Carnegie and Rockefeller's Philanthropic Legacy: Exclusion of African Americans From Medicine.

In the first 3 decades of the 20th century, John D. Rockefeller Sr. and Andrew Carnegie used their philanthropy to support 2 main mechanisms that functioned to exclude African American doctors from medical education and the medical profession. First, Carnegie funded the Flexner report, recommending reforms to medical education including the closure of most Black medical schools. Next, Rockefeller's General Education Board (GEB) funded restructures to medical education without equal support to ensure Black medical schools could keep up with changing standards. For every dollar the GEB donated to Black medical schools between 1902 and 1919, it donated $123 to White schools. During that period, for every dollar the GEB donated to White medical schools per White resident, it donated about $0.07 to Black schools per African American resident. Next, Rockefeller's philanthropy supported a system of school education that underprepared African American candidates to meet the requirements needed to enter medicine. For African American children, the GEB supported a kind of schooling termed industrial education, which emphasized manual training (e.g., skills related to agricultural science and efficiency). In 1933, industrial education schools were located in 57% of all Southern counties, and two-thirds of African Americans who attended primary and secondary school received an education that followed the industrial education curriculum. Industrial education underprepared candidates for applying to medical school, completing a medical school curriculum, and passing a medical board examination. This article examines how these 2 mechanisms had lasting and harmful effects on the underrepresentation of African American doctors in the medical workforce. These insights provide a broad and collective understanding of the early role of philanthropy in excluding African Americans from the medical profession, which is a crucial first step toward developing interventions to help redress racial discrepancies in the medical profession that persist today.

Developing an Infrastructure to Cultivate Equitable and Sustainable Community-Academic Research Partnerships: Meharry Community Engagement Core.

OBJECTIVES: Achieving health equity and reducing racial and ethnic health disparities require intentional community engagement efforts by academicians. Primary among these efforts is the acknowledgement of research-related mistrust. Efforts to build trust must begin with recognition of the invaluable knowledge and experience community stakeholders possess. METHODS: The Meharry Community Engagement Core builds on the foundation provided by Meharry Medical College, a Historically Black College and University, to achieve its mission to improve health and health outcomes through long-term collaborative research partnerships with community stakeholders. Early in its development, the Core actively engaged community stakeholders throughout all research phases. RESULTS: Early successes include achieving community feedback on research priorities, policies, and procedures and developing partnerships that span the research spectrum. Core work to date is promising and may serve as a model for addressing research-related mistrust and efforts to build trust.

Medical schools in Brasil: population, economic and historical analysis.

OBJECTIVE: To describe the current distribution and historical evolution of undergraduate courses in medicine in Brasil. METHODS: Analytical cross-sectional study of secondary data. Through the Ministry of Education, the data of the medical courses were obtained, and through the Brazilian Institute of Geography and Statistics, the population and economic data of the Brazilian states were obtained. RESULTS: In Brasil, there were 298 medical courses (1,42 courses / million inhabitants) in January 2018, totaling 31,126 vacancies per year, with 9,217 gratuitous vacancies (29.6%) and 17,963 vacancies in the hinterland (57, 7%). In Brazilian states, there are positive and statistically significant (p <0.001) correlations of the variables: "vacancies" and "population" (R 0.92); "vacancies" and "gross domestic product" ("GDP") (R 0.83); "percentage of vacancies in the hinterland" and "population in the hinterland" (R 0.71) and "percentage of vacancies in the hinterland" and "GDP" (R 0.64). There was a negative and statistically significant correlation between "gratuitous vacancy percentage" and "GDP" (R -0.54, p = 0.003). More paid courses than gratuitous courses and more courses in the hinterland than in the capitals have been created since 1964, in proportions that have remained similar since then, but in higher numbers since 2002. CONCLUSIONS: The distribution of medical courses in Brasil correlates with the population and economical production of each state. The expansion of Brazilian medical education, which has been accelerated since 2002, is based mainly on paid courses in the hinterland, in the same pattern since 1964.

Desegregating Medicine: Edith Irby Jones, MD, Broke Barriers in All-White Medical Schools in the South.

Houston internist Edith Irby Jones, MD, broke barriers in all-white medical schools in the South and in her hometown of Houston.

Medical schools in Brasil: population, economic and historical analysis

SUMMARY BACKGROUND To describe the current distribution and historical evolution of undergraduate courses in medicine in Brasil. METHODS Analytical cross-sectional study of secondary data. Through the Ministry of Education, the data of the medical courses were obtained, and through the Brazilian Institute of Geography and Statistics, the population and economic data of the Brazilian states were obtained. RESULTS In Brasil, there were 298 medical courses (1,42 courses / million inhabitants) in January 2018, totaling 31,126 vacancies per year, with 9,217 gratuitous vacancies (29.6%) and 17,963 vacancies in the hinterland (57, 7%). In Brazilian states, there are positive and statistically significant (p <0.001) correlations of the variables: "vacancies" and "population" (R 0.92); "vacancies" and "gross domestic product" ("GDP") (R 0.83); "percentage of vacancies in the hinterland" and "population in the hinterland" (R 0.71) and "percentage of vacancies in the hinterland" and "GDP" (R 0.64). There was a negative and statistically significant correlation between "gratuitous vacancy percentage" and "GDP" (R -0.54, p = 0.003). More paid courses than gratuitous courses and more courses in the hinterland than in the capitals have been created since 1964, in proportions that have remained similar since then, but in higher numbers since 2002. CONCLUSIONS The distribution of medical courses in Brasil correlates with the population and economical production of each state. The expansion of Brazilian medical education, which has been accelerated since 2002, is based mainly on paid courses in the hinterland, in the same pattern since 1964.

RESUMO OBJETIVO Descrever a distribuição e evolução histórica das vagas em cursos de graduação em medicina no Brasil. MÉTODOS Estudo transversal analítico de dados secundários. No Ministério da Educação obtiveram-se dados dos cursos de medicina e no Instituto Brasileiro de Geografia e Estatística foram obtidos dados populacionais e econômicos dos estados. RESULTADOS Havia no Brasil, até janeiro de 2018, 298 cursos de medicina (1,42 curso/milhão de habitantes), totalizando 31.126 vagas anuais, com 9.217 vagas gratuitas (29,6%) e 17.963 vagas no interior do País (57,7%). Nos estados há correlações positivas e significativas (p<0,001) das variáveis: "vagas em medicina" e "população" (R 0,92); "vagas em medicina" e "produto interno bruto" ("PIB") (R 0,83); "percentual de vagas em medicina no interior" e "população no interior" (R 0,71) e "percentual de vagas em medicina no interior" e "PIB" (R 0,64). Há correlação negativa e significativa entre "percentual de vagas gratuitas" e "PIB" (R -0,54, p=0,003). Passaram a ser criados mais cursos pagos do que gratuitos e mais cursos no interior do que nas capitais a partir de 1964 (p <0,001), e a relação curso/milhão de habitantes aumentou a partir de 2002 (p<0,001). CONCLUSÕES A distribuição de vagas em cursos de medicina no Brasil correlaciona-se à população e à produção econômica de cada estado. A expansão do ensino médico brasileiro, acelerada além do crescimento populacional a partir de 2002, é baseada principalmente em cursos pagos no interior dos estados brasileiros, característica inalterada desde 1964.

Curriculum Changes and Trends 2010-2020: A Focused National Review Using the AAMC Curriculum Inventory and the LCME Annual Medical School Questionnaire Part II.

Medical school curricula have evolved from 2010 to 2020. Numerous pressures and influences affect medical school curricula, including those from external sources, academic medical institutions, clinical teaching faculty, and undergraduate medical students. Using data from the AAMC Curriculum Inventory and the LCME Annual Medical School Questionnaire Part II, the nature of curriculum change is illuminated. Most medical schools are undertaking curriculum change, both in small cycles of continuous quality improvement and through significant change to curricular structure and content. Four topic areas are explored: cost consciousness, guns and firearms, nutrition, and opioids and addiction medicine. The authors examine how these topic areas are taught and assessed, where in the curriculum they are located, and how much time is dedicated to them in relation to the curriculum as a whole. When examining instructional methods overall, notable findings include (1) the decrease of lecture, although lecture remains the most used instructional method, (2) the increase of collaborative instructional methods, (3) the decrease of laboratory, and (4) the prevalence of clinical instructional methods in academic levels 3 and 4. Regarding assessment methods overall, notable findings include (1) the recent change of the USMLE Step 1 examination to a pass/fail reporting system, (2) a modest increase in narrative assessment, (3) the decline of practical labs, and (4) the predominance of institutionally developed written/computer-based examinations and participation. Among instructional and assessment methods, the most used methods tend to cluster by academic level. It is critical that faculty development evolves alongside curricula. Continued diversity in the use of instructional and assessment methods is necessary to adequately prepare tomorrow's physicians. Future research into the life cycle of a curriculum, as well optional curriculum content, is warranted.

The impact of the Cabanis reform on medical education in Brazil: an assessment of neo-Foucauldian archeology. / Impacto da Reforma Cabanis no ensino médico do Brasil: ensaio de arqueologia neofoucaultiana.

This text assesses the impact of the Cabanis reform on the formation of the health training model which became hegemonic in Brazil. First, we shall briefly discuss the process of constructing the social, ideological, and institutional framework for healthcare in post-revolutionary France. Next the main elements of the Cabanis reform are introduced, analyzing curricular and pedagogical aspects of the new plan for medical education based on professionalism, disciplines, and expertise that resulted in a system of higher education without universities. This is followed by assessment of the historical process which resulted in the "Francization" of the Brazilian educational system, particularly in higher education and more specifically medical education, producing a model of health training based on colleges, hospitals, classrooms, disciplines, skills, and diplomas.

O ensaio avalia o impacto da Reforma Cabanis na configuração do modelo de formação em saúde que se tornou hegemônico no Brasil. Primeiro, discute o processo de construção social, ideológica e institucional do modelo de assistência à saúde da França pós-revolucionária. Em seguida, introduz os principais elementos da Reforma Cabanis, analisando aspectos curriculares e pedagógicos da nova proposta de ensino médico baseado em profissionalismo, disciplinaridade e especialização que resultou num sistema de ensino superior sem universidades. Depois avalia o processo histórico que resultou no "afrancesamento" do sistema educacional brasileiro, resultando num modelo de formação em saúde baseado em faculdades, hospitais, aulas, disciplinas, especialidades e diplomas.

A Reflection Upon the Impact of Early 21st-Century Technological Innovations on Medical School Admissions.

The authors describe influences associated with the incorporation of modern technologies into medical school admissions processes. Their purpose is not to critique or support specific technologies but, rather, to prompt reflection on the evolution that is afoot. Technology is now integral to the administration of multiple admissions tools, including the Medical College Admission Test, situational judgment tests, and standardized video interviews. Consequently, today's admissions landscape is transforming into an online, globally interconnected marketplace for health professions admissions tools. Academic capitalism and distance-based technologies combine to enable global marketing and dissemination of admissions tests beyond the national jurisdictions in which they are designed. As predicted by disruptive business theory, they are becoming key drivers of transformative change. The seeds of technological disruption are present now rather than something to be wary of in the future. The authors reflect on this transformation and the need for tailoring test modifications to address issues of medical student diversity and social responsibility. They comment on the online assessment of applicants' personal competencies and the potential detriments if this method were to replace admissions methods involving human contact, thanks to the ease with which institutions can implement them without cost to themselves and without adequate consideration of measurement utility or contextual appropriateness. The authors advocate for socially responsible academic capitalism within this interconnected admissions marketplace: Attending to today's transformative challenges may inform how health professions education responds to tomorrow's admissions technologies and, in turn, how tomorrow's health professionals respond to their patients' needs.

Produzindo pesquisa, formação, saúde e educação na integração ensino, serviço e comunidade / Producción de investigación, formación, salud y educación en la integración enseñanza servicio y comunidad / Producing research, training, health, and education in the teaching-service-community integration

Trata-se de relato de experiência sobre o desenvolvimento de pesquisas, produção de conhecimento e formação na interface universidade e serviços de saúde, a partir do programa Pró-Ensino na Saúde (Capes Edital no 24/2010). Apresenta a educação problematizadora, a formação interprofissional, a educação permanente de professores e profissionais de saúde e as Diretrizes Curriculares Nacionais como mobilizadoras da formação profissional comprometida com o desenvolvimento do Sistema Único de Saúde (SUS), especificamente na valorização da integração universidade pública com serviços de saúde. As pesquisas desenvolvidas abordaram diferentes dimensões do ensino na Atenção Primária à Saúde, envolvendo práticas pedagógicas, formação e desenvolvimento docente, atuação do profissional de saúde como professor, inovações pedagógicas e questões relacionadas à prática do trabalho em saúde. Na riqueza e diversidade dos estudos, aponta-se fragilidade na relação orgânica entre universidade e atenção primária e observam-se inovações que caminham para a ruptura do ensino instituído.(AU)

Se trata del relato de una experiencia sobre el desarrollo de investigaciones, producción de conocimiento y formación en la interfaz universitaria y servicios de salud, a partir del programa Pro-Enseñanza en la Salud (Capes Pliego de Condiciones nº24/2010). Presenta la educación problematizadora, la formación interprofesional, la educación permanente de profesores y profesionales de salud y las Directrices Curriculares Nacionales como movilizadoras para la formación profesional comprometida con el desarrollo del Sistema Brasileño de Salud, específicamente en la valorización de la integración universidad pública con servicios de salud. Las investigaciones desarrolladas abordaron diferentes dimensiones de la enseñanza en la Atención Primaria a la Salud envolviendo prácticas pedagógicas, formación y desarrollo docente, actuación del profesional de salud como profesor, innovaciones pedagógicas y cuestiones relacionadas con la práctica del trabajo en salud. En la riqueza y en la diversidad de los estudios se señala la fragilidad en la relación orgánica entre universidad/atención primaria y se observan innovaciones que caminan hacia la ruptura de la enseñanza instituida.(AU)

The impact after 50 years of a new medical education programme with a regional workforce mission.

BACKGROUND: Tasmania established its medical programme in 1965 to produce graduates to address medical workforce recruitment challenges. Many Tasmanian graduates work in Tasmania, but workforce problems continue. This paper reports the workforce outcomes of the first 42 graduating cohorts. METHODS: A database for all University of Tasmania medical graduates from the years 1970 to 2011 was developed by combining information from university, registration and local workforce survey databases. RESULTS: A total of 2012 doctors graduated from 1971 to 2011 and 1707 (85%) were registered, most commonly in general practice (45.8%), medicine (13%), anaesthetics (7.9%), surgery (7.5%), psychiatry (4.3%), emergency medicine (35, 3.5%), paediatrics (3.4%) and pathology (3.3%). While 41.9% worked in Tasmania, they comprised 35.6% of the local workforce and were clustered around the two larger cities. The proportion entering general practice has fallen since 1980s. DISCUSSION: The contribution of the Tasmanian medical programme is substantial but appears less than other regional medical schools. Relatively few work in smaller communities, particularly in specialties other than general practice. Lifestyle choices and the availability of training opportunities and career positions might be contributing factors. The medical school has established clinical schools in rural communities, promoted admission of rural applicants and increased rural clinical placement opportunities, with some early signs of success. CONCLUSION: The Tasmanian medical programme is important in this regional, island economy, but the rural and remote communities have not benefited as much as the two larger cities. Sustaining a regional workforce mission over time might require frequent adjustments to admissions and curriculum processes.

A Escola Multicampi de Ciências Médicas da Universidade Federal do Rio Grande do Norte, Brasil, no contexto do Programa Mais Médicos: desafios e potencialidades / The Multicampi School of Medical Sciences of the Federal University of Rio Grande do Norte, Brazil, in the context of the More Doctors Program: challenges and potentialities / La Escuela Multicampi de Ciencias Médicas de La Universidad Federal de Riop Grande do Norte, Brasil, en el contexto del Programa Más Médicos: desafíos e potencialidades

A proposta deste artigo é relatar criticamente a experiência institucional e curricular de implantação do curso de Medicina da Escola Multicampi de Ciências Médicas do Rio Grande do Norte, da Universidade Federal do Rio Grande do Norte (UFRN). Este relato se coloca como forma de documentar, monitorar e refletir sobre o desenvolvimento das ações de expansão de vagas e criação de novos cursos de Medicina em universidades federais, no âmbito do Programa Mais Médicos. Para tanto, foram descritas de maneira crítica as ações de ensino, pesquisa e extensão já desenvolvidas, além de apresentar uma visão geral do curso e da integração ensino-serviço-comunidade, destacando os êxitos logrados e os desafios no desenvolvimento das ações de ensino, pesquisa e extensão. Por fim, são apresentadas as dificuldades inerentes à implantação de novos cursos fora dos centros urbanos no Brasil.

This paper reports on the institutional and curricular experience of launching the Medical Course of the Multicampi School of Medical Sciences of the Federal University of Rio Grande do Norte (UFRN). This report is a way of documenting, monitoring and reflecting on the development of actions of expansion of seats and creation of new medical courses in federal universities, within the framework of the More Doctors Program. To that end, the teaching, research and extension actions already developed are critically described, as well as it is presented an overview of the course and the teaching-service-community integration, highlighting the achievements and challenges in the development of teaching, research and extension. Finally, we describe the difficulties inherent in the implantation of new courses outside urban centers in Brazil.

El objetivo de este artículo es relatar la experiencia institucional y curricular de implantación del curso de Medicina de la Escuela Multicampi de Ciencias Médicas de la Universidad Federal de Rio Grande do Norte, de la Universidad Federal de Rio Grande do Norte (UFRN). Se presenta como una forma de comentar, monitorear y reflexionar sobre el desarrollo de las acciones de expansión de plazas y creación de nuevos cursos de Medicina en universidades federales, en el ámbito del Programa Más Médicos. Para ello, se describen de manera crítica las acciones de enseñanza, investigación y extensión ya desarrolladas, además de presentar una visión general del curso y de la integración enseñanza-servicio-comunidad, destacando los éxitos conseguidos y los desafíos en el desarrollo de las acciones de enseñanza, investigación y extensión. Finalmente se presentan las dificultades inherentes a la implantación de nuevos cursos fuera de los centros urbanos en Brasil.

Alliances in Human Biology: The Harvard Committee on Industrial Physiology, 1929-1939.

In 1929 the newly-reorganized Rockefeller Foundation funded the work of a cross-disciplinary group at Harvard University called the Committee on Industrial Physiology (CIP). The committee's research and pedagogical work was oriented towards different things for different members of the alliance. The CIP program included a research component in the Harvard Fatigue Laboratory and Elton May's interpretation of the Hawthorne Studies; a pedagogical aspect as part of Wallace Donham's curriculum for Harvard Business School; and Lawrence Henderson's work with the Harvard Pareto Circle, his course Sociology 23, and the Harvard Society of Fellows. The key actors within the CIP alliance shared a concern with training men for elite careers in government service, business leadership, and academic prominence. But the first communications between the CIP and the Rockefeller Foundation did not emphasize training in human biology. Instead, the CIP presented itself as a coordinating body that would be able to organize all the varied work going on at Harvard that did not fit easily into one department, and it was on this basis that the CIP became legible to the President of Harvard, A. Lawrence Lowell, and to Rockefeller's Division of Social Sciences. The members of the CIP alliance used the term human biology for this project of research, training and institutional coordination.

Policy commercializing nonprofits in health: the history of a paradox from the 19th century to the ACA.

UNLABELLED: POLICY POINTS: Health policy in the United States has, for more than a century, simultaneously and paradoxically incentivized the growth as well as the commercialization of nonprofit organizations in the health sector. This policy paradox persists during the implementation of the Affordable Care Act of 2010. CONTEXT: For more than a century, policy in the United States has incentivized both expansion in the number and size of tax-exempt nonprofit organizations in the health sector and their commercialization. The implementation of the Affordable Care Act of 2010 (ACA) began yet another chapter in the history of this policy paradox. METHODS: This article explores the origin and persistence of the paradox using what many scholars call "interpretive social science." This methodology prioritizes history and contingency over formal theory and methods in order to present coherent and plausible narratives of events and explanations for them. These narratives are grounded in documents generated by participants in particular events, as well as conversations with them, observing them in action, and analysis of pertinent secondary sources. The methodology achieves validity and reliability by gathering information from multiple sources and making disciplined judgments about its coherence and correspondence with reality. FINDINGS: A paradox with deep historical roots persists as a result of consensus about its value for both population health and the revenue of individuals and organizations in the health sector. Participants in this consensus include leaders of governance who have disagreed about many other issues. The paradox persists because of assumptions about the burden of disease and how to address it, as well as about the effects of biomedical science that is translated into professional education, practice, and the organization of services for the prevention, diagnosis, treatment, and management of illness. CONCLUSIONS: The policy paradox that has incentivized the growth and commercialization of nonprofits in the health sector since the late 19th century remains influential in health policy, especially for the allocation of resources. However, aspects of the implementation of the ACA may constrain some of the effects of the paradox.

The founding of the Mayo School of Graduate Medical Education.

The Mayo Foundation for Medical Education and Research (hereafter the Mayo Foundation), the precursor to the Mayo School of Graduate Medical Education, was incorporated in 1915. The Mayo Foundation, which was affiliated with the University of Minnesota Graduate School, aimed to establish a higher standard for training medical specialists. Together, the University of Minnesota and the Mayo Foundation pioneered a graduate medical education program that allowed residents to earn master's and PhD degrees in clinical medicine and surgery. Unlike elsewhere in the United States, the residency training program was not pyramidal. (In a pyramidal residency program, each training year, some residents are systematically eliminated to reduce the number of more senior trainees.) All those who started the Mayo Foundation residency program had an opportunity to finish depending on their own merits. Louis B. Wilson, the first director of the Mayo Foundation, became a major figure in graduate medical education in the 1920s and 1930s. Although the granting of graduate degrees in medicine and surgery stopped over time, Mayo Clinic ultimately became the largest site of graduate medical education in the world.