An Overview of Medical Education in the Late Twentieth Century
CHRISTINE H. MCGUIRE
The twentieth century witnessed two major worldwide revolutions in medical education. The locus, date, and nature of the precipitating event that triggered the first can be specified with precision, and its manifestations as it spread were readily visible and essentially uniform. Not so the second: no single event can be assigned responsibility for the seemingly spontaneous developments that began to appear in diverse places in the late 1950s and early 1960s, apparently in response to diffuse disappointments and disillusionments with the medical education establishment.
The first revolution was prompted by the publication in 1910 of Abraham Flexner's modest little report to his sponsors--the Carnegie Foundation--summarizing his observations of, conclusions about, and recommendations for reform in medical education. The prompt elimination of proprietary schools and the incorporation of medical education into the university system in the United States can be traced directly to Flexner's influence. The reform of the curriculum to stress the scientific basis of medicine and the implementation of that emphasis by separating instruction in the basic sciences from the clinical disciplines took root worldwide. While details of the educational system may vary from country to country, the general pattern everywhere reflects the philosophy and strategy advocated by Flexner. Even after the Flexnerian model began to be called into question in the West, it continued to be emulated by emerging institutions in the developing world, where other educational systems were regarded as inferior and as evidence of accepting second-class status for their citizens.
In contrast, the second revolution was not characterized by clear-cut origins or uniform development. Rather, following World War II, medical educators in some Western countries began to manifest concern about perceived changes in the numbers and quality of medical school applicants and to express the view that many excellent potential applicants were being seduced into the then more glamorous atomic sciences. At the same time, a new generation of medical