Flexner Report Transformed Med Schools

Abraham Flexner began working 100 years ago on a massive report that transformed the way doctors are taught in America. The Flexner Report led to a greater emphasis on science and the closing of dozens of medical schools across the United States. Dr. Gert Brieger, a emeritus professor of the history of medicine at Johns Hopkins University, talks about Flexner's report.

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ANDREA SEABROOK, host:

There was a time not so long ago when medicine wasn't even based in science. A hundred years ago you were just as likely to get your meds from a carpet-bagging quack as from a doctor. Then along came Abraham Flexner, not a doctor, but an expert in education. In 1908 he began an appraisal of American medical schools that would revolutionize the way doctors are trained.

It's called the Flexner Report and it ultimately led to the best medical education system in the world.

Dr. Gert Brieger is with Johns Hopkins University in Baltimore. His expertise, the history of medicine. Dr. Brieger, welcome to the show.

Dr. GERT BRIEGER (History of Medicine, Johns Hopkins University, Baltimore): Thank you.

SEABROOK: Take us back, if you would, 100 years. What was medicine like then?

Dr. BRIEGER: Medicine was a hit-or-miss proposition. Somebody said that around 1910 a random patient with a random illness consulting a random physician had just about a 50-50 chance of benefiting from that encounter. And part of that was because the training that many physician received was of very poor quality.

SEABROOK: Then along came Abraham Flexner. Who is he and how did he start his appraisal of medical schools?

Dr. BRIEGER: Abraham Flexner was asked by the Carnegie Foundation in New York to make an appraisal of American medical schools, which he did in 1908 and 1909. And it was a blockbuster kind of a report because it made scathing judgments about many medical schools that were really of very inferior quality. They were simply run as profit-making enterprises.

It was kind of a social classic in the sense that Betty Freidan's Feminine Mystique and Rachel Carson's Silent Spring, they were sort of social classics that were very important. And Flexner did the same thing about medical schools.

SEABROOK: In his report, Abraham Flexner reviewed all of the American medical schools at the time - more than 150 of them. What were some of the schools teaching?

Dr. BRIEGER: Well, that's a good question. They weren't teaching very much. They were exposing their students to a little bit of anatomical dissection and maybe a little bit of physiology lab. And some of the conditions that he found were truly atrocious. And his main criticisms were that they had very poor clinical education, very poor clinical facilities.

And what Flexner wanted to do was to have students understand where the knowledge came from and how it was derived, not mainly to learn memorization of facts given in a lecture.

SEABROOK: Dr. Brieger, you're associated with Johns Hopkins, one of the best medical schools in the world, obviously. Do you see on a daily basis the impact today of the Flexner Report?

Dr. BRIEGER: Well, you do in a sense that medical schools are much more alike today than they were in his day. And Flexner and others in his time who were involved in the reform of medical education, they all wanted a scientifically based education but what they were interested in was training good practitioners of medicine, people who would see patients.

And one of the things that this sort of scientific basis for medicine and medical education has given us is an ability to understand disease much better than it was previously the case, especially in the 19th century. And it's this way of approaching illness and approaching patients that Flexner and his contemporaries, who were medical reformers, were advocating.

SEABROOK: Well, Dr. Gert Brieger, thank you very much for speaking with us.

Dr. BRIEGER: Thank you.

SEABROOK: Dr. Gert Brieger is the William H. Welch professor emeritus in the history of medicine at Johns Hopkins University in Baltimore.

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