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Reforming Medical Education in Ethics and Humanities by Finding Common Ground With Abraham Flexner

Doukas, David J. MD; McCullough, Laurence B. PhD; Wear, Stephen PhD

Academic Medicine:
doi: 10.1097/ACM.0b013e3181c85932
Flexner Centenary: Article

Abraham Flexner was commissioned by the Carnegie Foundation for the Advancement of Teaching to conduct the 1910 survey of all U.S. and Canadian medical schools because medical education was perceived to lack rigor and strong learning environments. Existing proprietary schools were shown to have inadequate student scholarship and substandard faculty and teaching venues. Flexner's efforts and those of the American Medical Association resulted in scores of inadequate medical schools being closed and the curricula of the survivors being radically changed.

Flexner presumed that medical students would already be schooled in the humanities in college. He viewed the humanities as essential to physician development but did not explicitly incorporate this position into his 1910 report, although he emphasized this point in later writings. Medical ethics and humanities education since 1970 has sought integration with the sciences in medical school. Most programs, however, are not well integrated with the scientific/clinical curriculum, comprehensive across four years of training, or cohesive with nationally formulated goals and objectives.

The authors propose a reformation of medical humanities teaching in medical schools inspired by Flexner's writings on premedical education in the context of contemporary educational requirements. College and university education in the humanities is committed to a broad education, consistent with long-standing tenets of liberal arts education. As a consequence, premedical students do not study clinically oriented science or humanities. The medical school curriculum already provides teaching of clinically relevant sciences. The proposed four-year curriculum should likewise provide clinically relevant humanities teaching to train medical students and residents comprehensively in humane, professional patient care.

Author Information

Dr. Doukas is William Ray Moore Endowed Chair of Family Medicine and Medical Humanism, and director, Division of Medical Humanism and Ethics, Department of Family and Geriatric Medicine, University of Louisville, Louisville, Kentucky.

Dr. McCullough is Dalton Tomlin Chair in Medical Ethics and Health Policy, Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas.

Dr. Wear is codirector, Center for Clinical Ethics and Humanities in Healthcare, and associate professor, Departments of Medicine, Gynecology–Obstetrics, and Philosophy, University at Buffalo, Buffalo, New York.

Correspondence should be addressed to Dr. Doukas, Department of Family and Geriatric Medicine, University of Louisville, 501 East Broadway, Suite 270, Louisville, KY 40202; telephone: (502) 852-8401; e-mail:

© 2010 Association of American Medical Colleges