The Flexner report on medical education in the United States and Canada, commissioned by the Carnegie Foundation for the Advancement of Teaching, had a major influence in shaping contemporary medical education.<sup>4 Flexner A.   Medical education in the United States and Canada: A report to the Carnegie Foundation for the advancement of teaching. Bulletin No. 4 New York: Carnegie Foundation for the Advancement of Teaching (1910). 

Cliquez ici pour aller à la section Références</sup> Following the report's publication in 1910, undergraduate medical education took on a general format that has changed little to this day.

Since that time, educators and physicians involved in the training of medical students, residents, and fellows in ophthalmology have sought assurances that graduates have an adequate knowledge of medicine. Through the years, such knowledge has been tested in many ways.

Knowledge would seem, at least at first, to be much easier to assess than competence; however, assessment of medical knowledge has not always been adequate. For example, until the early 1990s, someone wanting to be an ophthalmologist could complete a preceptorship and then, after an indeterminate amount of time, declare himself or herself a practicing ophthalmologist or an eye, ear, nose, and throat specialist.

It is not surprising, then, that even before the Flexner report, Vail<sup>9 DT Vail, The limitations of ophthalmic practice. Transactions of the 13th Annual Meeting of the American Academy of Ophthalmology and Otolaryngology, 1908, pp 1–6.

Cliquez ici pour aller à la section Références</sup> pointed out what he considered to be the poor care in ophthalmology that Americans were receiving. He stated his case in his presidential address to the American Academy of Ophthalmology and Otolaryngology in 1908. His address was the stimulus for the formation of the first specialty board in the United States.