The Flexner Report: Commemoration and Reconsideration

2010 marks the centennial of the publication of the Flexner report [1]. YJBM commemorates this anniversary with two articles from our archives: One chronicles the expansion of Yale’s medical school in the wake of the report’s publication; the other is a personal reminiscence written by Flexner for YJBM some 50 years ago. Together, these articles invite a reconsideration of an important moment in the history of 20th century American medical education. At the beginning of the 20th century, the United States could boast some 150 medical schools nationwide. Most claimed to provide their students with training in anatomy, physiology, and newer laboratory sciences such as bacteriology; however, standards and quality of instruction, facilities, and access to clinical training varied widely from school to school. Many were organized as proprietary schools with no formal university affiliation. Abraham Flexner, appointed by the Carnegie Foundation at the behest of the American Medical Association, visited each U.S. school (as well as several Canadian institutions) to obtain a firsthand account of the state of medical education. The Flexner report, based on his extensive touring of medical institutions, was published in 1910. Flexner found the majority of schools either wholly lacking in educational “rigor” or in need of significant improvement. As such, he devoted considerable space to criticizing contemporary medical education in the United States. Indeed, the highly publicized report sounded the death knell for more than half of U.S. medical schools in the 20 years that followed the report’s initial publication. Despite his strongly worded critique of U.S. medical schools in general, the report did praise several medical institutions, including those affiliated with the universities of Michigan, Wake Forest, Harvard, and Johns Hopkins. Flexner considered the latter an ideal model for medical education: a formal college education requirement for admission coupled with a four-year, progressive medical curriculum placing substantial emphasis on clinical and basic sciences. When Flexner visited Yale, he found medical education in favorable, though not ideal, conditions. The articles that follow show the personal commitment Flexner subsequently made to improving Yale's medical campus. In an examination of Abraham Flexner’s relationship with the Yale Uni-