Tracing the history of medical education

In the mid-19th century, medical schools were faculty-owned, for-profit operations that churned out doctors after just a few months of lectures.

With the Flexner Report of 1910, medical educators realized that medical schools should be integral parts of universities, said Kenneth M. Ludmerer, M.D., professor of medicine and history at Washington University in St. Louis, in his address at the 30th Annual Yale Affiliated Hospitals Symposium in November.

By the 1920s, medical school had become academic centers that emphasized research and clinical care. The fee-for-service era of the 1960s to 1980s also afforded rich learning opportunities because hospital stays were longer. But that learning environment has been threatened by managed care, with its emphasis on seeing as many patients as possible.

Today, Ludmerer sees a need for a social contract that funds and values medical education and research, while medical schools teach and practice cost-effective medicine. Despite the faults of the current system, Ludmerer said he wouldn’t trade today’s problems for those of a century ago. “It’s better to have problems financing treatment for Alzheimer’s disease and cancer than to watch children die of diphtheria,” he said.