The first effective demand for the systematic review and scientific evaluation of medical care that is now termed "medical audit" originated soon after 1910. Surgery had gained great popular favor in the years just past when the dramatic relief of suffering and disability and the prolongation of life that were offered by surgery at its best had overcome much of the former dread of the hospital and surgeon. Although the need for welltrained surgeons far exceeded the available supply at that time, there was a surplus of poorly trained surgeons. The medical literature of the day, particularly Flexner's famous survey of medical education, gives us the picture of a greatly overcrowded profession made up in large part of poorly educated doctors. In the period between 1900 and 1909, some 165 medical schools had been turning out 5,200 doctors annually, a majority of whom had not even a high school education
Lembcke PA. Evolution of the Medical Audit. JAMA. 1967;199(8):543–550. doi:10.1001/jama.1967.03120080077012
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