Flexner Report
While it had many positive impacts on American medical education, the Flexner report has been criticized for introducing policies that encouraged systemic racism and sexism.
Homeopathy, traditional osteopathy, eclectic medicine, and physiomedicalism (botanical therapies that had not been tested scientifically) were derided.
However, he noted that these boards were failing in their mission, stalling progress and allowing substandard medical practices to continue, thereby jeopardizing public health.
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 training in human anatomy and physiology followed by two years of clinical work in a teaching hospital.
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.
[16] He visited every one of the 155 North American medical schools that were in operation at the time, all of which differed greatly in their curricula, methods of assessment, and requirements for admission and graduation.
After a long morning of dissection or a series of quiz sections, they might sit wearily in the afternoon through three or four or even five lectures delivered in methodical fashion by part-time teachers.
For example, Flexner described Chicago's fourteen medical schools as "a disgrace to the State whose laws permit its existence .
Minority groups, such as African Americans and women, faced fewer opportunities as a result of the publishing of the Flexner Report.
[19] To help with the transition and change the minds of other doctors and scientists, John D. Rockefeller gave many millions to colleges, hospitals and founded a philanthropic group called "General Education Board" (GEB).
American doctors varied enormously in their scientific understanding of human physiology, and the word "quack" was in common use.
When Flexner researched his report, in the nineteenth century, only 16 out of 155 medical schools in the United States and Canada required applicants to have completed two or more years of university education.
[23][26] Furthermore, many physicians who traveled to Europe to receive postgraduate training were impressed with the German dedication to research, innovation, and teaching.
[23] In effect, Flexner demanded that American medical education conform to prevailing practice in continental Europe.
Flexner identifies the critical role these boards were intended to play in upholding medical education standards, both legally and ethically, but argues that they had largely failed in this responsibility.
He insisted that state boards must rigorously ensure that only those who completed proper, standardized training could enter medical practice.
From a legal standpoint, state boards were to have the authority to license practitioners, while ethically, they were responsible for maintaining the integrity of the profession by enforcing these standards.
"[1] However, Flexner's report critiques the widespread corruption and lack of uniformity among state boards, which allowed substandard medical schools to continue operating.
The boards were often controlled by political forces rather than by educational or professional considerations, leading to inconsistency in their enforcement of licensing standards.
"[1] Flexner lamented that this patchwork regulatory system undermined his vision for a unified, scientific, and ethical medical profession across the U.S. His plan relied on the boards acting as ethical watchdogs for public health and safety, but the failures of these boards to fulfill their role were highlighted as a significant barrier to achieving widespread reform.
(In Canada, only the medical school at Western University was deemed inadequate, but none was closed or merged subsequent to the Report.)
In response to the Flexner Report, some schools fired senior faculty members as part of a process of reform and renewal.
"Furthermore, along with his adherence to germ theory, Flexner argued that, if not properly trained and treated, African-Americans posed a health threat to middle and upper-class whites.
Following the Flexner Report, African-American students sued universities, challenging the precedent set by Plessy v. Ferguson.
[33] In relation to the national Census, physicians belonging to minority groups, including African Americans, remain underrepresented in medicine.
"[4] However, the view that Flexner and the Report were detrimental to black medical schools is largely refuted by Thomas N. Bonner, a scholar referred to as a “distinguished historian” by the AAMC.
[38] The Flexner Report has also been criticized for introducing policies that encouraged sexism,[4] resulting in "the near elimination of women in the physician workforce between 1910 and 1970.
[39]Today, it is speculated that the Report may have been a factor in encouraging female physicians to specialize in pediatrics, obstetrics and gynecology rather than other disciplines.
Medical schools that offered training in various disciplines including electromagnetic field therapy, phototherapy, eclectic medicine, physiomedicalism, naturopathy, and homeopathy, were told either to drop these courses from their curriculum or lose their accreditation and underwriting support.
