Abraham Flexner and The Flexner Report

Reform in medical education throughout the country was triggered by the Flexner Report of 1910.  The American Medical Association had established a Council on Medical Education in 1904.  This council had laid out a drastic new vision for medical education.  The Council commissioned the Carnegie Foundation to produce a report on the current conditions of medical education.   The Carnegie Foundation asked Abraham Flexner to write the report.

Flexner is largely responsible for the high quality of today’s American educational system.  He had written a book in 1908, The American College: A Criticism, which caught the eye of the President of the Carnegie Foundation.  Flexner went on to help build, and serve as the first director of, the Institute for Advanced Study in Princeton.  He was instrumental in bringing over some of the top European mathematicians and physicists including Albert Einstein, John von Neuman, Hermann Weyl, and Kurt Gödel.

Abraham Flexner personally visited the 151 operating medical schools in the US, before writing his report.  The Flexner report was instrumental in ultimately both closing the low quality medical schools and triggering improvements in the better medical schools.  Everything that medical schools stand for today, a curriculum based on well-established science, clinical experience for medical students, and faculty involved in research to push the frontiers of medicine, was laid out in the Flexner Report.

The Flexner Report was exceptionally blunt about describing inferior medical schools.  Here is one example of its description of a medical school, National Medical University located in Chicago:

National Medical University. A night school, organized in 1891 as “homeopathic”, which word was subsequently dropped.  Ostensibly the medical department of the “Chicago Night University”, which claims departments of arts, law, dentistry, pharmacy, etc.  The school appears to be owned by the “dean”.

Entrance Requirement: Entrance is on the same basis as in other night schools, a “preparatory department” is also in operation.

Attendance: 150 “Free transportation from Chicago to Vienna by way of New York, London, Paris”, etc. is offered to any graduate who has for “three years or more paid regular fees in cash.”

Teaching Staff: 36.

Resources available for maintenance: Fees, amounting to $22,500 (estimated).

Laboratory Facilities: The school occupies a badly lighted building, containing nothing that can be dignified by the name of equipment.  There had been no dissecting thus far (October to the middle of April), anatomy being didactically taught.  Persistent inquiry for the “dissecting room” was, however, finally rewarded by the sight of a dirty, unused, and almost inaccessible room containing a putrid corpse, several of the members of which had been hacked off.  There is a large room called the chemical laboratory, its equipment “locked up,” the tables spotless.  “about ten” oil immersion microscopes are claimed—also “locked up in the storeroom.” There is not even a pretense of anything else.  Classes in session were all taking dictation.

Clinical Facilities: The top floor is the “hospital”.  It contained two lonely patients.  Access to a private hospital two miles distant is also claimed.

Recently this school has been declared by the Illinois State Board of Health as “not in good standing.”  The same action was taken once before, but was afterwards revoked; just why, it is impossible to find out; for the school was after the revocation just exactly what it was at the time of its suspension; and it is the same today.

The recommendations outlined in Flexner’s report were gradually adopted across the United States.  States enacted laws that prohibited for-profit schools from receiving accreditation, depriving their graduates of medical licenses. By 1935, only 66 medical schools were operating in the US. These remaining schools all had substantial laboratory and clinical facilities.  [Flexner report]