1952.
l!)“!).
BOARD
Its Origin,
OF OBSTETRICS
AND GYNECOLOGY
Progress, and Accomplishments
WALTER T. DANNREUTHER,
M.D., F.A.C.S., NEW YORK, N. Y.
T
HE American Board of Obstetrics and Gynecology was organized with the intent of supervising, not controlling, the practice of obstetrics and gynecology by specialists, and will have functioned for a quarter of a century within the next few months. Prior to the formation of the specialty boards, there were numerous self-appointed specialists and the public was accustomed to ask who is a specialist rather than to inquire what a specialist is. There were no criteria whereby either t.he lay or medical public could distinguish between those who were well qualified and those who were not, and the justification for the establishment of standards to fix the requirements for legitimate specialization appeared to be self-evident. In September, 192’7, I introduced a resolution at the meeting of the American Association of Obstetricians, Gynecologists and Abdominal Surgeons in Asheville, North Carolina, providing for the appointment of a committee on standardization of requirements for specialists in obstetrics and gynecology and suggesting the designation of a similar committee by the American Gynecological Society. The primary function of these committees was to consider ways and means for the organization of a.n American Board of Obstetrics and Gynecology. In May, 1926, the American Gynecological Society appointed its committee and in September of that year the two committees met in Toronto, C’anada, and proposed the election of nine members; three by the American Association of Obstetricians, Gynecologists and Abdominal Surgeons, three by the American Gynecological Society, and three by the Section on Obstetrics, Gynecology, and Abdominal Surgery of the American Medical Association. The committee’s formal report included a st,atement of the objectives of the Board, the general requirements for a,pplicants, and a provision for the esamina.tion of voluntary candidates and the certification of those found qualified. In July, 1929, I introduced another resolution at the meeting of the Section on Obstetrics, Gynecology, and Abdominal Surgery of the American Medical Association in Portland, Oregon, committing the Section to rooperate in the establishment of the Board, which was unanimously adopted. Shortly therea,fter application was made to t,he State of Delaware for a Certificate of Incorporation which was granted and filed in the Secretary of State’s office on Sept. 12, 1930. The three original incorporators were Grace B. Little, Murray R. Spies, and Reed B. Dawson, all of New York. Mr. Dawson has served as the Board’s counsel throughout its entire existence. The R~ard held its organization meet,ing and a.dopted its By-Laws at the (General Brock Hotel in Niagara Falls, C!anada, on Sept. 14, 1930, with the 15
16
l)ANPL’REUTHEIt
\,t7 I. Oli\l. s G)llCl Icriv, 1’15i
01’ New J-ark, 1)~. following members present : I)r. Walter 1’. I)annreuther Paul Titus of Pittsburgh, and Dr. f?rfIndiStJIl 1). Koystoll of’ St. hk. ~flo (~:yrl(t,.ologists it rl(l represented the American Association of Ohstet’ricians, AbdorninaI Surgectns ; Ik. .Jennings f ‘. T,itzcnherg of Minneal)olis. 1)r. *l(~sc!l)h 1,. Baer of Chicago, and Dr. Edward A. Schurnnun of Philadelphia. M.ho reFsented the American Gynecological Hociet.y ; and Dr. Fred 1,. Aclwir OL’ (-‘hicw~. iIll(l I>r. ET’CYClt .I). PlilSS Of Dr. Robert 1). Mussey of Rochester. Minnesota, lowa City, who represented the Section on Obstetrics, (:~~c(~logy, :tu(l Abdominal Surgery of the Americ;ln RIedicdal Association, wit.h Mr. J)aws(lll present as legal adviser. 14t this mt*cxting, the Board voted to illvile SOIII(~ two hundred obstetricians and gynecologists who were I’ellows IJ~’ ow ()I’ the two National societies or held professorial tit,les in the medical schr)ols to :tppl? for certification wit.hout examinat,ion. This list was supplemented with atlditional names until December, 1931. since when all applicants hn.~c~ bt~n suljjetted to examination regardless of their 1)roEessioual position. Members of the Board automatically become Directors of the (!arporat,ion, each with the same rights, privileges, and rrsponsibilities. The sole reason Siuce the for electing officers is for the orderly transaction of business. foundation of the Board, all of the original n~r~~llww hut. one have retirc(l There have been twelve such or resigned and have been replaced by others. All Board members havt> hrld professoria.1 positions anIl changes to date. have served without compensation except for espcnses and a modest honorarium paid to the Secretary. Having been conceived in idealism and horn into the world as a result of hard labor, the Board’s further activities proceeded from the Articles 01’ T~Icorporation which st.ate that t,he chief purposes of the Board arc “To rncontSngcL the study, improve the practice, and advance t,hr cause of obstetrics ilntl gynecology, subjects which should be inseparably interwoven : allcl to grant and to issue to physicians, duly licensed by law, certificates or other eqniv:~lenl recognition of special knowledge of obstetrics and gynecology. ” The Board promptly instituted a survey of the existiug facilities for postgratluatr 1raitting in obstetrics and gynecology. undertook to persuade hospitals anal rlleclic*;11 schools to provide adequately for such training, outlined the qualificaticms that obstetricians and gynecologists should hal-c before announcing thenselves as speciadists, and endeavored by every means possible to irlc+ulcat,r the idea that obstetrics and gynecology are but two phases of the sattIc> specia.1t.v a,nd shoultl be cnmhinetl in a single departmeut, The Boartl has ;ll~~il.~s I*(‘quired that an applicn.nt be of high ethical and professional standillp, that hr have not less than three years of formal residency ill the sl)eci;l]ty aff-er the completion of a.n internship. a.t least minimal bilateral training. il~tt[ ;I, knowedge of the fundamentals of both obstetrics ant1 gynecology. fIe 1t1nst nlso have some experience in private pr;Ic’tic,c, IW acdcepted by his lo~+aI (.olleil~u(~s as a competent pra.ctitioner of the speGlt~*, allrl as~urc th(l lioi1r11 that h(a limits his practice and intends t,o continue to (10 SO. 111 some quarters the motives of’ the Board were viewed with suspicion and considerable skepticism and it.s personnel was mistaken for a se] f-ap~~oi~lt,~(l
\‘olume 68 Number
I
AMERICAN
BOARD
OF OBSTETRICS
AND GYNECOLOGY
17
autocratic group who presumed to dictate to the profession. Sporadic instances of adverse criticism and hostility had to be overcome, and in this campaign four stalwart characters, Dr. George W. Kosmak of New York, Dr. John 0. Polak of Brooklyn, Dr. C. Jeff Miller of ?Sew Orleans, and Dr. Frank ‘MT. Lynch of San Francisco were of tremendous help. Dr. Kosmak’s ent’husiastic support from the inception of the Board has been invaluable, as he was instrumental in having The C. V. ?rZosby Company assent to making the hERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY the official organ of the Board, and has always accepted its publicity for monthly publication in the JOURNAL.
The first written examination was held on March 13, 1931, and the first oral, clinical, and pathological examination was given in the Philadelphia General Hospital on May 6, 1931. There were 79 candidates, of whom 65 were successful, and it is interesting to note that one of the latter group is presently a member of the Board. With the addition of these to the 156 who had already accepted cert,ificates without examination, the Board had 221 diplomates in 1931, contrasted with the 3,908 it has now. In the early days of its operation the Board conducted its examinations in hospitals and utilized patients to test the candidates’ clinical ability, but this custom had to bc discontinued after the number of candidates became unwieldy. The hospitals were uniformly rourteous and cooperative, but it was obvious that the influx of so many people at one time was disrupting their routine work. Until recently the Board has met in various cities, usually at or near the time of the meeting of the American Medical Association, but it has now decided to meet each year in Chicago because that city is easily accessible from all parts of the country and because a permanent set of microscopic slides and gross pathological specimens can more conveniently be maintained in one place. It certainly is not unduly exacting to expect one who professes to be expert in the diseasesof a limited field to be familiar with the intrinsic pathologic alterations in the tissues involved, but there is no doubt that before the Board required a knowledge of the pathology of thi: common obstetric abnormalities and pelvic diseases and neoplasms many obstetricians and gynecologists were quite indifferent in this respect. As a result of the stressing of pathology in the examinations it is probable that, the specialists certified by this Board know as much of this subject pertaining to their specialty as any other clinical group in the country. In the beginning the oral, clinical, and pathological examinations were given by the nine Board members alone. As the member of applicants increased it became apparent that this was an impossible task, SO since 1938 an additional group of fifty-three different assistant examiners has been enlisted to participate. In 1953 sixteen additional examiners were needed for the grading of 357 candidates. This practice has served to broaden the Board members points of view as examiners and familiarized many of the leaders of our specialty with the Board’s procedures. The Board has repeatedly refused to sponsor or lend its support to extraneous activities in the field of obstetrics and gynecology, adhering strictly to the principle that its sole businessis to put the stamp of approval on qualified
18 It has aJs(j often Jxyij ititportlInrt1 lo waive its I’f~~lt~i1’(~I~i~~1~1 1’01, of practice, hut, has firtl~ly cwJlt~~JJtlcv1 that c’SJ)c’lTJlNs ill ;I specialty cannot. logicall,v bc combiiic*tl wit11 c*oniI)arati\-c> mc~tlio(~f4~ iri 0111(‘1. branches of medicine. It has consist.c~lly rcfnserl to lower its lW)lli IwlWl~ts cc)J’ eligibility so that its certificate might be accel)te(l as a rcliablc ~~J~i~c~t~iOll I’oJ’ 1 IIt* Not. Long &gl, tJ+r1ncmdo1ts ~‘l”‘“S”l”’ \VilS identification of a capable specialist. brought to boar to accept as eanditlatt1s a small number of skillful pelvic Slit’on the supur-radical treatment r~l’ pelvic: maliEh‘reons who wcrc c*onrentrating nancies but who were ineligible because thev la&cd ol)strtrica I t Viiining. It seems questionable that a pelvic SUJ~~WJI~ JIO JlGlttc’t’ IJow skillful, nho has Itilt II’) obstetrical expcriencc can have tlic ~)i’opt’r’ pclrspec.tive wlicn operatitrc on wJllN1 in the childbearing period. Alt,hough separate certification in obst.ctrics and ggnecolog,V was &bated ;I1 lengt.11 at the organization meeting in 1930 and has been under consideration from time to time since then, after a full discussion it had always hec~l rcj~+ctl until 1951. The Board then made a concession to those who had been graduated hefore 1939, who had confined their practice to obstetrics or gync~log,v for fivcl years immediately prior to application, and who would surrender and relinquish TO any certificate they might hold from one of the other specia1t.v boards. date only nine obstetricians and six ggneqologists hold unilateral ccrtificntes. The members of the Board have unanimously believed that Ihe intelligenl practice of gynecologJ7, which is 80 per cent. nonoperative, depends in a farg~x part upon a thorough knowledge of obstetrics, and vice versa. The final conclusion after many arguments in each instance has been that indiscriminate unilateral certification would compromise the Board’s efforts to encourage the t,raining of all residents in both branches and thus indireetlp Imtlcrntillc~ ifs other objectives.
specialists. strict
1iJJlitatioJJ
The progress made by the Board is exemplified in many ways. Not only has all hostility and antagonism to the Board’s purposes disappeared, but some seventy-five professors of obstetrics and gyneco1og.y have volunteered their timr and efforts t.o its work. Mushroom specialists are now practically nonexistent. There can be little doubt that the principles on which the Board functions have promoted the unification or at least the correlation of obstetrics and gynecology in a substantial additional number of medical schools and hospitals, and that the cumulative trend toward such a.malgamations is still gaining momentum. As a result of this transition, a const,antly growing percentage of potential specialist,s is being exposed to better basic training in both branches. Many pre-existing residencies have been lengthened and new ones careat.cd, 1~11 despite this amplification of educational facilities. the availahlc residencies, which are approved jointly by the Council on Medical Education and Hospitals of the American Medic.al Association and the Board’s Committee on (iraduate Education, arc still inadequate in number. Ttl 1931. there were X3 approved residencies in obstetrics and gynecology, including 170 positions; iI) 1953 ther(L were 414 residencies, including 1,728 positions. The Board thcret’orxr is empelled to continue making some provision for preceptorship training and lo
\~ol,,mcDR
AMERICAN
Pumber I
BOARD
OE‘ OBSTETRICS
AND
GYNECOT,OGY
19
accept postgraduate apprenticeship and clinical experience under approved supervision in lieu of part of the required formal training in some instances, much against its inclination. Aspirants for certification realize that they must prepare themselves thoroughly before presenting t,hemselves, which stimulates them to compile good obstetrical and gynecological records, to read and to study, to attend medical meetings, to take postgraduate courses, and otherwise to augment their qualifications so that they may pass their examinations, habit,s which are likely t,o persist throughout their professional lives. The Board also demands that a candidate must acquire sufficient experience in private practice before seeking recognition as a specialist, because unless he practices for a reasonable time on his own responsibility his integrity and ability as a practitioner cannot be determined. In 1931 there were 79 candidates for examination; in 1953 there were 357; and the diplomates to date* number 3,908. During World War II the Armed Forces adopted certification by one of the specialty boards as their standard for specialty qualification. It also seems quite natural that medical schools, hospitals, and special societies should evaluate for themselves the significance of certification and utilize it as they choose, but it should be distinctly understood that whatever a&ion has been taken in this respect has been entirely spontaneous and has originated outside the hoards. The definite reduction during the past twenty-five years in the previous inexcusably high mat,ernal mortalit,y rate has in all likelihood been due to the fact t.hat hospitals have t,ended to enforce more obstetrical consultations and to impose restrictions on inexperienced obstetricians. It wo~dcl be presumptuous and unwarranted to imply that, all of t,he advances in obstetrical education and pract,ice during the past twenty-five years have been due to the accomplishments of the Board, but that it has exerted a powerful influence for good and has had a salutary effect on the elevation of obstetrics and gynecology as a specialty must be conceded. The members of the Board have t,ricd to exercise their best judgrnent~ at all times, regardless of censure or applause.
References 1. ‘:. n. 1. 5. 6.
DallllrcYlthc~r, I)annrel~t,her, Dannreuther, Dannreuther, Dannreuther,
waltzer Walter Walter Walter IValter Walter
580
AVENUE
Dannreuther,
PARK
*Exclusive
of 1954
.T. OBST. & GYNEC. 1’. : ibf. T.: .T. A. M. A. 96: 797, 1031. Ahr. J. 0~~1’. & GYNEC. 25: T.: T.: ;r. A. M. A. 120: 169, 1942. AM. .T. OBST. Bc GYNEC. 61: T.: ARI. J. OBS~‘. & GYNEC. 64: T.:
diplomates.
18:
s!f5,
165,
1933.
465, 713,
1951. 1952.
l!)“!).