The American College of Physicians' (ACP) Medical Knowledge Self-Assessment Program (MKSAP) was the first of its kind and is one of the most important and successful programs developed for continuing medical eduction. The program is designed for self-education but, more important, self-assessment remains the "heart of the program."
MKSAP was conceived in 1965. Interestingly, its development coincided with the introduction of the "persona.lized system of instruction" created by a well-known educator named Keller (1). This ,system of self-driven curriculum is now widely accepted in the field of eduction. It may have been a sign of the times that these self-driven programs were created concurrently.
The first edition of MKSAP was actually published in 1968 and consisted only of multiple-choice questions. About 12,000 internists subscribed to it. In October 1988, MKSAP VIII was published, having grown from a document of a few hundred pages to one of about 1200 pages. Its. 18 sections cover a wide range of areas relevant to internal medicine. The program now consists of syllabus text, multiple-choice questions, patient management problems, ann'otated bibliographies, and critiques that close the feedback loop and bring the user information on what the favored responses to the questions are. We expect about 50,000 internists to subscribe to MKSAP VIII.
The conceptual roots of MKSAP can be found in the archives of the American College of Physicians (ACE'), and from the minutes of committee meetings it is possible to trace its development from its earliest beginnings. In 1965, the college's educational activities committee noted the following: "The committee recognizes a widening gap between the increaise of knowledge in the biological, physical, and chemical sciences and the applications of this knowledge to practice" (2). There was no mention of the psychosocial aspects of medicine. At this time, the committee conducted a survey to discover what was missing from continuing medical eduction. It was revealed that the missing element in CME was that no one understood what the physician did not know, including the: physician himself. (Note that it was himseK herself was not mentioned.)
The committee decided to accept the suggestion that physicians might submit to selfevaluation, under the assumption of two major premises. First, physicians want to im-