Century of progress: AMA helps turn tarnished medical education system into gold standard

The 1910 Flexner report was a cornerstone in the school reform movement.

Editorial. Oct. 13, 2003.

"The city of Chicago is, in respect to medical education, the plague spot of the century."

Those strong words about the hometown of the American Medical Association were published in 1910 as part of the document now known as the "Flexner report," produced by educator Abraham Flexner with the strong support of the AMA and funding from the Carnegie Foundation.

The bluntly worded report (another sample, written about a Tennessee institution: "This is a typical example of the schools that claim to exist for the sake of the poor boy and the back country.") is widely credited with providing the impetus for the reform of the medical education system in the United States.

However, by the time Flexner's "Medical Education in the United States and Canada" was published, the movement for reform actually was well under way, largely at the instigation of the AMA. In fact, this year marks the centennial of the Association's first significant steps toward the development of the medical education system that exists today.

As the nation entered the 20th century, medical education was in disarray. Some excellent schools existed, but diploma mills flourished in many parts of the country. An "MD" degree could be earned with as little as six months of training, and a college education wasn't necessarily a prerequisite. The level of care being delivered varied widely from area to area, and there was little oversight of either training or care.

The AMA's leaders were seriously concerned and in 1903, the organization's president, Frank Billings, MD, began the effort that eventually produced the world's premier medical education system. At the same time, it established, without question, the American Medical Association's role in monitoring and nurturing that system.