Flexner Report Research Articles

Sociology's Flexner Report: The Education of Sociologists in the United States . Elbridge Sibley. Russell Sage Foundation, New York, 1963. 218 pp. $3.50.

Sociology's Flexner Report: <i>The Education of Sociologists in the United States</i> . Elbridge Sibley. Russell Sage Foundation, New York, 1963. 218 pp. $3.50.

Medicine for a New Age

N CINCINNATI 140 years ago, at the opening of what was then our westernmost medical school, Dr. Daniel Drake, president of the New Medical College of Ohio, in his Inaugural Discourse on Medical Education, said, Clinical medicine is an unceasing employment of means for the accomplishment of specific or definite objects. Considered in relation to our knowledge of these means, the profession is a science-in relation to the application of them, it is an art. He who acquires the former only is learned; he who relies on the latter alone is ignorant, empirical, and criminal; he who encompasses both reaches the highest attainable perfection. Perhaps this is where a quondam psychologist can speak up without feeling too de-fensive. There are many ways of dividing and subdividing the rapidly expanding world of science. We have the earth sciences versus the life scienceis. We have the physical sciences versus the behavioral sciences. But Elton Mayo, of Harvard, has divided the sciences into the successful and the unsuccessful. Into the former category he put chemistry and physics; into the latter he put psychology and economics. That was some time ago, and this state of affairs is not going to last forever. The behavioral sciences, so far, justify inclusion in the unsuccessful sciences, in the sense that they have more unknowns in them than they have equations with which to solve them. But foir the very reasions which Dr. Drake called forth, the medical sciences, so-called, also belong among the unsuccessful sciences because, despite medicine's enormous content of science, it is also an art. is interesting to a layman to take a ba,ckward glance at the history of medical education in this country. In modern times, I suppose, the opening of the Johns Hopkins Medical School and Hospital in 1893 was a ma,jor landmark, with the, emergence of those four great men of medicine-Welch, Osler, Halsted, and Kelly. So high had the standards of admission been set that one of Welch's principal worries was whether anyone would arrive to be taught, and Osler said to Halsted, so the story goes, It is very fortunate we are here as professors, for I greatly doubt if we could qualify as students. And there is that other landmark: the Flexner Report. is not very long ago in the scale of history that the Flexner Report on medical education turned things upside down, and this nat.ion assumed concern for the kind and quali.ty of medical education which was to place American physicians and surgeons at the very top of the world's best in their technical skill and qualifications. is not for me to say why another problem sometime thereafter began to beset medical eidncation and medical practice, nor could I even say with accuracy when the Age of the Specialist dawned in this country. But certainly there was a time which has not yet drawn to, a close when the general practitioner who ha.d once been the mainstay of American medicine declined almost to the role oif the preliminary classifier, whose principal function became th.at of referring the patient to the man who knew all the neek or the knee joint and almost prided This paper is based on a talk given at the dedication of the Stanford Medical Center, Palo Alto, Calif. Dr. Stanton is president of Columbia Broadcasting System, Inc., and former chairman, Center for Advanced Study in the Behavioral Sciences.

Abraham Flexner, an Autobiography: A Complete Revision Brought Up to Date of the Author's "I Remember."

A little more than a year ago I reviewed Medical Education in the United States and Canada (1910), Medical Education—A Comparative Study (1925), and I Remember: The Autobiography of Abraham Flexner (1940). Reading these three books was a memorable experience, a return to original sources in preparation for presenting the Abraham Flexner Award of the Association of American Medical Colleges to Dr. A. N. Richards. I had been in the large company of persons who often quoted or referred to The Flexner Report , but had not actually read it. After this concentrated exposure to Flexner I determined to write him a letter. In it I avowed my hero worship and said some things customarily reserved for obituary notices. For example, I expressed my confident opinion that Abraham Flexner and John Shaw Billings would be remembered as the great men in American medicine during the heroic years of its rising out

Medicine and Society in America 1660-1860.

In recent years medical history has come of age in this country. This scholarly study of medicine in America between 1660 and 1860 illustrates in great detail the basis upon which modern medicine was able to develop. The origins of the medical profession in this country, its extremely limited scope and primitive methods, as well as its meager status, are set forth with disarming clarity. One might almost say that the rise of the medical profession as we know it in this country now was a direct effect of the reforms resulting from Abraham Flexner's Report of 1910, though there were many important forerunners, as Jarcho has shown so well. The rise of university medicine began with the establishment of full-time clinical and basic science faculties, the equal of those of other university graduate schools. The largely proprietary methods of teaching, the very meager specific therapy which the best physician

Medicine's debt to Abraham Flexner.

Last September, an editorial in the Chicago Tribune contained the following statement. Abraham Flexner was one of the movers and shakers of his era. world is a different and a better one, thanks to his influence. New York Times editorial said that No other American of his time has contributed more to the welfare of his country and of humanity in general. Dr. Flexner made it possible for physicians to see clearly the direction of their efforts in medical education. size of medicine's debt to him can be appreciated by going back to the year 1908, when there were three classes of medical schools: good, bad, and indifferent. Medical Schools Before the Flexner Report Here is a brief picture of medical education in St. Paul, Minn., around the turn of the century. Dr. A. J. Stewart wrote the following. The students, reading in the different doctors' offices,

MEDICAL SERVICE AS A MEDICAL SCHOOL FUNCTION

Perhaps the two greatest developments in American medical education in the past 50 years have been the acceptance of the basic sciences as the foundation of medical practice and the introduction of the student in his clinical years to the wards and outpatient clinics as a full-fledged member of the health team. One of the major criteria applied by Abraham Flexner to the medical schools he evaluated in 1909 was the extent to which undergraduate students had access to patients. Henry Pritchett in his introduction to The Flexner Report wrote: A hospital under complete educational control is as necessary to a medical school as is a laboratory of chemistry or pathology. High grade teaching within a hospital introduces a most wholesome and beneficial influence into its routine. At that time only a handful of medical schools made use of bedside teaching while most resorted to demonstration of a few patients

The Teaching of Pathology, Microbiology, Immunology, and Genetics: Report of the Second Teaching Institute of the Association of American Medical Colleges, French Lick, Oct. 10-15, 1954.

The period since World War II has seen a great upsurge in a formal and organized approach to problems of medical education. Part of this is a natural outgrowth of the developments which have revolutionized medical education in its entirety. We tend to look on contemporary medical education as a development of the contributions of Johns Hopkins Hospital and Harvard Medical School supplemented and indeed deflected by the Flexner report. But things are more complex, and now we are caught up in all the multitudinous new advances which have stuffed the curriculum to bursting. The sometimes self-conscious introspections of medical teachers are made fretful by Education and all the machinery of examinations, committee evaluations, student opinion polls, and the like. The story of the influence of the great Eastern universities and medical schools has been told and many times over. No one has traced out the conspicuous influence of midwestern

The United States Public Health Service's Clinical Center for Medical Research.

The interrelationships between clinical medicine and medical research form one of the most intriguing chapters in the history of medicine. They have never been completely separated, or completely together, and the ways in which they have affected each other have varied markedly as medicine has evolved in this country. During recent years, perhaps as a cumulative effect of the general lifting of standards of medical education since the Flexner report, the spirit of inquiry has been widely dispersed among practicing physicians. Indeed, the innumerable studies and observations made in the course of medical practice are an indispensable contribution to the total medical research effort of the nation. At the same time, the scope of laboratory research related to medicine has expanded rapidly as the techniques and viewpoint of the biochemist and biophysicist have been brought to bear not only on disease problems but on the mechanism of normal body function.

Integrated teaching in the basic sciences; report on five years' experience.

The Flexner report on Medical Education in the United States and Canada 1 marked a turning point in the history of American medical schools. Among other things, Flexner found that, at the time of his report, the laboratory sciences were too much subordinated to clinical teaching. This defect was gradually corrected by the schools. However, the Commonwealth Fund, in its annual report of 1950, has noted that the pendulum has now swung to the other extreme and that these sciences now stand too much alone, so that their relation to clinical judgment is often left unclear in the student's mind. The Commonwealth Fund report emphasizes that... the first two years of medical school are characteristically split into discontinuous fragments and that the student is given little help in putting them together. In the poorer schools one department may neither know nor care what another teaches. Even in the better ones,