Flexner, Abraham

Abraham Flexner (1866–1959) made enormous contributions to the quality of healthcare by improving the education offered at medical schools in the United States and Canada. As a result of this work, Flexner is considered one of the most important health services researchers of the 20th century. His on-site assessment of medical schools resulted in a landmark report, Medical Education in the United States and Canada, which was published by the Carnegie Institute for the Advancement of Teaching in 1910. This report received wide attention and acclaim. So critical was Flexner of poor-quality medical schools that many closed or merged, while others were forced to implement immediate improvements. In 1909, when Flexner began his investigation, the United States had approximately 150 medical schools; by 1915, the number had dropped to 96.

Born to German Jewish immigrant parents in Lexington, Kentucky, Flexner was one of eight children. Flexner went to Johns Hopkins University, where he received his bachelor's degree in 1886. After graduation, he returned to Lexington and worked for that city's public school system as an instructor. After 4 years, he formed his own college preparatory school, where he had the freedom to try out certain theories of classroom education, and there he became convinced of the value of progressive principles of education—among them, small classes, tutoring rather than lecturing, and learning by doing, principles that later influenced him when he undertook his investigation of medical schools. After many years of teaching, Flexner left Lexington and attended Harvard University, where he received a master's degree in 1906.

In 1908, Flexner's book The American College: A Criticism came to the attention of Henry S. Pritchett, president of the Carnegie Foundation for the Advancement of Teaching. Pritchett was impressed by Flexner's critical ability and his forceful manner as a writer, and he felt that Flexner would be the ideal person for a new Carnegie project: a response to a request from the American Medical Association's Council on Medical Education to carry out a survey of medical schools.

Although the Council on Medical Education had completed its own survey in 1906, the results were not widely published as there was reluctance on the part of physicians to publicly criticize other members of the profession. Pritchett recognized the inherent bias in medical involvement in the survey and therefore favored hiring a competent outsider to manage the task.

The need for a survey of medical schools was widely felt. The dismal quality of many medical schools was generally known, and in the Progressive Era at the end of the 19th century and the beginning of the 20th, the reform impulse was strong. Medical schools were already feeling the heat of that momentum when Flexner accepted the charge and began his research.

What Flexner lacked in healthcare experience, he made up for with his sound grasp of educational principles and his practical, clear-thinking, analytical mind. He also had the advantage of his employer's august name as a calling card. Because Flexner represented the Carnegie Foundation, a possible funding source, medical schools opened their doors to him.

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