Abraham Flexner – Scientist of the Day

Abraham Flexner, an American educator, was born Nov. 13, 1866.

In this historical perspective report, Thomas P. Duffy provides insight into what the Flexner Report is, how it came to be, and how it affects the American medical education structure today.

The Hopkins Circle: Similar to the Oxford Circle in the 17th century, the Hopkins Circle was formed in hopes for scientific revolution within the American medical system.

"The membership of the Circle affirms a particularly American phenomenon in which an aristocracy of excellence was not defined by one’s origins or wealth, although wealth permitted the group’s recommendations to be successful." (270)

Abraham Flexner: The final member, Abraham Flexner is a former educator and education systems trainer. Flexner's background made him an outlier in the Hopkins Circle, though this intentional.

"An unflattering but not necessarily inaccurate description for Flexner’s assignment was that he was to be the hatchet man in sweeping clean the medical system of substandard medical schools that were flooding the nation with poorly trained physicians." (271)

The German Medical Education System: Flexner, in his preparation for assessing American and Canadian medical schools, used the German medical structure as his "major primer".

"He was resolute in his belief that medicine was a scientific discipline that could be best realized by using the German model as the prototype in America. This was a system in which physician scientists were trained in laboratory investigation as a prelude and foundation for clinical training and investigation in university hospitals." (271)

The Flexner Report: After formulating an evaluation method, Flexner would evaluate every medical school in America.

Little focus was placed upon clinical facilities or staff (272)

"Extent to which the school enjoyed rights or merely courtesies in the school catalogue" (272)

Admission standards, accessibility to physical facilities (especially labs), instruction by physician scientists (272)

"Equipped with extensive book knowledge and not a few prejudices and preconceptions, Flexner demonstrated near superhuman industry and energy in carrying out his review of American/Canadian medical education." (272)

"Flexner sounded the death knell for the for-profit proprietary medical schools in America." (272)

How American Medicine is Affected: The Flexner Report had contributed to laying a foundation of medicalization into the beginning of American physicians' careers, then and now.

"The powerful stimulus of philanthropy money also affected the fashion in which medical faculty would live their lives in academic medicine; this was the important introduction of the full-time system in medical schools." (273)

"Edmund Pellegrino’s lament was proven true that doctors had become neutered technicians with patients in the service of science rather than science in the service of patients. How else to explain the seemingly unexplainable Tuskegee experiments, the Henrietta Lacks tissue culture tragedy, the many occurrences in which the physician as scientist has taken precedence over the physician as healer." (275)

An article in the Tulsa World relayed the proceedings of a conference called "Beyond Flexner:  Social Mission in Medical Education."  This was sponsored in part by the University of Oklahoma School of Community Medicine.  You can read about the original Flexner Report here.  This report, a dream come true for the American Medical Association, closed most medical schools, threw women and minorities out of medical schools, increased the price of medical care (due to a deliberately engineered shortage of physicians) and changed medical education in this country to mirror the socialist European model.  Flexner was the son of German immigrants and so it should come as no surprise that his ideas for what was needed here were heavily influenced by the health care system designed by the predecessor to the Nazi party, the Social Democratic Party.  Unlike Flexner, I'm not arrogant enough to tell you here and now what the medical education apparatus should look like.  The free market, given a chance, would have shown us that.  The market didn't stand a chance after Flexner's report.  

Back to Tulsa.  As you can imagine, the crowd gathered there held Flexner and this heavy-handed approach to designing education systems in the highest esteem.  They are determined to radically change it once again, apparently.  Here are some quotes:

Jack Geiger (professor emeritus of the Sophie Davis School of Biomedical Education at the City College of New York.....whew!!!...sounds important) said medical education must be an instrument of social change.  Also, "Being politically activist is medically legitimate."  Wow.  That's useful.  I'm thinking that this guy is probably not voting for Ron Paul.  This is what happens to education when you take it out of the market and put it into the hands of the state and state-worshipers.  

Fitzhugh Mullan (professor at George Washington University and head of the Beyond Flexner Study) said this:  "Social purpose is important, and it should be a mission and there should be accountability for it."  His coercive tendencies are right on the surface aren't they?  Isn't he saying that if you don't do what he wants you should be accountable for it?  This statist also said that medical schools should hold themselves accountable for improving health equity and reducing health disparities.  More incomprehensible rubbish.  Don't you think it's ironic that the Flexner report these guys hold in such high esteem resulted in a doctor shortage and an absence of women and minorities in the practice of medicine?  Unless Mullan wants health equity and no health disparities...just doesn't want minorities or women as physicians.

I can't help but think that these guys' careers are characterized by the same degree of intellectual inconsistency as evidenced in this article.  My advice to any medical student?  If someone tells you that you must be a vehicle for social change, put your headset on and hit play.

Me (FB status): Hot date tonight with Abraham Flexner and a bottle of red wine. Oh la la.

My best guy friend: That's the most action you've gotten all week!

Me: I would have a snappy comeback if it weren't utterly and completely true.

Friend who is in my presentation group: I too have a date with Mr. Flexner, but we're getting coffee.

I still managed to pull off an A.

But, that doesn't change the fact that I felt like crap the rest of the day, and it was insanely stressful. So, I will still refrain from doing that ever ever again.