Can Teacher-Educators Learn From Medical-School Reform?
Do we need a Flexner Report for American colleges of education? Perhaps, but only if we appreciate the true history of the original Flexner Report's role in transforming medical education in this country.
The standard story of Abraham Flexner and his famous report goes something like this. In 1908, the Carnegie Foundation for the Advancement of Teaching and the Council of Medical Education, a division of the American Medical Association, jointly commissioned Flexner to study and report on the state of North American medical schools. Flexner, who had no medical training, spent the next two years visiting and evaluating 155 separate institutions. His efforts culminated in his publishing a scathing report in 1910 that recommended a majority of medical schools be closed immediately.
According to the standard story, an outraged public agreed with Flexner, and the council and various policymakers responded by taking swift action to shut down the fly-by-night programs churning out degrees for dangerous doctors. Within two decades, the number of medical colleges would be reduced by more than 50 percent, and our nation was finally on its way to developing the finest medical education system in the world.
This story is a myth. Like many myths, it contains elements of truth, but the facts this story leaves out are just as important—perhaps more important—to understanding the potential relevance of the Flexner Report to transforming our educator-preparation system today.
First, some data: It is true that in the years following the Flexner Report, many medical schools closed down, such that by 1928, only 76 were left. Yet what this leaves out is that schools were rapidly closing in the years prior to the report—approximately 40 schools closed between 1906 and 1910—and many others were already in poor fiscal health and on the verge of closure. While the Flexner Report may have hastened the demise of some of these schools (in particular, dubious for-profit proprietary schools), pressures from multiple sources, including state boards of health, began the trend toward consolidation, which was well under way before its publication.
Second, the Flexner Report mythology omits the salient fact that by 1910, according to Kenneth Ludmerer, a leading historian of U.S. medical education, "a consensus had emerged among medical educators regarding the proper approach to teaching medicine." This consensus placed scientific competence at its center and in service of a remarkably progressive vision: Future doctors were to be trained in the sciences (physics, chemistry, and biology) and then approach issues of medical practice with a scientific mind-set—inquire, observe, and infer. The leaders of reputable medical schools affiliated with major research universities not only agreed with this vision, they were already orienting medical training around this blend of scientific competence and progressive problem-solving.
Finally, and somewhat ironically, the dominant Flexner Report narrative masks the role that Abraham Flexner himself soon after played in catalyzing massive philanthropic support to medical schools that adopted this scientific-progressive vision. In 1912, Flexner joined the Rockefeller-funded General Education Board and spent the next 25 years helping raise more than $500 million—around $6 billion in today's dollars—to support the scientific, research-oriented medical schools endorsed in his report. Put another way, as much as Flexner's report memorialized what was bad in medical education, both the report and his subsequent actions directed tremendous resources to build and strengthen the good.
This context suggests that something important is missing at the moment from our national discussion on how to improve teacher preparation. Unlike the situation in 1910, at present there is no collective vision, agreed upon by the leaders of colleges of education, as to the proper approach to preparing teachers, although the recently formed organization Deans for Impact, which I head, is working toward this goal. Perhaps because this vision is presently lacking, few believe that new philanthropic or public resources will be marshaled to support the institutions that embrace a more rigorous and empirical approach to preparing future educators.
I would not go so far as to suggest that these are necessary preconditions for reform, but their absence hints at why the perpetual calls for transforming colleges of education over the past century have resulted in so little progress. It may be convenient to believe that a single report can radically reshape a complex system, but social-system transformation rarely works so neatly.
Vol. 34, Issue 32, Pages 26-27