Abraham Flexner: the life trajectory of an educator

https://doi.org/10.18294/sc.2022.4053

Published 11 September 2022 Open Access


Hugo Spinelli Doctor in Collective Health. Director, Institute of Collective Health, Universidad Nacional de Lanús, Buenos Aires, Argentina. image/svg+xml




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Keywords:

History of Medicine, Education, Medical Education


Abstract


This article centers on the life of Abraham Flexner, widely known in the field of health for the Flexner Report published in 1910, which is considered one of the most important theoretical discussions in the history of medical education. Flexner was first and foremost an educator, belonging to the progressive education movement led by John Dewey in the United States. The text analyzes the historical moment in which the health field began to consolidate in the United States, as well as the actors involved, the interests at play, the construction of doxa, and the role of philanthropic organizations and the American Medical Association. Flexner’s critiques in the field of education were primarily focused on pedagogical approaches at different stages of education; he was particularly critical of the university level, postgraduate programs, and the absence of humanistic training, which had been supplanted by research. The article closes by raising the question of whether or not the problems related to education – and medical education in particular – identified by Flexner between the late 19th and early 20th century are still relevant to medical schools and universities in Latin American countries today.


References


1. Hobsbawm E. La era del capital 1848-1875. Buenos Aires: Crítica; 2010.

2. Rosen G. De la policía médica a la medicina social. México DF: Siglo Veintiuno Editores; 1985.

3. Brown ER. Rockfeller medicine men: medicine and capitalism in America. Los Angeles: University of California Press; 1979.

4. Hudson RP. Abraham Flexner in perspective: American medical education 1865-1910. Bulletin of the History of Medicine. 1972;46(6):545-561.

5. Brown ER. El que paga la música: fundaciones, profesión médica y reforma de la educación médica. En: Navarro V, (comp.). Salud e imperialismo. Mexico DF: Siglo Veintiuno Editores; 1983.

6. Starr P. La transformación social de la medicina en los Estados Unidos de América. México: Secretaría de Salud, Fondo de Cultura Económica; 1991.

7. Flexner A. Medical education in the United States and Canada. New York: Carnegie Foundation for the Advancement of Teaching; 1910. DOI: https://doi.org/10.1126/science.32.810.41

8. Bonner TN. Iconoclast: Abraham Flexner and a life in learning. Baltimore: Johns Hopkins University Press; 2002.

9. Wraga W. The assault on «The assault on humanism»: Classicists respond to Abraham Flexner’s «A modern school». Historical Studies in Education/Revue d’histoire de l’éducation. 2008;(1):1-31. DOI: https://doi.org/10.32316/hse/rhe.v20i1.281

10. Fee E. Disease and discovery: a history of the Johns Hopkins School of Hygiene and Public Health, 1916-1939. Baltimore: Johns Hopkins University Press; 1987.

11. Almeida Filho N. Reconhecer Flexner: inquérito sobre produção de mitos na educação médica no Brasil contemporâneo. Cadernos de Saúde Pública. 2010;26(12):2234-2249. DOI: https://doi.org/10.1590/S0102-311X2010001200003

12. Ludmerer KM. Abraham Flexner and Medical Education. Perspectives in Biology and Medicine. 2011;54(1):8-16. DOI: https://doi.org/10.1353/pbm.2011.0009

13. Ebert RH. Flexner’s model and the future of medical education. Academic Medicine. 1992;67(11):737-742. DOI: https://doi.org/10.1097/00001888-199211000-00005

14. Bonner TN. Searching for Abraham Flexner: Academic Medicine. 1998;73(2):160-166. DOI: https://doi.org/10.1097/00001888-199802000-00014

15. Bourdieu P. La ilusión biográfica. Acta Sociológica. 2011;(56):121-128. DOI: https://doi.org/10.22201/fcpys.24484938e.2011.56.29460

16. Bourdieu P, Wacquant LJD. Una Invitación a la sociología reflexiva. Buenos Aires: Siglo Veintiuno Editores; 2008.

17. Abbagnano N, Visalberghi A. Historia de la pedagogia. Madrid: Fondo de Cultura Económica; 1964.

18. Payne M. Diccionario de Teoría Crítica y Estudios Culturales. Buenos Aires: Paidós; 2006.

19. Ferrater Mora J. Diccionario de filosofía. Barcelona: Ariel; 2002.

20. Deledalle G. Leer a Peirce hoy. Barcelona: Gedisa; 1996.

21. Dewey J. Democracia y educación: Una introducción a la filosofía de la educación. Madrid: Ediciones Morata; 1995.

22. Igelmo J, Fuentes JL, Jover G. Tres lecturas de John Dewey desde las teorías de la desescolarización. Crónica: Revista Científico Profesional de la Pedagogía y Psicopedagogía. 2017;(2):25-37.

23. Mead GH. Escritos políticos y filosóficos. Buenos Aires: Fondo de Cultura Económica; 2009.

24. Dykhuizen G. The life and mind of John Dewey. Carbondale: Southern Illinois University Press; 1973.

25. Cappelletti Á. Francisco Ferrer Guardia y la pedagogía libertaria. Madrid: La Malatesta; 2011.

26. Ferrer Guardia F, Bray M, Haworth RH, McCabe J. Anarchist education and the modern school: a Francisco Ferrer reader. Oakland: PM Press; 2019.

27. Avrich P. The modern school movement: anarchism and education in the United States. Princeton: Princeton University Press; 1980. DOI: https://doi.org/10.1515/9781400853182

28. Boyesen B. The Modern School In New York. New York: The Francisco Ferrer Association; 1911.

29. Döllerer S, Nubiola J. La correspondencia entre Emma Goldman y John Dewey. La Torre del Virrey. 2021;(29):20-25.

30. Joscha T. Anarchy and education: Dewey and the modern school movement. Ponencia presentada en: Dewey’s “Democracy and Educacion”: 100 year on [Internet]. 2016 [citado 10 may 2022]. Disponible en: https://tinyurl.com/2p8npwyp.

31. Glassman M. Dewey and Vygotsky: Society, experience, and inquiry in educational practice. Educational Researcher. 2001;30(4):3-14. DOI: https://doi.org/10.3102/0013189X030004003

32. Hobsbawm E. La era de la revolución: 1789-1848. Buenos Aires: Crítica; 2007.

33. Harris MR. Five counterrevolutionists in higher education: Irving Babbitt, Albert Jay Nock, Abraham Flexner, Robert Maynard Hutchins, Alexander Meiklejohn. Corvallis: Oregon State University Press; 1970.

34. Bonner TN. American doctors and German universities: A chapter in international intellectual relations, 1870–1914. Lincoln: University of Nebraska Press; 1963.

35. Halperin EC, Perman JA, Wilson EA. Abraham Flexner of Kentucky, His Report, Medical Education in the United States and Canada, and the Historical Questions Raised by the Report: Academic Medicine. 2010;85(2):203-210. DOI: https://doi.org/10.1097/ACM.0b013e3181c88506

36. Tamayo Pérez R. El Concepto de enfermedad, su evolución a través de la historia. Vols. 1 y 2. México DF: Fondo de Cultura Económica, Facultad de Medicina, UNAM, Consejo Nacional de Ciencia y Tecnología; 1988.

37. Berliner H. A larger perspective on the Flexner Report. International Journal of Health Service. 1975;5(4):573-592. DOI: https://doi.org/10.2190/F31Q-592N-056K-VETL

38. Riggs G. Commentary: Are we ready to embrace the rest of the Flexner Report?: Academic Medicine. 2010;85(11):1669-1671. DOI: https://doi.org/10.1097/ACM.0b013e3181f5ced4

39. Rosen G, Fee E, Imperato PJ. A history of public health. Baltimore: Jhons Hopkins University Press; 2015.

40. Geison GL. The private science of Louis Pasteur. Princeton: Princeton University Press; 1995. DOI: https://doi.org/10.1515/9781400864089

41. Barzansky B. Abraham Flexner and the era of medical education reform: Academic Medicine. 2010;85:S19-S25. DOI: https://doi.org/10.1097/ACM.0b013e3181f12bd1

42. Kanter SL, Groce VA, Littleton B, Gunderman RB. Henry Pritchett and His Introduction to the Flexner Report of 1910: Academic Medicine. 2010;85(11):1777-1783. DOI: https://doi.org/10.1097/ACM.0b013e3181f561fa

43. Wang DC. The Yale System at 100 Years. Yale Journal of Biology and Medicine. 2020;93(3):441-451.

44. Flexner A. The American College: A Criticism. New York: Century Company; 1908.

45. Flexner A. I remember: The autobiography of Abraham Flexner. New York: Simon and Schuster; 1940.

46. Spinelli H. Sentirjugarhacerpensar: la acción en el campo de la salud. Buenos Aires: De la UNLa - Universidad Nacional de Lanús; 2022. DOI: https://doi.org/10.18294/9789878926025

47. Cooke M, Irby DM, Sullivan W, Ludmerer KM. American medical education 100 years after the Flexner Report. New England Journal of Medicine. 2006;355(13):1339-1344. DOI: https://doi.org/10.1056/NEJMra055445

48. Flexner A. The Plethora of Doctors. The Atlantic Monthly. 1910;(106):20-25.

49. Wheatley SC. The politics of philanthropy: Abraham Flexner and medical education. Madison: University of Wisconsin Press; 1988.

50. Cabot RC, Locke EA. The Organization of a Department of Clinical Medicine. Boston Medical and Surgical Journal. 1905;153(17):461-465. DOI: https://doi.org/10.1056/NEJM190510261531701

51. Whitehead C. Scientist or science-stuffed? Discourses of science in North American medical education. Medical Education. 2013;47(1):26-32. DOI: https://doi.org/10.1111/j.1365-2923.2011.04136.x

52. Dewey J. Science as subject-matter and as method. Science. 1910;31(787):121-127. DOI: https://doi.org/10.1126/science.31.787.121

53. Bryan CS, Kopel JJ, Sorin M. Ira Remsen, Osler, the Flexner Report, and the full-time plan. Proceedings (Baylor University. Medical Center). 2021;34(4):532-536. DOI: https://doi.org/10.1080/08998280.2021.1898247

54. Rabinowitz DG. On the arts and humanities in medical education. Philosophy Ethics, and Humanities in Medicine. 2021;16:4. DOI: https://doi.org/10.1186/s13010-021-00102-0

55. Varughese H, Shin P. The Flexner report: commemoration and reconsideration. Yale Journal of Biology and Medicine. 2010;83(3):149-150.

56. Johnston GA. The Flexner Report and black medical schools. Journal of the National Medical Association. 1984;76(3):223-225.

57. Steinecke A, Terrell C. Progress for whose future? The impact of the Flexner Report on medical education for racial and ethnic minority physicians in the United States: Academic Medicine. 2010;85(2):236-245. DOI: https://doi.org/10.1097/ACM.0b013e3181c885be

58. Weston WW. Do we pay enough attention to science in medical education? Canadian Medical Education Journal. 2018;9(3):e109-114. DOI: https://doi.org/10.36834/cmej.43435

59. Custers EJFM. Commentary: Flexner and Dutch Medical Education: A Misinterpretation? Academic Medicine. 2010;85(11):1672-1674. DOI: https://doi.org/10.1097/ACM.0b013e3181f5cdb9

60. Vinten-Johansen P, Riska E. New Oslerians and real flexnerians: The response to threatened professional autonomy. International Journal of Health Service. 1991;21(1):75-108. DOI: https://doi.org/10.2190/7EDU-HA2D-Q39L-D70W

61. Relman A. The New Medical-Industrial Complex. New England Journal of Medicine. 1980;303:963-970. DOI: https://doi.org/10.1056/NEJM198010233031703

62. Flexner A. Medical Education in Europe: A Report to the Carnegie Foundation for the Advancement of Teaching. New York: Carnegie Foundation for the Advancement of Teaching; 1912.

63. Miller H. Fifty years after Flexner. The Lancet. 1966;288(7465):647-654. DOI: https://doi.org/10.1016/S0140-6736(66)92827-3

64. Flexner A. A modern school. New York: General Education Board; 1916.

65. Flexner A. Medical education—A comparative study. New York: The Macmillan Company; 1925.

66. Flexner A. Universities: American, English, German. New Brunswick: Transaction Publishers; 1994.

67. Flexner A. The usefulness of useless knowledge. New Jersey: Princeton University Press; 2017. DOI: https://doi.org/10.1515/9781400884629

68. Dijkgraaf, R. The world of tomorrow. New Jersey: Princeton University Press; 2017.

69. Martinovich V. Indicadores de citación y relevancia científica: Genealogía de una representación. Dados. 2020;63(2):e20190094. DOI: https://doi.org/10.1590/001152582020218

70. Flexner A. Failings of our graduate schools. The Atlantic Monthly. 1932; (149):441-452.

71. Mintzberg H. Directivos, No MBA´s: Una visión crítica de la dirección de empresas y la formación empresarial. Barcelona: Ediciones Deusto Planeta; 2004.

72. Fee E, Brown T, eds. Making medical history: the life and times of Henry E. Sigerist. Baltimore: Johns Hopkins University Press; 1997.

73. Nunes E. Henry Ernest Sigerist: pioneiro da historia social da medicina e da sociologia médica. Educación Médica y Salud. 1992;26(1):70-81.

74. Sigerist HE. Socialized medicine in the Soviet Union. New York: Norton & Company Inc; 1937. DOI: https://doi.org/10.1097/00000441-193805000-00021

75. Flexner A. Henry S. Pritchett a biography. New York: Columbia University Press; 1943. DOI: https://doi.org/10.7312/flex91390

76. Flexner A, Bailey E. Funds and foundations: Their policies past and present. New York: Harper & Brothers; 1952.

77. Nevins M. Abraham Flexner: A flawed American Icon. Indiana: iUniverse; 2010.

78. Bonner TN. Abraham Flexner and the historians. Journal of the History of Medicine and Allied Science. 1990;45(1):3-10. DOI: https://doi.org/10.1093/jhmas/45.1.3

79. Perkin H. The historical perspective. En: Clark BR, ed. Perspectives on higher education. Los Ángeles: University of California Press; 1984. DOI: https://doi.org/10.1525/9780520325920-004

80. Markowitz GE, Rosner DK. Doctors in crisis: A study of the use of medical education reform to establish modern professional elitism in medicine. American Quarterly. 1973;25(1):83-107. DOI: https://doi.org/10.2307/2711558

81. King LS. Medicine in the USA: historical vignettes. XX. The Flexner report of 1910. JAMA. 1984;251(8):1079-1086. DOI: https://doi.org/10.1001/jama.251.8.1079

82. Berliner HS. New light on the Flexner Report: Notes on the AMA - Carnegie Foundation background. Bulletin of the History of Medicine. 1977;51(4):603-609.

83. Illich I. Némesis médica. México DF: Planeta; 1976.

84. McKeown T. El papel de la medicina: ¿sueño, espejismo o némesis? México DF: Siglo Veintiuno Editores; 1982.

85. Canguilhem G. Lo normal y lo patológico. México DF: Siglo Veintiuno Editores; 2011.

86. Foucault M. Nacimiento de la biopolítica. Buenos Aires: Fondo de Cultura Económica; 2007.

87. Weinberg AM. Impact of large-scale science on the United States: Big science is here to stay, but we have yet to make the hard financial and educational choices it imposes. Science. 1961;134(3473):161-164. DOI: https://doi.org/10.1126/science.134.3473.161

88. Haldeman J, Abdellah F. Concepts of progressive patient care. Hospitals. 1959;33(11):41-46.

89. Weeks L, Griffith J. Progressive patient care, an anthology. Ann Arbor: The University of Michigan; 1964.

90. Peve A, Spinelli H. Los cuidados progresivos de pacientes como política hospitalaria: su implementación en EEUU, 1953-1969. Cuadernos Médico Sociales. 2021;61(1):7-16. DOI: https://doi.org/10.56116/cms.v61.n1.2021.20

91. Matus C. Adiós, señor presidente. Buenos Aires: De la UNLa - Universidad Nacional de Lanús; 2020. (Cuadernos del ISCo). DOI: https://doi.org/10.18294/9789874937681

92. Dawson B. Interim Report on the future provision of medical and allied services 1920. London: Published by his Majesty’s Stationery Office; 1920.

93. Spinelli H. Máquinas y arte-sanos. Salud Colectiva. 2018;14(3):483-512. DOI: https://doi.org/10.18294/sc.2018.1823

94. Redford G. AAMC renames prestigious Abraham Flexner award in light of racist and sexist writings [Internet]. 2020 [citado 3 may 2022]. Disponible en: https://tinyurl.com/msbfmh34.