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.

Dr. Billings, later instrumental in the development of the medical school at the University of Chicago, denounced the shameful state of the educational system along with the "evils of an overcrowded profession." (Decades later, this latter phrase was seized upon by critics of the AMA as an effort to limit the number of physicians, but on balance, Dr. Billings' statements reflected a clear motivation to improve the educational system.)

The AMA responded quickly. Here is a brief chronology of accomplishments, a remarkable achievement in a period of relatively primitive communications and difficult travel.

1904 The AMA forms its Council on Medical Education -- to this day a strong advocate for the profession in policy development and implementation, and in its work with other medical education entities.

1905 The council publishes the first version of the minimum and ideal standards for a medical school.

1906 The AMA publishes the first complete directory of the 160 medical schools then in existence, including their admissions criteria.

1906-07 Representatives of the council visit every U.S. medical school, and the council subsequently publishes a 10-point standard for medical school inspection.

1907 The council establishes a 100-member committee to evaluate the entire medical school curriculum, leading to the 1910 publication of the first "Essentials of an Acceptable Medical College."

1910 Flexner's "Medical Education in the United States and Canada" is published.

1912 The Federation of State Medical Boards is organized and agrees to accept the AMA's evaluation of medical schools as authoritative.

Today, a century after the AMA began its dramatic campaign to assure that the U.S. medical education system would meet the needs of a growing, vibrant nation, that system is widely recognized as the gold standard for training physicians.

The profession, the nation and the world owe much to the bold and visionary leaders of medicine who recognized an urgent need and moved forcefully and expeditiously to develop and implement solutions. Over the past 100 years, most of their names have been forgotten, but their legacy remains as strong as ever.