The Impact and Implications of the Flexner Report on Medical Education in Korea.

The recent debate surrounding the expansion of enrollment in Korean medical schools has reignited interest in the Flexner Report, published in the United States in 1910. Historically, medical education in the United States transitioned from small proprietary schools to university-affiliated institutions, emphasizing basic science and clinical experience. The Flexner Report advocated for scientific medicine and led to significant reforms in medical education, including standardization of curricula and strengthened admission requirements. The influence of this report extended to Korean medical education, shaping its curriculum, accreditation system, and emphasis on academic excellence. The expansion of medical school enrollment has led to a crucial dilemma. Should we prioritize the training of physicians who provide practical medical services or continue to emphasize academic medicine as we do now? There has been insufficient discussion of the individualized curricula, necessary investments, and societal efforts to accommodate these changes. It is imperative to move beyond mere enrollment expansion debates and collectively determine the future trajectory of Korean medical education, devising actionable plans to achieve overarching goals.

Fixing Flexner: Disrupting and Rebuilding Academic Medicine for Women of Color to Lead.

In an effort to address the lack of compositional diversity seen in academic leadership, our generation has an opportunity to rebuild academic medicine in a way that welcomes, values, and supports the development and success of women of color.

Realizing the vision of the Lancet Commission on Education of Health Professionals for the 21st Century: Transforming medical education through the Accelerating Change in Medical Education Consortium.

In the last two decades, prompted by the anticipated arrival of the 21st Century and on the centenary of the publication of the Flexner Report, many in medical education called for change to address the expanding chasm between the requirements of the health care system and the educational systems producing the health care workforce. Calls were uniform. Curricular content was missing. There was a mismatch in where people trained and where they were needed to practice, legacy approaches to pedagogical methods that needed to be challenged, an imbalance in diversity of trainees, and a lack of research on educational outcomes, resulting in a workforce that was described as ill-equipped to provide health care in the current and future environment. The Lancet Commission on Education of Health Professionals for the 21st Century published a widely acclaimed report in 2010 that called for a complete and authoritative re-examination of health professional education. This paper describes the innovations of the American Medical Association Accelerating Change in Medical Education Consortium schools as they relate to the recommendations of the Lancet Commission. We outline the successes, challenges, and lessons learned in working to deeply reform medical education.

The Yale System at 100 Years.

In this review of 100 years of the Yale System of Medical Education, a portrait emerges of what it is and what it has made possible. Founded in the 1920s under the leadership of Dean Milton C. Winternitz, the Yale System abandoned most educational mainstays including: grades, class rankings, roll call, daily assignments, course exams, and class year affiliations. Instead, a thesis and two broad qualifying examinations were required. Revised over decades, the essential elements endure. The Yale System has cultivated generations of humane physicians, academics, and leaders through the rise of modern medicine, and medicine's constantly evolving knowledge base.

Ira Remsen, Osler, the Flexner Report, and the full-time plan.

A famous letter from Sir William Osler to Ira Remsen, dated September 1, 1911, concerns Osler's objections to the full-time plan, whereby clinical professors should focus on research and abstain from private practice. Previous accounts of this well-known episode make little or no mention of the recipient other than his being president of the Johns Hopkins University. Remsen, in retrospect, was uniquely positioned to champion ideas advanced by Abraham Flexner, the General Education Board of the Rockefeller Foundation, and some of Osler's former colleagues at Johns Hopkins, notably William H. Welch. Remsen had previously expressed the need for Hopkins to advance science-based medicine; he had introduced Abraham Flexner to the Carnegie Foundation (which led to the Flexner Report); and he appears to have been the first US-born person to possess both a medical degree and a doctorate in basic science. Caught in the middle of a faculty controversy, Remsen chose not to pursue the matter further for reasons that included a passive administrative style, concerns about his health, and friendship with Osler.

Flexner 2.0-Longitudinal Study of Student Participation in a Campus-Wide General Pathology Course for Graduate Students at The University of Arizona.

Faculty members from the Department of Pathology at The University of Arizona College of Medicine-Tucson have offered a 4-credit course on enhanced general pathology for graduate students since 1996. The course is titled, "Mechanisms of Human Disease." Between 1997 and 2016, 270 graduate students completed Mechanisms of Human Disease. The students came from 21 programs of study. Analysis of Variance, using course grade as the dependent and degree, program, gender, and year (1997-2016) as independent variables, indicated that there was no significant difference in final grade (F = 0.112; P = .8856) as a function of degree (doctorate: mean = 89.60, standard deviation = 5.75; master's: mean = 89.34, standard deviation = 6.00; certificate program: mean = 88.64, standard deviation = 8.25), specific type of degree program (F = 2.066, P = .1316; life sciences: mean = 89.95, standard deviation = 6.40; pharmaceutical sciences: mean = 90.71, standard deviation = 4.57; physical sciences: mean = 87.79, standard deviation = 5.17), or as a function of gender (F = 2.96, P = .0865; males: mean = 88.09, standard deviation = 8.36; females: mean = 89.58, standard deviation = 5.82). Students in the physical and life sciences performed equally well. Mechanisms of Human Disease is a popular course that provides students enrolled in a variety of graduate programs with a medical school-based course on mechanisms of diseases. The addition of 2 new medically oriented Master of Science degree programs has nearly tripled enrollment. This graduate level course also potentially expands the interdisciplinary diversity of participants in our interprofessional education and collaborative practice exercises.

Flexner 3.0-Democratization of Medical Knowledge for the 21st Century: Teaching Medical Science Using K-12 General Pathology as a Gateway Course.

A medical school general pathology course has been reformatted into a K-12 general pathology course. This new course has been implemented at a series of 7 to 12 grade levels and the student outcomes compared. Typically, topics covered mirrored those in a medical school general pathology course serving as an introduction to the mechanisms of diseases. Assessment of student performance was based on their score on a multiple-choice final examination modeled after an examination given to medical students. Two Tucson area schools, in a charter school network, participated in the study. Statistical analysis of examination performances showed that there were no significant differences as a function of school (F = 0.258, P = .6128), with students at school A having an average test scores of 87.03 (standard deviation = 8.99) and school B 86.00 (standard deviation = 8.18; F = 0.258, P = .6128). Analysis of variance was also conducted on the test scores as a function of gender and class grade. There were no significant differences as a function of gender (F = 0.608, P = .4382), with females having an average score of 87.18 (standard deviation = 7.24) and males 85.61 (standard deviation = 9.85). There were also no significant differences as a function of grade level (F = 0.627, P = .6003), with 7th graders having an average of 85.10 (standard deviation = 8.90), 8th graders 86.00 (standard deviation = 9.95), 9th graders 89.67 (standard deviation = 5.52), and 12th graders 86.90 (standard deviation = 7.52). The results demonstrated that middle and upper school students performed equally well in K-12 general pathology. Student course evaluations showed that the course met the student's expectations. One class voted K-12 general pathology their "elective course-of-the-year."

Diagnosing diagnostic failure.

Diagnostic failure results from misplaced dependence on the clinical judgments of expert physicians. The remedy for diagnostic failure involves defining standards of care for managing clinical information (medical knowledge and patient data), and implementing those standards with information tools designed for that purpose. These standards and tools are external to the minds of physicians, thus bypassing two inherent constraints on human cognition: limited capacities for information retrieval and processing, and innate heuristics and biases. Medical education and credentialing socialize physicians into misplaced acceptance of these constraints. Medical students acquire scientific knowledge, but not scientific behaviors. A scientific approach to diagnosis begins with using information tools to identify all diagnostic possibilities for the presenting problem and the initial findings needed to determine which possibilities are worth investigating in the patient. If the initial findings do not reveal a clear diagnostic solution, then information tools must be employed as part of a system of care to enforce highly organized follow-up processes, that is, careful problem definition, planning, execution, feedback, and corrective action over time, all documented under strict standards of care for managing the complexities involved.

La formación de recursos humanos en salud necesarios para el mundo y los paradigmas vigentes / Formation of the human resources in health required worldwide and the present paradigms

Se reflexiona sobre los paradigmas vigentes para la formación de recursos humanos en salud necesarios para el mundo, tomando en consideración algunos de sus determinantes como: voluntad política, recursos financieros y flujo migratorio. Se ponen de manifiesto las causas e implicaciones, en última instancia, sociales, de la utilización del modelo flexneriano para la formación de estos recursos. Se analizan además los diferentes retos que enfrenta hoy a nivel mundial la educación de pregrado y posgrado en Ciencias de la Salud

Some reflections were made on the present paradigms of the formation of human resources in health worldwide, taking several determinants into consideration such as political willingness, financial resources and migration flows. The causes and implications, ultimately of social origin, of the use of the Flexner´s model for the formation of these resources were explained. Additionally, the different challenges that the undergraduate and the graduate education in health sciences are facing at present worldwide were analyzedAU)

Los grandes paradigmas de la educación médica en Latinoamérica / The big paradigms of the medical education in latin american countries

La educación médica ha sido y será un tema de preocupación para todas las generaciones en cualquier parte del mundo ya que de ello depende en parte el progreso de las sociedades y de nuestra profesión, necesaria en el Estado. En este artículo trataré de realizar un recuento histórico de los procesos que se han llevado a cabo en la educación médica en el mundo y en especial en los países de América Latina, tomando como puntos de referencia los dos paradigmas más importantes hasta el momento como son el paradigma "flexneriano" y el paradigma "crítico". También enuncio los inconvenientes y algunas reformas educacionales que ha tenido que pasar la mayoría de las naciones frente a la adversidad del contexto socioeconómico que los rodea. Además de ello hago un esbozo de un tercer paradigma en gestación generado por la introducción de un nuevo personaje en la educación médica: la tecnología.

The medical education has been and will continue to be a subject of concern to all generations anywhere in the world because it depends in part on the progress of societies and our profession; so necessary in the state. The objective of this article is to try to conduct a historical review of the processes that have taken place in medical education in the world and especially in Latin America; taking as a benchmark the two paradigms most important so far as the "Flexner" paradigm and the "critical" paradigm. I’ll also try to show the disadvantages and some educational reforms that most of the nations have faced, related to adversity in the socio-economic context that surrounds them. Besides that, I make an outline of a third emerging paradigm generated by the introduction of a new character in medical education: Technology.

El sistema de educación médica en Colombia: cien años de atraso / Colombian Medical Education System: A Hundred Years Behind

Hace casi 100 años, la Carnegie Foundation para el avance de la enseñanza le encargó a Abraham Flexner, experto en educación, realizar un estudio sobre la situación de la educación médica en Estados Unidos y Canadá. Este estudio resultó ser uno de los documentos más influyentes en la revolución de la educación médica de Norteamérica, que la llevó a ser lo que hoy en día es. Casi un siglo después, la educación médica colombiana ha alcanzado un parecido asombroso con el sistema descrito en el informe Flexner. El presente artículo resalta el paralelo entre la situación de la educación médica en Norteamérica hace 100 años y la situación actual de la educación médica en Colombia. Presentamos una reflexión sobre el sistema educativo actual en ésta área, basados en lo descrito en 1910, que consideramos como la actualidad de la educación médica en nuestro país y, tal vez, la de muchos otros de América Latina.

Almost one hundred years ago the Carnegie Foundation for the Advancement of Teaching authorized a study and report about the medical education of the United States and Canada directed by Mr. Abraham Flexner an education expert of the time. This report turned out to be one of the most important documents of the medical education revolution that took place by that time in North America and that led it to become what it is today. Almost a century after that, Colombian medical education has reached an outstanding similarity to the system described in the Flexner report. The present article highlights the parallel between North America's medical education situation a hundred years ago and Colombia's actual medical education situation. We present here some notions about the actual education system based on what was described on 1910 and which we consider, constitutes the current medical education situation on our country and possibly on many Latin American countries.