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The Flexner Report and Medical Education

August 17, 2010

Hi and welcome to the Global Education Group CME news video blog, where we address emerging hot topics in the CME enterprise and share them with you.

The Flexner Report

Today we are going to talk about the 100th anniversary of the Flexner Report, an influential report in medical education that has affected undergraduate medical education in America and Canada for the past hundred years. We will talk about a little bit of the history of the report, as well as an upcoming conference that’s cosponsored by the American Medical Association, as well as the Association of the American Medical Colleges to commemorate the 100th anniversary of the report. The Flexner Report was a study of the undergraduate medical education conducted in 1910, commissioned by the AMA’s committee on medical education, and was funded by the Carnicke Foundation. The report is named after its author and educator, Abraham Flexner, and again it had a huge impact on American medical professions, as well as undergraduate medical education.

Findings in the Flexner Report

The report has had some positive and negative implications and findings. Back in 1910, there were positive results from the report that we still see in practice today. First, it pushed for med schools to enact higher admission and graduation standards. Second, it advocated for four year medical school because at the time there were a lot of two year medical schools. It pushed to get rid of those two year medical schools, many of which included no laboratory time whatsoever. It also stated that medical schools should strictly adhere to the protocols of mainstream science in both teaching and research. Many American medical schools fell short of that standard, and as a result after the report was first published almost half of those medical schools either merged with other schools or closed their doors. Lastly, it allowed for regulation of medical schools by states. You can argue for or against the regulation, however, as a result of that regulation we did get more uniform standards from medical education, especially in the United States.

Issues with the Flexner Report

On the bad side, the report also had some negative findings and implications. It stated that there were too many medical schools in the United States, and that too many doctors were being trained. Given today’s crisis in terms of the number of primary care physicians, perhaps the report was a little bit short sighted. The report was also brazenly editorial and sometimes sexist and racist. On the editorial side it described Chicago’s medical schools of the day as “a disgrace to the state whose laws permit its existence, undesirably fowl, the plague spot of the nation”. On the racist front, it basically advocated that there should be very few black only and women only schools, which is both racist and sexist. For the black only schools, it argued that they should be focused on teaching hygiene in lieu of other medical sciences to the blacks. So the report has both a section of the medical education on women as well medical education for teaching negros. The report also stated that there was work in “educating the race to know and to practice fundamental hygienic principals and in developing schools in which the more promising of the race can be sent to receive a substantial education where hygiene rather than surgery, for example, is strongly accentuated.” The report lead to American versions of men only institution and medical programs. It also lead to some segregation of medical schools. Castle and others have argued that the Flexner Report actually decreased the supply of MD’s and drove up costs not only for medical school as well as medical costs in general as the costs trickled down. If you are going to pay a lot for medical school, you are going to charge a lot for services. If there is a shortage of physicians, costs can be driven up as well. As AMA and the Association of American Medical College’s commemorate the 100th anniversary of the Flexner report, rightfully they are focused on the future. A few things to think about as well look towards that future: we need to continue to rely on sound science, evidence based-medicine, and evidence-based undergraduate education of medical professionals. We also need to look at ways we can bring physicians closer and in greater connection, with not only the health care team, but with patients as well, so we are helping prepare those in undergraduate and medical education. Also, we need to help prepare those future physicians in school today for what they will see in practice tomorrow. As always, if you have any questions about issues in the CME enterprise, or about the Flexner Report in particular, feel free to contact us here