Restoring Oslerian clinical training in place of Flexnerian reductionism in medical education: A historical perspective

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N. A. L. S. H. J. M. Y. A. H. E. A. A. . Ayesha Fatima, Manoj Chakravarty*, “Restoring Oslerian clinical training in place of Flexnerian reductionism in medical education: A historical perspective”, ijmhs, vol. 9, no. 10, pp. 606–610, Oct. 2019.
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Abstract

This paper addresses the historical transformation of traditional medical education resulting from application of recommendations of Abraham Flexner?s seminal report of 1910 with the incorporation of a predominantly reductionist science into the medical curriculum, and assesses the resulting systematic de-emphasis of Sir William Osler?s vision of medical students being primarily trained at the bedside of the patient. William Osler was possibly the best combination of a dedicated physician, exemplary teacher and author amalgamated into a versatile and exceptional personality. In comparison, Abraham Flexner?s lack of medical training and obsession with the laboratory nurtured by the German proclivity towards research, served to transform traditional medical education by selectively projecting scientific reductionism at the cost of the natural and existing reality of holism of the human as a living and functioning entity both in states of health and disease. This paper reinforces the concept that Oslerian bedside training should once again form the mainstay of medical education rather than the Flexnerian curricular prioritization with reductionist science and that the step would restore the primacy of clinical bedside training to its historical glory, reconfigure medical education and rejuvenate it towards the fundamental ethos of skillful competence, and simultaneously offer the best form of respect that dedicated medical teachers and physicians can pay as homage to the excellence and exceptionalism of Sir William Osler on the hundredth anniversary of his death.
Key words: William Osler–Abraham Flexner–Reductionist medicine–Medical education–Medical curriculum.

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References

[1] Altschule M. (1989). Essays on the rise and decline of bedside medicine. Bangor (PA): Totts Gap Medical Research Laboratories; p. 396. [2] Bates D. Why not call modern medicine „Alternative?? Per-spectives in Biology and Medicine. 2000;43(4):502–518. [3] Beck AH. The Flexner report and the standardization of American medical education. Journal of the American Med-ical Association. 2004;291(17):2139–2140. [4] Bonner TN. Iconoclast. Abraham Flexner and a Life in Learning. Medical Education A Comparative Study. 1925;. [5] Burnham J; 1982. American medicine's golden age: What happened to it? Science; 215:1474 [6] Chesney A. The Johns Hopkins Hospital. vol. III. Baltimore: Johns Hopkins Press; 1963. P182 [7] Duffy TP. The Flexner Report - 100 Years Later. Yale J Biol Med. 2011;84(3):269–276. Published online. PMCID: PMC3178858. PMID: 21966046. [8] Galaty DH. The philosophical basis of mid-nineteenth century German reductionism. J Hist Med Allied Sci. 1974;29:295–316. [9] GPEP Report of the Project Panel on the General Professional Education of the Physician and College Preparation for Medicine. Association of American Medical Colleges. 1984;59(11):1–208. [10] GPEP Report Larrie W, Greenberg, Leslie SM, Jewett E. A Time for Change in Medical Education. Am J Dis Child. 1985 1985;139(10):1026–1027. GPEP Report. Available from: 10.1001/archpedi.1985.02140120072030. [11] Horsley GW. Medical Challenges in the Sixties. Virginia Med Monthly. 1961;88:693–693. [12] Johns Hopkins Medicine.https://www.hopkinsmedicine.org/Medicine/education/hstrainingprogram/overview/index.html [13] Lezner J. Researcher received undisclosed payments of $ 300,000 from Pfizer. 2006;333:1257–1257. BMJ. [14] Maulitz RC, editors. Physician versus Bacteriologist?: the ideol- ogy of science in clinical medicine. Philadelphia: University of Pennsylvania Press; 1979. The therapeutic revolution. Essays in the social history of American medicine. University of Pensylvania Press, 91-107. [15] Mcclelland CE, The German Model for American Medical Reform, http://www.europa.clio-online.de/2013/Article=596 [16] Mcneely IF; 2002. The Unity of Teaching and Research: Humboldt?s Educational Revolution. Scholarsbank, University of Oregon. 32-35 [17] Peabody FW. The physician and the laboratory. Boston Med Surg J. 1922;187:324–331. [18] Peabody FW. The care of the patient. Cambridge: Harvard University Press. 1927. https://archive.org/details/b29809873/page/n5 [19] Rothstein WG. American medical schools and the practice of medicine. New York: Oxford University Press: 144-150; 1987. [20] Sir William Osler. On Full-Time Clinical Teaching in Medical Schools. Canad Med Ass J Oct. 1962;6:762–765. [21] Stahnisch, FW, Maria, V. The Flexner Report of 1910 and Its Impact on Complementary and Alternative Medicine and Psychiatry in North America in the 20th Century. Evidence-Based Complementary and Alternative Medicine. 2012;2012. Article ID. Available from: 10.1155/2012/ 647896. [22] Starfield B. Is US medicine the best in the world. JAMA. 2000;284:483– 485. [23] Tauber, A. The last puritan. N Engl J Med. 1971;284:922–925.

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References

[1] Altschule M. (1989). Essays on the rise and decline of bedside
medicine. Bangor (PA): Totts Gap Medical Research
Laboratories; p. 396.
[2] Bates D. Why not call modern medicine „Alternative?? Per-spectives in Biology and Medicine. 2000;43(4):502–518.
[3] Beck AH. The Flexner report and the standardization of American medical education. Journal of the American Med-ical Association. 2004;291(17):2139–2140.
[4] Bonner TN. Iconoclast. Abraham Flexner and a Life in Learning. Medical Education A Comparative Study. 1925;.
[5] Burnham J; 1982. American medicine's golden age: What happened to it? Science; 215:1474
[6] Chesney A. The Johns Hopkins Hospital. vol. III. Baltimore: Johns Hopkins Press; 1963. P182
[7] Duffy TP. The Flexner Report - 100 Years Later. Yale J Biol Med. 2011;84(3):269–276. Published online. PMCID: PMC3178858. PMID: 21966046.
[8] Galaty DH. The philosophical basis of mid-nineteenth century German reductionism. J Hist Med Allied Sci. 1974;29:295–316.
[9] GPEP Report of the Project Panel on the General Professional Education of the Physician and College Preparation for Medicine. Association of American Medical Colleges. 1984;59(11):1–208.
[10] GPEP Report Larrie W, Greenberg, Leslie SM, Jewett E. A Time for Change in Medical Education. Am J Dis Child. 1985
1985;139(10):1026–1027. GPEP Report. Available from: 10.1001/archpedi.1985.02140120072030.
[11] Horsley GW. Medical Challenges in the Sixties. Virginia Med Monthly. 1961;88:693–693.
[12] Johns Hopkins Medicine.https://www.hopkinsmedicine.org/Medicine/education/hstrainingprogram/overview/index.html
[13] Lezner J. Researcher received undisclosed payments of $ 300,000 from Pfizer. 2006;333:1257–1257. BMJ.
[14] Maulitz RC, editors. Physician versus Bacteriologist?: the ideol-
ogy of science in clinical medicine. Philadelphia: University of Pennsylvania Press; 1979. The therapeutic revolution. Essays in the social history of American medicine. University of Pensylvania Press, 91-107.
[15] Mcclelland CE, The German Model for American Medical Reform, http://www.europa.clio-online.de/2013/Article=596
[16] Mcneely IF; 2002. The Unity of Teaching and Research: Humboldt?s Educational Revolution. Scholarsbank, University of Oregon. 32-35
[17] Peabody FW. The physician and the laboratory. Boston Med Surg J. 1922;187:324–331.
[18] Peabody FW. The care of the patient. Cambridge: Harvard University Press. 1927. https://archive.org/details/b29809873/page/n5
[19] Rothstein WG. American medical schools and the practice of medicine. New York: Oxford University Press: 144-150; 1987.
[20] Sir William Osler. On Full-Time Clinical Teaching in Medical
Schools. Canad Med Ass J Oct. 1962;6:762–765. [21] Stahnisch, FW, Maria, V. The Flexner Report of 1910 and Its Impact on Complementary and Alternative Medicine and Psychiatry in North America in the 20th Century. Evidence-Based Complementary and Alternative Medicine. 2012;2012. Article ID. Available from: 10.1155/2012/ 647896.
[22] Starfield B. Is US medicine the best in the world. JAMA. 2000;284:483– 485.
[23] Tauber, A. The last puritan. N Engl J Med. 1971;284:922–925.

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