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Would a Flexner Report Today Focus Only on Graduate Medical Education?

Whitcomb, Michael E. MD

doi: 10.1097/ACM.0b013e3181f5d006
Letters to the Editor

Professional lecturer in health policy, School of Public Health, George Washington University, Washington, DC;

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In Reply:

Needless to say, no one, including me, can take the position of knowing for sure what Flexner would do were he to rewrite his report today. Given that, I take the comments offered by Azer and Corbett seriously. But let me reiterate the main point of my commentary, and then offer a little additional food for thought.

My main point was that if in writing a contemporary report Flexner were to follow the directive set forth by Pritchett in commissioning the original report, there is no question that he would focus on graduate medical education. My reason for taking this position is pretty straightforward: In 2010, it is the graduate medical education experience that truly prepares doctors for the practice of one of the specialties of medicine, not the medical school experience. I don't think that position can be challenged, and I don't think Azer and Corbett meant to do so.

However, the points made by Azer and Corbett raise a very serious question: What value do specific elements of the medical school curriculum have for preparing doctors for practice? Azer and Corbett provide some specific examples they think meet that test. But do they? I would like to see data of any kind that support their views.

And more to the point, given that medical school graduates must now take a number of years of advanced training in a specific clinical specialty before entering practice, where is the evidence that any elements of the medical school experience have value in preparing new doctors for practice? More specifically, is there any evidence that the medical school experience provides future practitioners with necessary clinical skills that they would not acquire during their residency training? The fact is that at present, there is very little evidence, if any at all, that can be called on to justify the position that the medical school experience is essential for preparing doctors for clinical practice.1,2

Given the length of a medical education and the cost involved, I think the medical education community needs to take this issue more seriously as it considers how doctors should be educated in the future.

Michael E. Whitcomb, MD

Professional lecturer in health policy, School of Public Health, George Washington University, Washington, DC;

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1Whitcomb M. Research in medical education: What do we know about the link between what doctors are taught and what they do? Acad Med. 2002;77:1067–1068.
2Kalet AL, Gillespie CC, Schwartz MD, et al. New measures to establish the evidence base for medical education: Identifying educationally sensitive patient outcomes. Acad Med. 2010;85:844–851.
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