Third World of medicine

New Oslerians and real Flexnerians: the response to threatened professional autonomy

As federal governmental involvement in U.S. health care had become a fact in the mid-1960s, a significant number of contributors to The Journal of the American Medical Association (JAMA) had recommended educational reforms to save an autonomous profession. In the late 1970s, demands for additional professional reforms began to appear in JAMA and The Journal of Medical Education (JME), particularly from contributors who perceived threats to professional autonomy from corporate medicine. The New Oslerian reform agenda is an application of the "humanizing" movement to the clinical phase of medical education. In its most restricted formulation (the inherent ethic argument), proponents simply urged clinicians to permit every student's inborn sense of moral duty to blossom on the wards. Others argued that Sir William Osler's legacy was more complex and involved systematic instruction, especially in ethics, at the bedside (the service ethic argument). Real Flexnerian reforms were based on an assumption that unintended distortions in Abraham Flexner's reform measures had eventuated in stultifying and counterproductive teaching of the biomedical model. Consequently, medical education should be altered to train future physicians in what Flexner had really intended--the capacity to think and problem-solve in a scientific manner. In time, many reformers emphasized the complementarity of Real Flexnerian and New Oslerian curricular proposals. The most comprehensive proposal to date, GPEP (General Professional Education of the Physician), makes a strong case that implementation of these old, turn-of-the-century reform proposals would make physicians in the 21st century well-rounded and competent. But GPEP's proposed changes in medical education are inadequate because the recommendations do little to prepare future physicians to contend with the corporate context in which most of them will be practicing.