When Franklin Martin, MD, FACS, led the creation of Clinical Congress in 1910, the inclusion of “wet clinics,” or live, in-person surgeries, was a significant component for meeting the continuing education needs of surgeons in North America. The wet clinics were always well attended, but in the late 1940s were beginning to significantly outgrow the venues that were available, and Fellows began to complain about the inability to view desired films. Clinics were introduced at Clinical Congress in 1950. Cine Clinics, special sessions featuring films of surgical procedures, were an important step in expanding access to what has become an important educational tool for watching live surgeries. The transition to Cine Clinics was made possible by advancing technology, particularly the introduction of color television and the ability to project films on large screens. This technology was only just beginning to be utilized, with organizations like Johns Hopkins Hospital being one of the first to televise a procedure in February of 1947.ii
The Cine Clinic effort was a collaborative one between the American College of Surgeons (ACS) and Davis & Geck, a subsidiary of the American Cyanamid Company. The programs consisted of a series of comprehensive talks on specific surgical problems, each illustrated by specially prepared and edited color motion pictures demonstrating major points of the technique employed. The operating surgeon discussed the procedure performed and illustrated their lecture with highlights of the details of the operation.iii The Surgeon narrated as the film was shown at Clinical Congress, and a soundtrack was added when the film was made available for loan to medical schools and students for educational purposes. This new program, while retaining the important features of the surgical clinic, solved major spatial and temporal problems by permitting the demonstration of procedures that were difficult or impossible to schedule electively to a larger audience.iv
While Davis & Geck was responsible for the filming and production of the films, it was the ACS Committee on Medical Motion Picture Films, established in October 1926, that chose the subject and surgeon for the films. The Committee’s main purpose was to identify and approve medical films received by the College for both professional and lay use. Films approved by the committee were based on four main standards: Is the subject of the film suitable? Does it conform to the accepted principles of medical ethics? Is the operative technique one that is accepted generally by the profession? Is the technique adequately demonstrated?v These criteria ensured that the films were accurate and of high professional quality.
The Cine Clinics were a great success from the beginning. The heavy demand for the list of approved films caused the College’s Executive Director, Dr. Paul Hawley to comment that "the future of the 'wet clinic' at a large meeting is doubtful." The opportunity to view surgical procedures performed by masters, with sound-on-film narration, was filling the need that prompted the organization of Clinical Congress in the first place.vi By 1954, separate motion picture programs for several specialties were introduced, addressing the concern that all surgical specialties should have demonstrable participation within the College and at Clinical Congress. The College further invested in Cine Clinics in 1955, developing a large screen with three projectors to help superimpose images in color, allowing an audience of 1,000 to view the film simultaneously. For surgeries transmitted live, two-way communication was established so that the audience could participate, and the surgeon answered questions as they performed the operation.vii
The success of the Cine Clinics led to Davis & Geck suggesting, in 1970, they take over the Cine Clinic film library, on top of the production and distribution they were already managing. The company would be responsible for processing additional films, caring for the films after use, and satisfying distribution requests. From 1972 onwards, the Cine Clinics were facilitated by Davis & Geck, who issued an annual catalog with over 1,000 titles including Cine Clinics, nursing films, surgical technique films, and the ACS film library. By 1975, live Cine Clinic sessions were discontinued, but pre-recorded sessions were still shown at Clinical Congress. The Committee on Medical Motion Pictures became the Committee on Video-Based Education in 2002, and in 2003 introduced Video-Based Education Sessions. These sessions replaced Cine Clinics but continue the legacy of visual continuing education for surgeons. The last named “Cine Clinic” was shown on October 10th, 2007, at Clinical Congress in New Orleans.
i Bulletin, Vol 88, Number 8, pp22-23
ii George W. Stephenson, American College of Surgeons at 75, p86
iii Bulletin, Vol 88, Number 8, pp22-23
iv Bulletin, Vol 88, Number 8, pp22-23
v ACS Medical Motion Picture Films leaflet, September 1927, RG5/SG2/S2 Box 1
vi George W. Stephenson, American College of Surgeons at 75, p85
vii George W. Stephenson, American College of Surgeons at 75, p86