Clinician teachers: Formulating an intellectual framework for modern medical education.

Abstract

The 19th century was a watershed for the practice of clinical medicine. The hospital was gradually becoming a focus for healthcare, enabling the observation of a greater number of patients and facilitating description of the natural history of diseases. Sophisticated and structured physical examination methods were developed, backed by inventions such as Laennec's stethoscope, allowing better diagnosis. In the 18th century, the leading European medical schools were in the Netherlands in Leiden and, in Britain, in Edinburgh and London (1). Paris rose to prominence as the world center of medicine in the first part of the 19th century. Transmission of rapidly expanding knowledge in turn required effective teaching, which centered in the emerging teaching hospitals. Training of physicians was actually quite international: it was not unusual to study medicine abroad. European developments soon influenced the US. William Shippen and John Morgan (both Edinburgh graduates) established the Medical College in Philadelphia in 1767. Harvard introduced an innovative structured course in medicine in 1871, and in 1876 a university medical school was founded in Baltimore (2). The 19th century also marked the move of medicine toward science. …