CPAP 1605 Article - The Flexner Report and the Standardization of American Medical Education

CPAP 1605 Article - The Flexner Report and the Standardization of American Medical Education

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The Flexner Report and the Standardization of American Medical  Education  Andrew H. Beck  Brown Medical School, Providence, RI   JAMA.  2004;291:2139-2140.  If the sick are to reap the full benefit of recent progress   in medicine, a more uniformly arduous  and expensive medical   education is demanded. —Abraham Flexner 1   Medical education in the United States today is strikingly standardized   and demanding. It was not  always so. Prior to the widespread   implementation of educational reforms, medical training was  highly variable and frequently inadequate. It was not until   the early decades of the 20th century  that a "uniformly arduous   and expensive" system of medical education was instituted nationally.   In the 19th century, most medical education in the United States   was administered through 1 of 3  basic systems: an apprenticeship   system, in which students received hands-on instruction from   local practitioner; a proprietary school system, in which   groups of students attended a course of  lectures from physicians   who owned the medical college; or a university system, in which   students  received some combination of didactic and clinical   training at university-affiliated lecture halls and  hospitals.   These medical schools taught diverse types of medicine, such   as scientific, osteopathic,  homeopathic, chiropractic, eclectic,   physiomedical, botanical, and Thomsonian. 2  In addition,  wealthy   and industrious medical students supplemented their education   with clinical and  laboratory training in the hospitals and universities   of Europe, primarily in England, Scotland,  France, and Germany.   Because of the heterogeneity of educational experiences and   the paucity  of licensing examinations, physicians in America   at the turn of the 20th century varied  tremendously in their   medical knowledge, therapeutic philosophies, and aptitudes for   healing the  sick. 3 - 4   Throughout the second half of the 19th century, the American   Medical Association (AMA) lobbied  for the standardization of   American medical education. These efforts were largely unsuccessful,  both because political traditions in America dissuaded national   regulation of professions and  because the American public and   much of the medical profession were not convinced that any  particular   brand of medical education was significantly superior to any   other. "The great mass of  the public," declared the medical   educator John Shaw Billings in 1891, "know little and care less  about the details of professional education . . . . The popular   feeling is that in a free country every 
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CPAP 1605 Article - The Flexner Report and the Standardization of American Medical Education

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