Flexner report 1910 pdf

Johns Hopkins Medical School, where the medical school curriculum consisted of 2 years of basic science followed by 2 years of clinical science, was held up as a reference standard. In his report, Flexner wrote that African-American physicians should be trained in "hygiene rather than surgery" and should primarily serve as "sanitarians," whose purpose was "protecting whites" from common diseases like tuberculosis.

The schools that closed, including Flint in New Orleans, Leonard in Raleigh, and Knoxville in Memphis, were "wasting small sums annually and sending out undisciplined men, whose lack of real training is covered up by the imposing MD degree," Flexner wrote. Although some standardization of medical education was necessary, Flexner's report gravely diminished the number of African Americans who could have become physicians, said Earl H.

Harley, MD, of Georgetown University, who has written about the forgotten history of defunct Black medical schools. Most Black medical schools in the early 20th century educated students from rural, low-income communities, and they did not have the resources or philanthropic backing necessary to implement the rigorous standards Flexner called for in his report, said Marybeth Gasman, PhD, of the Rutgers University Center for Minority Serving Institutions, whose research focuses on historically Black colleges and universities HBCUs.

HBCUs and Black medical schools help close gaps in the workforce by increasing the number of Black undergraduates with science degrees, as well as Black medical students. African Americans are overrepresented in low-income communities and have reduced access to educational opportunities compared to white Americans. With physicians graduating medical school hundreds of thousands of dollars in debt, low-income students are also underrepresented in medical schools, said Louis W.

Department of Health and Human Services. The free tuition program at the New York University School of Medicine is one example of a way to circumvent these financial barriers, Sullivan said. More Stories. The poet adopted a "Pythagorean" diet, which eliminated meat, and wrote that vegetarians would "no longer pine under the lethargy of ennui. Social Sciences. Why do we celebrate on the 1st of January?

Do financial incentives help you stick to resolutions? And other burning questions. This year, readers were into peanut butter and jelly, semi-conductors, bayonets, Victorian knitting manuals, plus the hard-working dogs of Medieval Europe. Without our writers and editors and fact checkers and producers and you, we're nothing. Wilson, and January 6. This difference can be explained by referring to the considerable cultural differences in the acceptance of CAM-oriented research, health care, and education between the German- and English-speaking medical and scientific communities [ 20 ].

All of these developments shared a profound criticism of scientific reductionism in medicine, which had gained so much ground since the advent of medical modernity and was also made responsible for many digressions and atrocities of research with human patients in medicine and health care in the 19th and 20th centuries [ 24 , 25 ]. From the perspective of modern medicine, it had become necessary to understand and control bodily phenomena—and for the sake of argument one would need to abstract from the recent approaches in CAM—[ 27 ], clinical thinking, and scientific practices in functional frameworks.

At the same time, modern medicine had barely found ways of receiving nonreductionist views in both the medical and psychiatric clinical communities, probably with the exception of psychosomatic physicians, psychoanalysts, and behavioural therapists, who continued to be involved in philosophical considerations about the status of their theories and changes in their practice as a response to the organ-centred and scientific paradigm in medicine and biological psychiatry.

In his introductory lectures to psychosomatics, Gerhard Danzer b. Groddeck's supervisor at the University of Berlin, Ernst Schweninger — , who was the personal physician of the German Reich's Chancellor Otto von Bismarck — , did not prioritize one medical system over any other.

He rather developed a holistic approach integrated with elements of deep psychology, psychoanalysis, psychiatry, narrative literature, and physical therapy, which he argued that would avoid the theoretical and practical pitfalls and limitations that 19th century experimental physiology had introduced into contemporary medicine.

Through the process of forced migration many, leading psychosomatic psychiatrists in the s, such as Franz Alexander — from Budapest and Karl Stern — from Berlin, also introduced Schweniger's and Groddeck's concepts in the American and Canadian psychiatric communities [ 31 ].

In particular, psychiatric milieu therapy has advocated for this type of psychotherapy model, by focusing on the total environment in the treatment of mental and behavioral disorders or maladjustments by making substantial changes in a patient's immediate life circumstances, as this was historically advocated for and integrated into the therapeutic approaches of the American child psychiatrist Emmy Sylvester b.

The large weight, which is undoubtedly placed on the natural sciences with regard to the pursuit of medicine's healing tasks, does not mean, however, that medicine itself would be a natural science. Medicine is neither a natural science, nor a humanist discipline. Medicine is not a scientific discipline at all, but is based on scientific disciplines. The original text can be found in: Rothschuh, [ 34 ]. Differences in philosophical views about the scientific paradigm in medicine, medical reductionism, the place of the patient, and diverging interpretations of medical holism led to intense disputes between physicians, psychiatrists, and alternative practitioners [ 35 ].

A time of change had been brought about with the rise of the s, increasing the uses of CAM and widespread discussions about the practice and role of medicine and psychiatry in Western societies and cultures, as is intriguingly represented in the influential criticisms of the Austrian philosopher, theologian, and social scientist Ivan Illich — :. Physical sickness is confined to the body, and it lies in an anatomical, physiological, and genetic context. The psychiatrist acts as the agent of a social, ethical, and political milieu.

The prevalence of sickness is blamed on life in an alienated society, but while political reconstruction might eliminate much psychic sickness, it would merely provide better and more equitable technical treatment for those who are physically ill. The original text can be found in: Illich, [ 36 ]. Of course, these criticisms of the scientific paradigm in medicine were by no means a homogenous trend, but rather triggered through a heterogeneous mixture of social, medical, and psychiatric movements, events, and developments that impacted the changes towards auxiliary and increased use of Complementary and Alternative Medicine and Psychiatry in places where modern medicine had little if nothing to offer e.

Also, the human potential movement is worth mentioning as they advocated for therapeutic approaches such as vegetarianism, natural birthing, transcendental meditation, yoga, and biofeedback. Its participants were concerned with the quality of both personal life and social life in the modern world, such as the preceding protagonists of psychosomatic medicine, wellness, movement, and humanistic medicine. Dunn — from the US Public Health Service on the concept of wellness in the early s, which broke with earlier disease-based models that had developed during the 19th century scientific paradigm of medicine.

Socially, the tradition of postmodernism, feminism and environmentalism were also crucial for the reaction to the previous era of modernism, characterized by the belief in the existence of truth, objectivity, determinacy, causality and impartial observation and with an emphasis on individuality, complexity, and personal experience. These changes became further integrated into the social construction of curricula and values in the medical system in the 20th century [ 39 ].

The development of Complementary and Alternative Medicine and Psychiatry after the publication of Flexner's Report to the American Carnegie Foundation was manifold and in certain respects was also fruitful. The political and disciplinary crackdown on alternative and nonconventional forms of research and education in medicine and psychiatry, on the other hand, did not reach the general population, nor did its beliefs about the doctor-patient relationship and other forms of healing and medical support.

Largely due to such outside developments, plans for integrative forms of medical practice that selectively incorporated elements of CAM evolved into comprehensive treatment plans alongside solidly orthodox methods of diagnosis and health care [ 40 ]:.

Integrative Medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing. Large scale research could now be pursued under the leadership of the NIH, by combining mainstream medical therapies and CAM approaches, while investigating scientific evidence, safety, and efficacy:.

CAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Conventional medicine is medicine as practiced by holders of M. Some health care providers practice both CAM and conventional medicine.

While some scientific evidence exists regarding some CAM therapies, for most there are key questions that are yet to be answered through well-designed scientific studies—questions such as whether these therapies are safe and whether they work for the diseases or medical conditions for which they are used.

The list of what is considered to be CAM changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge. NCCAM, [ 43 ]. In its inaugural year of , the international Consortium of Academic Health Centers for Integrated Medicine CAHCIM expressed the future hope that integrative medicine would become the cornerstone of the urgently needed reconstruction of what was perceived as a dysfunctional healthcare system, including both the somatic and the psychiatric fields.

The development of new frameworks of CAM has also realized that genetic and translational aspects of modern biomedical and psychiatric research had their place in such a new health care paradigm [ 44 ]. In fact, psychiatrists and psychologists today display an increasing intellectual openness towards the use of CAM and integrative approaches in their therapeutic practice, as well as the growing evidence base for specific CAM modalities in both the treatment and prevention of mental illness and disease [ 45 ].

These major changes have largely occurred in the USA, or in countries that have adopted the US model. While the federal organization of Health Canada has also played an important role in Canada, quantitatively there has been only a minor level of involvement, especially when compared to the USA.

With the creation of the International Network of Integrative Mental Health INIMH in , there now exists an important institutional platform which furthers the development of a biopsychosocio-spiritual model in integrative mental health that is evidence based.

Some of these promising changes, which are taking place in mental health care in Western countries, are represented, for example, in the growing use of homoeopathy in mood and mild anxiety disorders and the increasing role of traditional Chinese acupuncture therapies in the management of chronic pain conditions, depression, and anxiety disorders, as well as folate and other substitutional nutritional factors in depression and bipolar disorders [ 46 ].

For some, the real trend in CAM medicine and psychiatry has become evidence-based medicine EBM , not complementary and alternative medicine itself. This observation further aligned with the fact that medical, and increasingly also psychiatric education, has changed considerably over the past decade along with new trends in CAM education [ 47 ], while EBM is now infiltrating medical school curricula on both the basic science and clinical care ends [ 48 ].

While this paper has looked back from a history of medicine perspective at the publication of the Flexner Report one century ago, it should also be emphasized that the Flexner Report was revolutionary and and is even today even today widely celebrated as a seminal document that subsequently raised the standards for general education in medicine and psychiatry.

Unfortunately, Flexner may be rotating all too rapidly. Meanwhile, the same schools seem to give only lip service to the application of logic and evidence to healthcare, as exemplified by the formal processes of EBM. We increasingly recognize today that treatment is not an isolated event in patients' lives, but it takes part in the patient's own bio-psycho-social context, which includes social networks, patients' subjective experiences, and their mental health status, along with the patient provider relationship a system.

These elements are crucial to testing an intervention, as a patient is not an average patient, with average beliefs, devoid from any contextual influences [ 50 ].

As CAM treatments in psychiatry become more and more efficient and safe, as well as increasingly supported by data from randomized controlled trials and other EBM methodologies in clinical epidemiology, new standards for an appropriate and reliable use of complementary and alternative medicine and psychiatry are emerging, which go hand in hand with recommendations for the monitored and evaluated use of CAM and integrative therapies in mental health care in the USA, Canada, and other developed countries [ 51 ].

In this context, INIMH aims at augmenting and adapting approaches in contemporary psychiatry, along with biomedical perspectives in health care and research and its attempts to work out a more adequate paradigm, one of which aims at transcending the boundaries of what Abraham Flexner had laid out a century ago in his influential Report on Medical Education in the United States and Canada [ 52 ]. Both authors are grateful to Mikkel Dack, M.

Calgary , for the meticulous adjustment of the English language of this paper, as well as to the anonymous referees for their very constructive criticisms on an earlier version of this paper.

National Center for Biotechnology Information , U. Evid Based Complement Alternat Med. Published online Dec Frank W. Author information Article notes Copyright and License information Disclaimer.

Stahnisch: ac. Received Sep 17; Accepted Nov Stahnisch and M. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC. Abstract America experienced a genuinely vast development of biomedical science in the early decades of the twentieth century, which in turn impacted the community of academic psychiatry and changed the way in which clinical and basic research approaches in psychiatry were conceptualized. Introduction Between and , the United States of America and Canada witnessed a major expansion of research activities in the field of biomedicine most notably impacting academic psychiatry, clinical research in internal medicine, and the integration of laboratory-based pathology , a process which became strongly connected with the great and lasting transformation of modern universities, colleges, and hospitals [ 1 ].

Open in a separate window. Figure 1. Methods Our historiographical research in this paper is based on an analysis of Flexner's Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching Figure 2 and the available secondary scholarly, medical, and psychiatric literature on the subject.

Figure 2. Results 3. His rhetoric would of course stir massive public criticisms in North America, at the time, when rather more than less medical and psychiatric care facilities and training programs were needed, especially in the underserved states of the American Midwest and South and the Canadian Atlantic and Prairie Provinces [ 15 ]: Of complete [M. Their program for restructuring American medical education was likewise based on the modern natural sciences, which aligned well with Flexner's strategy and Johns Hopkins' strive for preeminence among major American medical schools [ 16 ]: Logically, no other outcome is possible.

Figure 3. Figure 4. Community health provisions through homoeopathic neighborhood and district hospitals. Impact of the Social Movements of the s and the Opening of the NIH in the US Differences in philosophical views about the scientific paradigm in medicine, medical reductionism, the place of the patient, and diverging interpretations of medical holism led to intense disputes between physicians, psychiatrists, and alternative practitioners [ 35 ].

A time of change had been brought about with the rise of the s, increasing the uses of CAM and widespread discussions about the practice and role of medicine and psychiatry in Western societies and cultures, as is intriguingly represented in the influential criticisms of the Austrian philosopher, theologian, and social scientist Ivan Illich — : Physical sickness is confined to the body, and it lies in an anatomical, physiological, and genetic context.

Largely due to such outside developments, plans for integrative forms of medical practice that selectively incorporated elements of CAM evolved into comprehensive treatment plans alongside solidly orthodox methods of diagnosis and health care [ 40 ]: Integrative Medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing.

Large scale research could now be pursued under the leadership of the NIH, by combining mainstream medical therapies and CAM approaches, while investigating scientific evidence, safety, and efficacy: CAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.

Conclusions For some, the real trend in CAM medicine and psychiatry has become evidence-based medicine EBM , not complementary and alternative medicine itself. Figure 5. Level in health care systems [ 26 ].

Acknowledgments F. References 1. Sigerist H. American Medicine.