Foundation for Advancement of International Medical Education and Research, Philadelphia, Pennsylvania 19083, USA.
Med Educ. 2011 Jan;45(1):81-6. doi: 10.1111/j.1365-2923.2010.03738.x.
Abraham Flexner's 1910 report to the Carnegie Foundation was a successful attempt to improve the quality of health care by reforming the education of health care providers. It was accompanied by a significant reduction in the number of medical schools and an increase in the quality of those schools that remained. Although the report's focus on quality was laudable and appropriate to the times, we now face a significant shortage and maldistribution of health care workers, particularly in countries with the highest burden of disease. Hence, we see the challenges for the 21st century to involve increasing both capacity and quality.
In our view, these two goals can be achieved through three research-driven educational reforms. Firstly, many educational methodologies are retained based on tradition and new methods are adopted based on fashion. Educational research must become the basis for educational practice. Secondly, educational methodology is often focused on improving quality and does not consider resource utilisation, which reduces its relevance and utility. Educational research must focus on quality and efficiency. Thirdly, one form of educational quality control is provided by accreditation processes. Some of these processes are so prescriptive that they are a barrier to improvement and for none is there evidence of effectiveness. Accreditation processes should be based on data about what is effective and efficient.
Just as Flexner argued for a scientific basis in the practice of medicine, we argue for a scientific basis in the practice of education. In our view, this is the way to meet the challenges of the 21st century.
亚伯拉罕·弗莱克斯纳（Abraham Flexner）1910 年向卡内基基金会（Carnegie Foundation）提交的报告，通过改革医疗保健提供者的教育，成功地提高了医疗保健质量。随之而来的是医学院数量的显著减少，以及剩余学校质量的提高。尽管该报告对质量的关注是值得称赞的，并且符合当时的时代背景，但我们现在面临着医疗保健工作者的严重短缺和分布不均的问题，特别是在疾病负担最高的国家。因此，我们认为 21 世纪面临的挑战是既要增加医疗保健的数量，又要提高其质量。
在我们看来，这两个目标可以通过三项以研究为导向的教育改革来实现。首先，许多教育方法是基于传统保留下来的，而新方法则是基于时尚采用的。教育研究必须成为教育实践的基础。其次，教育方法往往侧重于提高质量，而不考虑资源利用，这降低了其相关性和实用性。教育研究必须注重质量和效率。第三，一种教育质量控制形式是通过认证过程提供的。其中一些过程如此具有规定性，以至于它们成为改进的障碍，而且没有一个过程有证据表明其有效性。认证过程应该基于关于什么是有效和高效的数据。
正如弗莱克斯纳（Flexner）主张在医学实践中要有科学依据一样，我们也主张在教育实践中要有科学依据。在我们看来，这是应对 21 世纪挑战的途径。
