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ACCP 1935—2009: An Inspiring History FREE TO VIEW

Kathy Jewett
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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

Copyright © 2009 American College of Chest Physicians

Chest. 2009;136(5_suppl):e2-e14. doi:10.1378/chest.09-2256
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In 1935, Murray Kornfeld had an inspiration that would prove historical. As a young man recuperating from tuberculosis, Kornfeld realized, firsthand, the need to educate general practitioners and the public about tuberculosis prevention and treatment. He envisioned a society of physician specialists who could share clinical knowledge to advance patient care. He envisioned what would become the American College of Chest Physicians (ACCP).

Founded in 1935 as the Federation of American Sanatoria, Murray Kornfeld established an organization to educate general practitioners about tuberculosis through education courses and a journal devoted to diseases of the chest. In March 1935, Murray Kornfeld published the inaugural issue of Diseases of the Chest. The first issue was distributed to 10,000 physicians throughout the United States. C. M. Hendricks, MD, editor in chief, wrote, “With this issue, Diseases of the Chest makes its bow to the medical profession of America. Inasmuch as there is no journal of large circulation among the general practitioners devoted to this subject, the publishers believe that Diseases of the Chest will fill a long-felt want, and it is their sincere hope that this journal will take its place as a leading factor in the fight against tuberculosis.”

That hope was quickly realized, as seen by the letters of appreciation received from physicians around the country. Champneys H. Holmes, MD, of Atlanta, GA, sent one such letter that appeared in the second issue of Diseases of the Chest, writing, “I am one of the few men in this section [of the country] who limits his work strictly to diseases of the chest and, naturally, this publication will hold a strong interest for me. If at any time it would be desired that I contribute an article from the viewpoint of a city chest consultant, it will be my pleasure to do so.” Articles by Dr. Holmes did, in fact, appear in subsequent issues of Diseases of the Chest. He also attended the first annual meeting in August 1935, became a charter member of the Federation, was named to the editorial board of Diseases of the Chest, and later served as ACCP President in 1939. Murray Kornfeld's vision for building a network of leaders in chest medicine had taken form.

Stories such as this occur throughout the ACCP's evolution from one man's inspiration to an international society of > 17,000 members. Like Dr. Holmes, thousands of chest physicians with a shared desire to improve patient care have joined the ACCP during the past 75 years. Through steadfast dedication to the prevention and treatment of diseases of the chest, ACCP members have built a lasting legacy of promoting patient-focused care through leadership, education, communication, and clinical practice.

Established as an organization to drive tuberculosis prevention and treatment, the ACCP's leadership role in chest medicine has been firmly rooted from the beginning. Founded in 1935 as the Federation of American Sanatoria, the fledgling society changed its name to the American College of Chest Physicians in 1937 to embrace its role to provide leadership for all chest diseases. Though the original mission had grown, tuberculosis remained a necessary and important focus.

Within a few short years, the ACCP's leadership work related to tuberculosis was of national significance. In 1938, a 10% decrease in mortality from tuberculosis was reported. This improvement was attributed to early diagnosis, which had been the main thrust of the articles published in Diseases of the Chest. The ACCP worked directly with all branches of the armed forces during World War II to institute a routine chest-radiograph screening program to identify and control cases of tuberculosis in the military. In June 1940, the ACCP was commended by The Washington Evening Star for its work to significantly reduce the incidence of tuberculosis cases. The program was so successful, chest x-rays soon became routine for all hospital admissions. In consideration of the positive changes members were making across the United States, the Board of Regents agreed they should be readily recognized as ACCP members. In 1943, the Board passed the resolution approving the use of the letters, FCCP, to designate ACCP Fellows. As it was hoped, the letters quickly became synonymous with leaders in chest medicine. In 1950, the ACCP extended its leadership reach by holding the first international meeting in Rome, Italy. The meeting, which focused on the eradication of tuberculosis, featured an audience with Pope Pius XII and was attended by Sir Alexander Fleming, Nobel Prize recipient for the discovery of penicillin. The Pope addressed the tuberculosis problem and urged ACCP members to continue efforts to conquer the disease. The ACCP did continue its work and, 2 years later, was one of the first societies to publish ground-breaking data about isonicotinic acid hydrazine, a promising new drug for treating tuberculosis.

With the battle against tuberculosis underway, the ACCP turned its leadership efforts to a growing international health threat: cigarette smoking. The ACCP questioned the health effects of cigarette smoking as early as 1936 when it published the editorial, “Cigarettes and Tuberculosis,” in Diseases of the Chest. Author George T. Palmer, MD, reported, “Medical men familiar with the treatment of tuberculosis will agree that cigarette smoking, with almost invariable inhaling, can do no good to the diseased lung and in many cases increases cough and is otherwise distinctly detrimental.” In 1962, the ACCP Board of Regents intensified its campaign to lead smoking cessation. A crowning achievement came in 1965 when ACCP's work contributed to the passage of the bill requiring the Surgeon General's warning label to be printed on all cigarette packages.

Not to rest on its laurels, the ACCP continued leading its campaign against cigarette smoking and attracted national media attention in 1972 when it restricted smoking to designated areas during the annual meeting. In 1979, the ACCP developed its No Tobacco Pledge, recited by all ACCP Fellow initiates to acknowledge their leadership role in smoking prevention and cessation. Concerned about the secondhand effects of cigarette smoking, the ACCP led efforts to protect the nonsmoker. Major victory came in 1990 when federal legislation, prompted by the lobbying efforts of the ACCP, was passed to ban smoking on domestic airline flights within the continental United States, Puerto Rico, and the Virgin Islands. Celebrating 75 Years of Inspiration: 1935–2009

As the twentieth century neared its end, ACCP members identified still another area where leadership was needed: philanthropic service. A young physician practicing in Brooklyn, NY, was discouraged by her patients' inability to pay for asthma medication and asked, “What can the ACCP do about this?” Then ACCP President, Bart Chernow, MD, Master FCCP, knew the ACCP could help and conceived The CHEST Foundation. In 1996, The CHEST Foundation was launched to help patients and their families live and breathe easier through work in four key areas: tobacco prevention, clinical research, humanitarian service, and critical care/end-of-life care.

The CHEST Foundation has led numerous relief efforts, providing medical care, equipment, and supplies to areas hit by natural disasters worldwide, including Hurricanes Katrina, Rita, and Wilma and the Indian Ocean tsunami of 2004. The Foundation responded to national tragedy in 2001 by developing the first-ever smoking cessation program for the New York City Fire Department following the September 11 terrorist attack. Alarming numbers of New York firefighters began smoking following the attack, so a program was designed specifically to help them stop smoking and find healthier alternatives to dealing with stress. Smoking cessation programs, targeted to a myriad of other audiences, have since followed and established The CHEST Foundation as a leader in tobacco prevention and cessation.

In 2009, the ACCP is embarking on a new leadership mission with the development of the AQuIRE Registry, a quality measurement program for pulmonary, critical care, and sleep specialists to communicate their practice performance and measure it against indicators. By sharing information about their own practice, participants can access data reports and peer comparisons to monitor their practices. This groundbreaking tool is a central resource for access to the information practitioners need in response to the increasing demands by credentialing bodies, regulatory agencies, payers, and the institutions in which they practice. By instituting the AQuIRE database, the ACCP will help its members manage their practices and will drive further advances in clinical chest medicine.

The first education event of the Federation of American Sanatoria was its annual meeting with 38 registrants, held August 9–10, 1935, in Albuquerque, NM. Problems dealing with sanatoriums in the United States were discussed, and guest of honor, Sir Henry Gauvin of London, England, presented the social and economic problems of tuberculosis in the United Kingdom. Charter member Orville E. Egbert, MD, described the meeting as having “sparkling and valuable discussion.”

In 1937, the society announced its name change to the American College of Chest Physicians, but assured, “The educational policy adopted by the society will be carried forward with greater vigor.” An education program was, indeed, carried on during the annual meeting. In 1945, the education program was expanded, and postgraduate courses were offered throughout the year to meet the educational needs of physicians returning from active duty during World War II. The ACCP Council on Postgraduate Medical Education also organized a nationwide speakers bureau of experts to update these physicians at state or county medical meetings by presenting the latest science from Diseases of the Chest.

In the 1950s, the ACCP increased its education efforts again by embracing new technology: motion pictures. A Committee on Motion Pictures was organized to review the growing number of education films on chest diseases. Those chosen were recommended in Diseases of the Chest and presented during education meetings.

As chest medicine evolved, the ACCP adapted its education offerings to meet the needs of clinicians. The topics presented grew at both the annual meeting and the courses held throughout the year. In the 1950s, cardiology was emerging, and ACCP members were feeling a growing need for education in this new field. Education sessions on cardiology were soon presented with regularity. “Amazing recent developments in cardiac surgery” were referenced at the annual meeting in 1951, where exploratory surgery of the heart was addressed, and a symposium to discuss the “controversial aspects” of electrocardiography was hosted in 1953. Cardiology and cardiac surgery presentations continued to grow through the 1960s and 1970s, by which time the ACCP was widely recognized for its education programs related to both pulmonary and cardiovascular diseases.

In 1984, the ACCP hit unprecedented success when it launched its board review program for pulmonary medicine. Subspecialty board certification for ACCP members was always considered essential for maintaining the integrity of membership, and certification had become increasingly important for practitioners in general. This intensive review course was immediately popular, so the ACCP added a critical care medicine board review program in 1989, following the introduction of the certification examination for critical care medicine in 1987. When the first sleep medicine certification examination was scheduled for 2007, the ACCP became one of the first medical societies to organize a sleep medicine board review course in 2006. Offering comprehensive, exam-focused reviews, all three programs remain extremely popular among physicians needing to certify or recertify and have established the ACCP as the proven leader in comprehensive board review for pulmonary, critical care, and sleep medicine.

To accommodate the education needs of busy health professionals, the ACCP explored self-study education. PCCU (Pulmonary and Critical Care Update) was released in 1989, and its success led to the release of ACCP-SEEK in 1991. Both programs featured reading material and quizzes for participants to complete at their convenience and were popular among physicians wanting a thorough review of current clinical topics in chest medicine. The programs initially offered clinical education material in pulmonary and critical care medicine, but grew to include sleep medicine as well. In 2001, PCCU migrated from print to an online format, making it easily accessible to health professionals around the world. This format change paved the way for still another innovative self-study tool—A Physician's Perspective, an online, interactive education program released in January 2009.

The mainstay of the ACCP's continuing education efforts has been its annual meeting. From the first meeting in 1935 with 38 registrants to the current meetings that attract > 5,000 practitioners from around the world, this education offering has long been known as the authority in clinical chest medicine. In 1995, the ACCP rebranded the annual meeting, changing its name from the annual international scientific assembly to CHEST. The new name readily connected the meeting to the ACCP and has become synonymous with relevant opportunities for clinical education and professional growth.

The CHEST Foundation has played its part in education programs along with the ACCP. Soon after it was founded, The Foundation took up the cause of tobacco prevention and cessation programs for patients. Because of rising smoking statistics among women and girls, The Foundation created the Women & Girls, Tobacco, & Lung Cancer Speaker's Kit in 2000 as a tool for physicians to deliver lung health messages. This and subsequent tobacco prevention resources have been used by ACCP members and other volunteers to educate tens of thousands of people on making responsible choices regarding smoking and lung health.

In 2009, the ACCP continues to offer relevant, innovative education opportunities. The ACCP Education Committee regularly assesses the needs of health professionals to develop a curriculum and recommend new education methodologies. Simulation education, first offered during CHEST 2005, is a successful result of the committee's work. Using technologically sophisticated equipment, the ACCP offers hands-on, clinical education experiences that allow practitioners to practice their skills and apply their knowledge in realistic scenarios. The success of simulation education at CHEST led to the opening of the ACCP Simulation Center for Advanced Clinical Education at the ACCP headquarters in Northbrook, IL, so hands-on education programs can be offered year-round. Following the precedent set, the ACCP will continue to monitor needs and develop the education programs that promise to advance knowledge in clinical chest medicine.

Effective communication has always been vital to the ACCP in its work to improve patient care, and the backbone of its efforts has been Diseases of the Chest/CHEST. Diseases of the Chest was first published March 1935 as a monthly publication. It went to bimonthly publication with the January 1943 issue due to conditions resulting from World War II, but monthly publication resumed with the January 1949 issue. Coincident with the January 1943 issue was a reorganization of the journal and a change in focus. Editor in Chief Ralph C. Matson, MD, FCCP, explained the articles would be of “more scientific value” and the readership focus would shift from general practitioners to chest specialists. Also beginning with the January 1943 issue, the journal was indexed by the Medical Library Association.

As the field of cardiology grew during the 1950s, papers on cardiovascular diseases and cardiac surgery were published with growing frequency. It was soon recommended that a third of each issue be devoted to tuberculosis, a third to nontuberculous chest conditions, and a third to cardiovascular conditions. Social responsibilities of physicians were also of interest to ACCP members, so, in 1955, with worldwide tension mounting from the cold war, Arnold S. Anderson, MD, FCCP, expressed his thoughts on world peace in, “Doctors and Peace.” The editorial was immediately popular and triggered a themed series on physicians and world peace. The first 14 editorials were published as a pamphlet distributed at an International Congress on Diseases of the Chest in 1958 and made available to the United States Department of State.

In 1968, the peer review process was introduced. Prior to peer review, articles and editorials were published in Diseases of the Chest at the discretion of the editor and editorial board. Editor in Chief, Alfred Soffer, MD, Master FCCP, who is credited for instituting the peer review process, described it as a “crucial factor in the journal's efforts to publish accurate and well-organized communications.” In keeping with this goal, the name of the journal changed from Diseases of the Chest to CHEST in 1970 to better reflect the multidisciplinary nature of ACCP members and educational endeavors.

Careful editorial review policies for CHEST remained, and the journal maintained its status as an essential communication resource for chest professionals. Changes in content and style were made as needed to keep the journal current, and, in the 1970s, supplements were first introduced to provide an in-depth focus on a single topic. Growth continued through the 1980s, and, by the 1990s, CHEST had achieved the highest circulation of any respiratory or critical care journal in the world. In 1999, the first foreign language editions of CHEST were published, and the online edition was launched at www.chestjournal.org, making it accessible to anybody, anywhere in the world. Moving into the twenty-first century, critical care and sleep medicine topics were added and new departments and features were introduced to reflect contemporary times and the needs of the diverse readership.

Beyond CHEST, the ACCP has employed tactical communication methods to benefit members and patients. In 1940, ACCP Chapters were introduced to enhance communication by allowing members to meet on a local level and discuss area-specific concerns. The first chapter to organize was Illinois, while the first international chapter to organize was Cuba. To communicate important health information to patients, the ACCP developed first-of-their kind no smoking placards in 1967 for use in physician offices. The placards warned: “Smoking can be a serious health hazard. Please do not smoke in the reception room—it may affect other patients.” In 1949, the ACCP adopted a policy to interact with legislators on legislative issues “when appropriate.” Forty-five years later, in 1994, the ACCP committed to building ongoing relationships with legislators and held the first ACCP Capitol Hill Caucus. Subsequent caucuses have followed, allowing ACCP members to discuss timely, national issues with influential health-care proponents.

The 1990s marked a technological boom and widespread use of the Internet. The ACCP capitalized on this new technology in 1995 by launching its Web site, www.chestnet.org. This powerful tool, which allowed members around-the-clock access to material posted, quickly proved to be an effective communication method and has become a central source for information. The ACCP has used the power of the Internet and its Web site to quickly communicate important information to members, particularly international members. In 2004, an electronic membership category, e-member, was developed for international members. By opting to be an e-member, international members can pay lower dues and receive all ACCP communications electronically, gaining instant access to vital material.

The CHEST Foundation has complemented ACCP communication efforts with its programs. Partnering with the Industry Advisory Council, The Foundation held its first Community Outreach Event during CHEST 2000, where volunteers went to a local elementary school to promote lung health to students and staff. In 2001, The CHEST Foundation's Ambassadors Group compiled Stories at the End of Life, a six-booklet series of stories shared from patients around the world to help others cope with end-of-life experiences. The following year, in 2002, The CHEST Foundation released its Critical Care Family Assistance Program, a first-of-its-kind program providing a framework to help hospital ICU staff better communicate with and assist families of critically ill patients.

In 2009, the ACCP continues developing improved methods of communication, but CHEST remains its main tool. The value of CHEST is repeatedly recognized and rewarded. In a 2006 survey, pulmonologists named it the leading essential publication. In 2009, CHEST was voted one of the 100 most influential journals over the last 100 years in medicine and biology by the Biomedical and Life Sciences Division of the Special Libraries Association. Also in 2009, CHEST achieved its highest impact factor score of 5.154, a measure of the frequency in which the average article is cited in a given period of time. CHEST consistently ranks second in total number of citations in the respiratory field, making it a significant communication resource for promoting clinical chest medicine.

Improving clinical chest medicine was the impetus for founding the ACCP, and it remains the underlying mission today. The clinical focus began with tuberculosis, but quickly grew to include the full array of chest diseases. Within the first year of publication, Diseases of the Chest articles had addressed chronic bronchitis, asthma, pneumonia, and cough, to reflect growing clinical interests.

Tuberculosis remained a primary focus of the ACCP through the 1940s and into the 1950s, when the ACCP published data on a new and effective treatment. Around this same time, the field of cardiology emerged, along with the demand for clinically relevant information. The ACCP responded by publishing more papers on cardiovascular disease and cardiac surgery in Diseases of the Chest and by offering more education sessions in these areas.

The development of mechanical ventilation in the 1950s led to the advent of ICUs and, gradually, the discipline of critical care medicine. Chest professionals played a valuable role on the critical care team, so the ACCP expanded its focus to include critical care medicine. In 1971, a special report, “Critical Care Medicine: Organizing and Staffing Intensive Care Units,” by Peter Safar, MD, FCCP, who is credited for establishing the world's first intensive care medicine training program, was published in CHEST and detailed information vital to running a patient-focused ICU. During the 1980s, there was much collaboration between medical specialty societies to better define critical care and its range of diseases. The ACCP was an important part of these collaborations and, in 1991, partnered with the Society of Critical Care Medicine to hold a consensus conference that is heralded for forming a pathway and strategy for progress in the field. The ACCP continued promoting advances in critical care through CHEST articles and clinically-relevant education courses and was soon established as a worldwide leader in the advancement of critical care medicine. In 2004, the ACCP established its Critical Care Institute to further promote critical care by serving as the premier resource for excellence in the care of the critically ill.

Sleep medicine was recognized as a specialty by the American Medical Association in 1996. Because of the crossover with pulmonary medicine, sleep medicine quickly became a clinical interest of ACCP members. As with cardiology and critical care, sleep medicine topics were published in CHEST and presented at education sessions with growing frequency. In 2005, the ACCP Sleep Institute was established to promote sleep health through leadership, education, research, and communication. When the American Board of Internal Medicine announced its first sleep medicine subspecialty board examination for 2007, the ACCP was well-prepared to offer a first-of-its-kind sleep medicine board review course in 2006, further establishing itself as a leader in sleep medicine.

A hallmark of the ACCP's contribution to clinical practice has been its consensus statements and evidence-based guidelines. In 1969, a new department, Therapeutic Guidelines, was created in Diseases of the Chest to provide reviews of therapy and information on total management of patients. Early therapeutic guidelines included “Management of Hypertension” and “Septic Pulmonary Embolism.” In 1986, the first antithrombotic guidelines were published as a consensus statement and quickly came to be considered the “gold standard” for prevention and treatment of thrombosis. As consensus statements and evidence-based methodology came to be regarded as the best recommendations for clinical medicine, the ACCP created a Health and Science Policy Committee in 1991 to oversee and encourage the further development of statements and guidelines. Committed to improving patient care, the ACCP designed rigorous methodology for its own guideline development and has subsequently published sought-after guidelines for lung cancer, cough, pulmonary hypertension, and more. Having earned a reputation for developing scientifically valid evidence-based guidelines, the ACCP was asked to present its conflict of interest procedures and firewalls to the Institute of Medicine in 2008.

Practice management is an important part of clinical medicine, so the ACCP has developed tools and resources to help health professionals run their practices more efficiently. In 1993, the ACCP formed the Current Procedural Terminology/Relative-Value Update Committee (CPT/RUC) to monitor Medicare reimbursement relative to a resource-based relative value system. This led to greater involvement in coding and reimbursement and resulted in the ACCP's first specialty-specific coding book, Appropriate Coding for Critical Care Services and Pulmonary Medicine, in 1996. In 2006, sleep medicine codes were added, and the book was renamed, Coding for Chest Medicine, the following year. In addition to its top-selling coding manual, the ACCP created a practice management CD series addressing business and legal issues and has recently taken advantage of the power of the Internet to offer webinars on timely practice management issues.

The CHEST Foundation has supported clinical practice through its extensive awards program. In 2000, The Foundation established a humanitarian service awards program to support the pro bono work of ACCP members who volunteer their time and medical expertise to help patients. Since then, The Foundation has expanded its program to include awards for clinical research and leadership in end-of-life care. Since 1997, The CHEST Foundation has awarded more than $5.5 million to support projects that have had a lasting impact on clinical medicine.

In 2009, the ACCP is a recognized clinical leader in pulmonary, critical care, and sleep medicine and improving patient care continues to be its focus. In an effort to control quality, cost, and access to health care, the ACCP is exploring the use of technology and the promising field of telemedicine. CHEST 2009 is featuring telemedicine sessions, including adult tele-ICU simulation sessions and a keynote address on how telecommunications can dramatically improve health-care delivery. By exploring new options available through changing technology, the ACCP advances patient care by making the best practices available to health professionals and patients around the world.

In its 75-year history, the ACCP has grown from 38 registered attendees at the first annual meeting to its current membership of > 17,500 members worldwide. What began as a society of professionals to lead the prevention and treatment of tuberculosis has become the recognized clinical authority in pulmonary, critical care, and sleep medicine. Despite changes through the years, the ACCP maintains its commitment to advancing patient care. To underscore this commitment, ACCP Fellow initiates recite a Patient-Focused Care Pledge, acknowledging their responsibility to provide safe and compassionate care. In turn, the ACCP supports their efforts by driving leadership, education, and communication to advance clinical practice. The result of this pact has been an inspired past … and the continued promise of an inspiring future.



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