How the Flexner Report impacted Western Medicine. A quick overview!

The Flexner Report of 1910

During the nineteenth century, American medicine was neither economically supported nor regulated by the government. Few state licensing laws existed, and when they did exist, they were weakly enforced. There were numerous medical schools, all varying in the type and quality of the education they provided.

In 1904, the American Medical Association (AMA) created the Council on Medical Education (CME), whose objective was to restructure American medical education. At its first annual meeting, the CME adopted two standards: one laid down the minimum prior education required for admission to a medical school; the other defined a medical education as consisting of two years of training in human anatomy and physiology followed by two years of clinical work in a teaching hospital. Generally speaking, the council strove to improve the quality of medical students, looking to draw from the society of upper-class, educated students.

In 1908, seeking to advance its reformist agenda and hasten the elimination of schools that failed to meet its standards, the CME contracted with the Carnegie Foundation for the Advancement of Teaching to survey American medical education. Henry Pritchett, president of the Carnegie Foundation and a staunch advocate of medical school reform, chose Abraham Flexner to conduct the survey. Neither a physician, a scientist, nor a medical educator, Flexner held a Bachelor of Arts degree and operated a for-profit school in Louisville, Kentucky. He visited every one of the 155 North American medical schools in operation at the time, all of which differed greatly in their curricula, assessment methods, and admission and graduation requirements.

Finally, in 1910 the Flexner Report commissioned by the Carnegie Foundation and funded by the Rockefeller Foundation was released, and it had a significant impact on medical education in the United States:

1. Standardization of Medical Education: The report advocated for strict standards and uniformity in medical education, emphasizing science-based curricula, robust faculty, and adequate resources for teaching and research. As a result, medical schools began adopting a standardized curriculum, improving medical education across the U.S.
2. Closure of Inadequate Medical Schools: Flexner's report exposed many inadequate medical schools that lacked proper facilities, faculty, and clinical training opportunities.The report recommended the closure or consolidation of such schools, leading to the closure of about 75% of U.S. medical schools, including five of the seven Black medical colleges.
3. Emphasis on Clinical-Based Learning: The report stressed the importance of clinical experience in medical education and the need for medical students to have direct patient care experience in well-equipped hospitals.This led to the establishment of teaching hospitals associated with medical schools, enhancing the clinical training of medical students.
4. Focus on Medical Research: The report recommended the inclusion of research opportunities for both faculty and students and the integration of research findings into medical practice. This resulted in a significant increase in medical research and advancements in medical knowledge.
5. Increased Professionalism and Ethics: The report called for medical schools to instill ethical values, integrity, and a sense of responsibility among their students. Following the report, medical schools began to give more attention to teaching medical ethics, fostering a sense of professionalism among future healthcare professionals.
6. Shift to Biomedical Research: The report's emphasis on scientific research and the biomedical paradigm led to a significant increase in biomedical research and advancements in medical knowledge.
7. Impact on Complementary and Alternative Medicine (CAM): The report's dismissal of CAM practices and the closure of CAM-oriented hospitals and medical schools contributed to the decline of CAM in North America.
8. Unintended Consequences: The report's emphasis on scientific research and the biomedical paradigm led to unintended consequences, such as the near elimination of women in the physician workforce between 1910 and 1970.
9. Continuing Influence: The Flexner Report continues to influence medical education and research, with its principles and recommendations still shaping the medical profession today

However, the report also hurt medical education for African Americans. It recommended closing all but two traditionally Black medical schools, leaving only Howard University College of Medicine and Meharry Medical College open. This significantly reduced access to medical education for African Americans and contributed to the lack of diversity in the medical profession for over a century.

Impact of the Flexner Report

Many aspects of the medical profession in North America changed following the Flexner Report. Medical training adhered more closely to the scientific method and became grounded in human physiology and biochemistry. Medical research aligned more fully with the protocols of scientific research. Average physician quality significantly increased.

The vision for medical education described in the Flexner Report narrowed medical schools' interests to disease, moving away from an interest in the system of health care or society's health beyond disease. Preventive medicine and population health were not considered the responsibility of physicians, bifurcating "health" into two separate fields: scientific medicine and public health.

The Flexner Report has also been criticized for introducing policies that encouraged sexism. Before the publication of the Flexner Report, in the mid-to-latter part of the nineteenth century, universities had just begun opening and expanding female admissions as part of both women's and co-educational facilities with the founding of co-educational Oberlin College in 1833 and private all-women's colleges such as Vassar College and Pembroke College. Furthermore, many women opened their medical schools for women as a response to other medical schools refusing to admit them.

When Flexner researched his report, "modern" medicine faced vigorous competition from several quarters, including osteopathic medicine, chiropractic medicine, electrotherapy, eclectic medicine, naturopathy, and homeopathy.[34] Flexner doubted the scientific validity of all forms of medicine other than that based on scientific research, deeming any approach to medicine that did not advocate the use of treatments such as vaccines to prevent and cure illness as tantamount to quackery and charlatanism. Medical schools that offered training in various disciplines including electromagnetic field therapy, phototherapy, eclectic medicine, naturopathy, and homeopathy, were told either to drop these courses from their curriculum or lose their accreditation and underwriting support.

In summary, the Flexner Report had a profound impact on medical research in the United States and Canada, leading to the standardization of medical education, increased professionalism and ethics, a shift to biomedical research, and the closure of inadequate medical schools. Also, the Flexner Report had a significant impact on the development of modern universities in the United States and Canada by standardizing medical education, promoting biomedical research, and dismissing CAM practices.