THE FLEXNER REPORT

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THE FLEXNER REPORT

• THE FLEXNER REPORT
• ON MEDICAL EDUCATION
• OVERVIEW AND RELEVANCE
• TO TEACHER PREPARATION

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THE FLEXNER REPORT

• Edward Crowe
• Senior Consultant
• National Commission on Teaching and Americas
  Future

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THE FLEXNER REPORT

• Society reaps at this moment but a small
  fraction of the advantage which current knowledge
  has the power to confer.
• Abraham Flexner (1910)
• Bulletin No. 4, Carnegie Foundation for the
  Advancement of Teaching

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THE FLEXNER REPORT

• The report was published as Bulletin No. 4 of
  the Carnegie Foundation for the Advancement of
  Teaching.
• It is a very large document (over 300 pages)
  and is available at the Carnegie Foundation
  website (www.carnegiefoundation.org).

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THE FLEXNER REPORT

• BACKGROUND
• Funded by Carnegie Foundation for the Advancement
  of Teaching
• Flexner visited 155 medical schools in U.S. and
  Canada in 1909-10
• Focused on these areas students, curriculum,
  faculty quality, laboratories, clinical training
  and sites, finances, governance

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THE FLEXNER REPORT

• Key Recommendations
• Raise entry standards for students
• Close 80 of medical schools
• Strengthen state oversight
• Faculty should engage in research
• Practitioners should be scientists
• Full-time clinical faculty
• Medical school-hospital clinical ties

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THE FLEXNER REPORT

• Impact of Flexner Report
• Number of medical schools reduced from 155 to
  61
• Complete redesign of curriculum, training,
  finances, faculty roles and compensation,
  clinical experiences and links between medical
  schools and hospitals

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THE FLEXNER REPORT

• Impact of Flexner Report
• General Education Board invested 91 million to
  develop medical education along the lines
  recommended by Flexner
• Other foundations added 60 million more
• States invested several hundred million dollars

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THE FLEXNER REPORT

• Other Factors at Work
• Growth of science
• Gradual contemporary emergence of the university
  as center of teaching, learning and research
• Renewed emphasis on state licensure to control
  entry and regulate conditions of practice
• Changing role of the clinical site (hospitals)

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THE FLEXNER REPORT

• Flexner on Flexner
• such a rattling of dead bones has never been
  heard in this country before or since
• Autobiography, 1940

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THE FLEXNER REPORT

• Whats its relevance to teacher preparation?

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THE FLEXNER REPORT

• Teacher preparation goal
• Establish and sustain professional authority for
  teacher preparation and for teachers through
  education, clinical training, state licensing and
  standards boards

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THE FLEXNER REPORT

• We want to flexnerize ourselves and obtain the
  benefits of professional authority

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THE FLEXNER REPORT

• But are we willing to pay the price to achieve
  professional status and authority?

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THE FLEXNER REPORT

• Program Quality
• Do we have the courage to deal effectively with
  weak programs?

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THE FLEXNER REPORT

• Are we willing to establish and enforce rigorous
  program admission standards into teacher
  preparation programs?
• Flexner No applicant for instruction who could
  pay his fees or sign his note was turned down

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THE FLEXNER REPORT

• Are we committed to the use of reliable and valid
  evidence to design and assess preparation
  pathways?
• 1300 university preparation programs
• Does ideology trump evidence?

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THE FLEXNER REPORT

• Where is the focus on outcomes tied to student
  learning and academic achievement?
• In the end the final test of a medical school is
  its outcome in the matter of clinicians.
• Abraham Flexner

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THE FLEXNER REPORT

• Do we really care about teaching as
• a clinical practice profession?
• Medical education is not completed at the
  medical school it is only begun
• William Welch, MD (1892)

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THE FLEXNER REPORT

• Rigorous licensure standards
• Does the profession advocate tough licensure
  standards for our own graduatesregardless of the
  way other program completers are treated?

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THE FLEXNER REPORT

• University resources
• It is important that our universities realize
  that medical education is a serious and costly
  venture (Flexner)

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THE FLEXNER REPORT

• Shortchanging teacher education results in weak
  programs with poor clinical training The
  presidents and boards of trustees of these
  institutions have a moral responsibility to
  Americas children. If they are unable to make
  this commitment, they should not be in the
  business of teacher preparation.
• NCTAF, No Dream Denied (2003)

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