The History Will Tell You What You Need To Know

“Take the history.”

In medical school, I quickly learned this was the go-to answer that would always be right but also buy you a few more minutes to figure out which medical factoid your attending was really asking you about. Some clinical mentors would go so far as to say that a history was the only thing you really needed to make a diagnosis – forget physical exam, laboratory tests, imaging. Take the history.

The history of the Flexner Report on Medical Education is double-sided. The 1910 document by Abraham Flexner unequivocally changed the course of medical education in the United States. It standardized medical education, creating a basis for licensure and a set of common educational goals for medical schools. However, some of the effects of its publication have been detrimental to both medical education and healthcare in the U.S. Prior to 1910, African Americans and females were not permitted into many medical schools, and so had begun to form black or female medical colleges and hospitals. The Flexner Report’s review of these institutions resulted in the closure of five of the seven medical schools that were Historically Black Colleges or Universities and six of the seven women’s medical colleges in the U.S. The Flexner Report also used racist and delegitimizing language in reference to black physicians and their role in medicine. While medical schools were eventually integrated to include both women and persons of all races, the consequences of Flexner’s statements and recommendations persist.

Medical educators to this day struggle to address the racial and gender disparities that exist in the physician workforce. While significant progress has been made to eliminate gender disparities, with female matriculants outnumbering male matriculants in 2017 and 2018, racial disparities remain. The Association of American Medical Colleges reports that only 7.1% of matriculants to U.S. medical schools in 2018 were Black or African American, despite Blacks and African Americans comprising 13.4% of the general population of the U.S.

In order to create a physician workforce that is representative of our population, we must take the history. The answer is always in the history. At my school, the University of South Carolina School of Medicine Greenville, we are trying to take the history and change the future for the better. I had never heard of the Flexner Report until this spring, when a mentor of mine shared with me an article about its impact. But I had heard of Flexner, because this was the name of one of our school’s “colleges”. The Colleges Program at UofSC-SOMG groups students into five different colleges named after historical figures who were integral to medical education. The program is “designed to promote camaraderie, a sense of community, wellness and mentorship through activities related to team building, civic engagement and medical student well-being.” When the negative consequences of the Flexner Report were brought to the attention of the school’s administration, they responded promptly to change the name, as Flexner’s statements and the consequences of

his actions do not align with the mission or guiding principles of our school, which seeks to educate students of all backgrounds to serve our diverse community.

Looking at the history of medical education in the United States, I gained a better understanding of how women, African Americans, and other groups fought to be included in the field of medicine. At the same time as people like Flexner were taking action to keep them out, there were people joining the field medicine like Dr. Rebecca Crumpler (the first African American female physician in the U.S.), Dr. Elizabeth Blackwell (the first woman to receive a medical degree in the U.S.), Dr. Charles Drew (an African American surgeon who pioneered the blood banking process), Dr. James McCune Smith (the first African American granted an M.D. in the U.S.), Dr. Susan La Flesche Picotte (the first Native American physician in the U.S.), Dr. Antonia Novello (the first female and first Hispanic Surgeon General of the U.S.) , and Dr. Helen Rodríguez Trías (the first Latina president of the American Public Health Association and an award-winning pediatrician for her work with vulnerable populations), who as the “firsts” in various positions persevered and cleared a path for others to follow. Even today there continue be “firsts” in our field, people like Dr. Patrice Harris, who just recently was sworn in as the 174th President of the American Medical Association and the first African American female to hold the position. When we look at our history, these are the people and accomplishments we need to be celebrating today.

Julia Moss

I grew up in Charleston, SC and graduated from the College of Charleston in 2015 with a degree in Biology, Health, and Neurosciences. As an undergraduate, I worked in a neuroscience lab, travelled to South America as much as possible, and volunteered at free clinics. Back in Greenville for my medical education, on the same hospital campus where I was born, I’m excited to be a part of the USCSOMG class of 2020!

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