School of Medicine, University of Louisville, Louisville, Kentucky 40202-3866, USA.
Acad Med. 2010 Feb;85(2):203-10. doi: 10.1097/ACM.0b013e3181c88506.
One hundred years ago, the time was right and the need was critical for medical education reform. Medical education had become a commercial enterprise with proprietary schools of variable quality, lectures delivered in crowded classrooms, and often no laboratory instruction or patient contact. Progress in science, technology, and the quality of medical care, along with political will and philanthropic support, contributed to the circumstances under which Abraham Flexner produced his report. Flexner was dismayed by the quality of many of the medical schools he visited in preparing the report. Many of the recommendations in Medical Education in the United States and Canada are still relevant, especially those concerning the physician as a practitioner whose purpose is more societal and preventive than individual and curative. Flexner helped establish standards for prerequisite education, framed medical school admission criteria, aided in the design of a curriculum introduced by the basic and followed by the clinical sciences, stipulated the resources necessary for medical education, and emphasized medical school affiliation with both a university and a strong clinical system. He proposed integration of basic and clinical sciences leading to contextual learning, active rather than passive learning, and the importance of philanthropy. Flexner's report poses several questions for the historian: How were his views on African American medical education shaped by his post-Civil War upbringing in Louisville? Was the report original or derivative? Why did it have such a large impact? This article describes Flexner's early life and the report's methodology and considers several of the historical questions.
一百年前，医学教育改革的时机已经成熟，需求也非常迫切。医学教育已经成为一项商业活动，拥有各种质量参差不齐的私立学校，在拥挤的教室里授课，通常没有实验室指导或接触患者。科学、技术的进步以及医疗质量的提高，加上政治意愿和慈善支持，促成了亚伯拉罕·弗莱克斯纳（Abraham Flexner）撰写报告的环境。弗莱克斯纳在准备报告时对他访问过的许多医学院的质量感到沮丧。他在《美国和加拿大的医学教育》（Medical Education in the United States and Canada）中提出的许多建议仍然具有现实意义，尤其是关于医生作为一种从业者的角色定位，其目的更多是社会性和预防性的，而不是个体性和治疗性的。弗莱克斯纳帮助确立了预备教育的标准，制定了医学院的录取标准，协助设计了一个以基础科学为先导、以临床科学为后续的课程，规定了医学教育所需的资源，并强调医学院要与大学和强大的临床体系相结合。他提出了基础科学和临床科学的整合，以实现情境学习、主动学习而非被动学习，并强调慈善事业的重要性。弗莱克斯纳的报告给历史学家提出了几个问题：他对非裔美国医学教育的看法是如何受到他在内战后在路易斯维尔的成长经历影响的？报告是原创的还是衍生的？为什么它会产生如此大的影响？本文描述了弗莱克斯纳的早年生活以及报告的方法，并探讨了其中的几个历史问题。
