Abraham Flexner Research Articles

A Major Challenge for Graduate Medical Education

Arguably, the most pivotal period in medical education in this country was during the early 20th century when a nonphysician was given the task to objectively evaluate medical education in America. Abraham Flexner, an educator who worked at the Carnegie Foundation for Advancement of Teaching, provided a critical analysis of an educational system in medicine that had no regulatory body or structured curriculum. This landmark report on Medical Education in the United States and Canada was unveiled in 1910. 1-3 The “Flexner Report,” as it is commonly called, highlighted that a large percentage of medical schools were strictly proprietary. Very few had any type of standards or required prerequisites prior to matriculation. In fact, most medical schools were faculty owned, with tuition funding most of the faculty salaries. The majorityofthemedicalschoolsduringthis period had no hospital or university affiliation. It was reported that some of the graduates from these schools never dissected a cadaver and often did not see a singlepatient.Theshockingconclusionof theFlexnerReportwasthatmorethan120 of the 150+ operating medical schools should be closed. The report generated a quick response from the American MedicalAssociation’sCouncilonMedicalEducation, which initiated the following ratingsystem:classA,fullysatisfactory;class B, redeemable; and class C, complete reorganization needed. With most of the states denying licensure to new graduates of class C schools, it resulted in almost immediate closure of the schools in this category. If they did not close outright,theclassBschoolsoftenmergedwith other schools to survive. As predicted, more than 100 medical schools eventually closed. An unexpected consequence of the Flexner Report was the increase in philanthropic funds to the medical schoolswithalmosthalfofthefundsgiven toallcausesbeingdirectedtoundergraduate medical education. Approximately $154 million (excluding matching funds) were poured into medical schools. Fortunately,medicalschoolstodayare

Osler, Flexner, apprenticeship and 'the new medical education'

These are bewildering times for doctors who teach medical students. The UK General Medical Council (GMC) has reminded them they have a duty to teach,1 yet stirred up such radical change that their task is unrecognizably different from what they themselves experienced as students.2,3 This essay draws on biographies of two people who changed the face of medical education in the 20th century to trace the origins of this bewilderment and suggest a direction for the 21st century.4,5 Most of today's doctors just associate the name of William Osler with nodes they were taught about but never see. In Michael Bliss's biography, he comes to life as a master clinician, apprentice-master, and humanist role model. I first became aware of Abraham Flexner as the author of a century-old report that got medical education into the mess it is in today. Wrong. He was a visionary educationalist who raised standards of medicine round the world by wedding it with biomedical science. After vignettes of these two men, I describe what the GMC has recommended and read between the lines of its recommendations. To finish, I suggest the wheel has come full circle. Apprenticeship, central to Osler and Flexner's educational visions, needs to be revitalized.

Contextual Culture of the Master's Degree and the Decline of the M.L.S. Thesis: An Exploratory Review Essay

Iconoclast: Abraham Flexner and a Life in Learning. By Thomas Neville Bonner. Baltimore, Md.: Johns Hopkins University Press, 2002. 432 pp. $36.00. ISBN 0-80187-124-7. Higher education has never really been free of critics, nowhere more so than in the United States, where until recently higher education has enjoyed a near mythological stature within the collective mind. American colleges and graduate and professional schools have been instrumental in providing necessary training and education for the nation, signaling a qualified success.1 However, as with any human enterprise, such activities must undergo scrutiny and periodic pulse reading. Abraham Flexner proved to be one of the most powerful observers of higher education, and to this day he would comprehend many of its ills with measured concern. Bonner's biography is a well-conceived tour de force, situating Flexner within the intellectual and educational milieu in which he operated. Of humble origins, Flexner joined the Carnegie Foundation for the Advancement of Teaching and evolved into an influential figure affecting the course of medical education by releasing his 1910 report, which paved the way for research-based hospitals and medical scientific education. Later he became a leading figure in philanthropy through the Rockefeller Foundation, and founded the Institute for Advanced Studies at Princeton. A flawed individual, Flexner is portrayed as a champion of criticism and reform, a watchdog of higher learning.2 A staunch supporter of law and medicine within the academy, he held professional programs other than the former as philistine, better offered elsewhere.3 Iconoclast is a richly drawn texture of intellectual history and a necessary signpost for further reflection. It masterfully addresses an [End Page 63] individual crusader whose ideas and concerns loom large for all professional programs, especially where research and scholarly acculturation are concerned. The influence and concern Flexner exercised are best illustrated when viewing the protean nature of master's education in America. The drive to professionalize various occupations has led to the Flexnerian prognostication that higher learning was not only in jeopardy in his time but has metastasized into the unbridled enterprise it is today.4 When Abraham Flexner's Universities: American, English, German first appeared in 1930, it focused concentrated criticism on American higher education. Like a laser cutting through moribund flesh, Flexner left little to be misunderstood, so much so that higher education officials and the interested public knew exactly where his philosophy lay within the growing enterprise that was American higher education. Most striking was the added vehemence leveled against graduate education in the main but especially professional education.5 In light of the almost universal celebratory response to American higher education and its continued success since Flexner's first critique, graduate education has evolved into a massive enterprise. Compounding Flexner's position, which at times could appear Eurocentric and unmistakably elitist, coexisted an equally strong disdain for classical education as conceived in the eighteenth and nineteenth centuries, especially as it manifested itself in American colleges and universities prior to the turn of the twentieth century. Evenly tempered by a willful sense of purpose and idealism bordering upon the purist form of Bildung, Flexner's perceived attack on American higher education must be seen as an attempt to foster a sustained respect for the life of the mind for the seriousness it deserves. Consequently, professional education within the confines of such sacred groves as the University of Chicago, Harvard, or elsewhere, including some large state universities (e.g., the University of Illinois, the University of California at Berkeley or Los Angeles), was an aberration to be excised from the otherwise robust body of higher education. Incisive and cogently critical, Flexner navigated among the diverse and fluid definitional concerns of the public perception of what constituted proper higher education and the accommodating forces of utilitarian-driven...

The great influenza The epic story of the deadliest plague in history

The great influenza: the epic story of the deadliest plague in history is a great book. It is well conceived, well researched, and extremely well written. The appropriate audience goes beyond the interested physician, scientist, or medical student. The book will also appeal to history buffs, who will be fascinated by the dangerous mix of politics, war, and pestilence presented here. In the first third of the book, the word “influenza” rarely appears, because author John M. Barry is painting the landscape of science, medicine, and politics in the pre-World War I era. What comes to life in these pages is the sad state of US science and medicine at the time. For example, admission to US medical schools was dependent not on academic achievement, but rather on whether the applicant would pay the tuition. This changed with the Flexner Report, published in 1910 by Abraham Flexner, and with the establishment of such institutions as the Rockefeller Institute for Medical Research, ably led by Simon Flexner (brother of Abraham). As highlighted by Barry, the other major change leading to the modern era of American medicine was the founding of Johns Hopkins Medical School at the very end of the 19th century, with William Welch as the legendary force behind it. For anyone who has had the opportunity to interact with Johns Hopkins University, this introductory chapter in Barry’s book is mandatory reading. The writing is facile and gripping at the same time, and the author does an extraordinarily good job of creating a fluent narrative from historical research. Even when Barry describes the replication of the influenza virus in the cell, the writing is easily comprehensible and convincing. He creates numerous wonderful images, such as likening the translation of a messenger RNA to reading Braille. When it comes to the actual influenza pandemic of 1918, Barry does a brilliant job. The facts of this extraordinary event are well presented and discussed. The reader is given the diverse data on the number of people who died during this pandemic; descriptions of those who did the analysis and the basis for arriving at the different numbers allow the reader to decide for him- or herself what the best estimates are. A conservative — and the most convincing — estimate is 50 million. In the context of the present world population of six billion, compared with two billion in 1918, this would translate into 150 million deaths today. The political and military scene of 1917 as described by Barry is equally fascinating. Despite major scientific and public health advances, many of the influenza casualties resulted from uninformed and misguided decisions by military and political leaders. Hiram Johnson is quoted as saying, “The first casualty when war comes is truth.” This statement certainly remains true some eighty years later. When Barry recounts the suspicion that “German agents . . . from submarines” are suspected of having brought influenza to the United States, we can see that propaganda is not new either. Barry raises the frightening possibility that President Wilson was weakened by influenza in April 1919 and that this caused him to give in to the demands by the European allies, which resulted in the unfortunate outcome of the negotiations at Versailles. The book is particularly powerful when it describes the actual disease and its effect on the population. The outbreak in Philadelphia must have been horrendous, with 4,597 influenza deaths in a single week. The effects of influenza in other parts of the world are described as equally harrowing. Barry quotes a report about an Alaskan village in which “ . . . it was quite impossible to estimate the number of dead as the starving dogs had dug their way into many huts and devoured the dead . . . ” A few good things did come from this devastating pandemic. A restructuring of the country’s public health system had its beginning as a direct result of the events of 1918, and efforts were made to push for the establishment of the NIH, which became a reality about ten years later. Overall, this book is engrossing reading, with plenty of relevance for our own time, which is threatened by natural (and/or deliberately released) emerging pathogens. It is a question not of if, but of when we will be faced with another epidemic of this magnitude. On the last page of the book, Victor Vaughan is quoted on the 1918 influenza pandemic: “Civilization could have disappeared within a few more weeks.”

Review: Iconoclast: Abraham Flexner and a Life in Learning

Review: Iconoclast: Abraham Flexner and a Life in Learning

Review: Iconoclast: Abraham Flexner and a Life in Learning

Review: Iconoclast: Abraham Flexner and a Life in Learning

Iconoclast: Abraham Flexner and a Life in Learning

Iconoclast: Abraham Flexner and a Life in Learning

Reminiscences from my medical school and residency days.

A physician who was a medical student and resident in the 1930s at the Washington University School of Medicine recalls many of the remarkable professors who were recruited after Abraham Flexner had recommended a complete reorganization of the school in 1910, and who shaped the development of the school. Each of these individuals pioneered developments that shaped the research, clinical, and organizational advances of medicine in the 20th century. More than 60 years after graduation, the recollections rekindle the excitement and fun of medical education during that period.

Centers, institutes, and the future of clinical departments: part II

The Association of Professors of Medicine (APM) continued its efforts to examine the structure of departments of internal medicine by publishing an article in the September 2003 issue of the Journal that defined centers, institutes, and interdepartmental structures in academic medical institutions; provided a brief history of these entities; and outlined the association's agenda for examining centers ( 1 Ibrahim T. O'Connell J.B. LaRusso N.F. Meyers F.J. Crist T.B. Centers, institutes, and the future of clinical departments part I. Am J Med. 2003; 115: 337-341 Abstract Full Text PDF PubMed Google Scholar ). Since the creation of centers, the center-department relationship has been controversial. According to a 1930 report by Abraham Flexner “… in America, [centers] may mean something or nothing… Harvard has in its faculty of law an institute of criminal law, which would appear to be simply the name of the research activities of the chair devoted to that subject—a dubious departure, since it implies a possible separation of teaching and research within the limits of the university chair” ( 2 Flexner A. The Flexner Report on Medical Education in the United States and Canada 1910. Science and Health Publications, Inc, Washington, DC1960 Google Scholar ).

Arthur C. Guyton, MD

The sudden loss of Dr Arthur C. Guyton in an automobile accident on April 3, 2003 and the loss of his devoted and remarkable wife, Ruth Weigle Guyton, one week later as a result of injuries from the accident stunned and saddened all who were privileged to know them. Arthur Guyton was a giant in the fields of physiology and medicine, a leader among leaders, a master teacher, and an inspiring role model for people throughout the world. Arthur Clifton Guyton was born in Oxford, Mississippi, to Dr William (Billy) S. Guyton, an eye, ear, nose, and throat specialist and dean of the University of Mississippi Medical School, and Kate Smallwood Guyton, a math and physics teacher who had been a missionary in China before their marriage. During his formative years, he enjoyed watching his father work at the Guyton Clinic, playing chess and swapping stories with William Faulkner, and building sailboats (one of which he later sold to Faulkner) and countless mechanical and electrical devices, which he continued to do throughout his life. Arthur Guyton’s brilliance shone early. He graduated top in his class at the University of Mississippi, distinguished himself at Harvard Medical School, and began his postgraduate surgical training at Massachusetts General Hospital. His medical training was interrupted twice—once to serve in the Navy during World War II and again in 1946 when he was stricken with poliomyelitis during his final year of residency training. Suffering paralysis in his right leg, left arm, and both shoulders, he spent nine months in Warm Springs, Georgia, recuperating and applying his inventive mind to building the first motorized wheelchair controlled by a “joy stick,” motorized hoists for lifting patients, special leg braces, and other devices to aid the handicapped. For those inventions he received a Presidential Citation. He returned to …

Iconoclast: Abraham Flexner and a Life in Learning

Iconoclast: Abraham Flexner and a Life in Learning

Rockefeller philanthropy and the “Flexner Report” on medical education in the United States

Ponders on whether Abraham Flexner was responsible for the change in medical education in North America in the early 20th century, owing to his report of 1910. Tries to demonstrate that medical education in the USA was part of a greater whole of major changes at that time. Concludes, though there was a philanthropic influence, Flexner (who refused to accept credit for change) was not the father of the medical reform plan.

Clinical Chemistry Since 1800: Growth and Development

The 19th and 20th centuries witnessed the growth and development of clinical chemistry. Many of the individuals and the significance of their contributions are not very well known, especially to new members of the profession. This survey should help familiarize them with the names and significance of the contributions of physicians and chemists such as Fourcroy, Berzelius, Liebig, Prout, Bright, and Rees. Folin and Van Slyke are better known, and it was their work near the end of the second decade of the 20th century that brought the clinical chemist out of the annex of the mortuary and into close relationship with the patient at the bedside. However, the impact on clinical chemistry and the practice of medicine by the 1910 exposé written by Abraham Flexner is not as well known as it deserves to be, nor is the impetus that World War I gave to the spread of laboratory medicine generally known. In the closing decades of the 20th century, automated devices produced an overabundance, and an overuse and misuse, of testing to the detriment of careful history taking and bedside examination of the patient. This is attributable in part to a fascination with machine-produced data. There was also an increased awareness of the value of chemical methods of diagnosis and the need to bring clinician and clinical chemist into a closer partnership. Clinical chemists were urged to develop services into dynamic descriptions of the diagnostic values of laboratory results and to identify medical relevance in interpreting significance for the clinician.

Joseph W. St. Geme, Jr address 2001: can one have a successful academic career in 2001?

One of the attributes of Dr Joseph W. St. Geme, Jr, was his ability to mentor and motivate his house officers and junior faculty to engage in successful pediatric career paths.1 His presence was a huge one, both in person and in terms of his interactions with members of his pediatric family at Harbor UCLA and Colorado. He also was generous in giving credit to all who did the work that resulted in their success. It is fitting that the recipient of the Howland Award today, Dr Delbert Fisher, was a member of the Harbor UCLA faculty, and while there, his career tangent was distinguished. Joe St. Geme remains an admirable role model whose disciples and their trainees are in the audience today. It is truly humbling to receive this award. In 1910, Abraham Flexner explicitly recommended that medical schools should be formally affiliated with public or private universities. Progressively, this association has resulted in a powerful recognition of the importance of biomedical research in the community of scholarship that exists at a University.2 Ninety-one years later, in a new century, this link has become pivotal because of the impact that biological concepts will have in the 21st century. The February 15, 2001 issue of Nature 3 and the February 16, 2001 issue of Science 4 were devoted to the announcement of the completion of the Human Genome Project by 2 separate approaches (National Institutes of Health [NIH] and Celera). Several huge surprises have emerged.3,4 The human genome has approximately 30 000 genes, far fewer than the 100 000 predicted. These are only 30% more genes than the nematode Caenorhabditis elegans . There are 85 000 to 100 000 different mRNA sequences (as inferred from expressed sequence tags) or roughly 3 sequences per gene, indicating the …

AUR-Kodak Introduction to Management Program

The Association of University Radiologists (AUR) has partnered with the Eastman Kodak Company to sponsor a new program that will provide management training for academic radiologists. Existing programs through the AUR and corporate sponsors play a valued role in supporting research in radiology and fostering junior faculty in the academic system. However, the AUR has not had a sponsored program in radiology management and leadership for physicians. The partnership is a natural one. The AUR continues to be the society that represents the major academic radiology programs in the United States. Kodak has been one of the prime movers in the development of medical imaging. The company has demonstrated a sustained commitment to product and process innovation, but of equal importance has been its commitment to customer education. In the early 1900s, American medical education was conducted in “proprietary” medical schools, which were either unrelated to universities or maintained in an unequal status. The Carnegie Endowment commissioned a review of medical education by Abraham Flexner, who said of medical schools: “many are. . .without redeeming features of any kind. Their general squalor consorts well with their clinical poverty” (1). The Flexner report created a revolution in American medical education. Universities revitalized medical schools by emphasizing entrance requirements, the scientific basis of clinical practice, and “active learning.” Academic medical centers remain unique in combining undergraduate and graduate education, basic and applied research, and faculties who spend most of their time in the daily practice of their profession (2). Remarkable as the subsequent advances in clinical science have been, the future is equally promising. We can anticipate minimally invasive therapies that utilize threedimensional imaging and virtual reality, robotics and nanomachines; regeneration of damaged tissues; molecular imaging and diagnosis; and control of aging, cancer, and psychiatric illness. Medical education also is poised for dramatic advances utilizing life-long “intelligent agent” computerized personal tutors; the use of actors, mannequins, and robots; and procedure simulators and virtual reality. These advances will alleviate the information overload in medical education, and they will permit medical schools and students to enhance their focus on human interaction skills, ethics, and social values. Academic medical centers are essential in generating new knowledge, translating research into patient care, and training the next generations of physicians. However, they face severe economic challenges. On the one hand, there are declining revenues related to the Balanced Budget Act of 1997 and other government initiatives, managed care, and regulatory focus on industry coding practices. On the other hand, there are increasing costs from uncompensated care of the uninsured, wage and benefits expense in tight labor markets, the administrative infrastructure needed for managed care and regulatory compliance, and losses from physician integration strategies. Academic departments of radiology have been critical to introducing new developments in imaging such as magnetic resonance imaging and picture archiving and communication systems, but they, too, must deal with the economic pressures. Radiologic societies have responded with development of research and education foundations, which support junior faculty and trainees in the academic aspects of the field. The National Institutes of Health budget has increased substantially, and recently we have seen the creation of a National Institute of Biomedical Imaging Acad Radiol 2001; 8:1134–1135

I view with alarm plus a note of optimism (2001)

I view with alarm plus a note of optimism (2001)

Exploring the pathology of quality failings: measuring quality is not the problem--changing it is.

The USA can boast a long history of investigation into quality failings in health care. From Ernest Codman and Abraham Flexner in the opening decades of this century through to the intense activity of the 1980s and 1990s, much careful study has exposed extraordinary and at times scandalous deficiencies in the quality of care (Millenson 1997; Chassin & Galvin 1998; Schuster et al. 1998). Yet we are still far from developing 'industrial strength' quality in health care: in all but a few isolated areas, such as general anaesthesia, 'six sigma quality' (i.e. a handful of errors per million) seems wishful thinking (Chassin 1998). Pockets of excellence and innovation notwithstanding, the dominant experience of the past two decades has been an increasing ability to document quality failings and a seeming inability to mobilize effective action (Coye & Detmer 1998). The rich literature on health-care quality that has sprung up over the past few decades has largely failed to provide a clear direction for quality improvement activity. This paper analyses some of the reasons why this might be so. Contrasting the relative absence of progress on health-care quality with the relative success of disease epidemiology provides some illuminating parallels. In essence, study of the quality of care has focused largely on providing a 'descriptive epidemiology'. Much more work is needed yet to unravel the underlying pathology of quality failings, in order to empower development of an 'aetiological epidemiology' of quality in health care. Such understanding is essential as a precursor to targeted and effective preventative and remedial action.

Reflections of a Social Work Practitioner: Bridging the 19th and 21st Centuries

This is a practitioner’s personal account of social work as a profession. The primary purpose of the article is to offer a vantage outside traditional academic explorations of this topic. A principal theme is the current state of professionalism in social work, especially in reference to Abraham Flexner’s 1915 critique of the field. The author maintains that social work is unquestionably a profession and that the time has arrived to move beyond the repeated questioning of ourselves. Drawing on the pragmatic experimentalism of Jane Addams, the author suggests a refocusing, or re-viewing, of social work as a relational field. This departs from the traditional focus on targeted functions and groups that define our purposes and methods and contribute to interdisclipinary debates about the true nature of social work.

Hand transplantation: Rehabilitation: Case report

MicrosurgeryVolume 20, Issue 8 p. 389-392 Original Article Hand transplantation: Rehabilitation: Case report Anne Hodges P.T., M.S.Ed., Corresponding Author Anne Hodges P.T., M.S.Ed. Hand Therapy Center, Louisville, KentuckyHand Therapy Center, 225 Abraham Flexner Way, Suite 650, Louisville KY 40202Search for more papers by this authorSteve Chesher C.P.T.A., B.O.C., Steve Chesher C.P.T.A., B.O.C. Center for Orthotic and Prosthetic Care, Louisville, KentuckySearch for more papers by this authorSandra Feranda M.S., O.T.R., C.H.T., Sandra Feranda M.S., O.T.R., C.H.T. Heartland Rehabilitation Services, Cherry Hill, New JerseySearch for more papers by this author Anne Hodges P.T., M.S.Ed., Corresponding Author Anne Hodges P.T., M.S.Ed. Hand Therapy Center, Louisville, KentuckyHand Therapy Center, 225 Abraham Flexner Way, Suite 650, Louisville KY 40202Search for more papers by this authorSteve Chesher C.P.T.A., B.O.C., Steve Chesher C.P.T.A., B.O.C. Center for Orthotic and Prosthetic Care, Louisville, KentuckySearch for more papers by this authorSandra Feranda M.S., O.T.R., C.H.T., Sandra Feranda M.S., O.T.R., C.H.T. Heartland Rehabilitation Services, Cherry Hill, New JerseySearch for more papers by this author First published: 04 January 2001 https://doi.org/10.1002/1098-2752(2000)20:8<389::AID-MICR8>3.0.CO;2-OCitations: 18AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume20, Issue8Special Issue: Proceedings of the Second International Symposium on Composite Tissue Allotransplantation, Louisville, Kentucky2000Pages 389-392 RelatedInformation

Indirect Work: Social Work's Uncelebrated Strength

On first centenary of professional social work education in United States, there are several ways of celebrating social work's contribution to society. We can remember profession's pioneers and praise advances made in theory and research. Alternatively, we can examine everyday practice and what clients say they value about our efforts. This latter approach reveals importance of indirect social work's unsung hero (Grinnell, 1973). Historically, indirect work has referred to clinical social worker's intervention in clients' environments and collaboration with others in bureaucracies or clients' social networks in an attempt to alleviate clients' difficulties. Grinnell and Kyte (1975) succinctly defined two components of indirect work. The first is concrete assistance, that is, provision of practical or tangible help whereby social worker uses resources or opportunities that exist or are potentially available for benefit of (p. 314). The second is sociopsychological intervention, that is, the modification of attitude or behavior of significant others within client's social . . . environment (p. 314). Direct work, in contrast, has referred to what is achieved mind upon mind, to use Mary Richmond's phrase, through relationship between client and social worker. Indirect and direct work frequently appear in tandem. For example, social worker may collaborate with other professionals in client's presence (Weissman, Epstein, & Savage, 1983). Why Examine Indirect Work? A historical analysis of indirect work traces thinking of many social work theoreticians and therefore enriches our understanding of profession. In addition, an examination of indirect work has conceptual, ethical, and practical relevance. I will argue that indirect work helps define conceptually social work's professional jurisdiction - that is, an area in which social workers exhibit both competence and expertise (Abbott, 1988). Ironically, social work literature has neglected indirect work and, sadly, history reveals that some practitioners have also. This neglect is worrisome given that social work's ethical mandate is to meet people's basic human needs and to give special attention to environmental forces (NASW, 1996, p. 1). Contemporary social problems, for example, fragmented medical and welfare services, require indirect work. Social work has made some progress in classifying distinct components of indirect but there is a need to develop practice principles grounded in empirical research. In addressing these themes, this article traces development of idea of indirect work through works of Flexner, Richmond, Reynolds, and Hollis and comments on social work's ambivalence toward this work. The article also discusses research on indirect work and clients' views of it. In addition, article examines modern portrayals of indirect work that include wider political arena and offers recommendations for practice and research. Indirect Work: History of an Idea History reveals recurring themes and ideas. A few years ago, Andrew Abbott, sociologist, stated that probably vast majority of what people with title 'social worker' actually do in United States is indeed connecting together services provided largely by other professions and other institutions (Abbott, 1995, p. 559). How similar is this depiction to one made by Abraham Flexner some 80 years earlier? Flexner In 1915 Flexner, a prominent developer of medical training programs, delivered a lecture entitled Is Social Work a Profession? at annual session of National Conference of Charities and Correction (a precursor of National Conference of Social Work) (Flexner, 1915). The question addressed in Flexner's speech may have been premature, as social work was in an embryonic stage. Settlement houses had existed for more than 25 years (Addams, 1990), but professional social work training was relatively new. …