Proprietary Medical Schools Research Articles

Second Flexner Century: The Democratization of Medical Knowledge: Repurposing a General Pathology Course Into Multigrade-Level “Gateway” Courses

Starting in 1910, the “Flexner Revolution” in medical education catalyzed the transformation of the US medical education enterprise from a proprietary medical school dominated system into a university-based medical school system. In the 21st century, what we refer to as the “Second Flexner Century” shifts focus from the education of medical students to the education of the general population in the “4 health literacies.” Compared with the remarkable success of the first Flexner Revolution, retrofitting medical science education into the US general population today, starting with K-12 students, is a more daunting task. The stakes are high. The emergence of the patient-centered medical home as a health-care delivery model and the revelation that medical errors are the third leading cause of adult deaths in the United States are drivers of population education reform. In this century, patients will be expected to assume far greater responsibility for their own health care as full members of health-care teams. For us, this process began in the run-up to the “Second Flexner Century” with the creation and testing of a general pathology course, repurposed as a series of “gateway” courses on mechanisms of diseases, suitable for introduction at multiple insertion points in the US education continuum. In this article, we describe nomenclature for these gateway courses and a “top–down” strategy for creating pathology coursework for nonmedical students. Finally, we list opportunities for academic pathology departments to engage in a national “Democratization of Medical Knowledge” initiative.

Congratulations, APS! 125 and counting …

Congratulations, APS! 125 and counting …

Commentary: Taking Back Year 4: A Call to Action

In this issue of Academic Medicine, Walling and Merando's literature review on the senior-year curriculum finds a broad consensus that this final year underperforms educationally at many U.S. medical schools, but little agreement on how to improve it. The review challenges us to consider how best to develop this key piece of educational real estate, which is too often frittered away on auditions, interview odysseys, and electives of uncertain educational value. In this commentary, the author approaches this education question from an unorthodox viewpoint, the delivery system and medical workforce perspectives. He proposes taking back major portions of Year 4 from elective clerkships and investing the time in required course work to prepare graduates to practice and lead in a redesigned 21st-century health system, providing superior access and outcomes at sustainable costs. The recommendations draw inspiration from the Institute of Medicine's "Chasm" reports, specifically echoing its 2003 Health Professions Education report that identified five new competencies deemed essential for all 21st-century health professionals. Finally, the author disputes the view that delivery system overhaul lies beyond the purview of educators, pointing to the historical precedent of the greatest medical paradigm shift of all time, the closure of the proprietary medical schools a century ago triggered by Flexner's report. The author closes by calling medical educators to action, to prepare the next generation of physicians to radically redesign health care and lead us out of the present crisis.

The 21stCentury Abraham Flexner

Pharmacy needs an Abraham Flexner for the 21st century to remind us of the standards that are most important to pharmacy education. Every pharmacy academician should know about Abraham Flexner and the “Flexner Report” published in 1910 that was a critical evaluation of colleges of medicine.1 The report challenged the existence of substandard medical schools and resulted in the closing of many of them over the next 20-30 years. Most of Flexner's standards and expectations of medical education are still relevant today to medicine as well as pharmacy and other health disciplines. In his era there was a proliferation of proprietary medical schools. Many medical schools were small trade schools, run mainly for profit. Often, they were not associated with hospitals or established universities. Flexner railed against medical schools that had lax admission standards, faculty members who were poorly trained local doctors as opposed to physicians who were fully trained in the science of medicine, part-time professors as opposed to full-time clinical instructors, and tedious lectures in large classes that inhibited learning. According to his biographer Thomas Neville Bonner, Flexner worried that “the imposition of rigid standards by accrediting groups was making the medical curriculum a monstrosity,” with medical students moving through it with “little time to stop, read, work or think.” The description is both a picture of the times 100 years ago and a mirror to our present age. There are many parallel comparisons between the medical schools of 1900 and the pharmacy schools of today. Flexner was not a physician but a secondary school teacher and educational reformer. In fact, he had never been in a medical school before beginning his study. However, he had well founded ideas of what medical education should be like and he rigorously applied these views to his evaluations. He visited all 155 colleges in the US and Canada over a few months. Flexner believed that modern medical education should be a union of practice with the scientific method. The scientific method produced problem solvers—what we might call “critical thinkers” today—not merely practitioners of a trade. Pharmacy schools have entered an era of unsustainable growth, often fueled by institutional desires for “economic impact” or the profit that can be derived from a large class of pharmacy students. Schools exist with a handful of full-time faculty members and modest facilities not integrated with health care centers, as long as there is a large cadre of volunteer instructors for practice experiences. Many schools are now only nominally affiliated with academic health centers and many faculty members and students visit health care sites rather than actually provide care as part of an organized health system. The lack of adequate numbers of faculty members has resulted in the hiring of many individuals with minimal training in teaching who are given little time and support to pursue the sciences of pharmacy as a foundation for practice. A diminished emphasis on the science of our profession encourages a trade school mentality. We would surely benefit from a 21st century Flexner to take a critical look at schools of pharmacy in the United States, both new and old, and remind us of the importance of our scientific foundations and primary purpose to serve the public. The Flexner of today would insist that quality pharmacy education should be built on: A faculty that actively engages in scholarship to assure that the profession continues to progress and does not become a “trade.” Functional integration with (not just affiliation with) academic health centers, as these are the centers of learning in health professions. A faculty that actively engages in providing health care with a primary mission of public service. A curriculum that promotes learning through active participation rather than through lectures on factual knowledge, which is an approach Flexner would have recognized as boring and ineffective. Where the Flexner of our era will come from is not apparent. Perhaps as Flexner was, he or she should be an outsider to the profession. Wherever he or she comes from, the 21st century Flexner is needed now for pharmacy to sort out the differences between professional and trade school education.

Money versus mission at an African-American medical school: Knoxville College Medical Department, 1895-1900.

Knoxville College Medical Department (KCMD) was, to all appearances, a missionary medical school established in 1895 by a small black Presbyterian college in the Tennessee mountains to train African-American physicians. In reality, it functioned as a proprietary medical school organized and operated by a group of local white physicians who were more interested in making money than in furthering the school's mission of educating black Christian physicians. KCMD limped along until 1900 when the college's new president reported to the trustees about the white faculty's greed, irreligious behavior, poor teaching, and bad medical reputation, and about how the presence of the medical school on campus undermined the college's overall mission. KCMD graduated two students before closing its doors in 1900. A group of faculty then reopened the school off-campus as the Knoxville Medical College. That school closed in 1910.

Illustrations of the effects of rheumatic gout or chronic rheumatic arthritis on all the articulations with descriptive and explanatory statements. 1857.

Illustrations of the effects of rheumatic gout or chronic rheumatic arthritis on all the articulations with descriptive and explanatory statements. 1857.

"Reform without change": update, 1998.

As a result of the Flexner Report in 1910, proprietary medical schools disappeared and science taught by researchers became a part of every medical school curriculum. Medical research produced products that improved health and brought large profits to health-related industries. Research became the currency most valued within the organizational power structure of medical schools, overshadowing the educational mission. Almost 90 years and multiple calls for the educational reform of medical education have failed to bring about true change in medical education because of researchers' conflict of interest--that is, the time spent providing effective education equals time away from the research necessary to maintain their careers. Basic scientists have kept teaching in medical schools efficient by giving discipline-related lectures that allow them to maximize their research time. Planning for meaningful learning with integration of disciplines and small-group teaching requires an investment of time that researchers are unwilling to make because it does not further their careers. Separation of scientific research from medical school teaching is necessary for reform of medical education. Medical students need to be taught by teachers who are not researchers.

Why the university-based medical school should survive: a historical perspective.

Universities and medical education have been allied since the Middle Ages. In the United States, proprietary medical schools began to unite with universities at the turn of the century. At the end of the century, this traditional alliance is being questioned, even threatened, by marketplace demands, and medical schools and their universities continue to deal with internal struggles regarding teaching and research goals, and funding. In this paper, the author defines and discusses the origins of university-medical school tensions, provides a brief review of the history of university-based medical education in the United States, and describes some of the advantages and disadvantages of the alliance. Finally, he makes a case for why medical education must continue to be grounded in universities.

The Reorientation of Medical Education in Late Nineteenth-Century Ontario: The Proprietary Medical Schools and the Founding of the Faculty of Medicine at the University of Toronto

Histoire de la fondation de la faculte de medecine a l'universite de Toronto au XIX e siecle.

The Supermeds: How the Big Business of Medicine Is Endangering Our Health Care

In 1906, when Theodore Roosevelt borrowed a metaphor fromPilgrim's Progressto warn against unbalanced reporting, he coined name for a journalistic tradition. most tenacious investigative reporters of that day became known as muckrakers, after Bunyan's description of the man with muckrake. Among targets of these reporters, many were medical businesses. first was patent medicine industry, which Samuel Hopkins Adams exposed in a series of magazine articles that helped to pass Pure Food and Drug Act. More than 100 000 reprints of Adams' articles were distributed by American Medical Association, which also began running its own exposes of nostrums and quacks in a regular column inJAMA, The Propaganda for Reform. Another report in muckraking tradition was Abraham Flexner'sBulletin Number Four, with its attack on proprietary medical schools. From 1930s through mid-1960s, a period when organized medicine's

Proceedings of a conference on the role and training of the general internist.

American medicine is undergoing public scrutiny with an intensity never before experienced by a profession. The immediate cause for this scrutiny is the recent perception of a in the health care system. The factors that cumulatively contributed to this sense of crisis are multiple and interdependent and some are probably at least 100 years old. During the past century, medicine has changed from an empiric art toward a research-based, quantitative, technologically oriented, specialty-dominated scientific discipline. The 19th-century advances in microbiology and anesthesia, which transformed the disciplines of surgery and public health, were previews of the remarkable 20th-century achievements in physics, biochemistry, physiology, and pharmacology that were to transform the practice of clinical medicine. The Flexner report of 1910 encouraged the development of scientific medicine by integrating medical schools into universities and helped to effectively eliminate proprietary medical schools. In addition, Flexner urged that the clinical teaching of medical students

The Scandal of Foreign Medical Doctors in the U.S.

Professional and lay articles now appearing on immigrant physicians in the U.S. leave the impression that this is a quite new problem. In fact the earliest doctors in America were foreign medical graduates (FMGs), and for a couple of hundred years after that they were the most sought after practitioners in the Colonies. American medical school graduates date only from the 1760's, and until the beginning of this century the native-trained products of proprietary medical schools were viewed with considerable distrust. Respectable doctors had at least some European training.

Will Proprietary Medical Schools Be Approved?

Will Proprietary Medical Schools Be Approved?