This session, part of the National Library of Medicine's 1976 Colloquium on the Bicentennial of Medicine, features Dr. William D. Holden, the Payne Professor of Surgery and Director of the Department of Surgery at Case Western Reserve University School of Medicine. Dr. Holden presents an overview of the evolution of graduate medical education in the U.S. He notes that in the latter part of the 19th century, such advanced education was essentially nonexistent, except in some larger hospitals. The state of undergraduate medical education was also chaotic. Physicians in training often traveled to Europe to complete their studies. The American Medical Association (AMA), organized in 1847 to improve the state of medical education, did not effectively address the subject of graduate-level work until after the Council on Medical Education was organized in 1904. Gradually the residency system was developed, followed by the creation of specialty boards. In the latter half of the 20th century, the AMA established commissions and accrediting authorities that refined the process and requirements of graduate medical education.