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Special Article
March 1, 2005

A Major Challenge for Graduate Medical Education

Author Affiliations

Author Affiliations: Department of Surgery, Eastern Virginia Medical School, Norfolk.

Arch Surg. 2005;140(3):250-253. doi:10.1001/archsurg.140.3.250

Arguably, the most pivotal period in medical education in this country was during the early 20th century when a nonphysician was given the task to objectively evaluate medical education in America. Abraham Flexner, an educator who worked at the Carnegie Foundation for Advancement of Teaching, provided a critical analysis of an educational system in medicine that had no regulatory body or structured curriculum. This landmark report on Medical Education in the United States and Canada was unveiled in 1910.1-3

The “Flexner Report,” as it is commonly called, highlighted that a large percentage of medical schools were strictly proprietary. Very few had any type of standards or required prerequisites prior to matriculation. In fact, most medical schools were faculty owned, with tuition funding most of the faculty salaries. The majority of the medical schools during this period had no hospital or university affiliation. It was reported that some of the graduates from these schools never dissected a cadaver and often did not see a single patient. The shocking conclusion of the Flexner Report was that more than 120 of the 150+ operating medical schools should be closed. The report generated a quick response from the American Medical Association’s Council on Medical Education, which initiated the following rating system: class A, fully satisfactory; class B, redeemable; and class C, complete reorganization needed. With most of the states denying licensure to new graduates of class C schools, it resulted in almost immediate closure of the schools in this category. If they did not close outright, the class B schools often merged with other schools to survive. As predicted, more than 100 medical schools eventually closed. An unexpected consequence of the Flexner Report was the increase in philanthropic funds to the medical schools with almost half of the funds given to all causes being directed to undergraduate medical education. Approximately $154 million (excluding matching funds) were poured into medical schools.