The state of the science, 2011: (100+/−1) years post-Flexner

Abstract

Flexner (1910)1 It is unquestionably the seminal work in our field. One could not possibly forget the publication date. So why would we use it to frame Medical Education’s 2011 special issue on the state of the field in the modern day when the 100th anniversary of the publication of Flexner’s report on the state of medical education in the USA and Canada occurred last year, in 2010? The cynical among you might think we are just plain late. Not so. In fact, 2011 is the ideal time for Medical Education to celebrate how far we have come since Flexner and to contemplate where we might be headed now because, in 1910, Flexner wasn’t done. The centenary anniversary of Flexner’s parallel report on the state of medical education in Europe occurs next year,2 in 2012. It’s not that we can’t count; we’re just really good at averages. In actuality, Flexner’s impact was not limited to only those parts of the globe as his reports laid the seeds for education reform worldwide (albeit in variable ways). One can debate whether Flexner’s ideas were truly revolutionary at the time or simply reflective of the direction in which the wind was blowing,3 but the fact remains: Flexner’s pointed (and at times aggressive) prose created fertile ground for change and debate has flourished over the subsequent century. Flexner called for more stringent and merit-based admissions requirements, suitable length of training, a reduction in the emphasis on lecturing, and the incorporation of basic sciences into medical training, all of which reflect issues with which the health professional education community continues to grapple. That statement should not be taken as indicative of a lack of progress. On the contrary, the papers in this issue demonstrate just how sophisticated our field has become and make clear statements regarding just how much further we have to go. There is no right answer to many of the problems we face, but, with scholars of the quality of those who contributed to this issue leading the way, I am confident we are on the right path. Although much less heralded than the Flexner reports themselves, the vision of Henry Pritchett (then president of the Carnegie Foundation) and his colleagues arguably warrants as much credit for foreseeing the importance of, as well as enabling, a study with the scope of Flexner’s. Similarly, I would applaud the vision and considerable effort engaged by our guest editors. Throughout the processes of planning the issue, commissioning the articles and managing the review process, Tim Dornan, Jean McKendree and Iain Robbé have ensured that each paper will drive the conversation of where health professional education stands a century post-Flexner further into the next century. The result is an issue that is surprisingly cohesive given that so many authors from such diverse perspectives and backgrounds were recruited to contribute. Fortunately, that cohesion does not simply reflect a uniformity of perspective, but, rather, is derived from the presence of clear themes that are intertwined across the articles. Dornan et al.4 lay out their vision for this issue and their impression of the result in their introductory commentary, so I will not delve into those themes here. On behalf of the journal and its readers, I do wish, however, to thank these three individuals and each of the authors, reviewers, and commentators they recruited, for the time and clear scholarship they dedicated to making this a very special issue indeed.