Flexner Report Research Articles

Southern Surgical Association: Leadership Pre and Post Flexner's Report.

The Joseph M Donald Endowment for the Archival Collection of the Southern Surgical Association is named for the 73rd President Elect of the Southern Surgical Association (Figure 1), who died in 1961 at age 57 before he had the opportunity to deliver his Presidential Address. Dr Donald's career as a surgeon in Birmingham began in 1931 after the completion of his residency at the Mayo Clinic. He was one of four generations of Donalds to serve Alabama as physicians. Joe practiced General Surgery at three hospitals in Birmingham, including work as voluntary faculty at University Hospital under Dr James Mason and later Dr Champ Lyons.Dr Donald interrupted his practice to serve in the European Theater with the US Army Medical Corps during the Second World War. He was a Governor and Regent of the American College of Surgeons (ACS) and a leader in the Alabama Chapter of the ACS. Two of his sons, Joseph, Jr and Thomas trained as surgeons. From 1854 until the present, twenty-four Donald or Donald-related physicians have practiced in Alabama (personal communication, Dr Thomas T Donald). The present talk is dedicated to the memory of Dr Joseph Marion Donald and his contributions to the field of surgery.

The Pragmatist roots of scientific medicine: Reassessing Abraham Flexner's report on medical education

Abraham Flexner's 1910 report on medical education is widely regarded as a watershed moment in the history of modern medicine in the US and beyond. Most commentators focus on its administrative and managerial impact, despite Flexner dedicating a sizeable portion of his report to a theoretical account of the kind of medicine that he seeks to implement. Close attention to these sections reveals a surprisingly coherent account of medicine that, based on a Deweyan Pragmatist philosophy of science, unites scientific investigator and medical practitioner in a new experimental paradigm of science. Flexner can develop an account that goes beyond a mere epistemic redefinition of medicine, providing the profession with a social, cultural, and ethical identity that avails itself of the extremely wide purview that Dewey granted to modern science. Due to the subsequent narrowing of philosophy of science to a delimited academic subdiscipline, these broad Pragmatist philosophical commitments at the roots of Flexner's scientific medicine remained a largely unexplored intellectual legacy.

The impact of Flexner's report on medical education in Sub-Saharan Africa Sudan as an example

The impact of Flexner's report on medical education in Sub-Saharan Africa Sudan as an example

Studying the history of histopathology in preclinical medical education as a guide for the uniform integration of radiology in medical education

Radiology and pathology, though distinct fields within medical education, share a common foundation in their essential roles for accurate diagnosis and understanding of diseases. While pathology, particularly histopathology, has long been integrated into preclinical medical education in the United States, radiology education has traditionally been less emphasized. This paper examines the historical development of histopathology training in medical education and its central role, contrasting it with the comparatively peripheral position of radiology education. We explore the historical context of medical education in the United States, tracing the integration of histopathology following the Flexner Report of 1910. In contrast, radiology, emerging later as a specialized field, has faced challenges in achieving comparable integration into medical curricula. Despite the increasing importance of medical imaging in diagnosis and treatment, radiology education remains variable and often lacking in standardization across medical schools. We highlight the need for greater emphasis on radiology education to better prepare medical students for modern clinical practice, where medical imaging plays an increasingly pivotal role. A call for a comprehensive assessment of radiology education and advocacy for its integration into preclinical curricula is made, emphasizing the importance of collaboration between the radiology profession and accrediting bodies to ensure competence in imaging across medical specialties. As medical imaging continues to advance and become more integral to healthcare, it is imperative that medical education reflects this evolution by establishing radiology as a fundamental component of preclinical training.

Historical Inequities in Medical Education - Commitment to Opportunity, Diversity, and Equity at the University of Hawai'i School of Medicine.

Medical education in the US has contributed to institutionalized racism through historically exclusionary practices, which has led to health disparities and inequities in health care today. The 1910 Flexner report, which favored schools with greater resources, led to the closure of nearly half of medical schools in the Us, which were mostly small schools located in rural communities that served economically disadvantaged, ethnic minority, and female populations. Closing these schools ultimately limited the availability of physicians willing to serve disadvantaged and minority populations in impoverished and underserved communities. In order to transform medical education to be more equitable, medical schools must be proactive in opportunity, diversity, and equity efforts. This not only includes efforts in admissions and faculty hiring, but also curricula related to social and health disparities, interracial interactions between students and faculty, and service learning activities that engage and work with marginalized communities. The University of Hawai'i John A. Burns School of Medicine has a longstanding commitment to diversity, which is integral to the school's mission. Providing opportunities to underserved populations has been a priority since establishment of the school. As one of the most diverse univeristies in the US, the school of medicine continues to focus on opportunity, diversity, and equity priorities in both its strategic planning and overall mission.

Integrating Basic Sciences and Clinical Practice: A Cross-Sectional Study of UQUMED's Medical Education Approach

Introduction. Since the early 20th century, medical education has evolved, notably with the Flexner report emphasizing the fusion of foundational sciences and clinical reasoning. As the field grew, educators adeptly incorporated new sciences and technologies, ensuring curriculum balance and depth.
 Aim. This research aimed to explore the role of basic sciences in contemporary medical education, focusing on their integration with clinical practice.
 Methods. An institutional-based cross-sectional study design was implemented at Umm Al Qura University, College of Medicine, Makkah, Saudi Arabia, from March to June 2023. This study involved surveying 470 medical students, from a total campus population of 1,360 students (excluding preparatory year), using a pre-tested and structured self-administered questionnaire. All questions in the survey were formatted to elicit dichotomous responses, namely “yes” or “no”, and the collected data were analyzed using SPSS version 20.
 Results. The study discovered that while a high percentage of medical students (96.6% in earlier years to 94% in senior years) recognized the importance of basic sciences in the MBBS curriculum, there was a noticeable decline in this belief as students advanced through their clinical years. Similarly, the perception of the utility of foundational knowledge of basic sciences for understanding clinical subjects decreased slightly from 93% in earlier years to 85% in senior years. About 92.7% of students across all years believed a strong understanding of basic sciences was crucial for clinical proficiency. However, the perceived benefit of suggested readings/textbooks declined from 82% in earlier years to 77% in senior years. Feedback on curriculum enhancements showed robust support for more engaging teaching methods, with over 90% favoring the incorporation of multimedia tools and group-based sessions.
 Conclusions. Our findings underscore the foundational role of basic sciences in medical education for clinical competency, highlighting a gradual shift in student perceptions as they progress through their training. This shift signals the necessity for adaptive teaching strategies that effectively integrate basic sciences with clinical practice to maintain relevance and efficacy in medical curricula.

The Impact and Implications of the Flexner Report on Medical Education in Korea.

The recent debate surrounding the expansion of enrollment in Korean medical schools has reignited interest in the Flexner Report, published in the United States in 1910. Historically, medical education in the United States transitioned from small proprietary schools to university-affiliated institutions, emphasizing basic science and clinical experience. The Flexner Report advocated for scientific medicine and led to significant reforms in medical education, including standardization of curricula and strengthened admission requirements. The influence of this report extended to Korean medical education, shaping its curriculum, accreditation system, and emphasis on academic excellence. The expansion of medical school enrollment has led to a crucial dilemma. Should we prioritize the training of physicians who provide practical medical services or continue to emphasize academic medicine as we do now? There has been insufficient discussion of the individualized curricula, necessary investments, and societal efforts to accommodate these changes. It is imperative to move beyond mere enrollment expansion debates and collectively determine the future trajectory of Korean medical education, devising actionable plans to achieve overarching goals.

The Disappearance of Black Men From Medicine: A Consequence of Racism and the Flexner Report

The Disappearance of Black Men From Medicine: A Consequence of Racism and the Flexner Report

Accessibility in health professions education: The Flexner Report and barriers to diversity in American physical therapy

Health professionals do not reflect the broader racial/ethnic diversity of the United States. Historical barriers to accessing health professions education have played a major role in initiating and perpetuating these disparities. Sociologists of professions have highlighted the role of educational reform in professions' efforts to enhance their status, but have overlooked the central role of government bodies in facilitating or impeding these strategies. The Flexner Report (1910) enhanced the status of medicine, but only after state medical boards adopted its recommendations, leading to the closure of half of the nation's medical schools and limiting opportunities for marginalized populations to enter the medical profession. Physical therapy leaders have espoused Flexner's precepts in seeking to advance their field's professionalization. In doing so, they consistently overlooked the more insidious impacts of Flexnerian approaches on student and practitioner diversity. This article examines how physical therapy's Flexnerian ambitions disrupted its parallel efforts to increase the field's racial/ethnic diversity. I argue that physical therapy leaders' focus on enhancing their profession's status and indifference toward facilitating educational access and mobility played a significant role in the field's racial/ethnic homogeneity. To increase practitioner diversity in the future, especially following the 2023 US Supreme Court decision (600 U.S. 181) restricting race conscious affirmative action, health professions must do more to address barriers to student access. This will involve moving away from the Flexnerian model and pursuing approaches that have helped more diverse and inclusive health professions, like nursing, to achieve greater educational opportunity and mobility.

From The Editor: Flexner Report 3.0—Structurally competent healthcare

The editor advocates to formalize the addition of “Medical Social Sciences” as a basic science in our Schools of Medicine and “Clinical Decision Science” as the corollary clinical practice discipline: a “Flexner Report 3.0."

Impact of the Flexner's report on health professional education

Flexner's report on health professional education, also known as the Flexner Report, was published in 1910. It was a landmark document that revolutionized medical education in the United States and influenced healthcare education globally. The report was written by Abraham Flexner, who was commissioned by the Carnegie Foundation, and its objective was to assess the quality and standards of medical schools in the U.S. and Canada. Flexner visited 155 medical schools and evaluated them based on certain criteria such as faculty qualifications, curriculum, facilities, and research output. The Flexner Report was instrumental in improving the quality of health professional education and establishing the notion that physicians should receive comprehensive scientific education and clinical training. Its legacy continues to this day, as the principles and standards introduced by the report still guide modern medical education.

COVID-19 challenge with regard to medical schools social accountability: new professional and human perspectives

Medical schools play a central role in the compilation and development of professional knowledge, which is why they have privileges and resources that are justified only to the extent that they use them to serve the community, particularly those who are most in need. Medical schools social accountability focuses on the training, healthcare provision and research services they offer. The principles of medical education and the structure proposed by the Flexner Report are in crisis due to the COVID-19 pandemic, and redefinition of the social contract is required. This document offers a proposal for medical schools social accountability that includes anticipation of the needs of the community, patient-centered inter-professional care, training of people in the area of health and collaboration between institutions. It highlights the need for a conscious institution that finds new training spaces other than hospitals, where each patient is cared for in a personalized way, with inter-professional training models that consider the student as a person who takes care of him/herself in open collaboration with organizations. Leaders must act now because it is their social responsibility and because it is the right thing to do.

Chest Pain in a Patient with All Normal Cardiologic Exams Can Exclude That the Patient is Not Life- Threatening?

In my daily clinical practice, I constantly see patients complaining of chest pain and do routine cardiological exams, many of which come back with normal results. The phase of modern medicine we are going through today means that diagnoses are only partially correct because, after the implementation of the Flexner report in 1910, it made medical schools teach only what they see with the naked eye and thus, only this part of medicine was considered “scientific” [1].

Patient-oriented research and the shiny object syndrome.

Patient-oriented research and the shiny object syndrome.

Carnegie and Rockefeller's Philanthropic Legacy: Exclusion of African Americans From Medicine.

In the first 3 decades of the 20th century, John D. Rockefeller Sr. and Andrew Carnegie used their philanthropy to support 2 main mechanisms that functioned to exclude African American doctors from medical education and the medical profession. First, Carnegie funded the Flexner report, recommending reforms to medical education including the closure of most Black medical schools. Next, Rockefeller's General Education Board (GEB) funded restructures to medical education without equal support to ensure Black medical schools could keep up with changing standards. For every dollar the GEB donated to Black medical schools between 1902 and 1919, it donated $123 to White schools. During that period, for every dollar the GEB donated to White medical schools per White resident, it donated about $0.07 to Black schools per African American resident. Next, Rockefeller's philanthropy supported a system of school education that underprepared African American candidates to meet the requirements needed to enter medicine. For African American children, the GEB supported a kind of schooling termed industrial education, which emphasized manual training (e.g., skills related to agricultural science and efficiency). In 1933, industrial education schools were located in 57% of all Southern counties, and two-thirds of African Americans who attended primary and secondary school received an education that followed the industrial education curriculum. Industrial education underprepared candidates for applying to medical school, completing a medical school curriculum, and passing a medical board examination. This article examines how these 2 mechanisms had lasting and harmful effects on the underrepresentation of African American doctors in the medical workforce. These insights provide a broad and collective understanding of the early role of philanthropy in excluding African Americans from the medical profession, which is a crucial first step toward developing interventions to help redress racial discrepancies in the medical profession that persist today.

Invited Commentary: From Unacceptable to Intolerable

Invited Commentary: From Unacceptable to Intolerable

Creating Alignment: How the Humanities Can Help Heal Physicians and Patients.

The medical humanities, an umbrella term for the fields of ethics, social science, and fine arts, are increasingly recognized as an important component of medical education. Since the Flexner report, the primacy of science and evidence-based medicine has replaced subjectivity and nuance. While this has been critical for standardization of care and patient safety, an exclusive emphasis on science in undergraduate medical education can devalue more humanistic pursuits. Modern medicine is now plagued with burnout, pandemics, and societal ills that permeate into medicine. Addressing these requires a thoughtful, holistic approach where we extend our sights beyond strict evidence-based medicine.

The Sudanese Medical Education in the Light of Flexner Report

Medical education as a profession is a legitimate offspring of Flexner’s report in 1910. It strived to excel in preparing future doctors and increasing the competency of medical practitioners. We provide a scientific critique of Flexner’s report, displaying its merits and shortcomings and shedding a spotlight on Sudan’s medical education milestones and its current strive for excellence and innovation in curricula designing, accreditation, graduate competencies, staff professional development, and quality improvement. Since the publication of this inspiring study, a global effort has been launched to improve the quality of health system policies and health professions’ competency through education. All stakeholders now seek fundamental reform in medical education in Sudan to improve its quality and trustworthiness. Based on this study, our impost does not necessarily propose following its footsteps but instead evaluates its stimulating role in planning and intervention.

El currículo médico, los alumnos y los docentes. ¿Cuál debe ser su papel?

A century after the Flexner report in 1910, the book entitled "Educating Physicians: A Call for Reform of Medical School and Residency" was published, which called for strengthening the formation of professional identity, integrating basic sciences with clinical learning and implementing competency assessment. Traditional education is not compatible with these recommendations. One learns to do by doing it, and the way to achieve this is to “play the whole game”.

A Scientific Revolution: Ten Men and Women Who Reinvented American Medicine

A Scientific Revolution: Ten Men and Women Who Reinvented American Medicine