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Commentary: Flexner and Dutch Medical Education: A Misinterpretation?

Custers, Eugène J. F. M. PhD

Academic Medicine:
doi: 10.1097/ACM.0b013e3181f5cdb9

Abraham Flexner's 1910 report, Medical Education in the United States and Canada, was hardly noticed in the Netherlands, and though his 1925 book, Medical Education: A Comparative Study, was extensively discussed in the Dutch Medical Journal, it did not and could not affect medical education in the Netherlands. Until the 1970s, the medical curriculum in the Netherlands consisted of four phases: the propaedeutic year (premedical sciences), two preclinical years, two theoretical clinical years, and one-and-a-half to two years of clerkships. When in the 1970s interest in curriculum innovation arose in the Netherlands, it was based on developments in North America that challenged “Flexnerian” norms in medical education. As hardly anyone in the Netherlands cared to study Flexner's work closely, his name became synonymous with the conventional curriculum just as it had in North America. However, the Dutch conventional curriculum was quite different from the American conventional curriculum, so attributing its origins to Flexner's work was a serious misrepresentation. In this commentary, the author clarifies common misconceptions about the history of Dutch medical education and argues that the curriculum as Flexner saw it differed considerably from the Dutch medical curriculum a century ago.

Author Information

Dr. Custers is researcher in medical education, Center for Research and Development of Education, School of Medical Sciences, University Medical Center, Utrecht, Utrecht, the Netherlands.

Correspondence should be addressed to Dr. Custers, University Medical Center Utrecht, Center for Research and Development of Education, HB Building, 4.05, PO Box 85500, 3508 GA Utrecht, the Netherlands; telephone: (31) 88-75-56793; e-mail:

© 2010 Association of American Medical Colleges