Flexner Report

The Flexner Report was instrumental in changing the profession of medicine in North America. Submitted by Abraham Flexner in 1910, as the culmination of his investigation of each medical school operative at that time, it was released to the public as well as to the professional associations. "Hired by the American Medical Association's Council on Medical Education and the Carnegie Foundation for the Advancement of Teaching" (reference for quote: Savitt, Todd Lee 1943-Four African-American Proprietary Medical Colleges: 1888-1923 Journal of the History of Medicine and Allied Sciences - Volume 55, Number 3, July 2000, p 219) he "evaluated all 155 medical schools in the United States and Canada" (reference for quote: Cooke, Molly; Irby, David M.; Sullivan, William; Ludmerer, Kenneth M. Medical Education: American Medical Education 100 Years after the Flexner Report. New England Journal of Medicine. 355(13):1339, September 28, 2006. ) These ranged from university affiliated X year programs with admission standards that included XX, to programs run by individual physicians in private practice that had no formal admission standards, no laboratory teaching in science and no criteria for graduation other than successful payment of fees.

Flexner and the Carnegie foundation valued medical training that was based in science rather than tradition and academic rather than commercial in nature. The report made this opinion clear even in its introduction, as well as the fact that there seemed to be both well-trained physicians in the continent, as well as poorly trained and uneducated physicians, and that the public had no means to distinguish them. Since the report was released to the public, and the concept that the public welfare was jeapordized by the "inadequately trained physician", it is easy to understand why popular support for the reform of medical education followed its publication.

Education of medical physicians and surgeons in the 19th Century In the United States, requirements at different medical schools varied tremendously. Only a minority of medical schools were affiliated with universities, there were hundreds of small "proprietary" schools of medicine that were administered by physicians in private practice. In many regions of the United States, such as rural states, there was no regulation of these schools. As state boards of health were established, many of the school came under the purview of these government aganecies.

Particular schools lauded

Johns Hopkins

Recommendations for professional medical education

University affiliation

Abraham Flexner was not neutral in his attitude towards educational institutions. He condemned "for profit" schools, for which he coined the term "proprietary", and admired academic education in a University setting. Mere affiliation was not enough to earn Flexner's approval, he argued that a University must support a medical school at a high level of educational standards and provide first class physical and laboratory facilities. His language was blunt to the point of being inflammatory: " There is a certain minimum of equipment and a certain minimum of educational requirement without which no attempt ought to be made to teach medicine. Hitherto not only proprietary medical schools, but colleges and universities, have paid scant attention to that fact. They have been ready to assume the responsibility of turning loose upon a helpless community men licensed to the practice of medicine without any serious thought as to whether they had received a fair training or not" (page xii, Introduction. Flexner Report.)

Hospital for clinical training

Flexner stated that a hospital for clinical training was as important to a medical school as a laboratory for training in chemistry or pathology. Just as he specified that adequate laboratories were well equipped and supervised, he specified that the appropriate hospital was to be under the direction of the medical school.

Impact of the Flexner Report

"Although reform in medical education was already under way, Flexner's report fueled change by criticizing the mediocre quality and profit motive of many schools and teachers, the inadequate curricula and facilities at a number of schools, and the nonscientific approach to preparation for the profession, which contrasted with the university-based system of medical education in Germany."(reference for quote: Cooke, Molly; Irby, David M.; Sullivan, William; Ludmerer, Kenneth M. Medical Education: American Medical Education 100 Years after the Flexner Report. New England Journal of Medicine. 355(13):1339, September 28, 2006.)

Many Medical Schools Closed, "Allopathic", and Osteopathic Schools Survive

Johns Hopkins University was lauded in the Flexner Report.

External links

PDF Image of the full text of the original Flexner Report- provided by the Carnegie Foundation [1]

Andrew H. Beck :The Flexner Report and the Standardization of American Medical Education JAMA. 2004;291:2139-2140. [2]