Flexner report pdf

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In the early half of the 20th century, a coup was organized on the medical research facilities, hospitals and universities. The Rockefeller family, ye ole step-n-fetch-its of the actual slavemasters, sponsored research and donated sums to universities and medical schools which had drug based research. In this frenzy for the latest and greatest, the door was wide open for how new technology might improve our lives in every way.

So why not also give our health over to science and technology and see if they can also improve and lengthen our lives? This proverbial search for the fountain of youth that seems to emerge in different ways in every generation appeared in the form of medical advances in the early s. So when educational theorist and celebrity Abraham Flexner caught the attention of American aristocracy, who saw advances in education as a way to build their empire, they Rockefeller, Carnegie, et al.

One of our roles though is to challenge assumptions and the status quo. Galileo would agree with us on this. And speaking of assumptions, we make a few of our own. We assume that the body has an amazing capacity to heal itself if given a chance. While this system has done many good things, we believe we have given it too much power. It is a system that is, for the most part, blind to its own sins and shortcomings. There are many good doctors and other medical professionals who seek to do their best for their patients and who know and seek to challenge the status quo.

But for the most part, medicine has become tone deaf to the oath it claims to uphold — the Hippocratic oath. Natural medicine practitioners would be on that list. I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. Above all, I must not play at God. I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability.

My responsibility includes these related problems if I am to care adequately for the sick. I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

Keep in mind there were no real effective governmental agencies in place monitoring the state of affairs within the medical community, so what Flexner did at the behest of the robber barons, he did so in favor of profits rather than the long-term care of patients. He effectively created a culture that enabled the monetization of medicine like never before. This might not have been his intent, but the outcome speaks for itself. Flexner threw out the baby with the snake oil.

There has been a fall from grace of our vaunted profession [ 10 ]. Physicians have lost their authenticity as trusted healers. We have become derelict in many realms. The profession appears to be losing its soul at the same time its body is clothed in a luminous garment of scientific knowledge. This was a world of hyper-rationalized medicine that Flexner investigated during his early sabbatical years post-Louisville phase and to which he returned for a second time after his completion of the Flexner Report in Two years later, he published a European version of the report with a critique of medical education in France, Britain, and Germany [ 12 ].

His uncritical description of the German system is surprising, especially for a modern reader in retrospect. The German clinic is described as being surcharged with energy and ideas, but there is little if any mention of ideals. Oslerian wisdom regarding the primacy of patient beneficence is not evidenced. Patients were primarily viewed as serving the academic purposes of the professor.

These attitudes were not of apparent concern for Flexner or his advocates. The book contains several anti-Semitic passages that are very offensive for all readers and especially disturbing for a Jewish reader.

It was a work for which Welch also had great admiration. In his preface to a translation published in , he described the book as a work of enduring value, characterized by a breadth of view as sound and as needful today as when it was first published in Flexner and Welch must have been aware that its prejudiced views had led to near riots over its depictions of Jews and the superiority of pure German racial stock.

Social involvement of the physician was unimportant for the physician as envisioned by Flexner. The Flexner Report set American medicine on a course that was fueled by the energy of scientific discovery.

Those discoveries have immeasurably improved the lives of all human beings, and it is difficult to cavil in the face of such accomplishments. But the oversights of Flexner and his associates need not have occurred if these leaders had recognized the primary role of physicians as beneficent healers; the delicate balance of patient care and research could have been pursued with mutual benefits for both sides.

As it was, the science of medicine eclipsed the active witnessing of our patients. How else to explain the seemingly unexplainable Tuskegee experiments, the Henrietta Lacks tissue culture tragedy, the many occurrences in which the physician as scientist has taken precedence over the physician as healer.

This lapse has not escaped our patient population nor our critics who have richly documented the poverty of professional ideals now current in medicine.

They have called for a new Flexner Report, a centennial taking stock, to address the shortcomings in medical education that have occurred in the aftermath of the original report.

Dr Tom Inui, an internist and medical educator, was enlisted by the AMA to spend a year in this investigation [ 14 ]; Molly Cooke and her associates undertook the same task for the AMA and performed a mini-version of the Flexner initiative by visiting 10 medical schools throughout America [ 15 ]. Everyone is a proponent of what is now happening in many medical schools.

Major emphasis is being placed upon the professional formation of students and specific core competencies. Practice-based learning, a Flexner initiative, is supplemented by courses in patient communication, medical ethics, and medical humanities. Departments of medical education are now part of medical faculties that train their members to incorporate these ideals into their courses.

The coming century has received a bounteous richness of medical accomplishments thanks to Flexner; a system of education that was conceived more than a century ago still remains a vibrant system. There is in place an edifice that is the envy of the entire world, but it is a structure that has required a re-molding in light of its too-narrow focus. The original Hopkins edifice has been rebalanced in the last 10 years following the revisions in the medical curriculum that recent re-evaluations have called for.

The distinguished gardener, diarist, architect ,and polymath John Evelyn assisted with the plans to repair the cathedral. He also made an important gift to the corpus of scientific knowledge with the later donation of the anatomical tables to the Royal Society [ 16 ].

Anatomists later recognized that the delicate arborizations of the three systems were virtually super imposable upon one another. Very recent studies, only doable as a result of modern molecular techniques, have identified the inter-dependence of the vascular and nerve systems.

They are not only structurally related. There is constant cross-talk between them with shared growth factors, receptors, and specialized cells. During embryogenesis, the nerves and vessels impose the directions of growth that become the vascular and nervous systems that Harvey and Willis originally described; failure of coordinated interaction of these vital systems results in death or maldevelopment of the embryo [ 17 ].

There was maldevelopment in the structure of medical education in America in the aftermath of the Flexner Report. We have learned that scientific medicine must travel linked to a professional ethos of caring that has been in place in our oaths and aspirations.

Cross-talk must occur between the two with a bi-directional bedside to bench dialogue. This creates the frisson that animates the quest for breakthroughs in a medical realm.

The Flexner model remains in place, the foundation of the magnificent edifice that is American medicine. National Center for Biotechnology Information , U. Yale J Biol Med. Thomas P. Duffy , MD. Author information Copyright and License information Disclaimer. To whom all correspondence should be addressed: Thomas P. This is an open access article distributed under the terms of the Creative Commons CC BY-NC license, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited.

You may not use the material for commercial purposes. This article has been cited by other articles in PMC. Abstract The Flexner Report of transformed the nature and process of medical education in America with a resulting elimination of proprietary schools and the establishment of the biomedical model as the gold standard of medical training. Rockefeller, Theodor Billroth, medical professionalism.

References Zimmer C. The Soul Made Flesh.