Abraham Flexner was not a doctor but was a secondary school teacher and principal for 19 years in Louisville, Kentucky (where this writer’s uncle was one of his students). Flexner then took graduate work at Harvard and the University of Berlin and joined the research staff of the Carnegie Foundation for the Advancement of Teaching. For the Carnegie Foundation, Flexner researched, wrote and in 1910 published a report entitled “Medical Education in the United States and Canada.” It is known today as the Flexner Report. The Flexner Report is the most important event in the history of American and Canadian medical education. It was a commentary on the condition of medical education in the early 1900s and gave rise to modern medical education. The report is named for Abraham Flexner (1866-1959) who prepared it. The Flexner Report triggered much-needed reforms in the standards, organization, and curriculum of North American medical schools.
At the time of the Report, many medical schools were proprietary schools operated more for profit than for education. Flexner criticized these schools as a loose and lax apprenticeship system that lacked defined standards or goals beyond the generation of financial gain. In their stead Flexner proposed medical schools in the German tradition of strong biomedical sciences together with hands-on clinical training. The Flexner Report caused many medical schools to close down and most of the remaining schools were reformed to conform to the Flexnerian model. When Flexner researched his report, many American medical schools were “proprietary”, namely small trade schools owned by one or more doctors, unaffiliated with a college or university, and run to make a profit.
A degree was typically awarded after only two years of study. Laboratory work and dissection were not necessarily required. Many of the instructors were local doctors teaching part-time, whose own training left something to be desired. The regulation of the medical profession by state government was minimal or nonexistent. American doctors varied enormously in their scientific understanding of human physiology, and the word “quack” flourished. In conclusion, due to Flexner’s scathing report, medical schools were forced to implement stricter admissions and curriculum requirements, causing many institutions to shut down altogether.
In 1912, a group of licensing boards created the Federation of State Medical Boards, which voluntarily agreed to base its accreditation policies on standards determined by the CME and Flexner’s report. Consequently, the CME’s decisions came to have “the force of law.” I believe it is Flexner’s report that had made medical schools what they are today. Many medical schools still follow the suggestions in Mr. Flexner’s report to this day. His report makes sure that students who attend medical schools receive the proper training to be good Doctors.
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