Flexner Report
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The Flexner Report, written by the professional educator Abraham Flexner (1866-1959), advocated radical change in the way medical schools were run in Canada and the United States. It was published in 1910 under the aegis of the Carnegie Foundation. Highlights of the report included the fact that there were too many medical schools, that many were substandard, and that pre-requisites for the study of medicine and the content of medical education needed to be defined. At the time of publication, out of 155 Medical Schools in the United States and Canada, only sixteen required two or more years of college work for entrance (p 28).
Recommended changes
- Flexner introduced the concept of minimum requirements for admission to medical school: a high school diploma and at least two years of college or university level science.
- Flexner recommended that medical school be of four years in duration. The first two years would involve the basic sciences and the last two years would be clinical.
- The report advocated a change in the financing of medical education. The cost of satisfactory training was too great for most stand-alone institutions, so Flexner suggested the closure or incorporation of "proprietary" schools into universities.
School closures
The Flexner Report resulted in the closure of most of the M.D. and D.O. granting institutions in the United States. In 1904 there were 160 M.D. granting institutions, and by 1935 there were only 66. The decline in the number of medical colleges was partially due to Flexner's recommendation that all "proprietary" schools be closed, favoring medical colleges that were connected to universities. This was largely realized. Of the 66 surviving M.D. granting institutions in 1935, 57 were part of a university. The trend was further strengthened by a gradual increase in compliance to the report's recommendations by state medical boards.Osteopathic inclusion in the report
Osteopathic institutions were hit particularly hard by the aftermath of the Flexner Report. They had fought vehemently for their independence from orthodox medicine, and resented being included in Flexner's report. However, because in many states D.O.s had gained a similar scope of practice to M.D.s, Flexner insisted they deserved to be held to the same standards. The report demonstrated that their standards were, at the time, substantially lower. As a result, the American Medical Association (AMA) anticipated the elimination of osteopathic schools. Quite the opposite happened. Through a series of internal revolutions, the American Osteopathic Association (AOA) brought its surviving schools in line with Flexner's recommendations, both validating their claims to independent equality, and ensuring their continuance into the future.
References
- Flexner A. Medical Education in the United States and Canada. 1910.[link]
- Hyatt and Stockton The Impact of the Flexner Report on the Fate of Medical Schools in North America After 1909. [link]
- Beck The Flexner Report and the Standardization of American Medical Education[link]
- Goodman and Musgrave How The Cost-Plus System Evolved [link]
- Gevitz, Norman; Grant, U. S. (2004). The D.O.s (2nd ed.). Baltimore: The Johns Hopkins University Press. ISBN 0-8018-7834-9.
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