Unintended Consequences of the Flexner Report: Women in Pediatrics

The 1910 Flexner report is recognized as a critical component of the transition to the current model of medical education. Within a decade of the report's publication, the curriculum of nearly every American medical school included 2 years of basic science education and 2 years of clinical apprenticeship. By midcentury, the practice of medicine focused on acute care visits and technologically sophisticated procedures performed in hospitals. As we mark the 100th anniversary of the Flexner report, it is also important to draw attention to one of the unintended consequences of Flexner-era reforms, namely, the near elimination of women in the physician workforce between 1910 and 1970. In this essay we briefly trace the history of women in medicine in the decades surrounding the Flexner report and suggest some implications for the future of pediatrics at a time when women outnumber men. In the late 19th century, there were hundreds of medical schools in the United States, and the quality of medical education varied substantially. Generally, medical schools offered minimal training in basic science, and few schools provided their students with the opportunity to acquire clinical skills. Concerned about this situation, the American Medical Association worked with the Carnegie Foundation to hire a professional educator, Abraham Flexner, to review the state of medical education in the United States. Flexner chose the Johns Hopkins Medical School as the model educational system, and he toured medical schools throughout the country to gather information about current standards of education. His report, which was considered provocative when it was issued in 1910, indicted the quality of medical education in most American medical schools. The recommendations focused on rigorous entrance requirements, longer periods of study, and more attention to the basic and clinical sciences. The principles in the … Address correspondence to Shari L. Barkin, MD, MSHS, 8232 Doctor's Office Tower, 2200 Children's Way, Nashville, TN 37232-9225. E-mail: shari.barkin{at}vanderbilt.edu