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Practical knowledge (1) - people, communities and health workers
Published in Nigel Crisp, Turning the World Upside Down Again, 2022
We called Nursing Now's final report Agents of Change as a direct reference to the Lancet Commission on the Education of Health Professionals for the 21st Century chaired by Julio Frenk and Lincoln Chen and of which I was privileged to be a member. Its report was published in 2010, a century after the Flexner Report which had led to radical changes in medical schools through integrating modern science into their curricula.
Healthcare Policy in the United States
Published in Kant Patel, Mark Rushefsky, Healthcare Politics and Policy in America, 2019
After World War I, public health and private medicine continued on their own separate ways. Each developed a separate system of financial, social, educational, and professional support. The American Medical Association played a crucial role in the professionalization of medical education following the Flexner report, helping to establish medical schools to train and ultimately license physicians. By 1915, there were 92 medical schools in the country. By 1932, most medical schools and state medical boards required a standard educational curriculum. The Welch-Rose Report of 1915 led to the establishment of separate institutionalized public health education, i.e., the establishment of schools of public health. The Johns Hopkins School of Hygiene and Public Health was established in 1916 and by 1922, schools of public health were established at Columbia, Harvard, and Yale Universities. Foundations such as the Rockefeller Foundation and the Carnegie Foundation played a major influential role in American medicine between 1910 and the 1930s (Patel and Rushefsky 2005a).
The performing arts in medicine and medical education
Published in Alan Bleakley, Routledge handbook of the medical humanities, 2019
In the early twentieth century, medical education narrowed to training students in scientific methods. The famed Flexner Report (1910), which advocated this, also recommended the closure of five out of seven medical schools dedicated to enrolling black students, and all medical schools for women (Byrd and Clayton 2002). New regulations—much needed—to safeguard patients from unscrupulous quackery, including faith healing, also suppressed Indigenous and other traditional healers, and ridiculed their performance-based practices.
Teaching compassion for social accountability: A parallaxic investigation
Published in Medical Teacher, 2023
Hoi F. Cheu, Pauline Sameshima, Roger Strasser, Amy R. Clithero-Eridon, Brian Ross, Erin Cameron, Robyn Preston, Jill Allison, Connie Hu
In contrast to the long evolution of compassion, SA is a relatively younger concept. We may trace the discourse back to the Flexner Report of 1910, which, as Thomas Duffy describes, ‘transformed the nature and process of medical education in America with a resulting elimination of proprietary schools and the establishment of the biomedical model as the gold standard of medical training’ (Duffy 2011, p. 296). However, it is only in principle but not in contemporary terminology that the 1910 Flexner Report (Flexner 1910) relates to ‘social accountability’ – the Flexner Report’s concentration on science education and advocacy for state regulation of medical licensure is based on a principle of accountability. It is unfortunate, however, that the Flexner Model’s science-based classroom educational model is in part responsible for the eventual development of a subspecialist-privileged culture in the second half of the twentieth century (Strasser and Strasser 2020, p. 30–31). The need for a renewal of SA for more socially responsive physicians was introduced close to the end of the twentieth century.
Acting wisely in complex clinical situations: ‘Mutual safety’ for clinicians as well as patients
Published in Medical Teacher, 2021
Tim Dornan, Ciara Lee, Florence Findlay-White, Hannah Gillespie, Richard Conn
The year 2010 marked the centenary of the Flexner report. The Carnegie Foundation commissioned influential scholars to recommend, anew, how to educate doctors to benefit American people (Cooke et al. 2010). The Lancet commissioned experts to recommend ways of improving global health (Frenk et al. 2010). Both reports recommended that clinicians’ competencies should be standardised, which consolidated CBME’s status as a paradigm. The recommendations introduced new contradictions, though, which Table 1 presents in detail. Recommending that doctors should approach patients holistically acknowledged implicitly that clinical problems are complex, and yet competence is simple. It was proposed that (inter)nationally agreed, standardised competencies should be the currency of a global, interprofessional labour market. Table 1 argues that such a huge Lego model of interchangeable competencies could never have been agile enough to address a real global health threat like COVID-19. Later publications (Irby and Hamstra 2016) showed that these contradictions arose because assessment, which requires simplicity for reliability, was wagging the dog of professional practice, whose strength lies in the ability of doctors to manage complexity.
Expanding innovation from undergraduate to graduate medical education: A path of continuous professional development
Published in Medical Teacher, 2021
John S. Andrews, Kimberly D. Lomis, Judee A. Richardson, Maya M. Hammoud, Susan E. Skochelak
One hundred years ago, the Flexner report promoted change in medical education. Some of those changes raised standards, contributing to a medical education system in the United States that has produced groundbreaking medical discovery and a physician work force that is among the most skilled in the world. Most of these advances are due to instructional reform, changing the way medicine is taught. But the Flexner report, through its narrow focus, also compromised diversity, teaching, patient care, and health promotion in important ways (Sullivan and Mittman 2010). The next step in our evolution is to critically examine how structures and institutions may hinder progress toward meeting the needs of patients and populations. This will require ongoing instructional reform, but also institutional reform (Frenk et al. 2010). The necessary institutional reforms demand collaboration and cooperation of the type demonstrated through communities of practice such as the Accelerating Change in Medical Education Consortium. Sharing approaches enhances innovation, and collaborative efforts lead to more rapid and full adoption of new ideas. Furthermore, regulatory and certifying bodies will be more likely to engage with innovation when a critical mass of institutions is pursuing reforms.