The Flexner Report

Abraham Flexner was not a physician. He was a teacher from Louisville, Kentucky, the sixth of seven children in a Jewish family, who went to Johns Hopkins University on money from his older brother Simon, later head of the Rockefeller Institute, and majored in Greek and Latin. He opened a private high school in Louisville, later studied philosophy at Harvard, visited schools in Britain, France and above all Germany, and set out his criticisms of American education in a book, The American College.

The book reached Henry Pritchett, head of the Carnegie Foundation for the Advancement of Teaching, at a time when the foundation had made the improvement of American health care its main concern. Flexner was sent to look at how doctors were trained. On clinical teaching his main question was practical: did the school have real rights in the hospitals its catalogue named, or only courtesies?

The report, published in 1910 as the foundation's Bulletin Number Four, ran to 346 pages. Flexner sorted schools into three groups: sound ones, substandard schools that money could rescue, and schools so poor that closure was the answer. A majority were rated defective, with low admission standards, poor laboratories and little contact with patients.

His yardstick was the scientific medicine associated with Johns Hopkins, where William Welch had put the German model of medical education in place. Thomas Duffy of Yale School of Medicine writes that closure was the fate of one third of American medical schools in the aftermath, and that the proprietary schools run for profit largely disappeared. Large gifts from the Rockefeller and Carnegie foundations paid for reform at the schools that survived and brought in the full-time system, under which clinical professors were freed from most patient-care duties to teach and do research, the model of the German universities.