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August 25, 1989

The Long Shadow of Flexner: A Prolonged Polemic in Assessing Outcomes in Medical Education

JAMA. 1989;262(8):1008-1010. doi:10.1001/jama.1989.03430080024004

Eighty-three years after the first recorded use of outcome measures in the evaluation of medical education, the US Secretary of Education has strengthened the outcome criterion for its recognition of accrediting agencies as follows1:

The secretary determines whether an accrediting agency, in making its accrediting decisions, systematically obtains and considers substantial and accurate information on educational effectiveness... by determining that institutions or programs document the educational achievement of their students,... in verifiable and consistent ways, such as... graduate or professional school placements, job placement rates, licensing examination results, employer evaluations, and other recognized measures.

At least one of these applications of outcome evaluation, the use of licensing examination results, would not have been accepted by Abraham Flexner in his time, although Dr Nathan P. Colwell, a former secretary of the American Medical Association (AMA) Council on Medical Education, surely would have felt vindicated.

Colwell vs Flexner  In 1906, the