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[–] Vindicator [S] ago
Biographical articles behind paywalls:
https://insights.ovid.com/crossref?an=00001888-199802000-00014
https://insights.ovid.com/crossref/00000441-201805000-00017?isFromRelatedArticle=Y
My name is Abraham Flexner. You may have heard of my report. We need to talk.
I never mentioned it, but I had a tough childhood. Growing up in poverty in Louisville, Kentucky, taught me the value of hard work. I was 7 years old when my father’s business failed; 16 when he died. After supporting my family during high school, I only had enough money for 2 years at Johns Hopkins University. Enrolling in 14 courses per semester, alternating attendance between 2 or 3 classes at the same hour, I developed the ability to master enormous amounts of information and graduated on time with good grades.
Returning home, I created an internationally known preparatory school with small classes, no organized lectures, no homework, no report cards and no tests. My students entered the nation’s best schools at a younger age and were more likely to graduate than students from the top New England prep schools.
I published my unorthodox educational philosophies in a book, “The American College: A Criticism,” which attracted the attention of Henry Pritchett at the Carnegie Foundation. Pritchett had been working with the American Medical Association to address the proliferation of for-profit and lecture-dominated medical schools in the United States. In 1910, at age 44, I visited all 46 states and Canada, reviewing over 155 medical schools in 16 months.
My final report was less than 400 pages, but it included a detailed assessment of every medical school in North America as well as a history of medical education in the United States, the proper and actual basis of medical education, and recommendations for change.
I redesigned the medical schools of Vanderbilt, Washington University and Cincinnati. I persuaded Northwestern, the University of Chicago, and the University of Illinois to share Cook County Hospital. I advised Yale on research investment and recommended deans for half a dozen medical schools before I even finished the survey.
After the report was published, I was sued for libel, received death threats, and was told never to set foot inside the city of Chicago, but the inferior medical schools began closing.
In 10 years, I was able to secure the equivalent of $6 billion and triple the amount of money spent on medical education in the United States, while closing 50 medical schools.
For many years after my death, the reforms I had made—standardizing entrance requirements, teaching the students a scientific curriculum, embedding them in the clinical activities the hospital, and assuming responsibility for their education—remained intact. Now, I am disturbed to see that issues that I addressed over a century ago are recurring. Changes have occurred in medical education that have led to a passive student experience, the reemergence of proprietary medical schools, and the disruption of the bond between teacher and student that is vital to educational success. Below are four problems we encountered in 1910 which have resurfaced in your time.
In my 1910 report, I said: Out-and-out didactic treatment is hopelessly antequated; it belongs to an age of accepted dogma or supposedly complete information, when the professor “knew” and the students “learned.” The lecture indeed continues of limited use.
Medical education requires hands-on experience, not lectures.Learning medicine is not fundamentally different from learning anything else. If one had 100 hours in which to learn to ride a horse… one might profitably spend perhaps an hour in being told how to do it… and the remaining hours in practice, at first with close supervision, later under general oversight.