The basic role of basic science

Abstract

As the celebrations of the hundredth anniversary of the Flexner Report become a distantmemory, it may be a good time to review the legacy of Flexner one last time. Unfortu-nately a few page editorial will not do justice to the topic; many others have made moreextensive comments on the impact of the report (Duffy 2011; Markel 2010) and MedicalEducation devoted an entire issue to discussion of the impact of Flexner and the evolutionof medical education since his time.At the risk of gross oversimplification, the essence of Flexner’s report was to stronglyencourage the linkage between the medical school and the university—to establish thefundamental role of basic medical sciences in the medical curriculum. His ‘‘gold standard’’was the curriculum at Johns Hopkins, which itself emulated the German medical schools ofa few decades earlier (Duffy 2011). The immediate impact of the report was the closing ofabout 1/3 of American and Canadian medical schools that did not meet the standards usedin the report, as well as the provision of large sums of Carnegie and Rockefeller money toenhance the remaining schools (Barr 2011).Arguably, the real impact of the Flexner report occurred half a century later, when,following World War 2, the National Institutes of Health established a grant program(National Institutes of Health 2012) that dramatically increased funding for basic scienceresearch in medical schools (from $8 million in 1947 to $1 billion in 1966!). Manypositions were created for basic scientists, and the Hopkins curriculum, with 2 years ofbasic science followed by 2 years of clinical became the norm.Basic science dominated the medical school, whose raison d’eˆtre was the production ofmedical scientific knowledge (Duffy 2011). Few academics (but sadly far more lay per-sons, including some notables like Prince Charles) would challenge the critical role ofbasic biological science as a catalyst for the stunning advances we have observed in qualityand quantity of life in the past century as a consequence of medical progress. But while themarriage of basic science and clinical medicine directed at advances in knowledge is ahappy one, it is less clear why the undergraduate medical curriculum should be dominatedby biological science. Indeed, while the articles in the special issue of Medical Educations