Medical Education

Medical Education. Medical education in colonial and antebellum America typically involved individual apprentices laboring under older doctors. These apprenticeships varied widely in length and quality, while always emphasizing practical experience. Those with the desire and the resources could pursue more formal training in a European medical school, but most American doctors remained content with domestic education.

The advantages of some form of institutional medical training, particularly as a means of imparting formal scientific knowledge, encouraged the growth of medical schools along the proprietary (physician‐owned) model. These schools, which were self‐governing even when associated with universities, functioned as a supplement to apprenticeship. Although most taught so‐called regular medicine, homeopathic, eclectic, and other sectarian physicians also established medical schools. A few medical schools offered training to blacks and women. The number of medical schools burgeoned in the late nineteenth century, leading to a rapid increase in physician supply.

The establishment of the Johns Hopkins Medical School in Baltimore in 1893 provided a new model. This institution was from the beginning integrated into the Johns Hopkins University. It emphasized research and established high standards for admission and graduation. Concern about the quality of medical education in America had been growing during the late 1800s. Issues of clinical quality, social position, financial gain, licensing, and research opportunities led medical reformers to call for fewer and more rigorous schools. This movement, well established by the early 1900s, received validation in the Flexner Report of 1910. Abraham Flexner, an educator from Louisville, Kentucky, had been hired by the Carnegie Foundation for the Advancement of Teaching to survey medical education in the United States and Canada. He used his report to praise the Hopkins model, and later, as an official at the Rockefeller Foundation philanthropies, funneled resources to institutions adhering to that model.

The number of medical schools in America fell rapidly as the Hopkins model became dominant. Standards rose across the board, but the number of women and African Americans entering medical school declined sharply. The Hopkins model remains the dominant paradigm of medical education in America. By the 1930s, medical schools were becoming heavily involved in postgraduate education, with the establishment of hospital internships and residency programs. Initially utilized by only a few practitioners, these programs soon became a required extension of medical training.

The rapid expansion in federal funding for scientific research after World War II proved a bonanza for medical faculties, as did the growth of federal spending for health care associated with the Medicare and Medicaid legislation of 1965 and the introduction of many new modes of treatment. The cost of medical education and health care, however, soared to prohibitive levels as the twentieth century wore on. As state and federal governments adopted ever more stringent cost‐containment measures, medical schools found themselves tightly strapped. At the same time, more women and minorities began to enter medicine, and concern grew over the grueling and sometimes dehumanizing nature of medical training.

In 1997, the nation's 125 medical schools awarded 16,000 M.D. degrees. Medical education in the 1990s enjoyed access to advanced technologies, but faced ever greater challenges. Money continued to be tight, while crises such as the acquired immunodeficiency syndrome (AIDS) epidemic and the debate over genetic technologies embroiled medical schools in troubling and complicated issues. Pressures to compete with private‐sector health providers caused many schools to place their hospitals and clinics at least partially under commercial control, and criticism of the exhausting demands placed on medical students and residents continued. American medical education left the twentieth century as it had entered it—worried and apprehensive on the one hand, but excited and hopeful on the other.
See also Biological Sciences; Biotechnology Industry; Education: The Rise of the University; Medicine; Philanthropy and Philanthropic Foundations.

Bibliography

Abraham Flexner , Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching, 1910.
E. Richard Brown , Rockefeller Medicine Men: Medicine and Capitalism in America, 1979.
Ronald L. Numbers, ed., The Education of American Physicians: Historical Essays, 1979.
Kenneth M. Ludmerer , Learning to Heal: The Development of American Medical Education, 1985.
Thomas N. Bonner , Becoming a Physician: Medical Education in Britain, Germany, France, and the United States, 1750–1945, 1995.
Kenneth M. Ludmerer , Time to Heal: American Medical Education in the 20th Century, 1999.

Robert Oliver