@Med Ed thanks for presenting me with new information that I was previously unaware of before now. Help me though as I am confused.
Don't let an ounce of skepticism go to your head.
I don't understand what you mean by this.
Combined with your quote from a study with lacking explanation on your part and your unclear statement that I shouldn't let skepticism get to my head, I don't see the point of your post.
Are you trying to just add more info to this subject? That's cool! Thanks!
The study you reference is just a piece of the answer, not the only one. And because your response was pithy, I have no way of knowing what you meant. Assuming you meant to correct me with a quick google search to an article that can't be accessed in full unless one has a subscription, I can't accurately analyze the whole article.
But I can tell you from reading the quote that the abstract you cite is only one part of the answer. Unfortunately, there's more to this issue than your quote. Again, as with shades of grey, there's more to it than just one answer.
The AMA and licensing boards did have the ultimate say in refusing licensing to schools, which ultimately would then close their doors. Flexner was not in a position to literally close their doors. And I never wrote that he did. I think I said his advise directly led to their closure. Which in large part, it did. As it turns out, the answer lies on a spectrum somewhere in the middle and I'm so happy you've brought up a particular part of US medical education and history that most people are unfamiliar with! So, irrespective of your intentions, I will now try to succinctly explain my thoughts because I think this time in our history is so cool!! Let's begin.
Flexner was not the first person to seek medical education reform when he reported his two year findings in 1910. The AMAs Council on medical education (CME) formed in 1904 and gave recommendations to all schools to improve based on their board rates and personal visits to schools, starting in 1904. These pre-Flexner reports were not explicitly targeting black colleges, but instead giving them, and others, notice. And many, including the black schools, sought immediate revisions. Unfortunately, because most black applicants did not meet new qualification requirements (one year of science pre reqs), coupled with the fact that black schools still depended on enrolled student tuition to avoid financial ruin due to lack of outside funding, these colleges were not as eager to implement these AMA guidelines as were the other colleges. For the simple fact that financial aid to black colleges was scarce, colleges already had pressure, pre-Flexner, from the AMA to improve their quality.
The year Flexner started his report, 3 of the black schools in the worst shape, both financially and academically, had to close their doors- before his report came out. Historians show that the AMA had already found, in 1904 and in 1908, that some black medical schools were lacking. Flexners report, completed in 1910, reflected their previous ideas, so they readily acted on his recommendations.
I'm choosing not to go into the uncomfortable facts of Flexner's thoughts on black physicians, his ideas of their inferior capabilities, and his subscription that black people carried around specific germs that put whites at risk.
What is interesting to note though is the awareness of black medical schools and their standards pre 1910. Or rather, how little anyone really cared before Flexner to implement changes. Although the CME did publish results on medical education since its inception, none of the discussion about medicine in JAMA ever mentioned black medical school education pre-1910; and JAMA mentioned women's education only very briefly. The point is that it was not until Flexner that there was a relatively microscopic view placed over the black colleges. A view that has historically shown to reflect the opinions of a country with racial tensions. His views were that 5 black schools needed to be shut down because they were wasting money and producing unqualified physicians (while also hinting that black physicians couldn't be solely responsible for the health of their people because of perceived lack of abilities). He instead supported Howard's and Meharrys current facilities and endowments, urging that these two schools become recipients of financial aid and improvement.
The following years saw an immediate closure of one school Flexner severely criticized, all the way until 20 years later when the last of the five finally gave in to closure. The first school to immediately close cited their inability to fund the conditions for the new and intense CME guidelines. What official response was there to this? The black physician equivalent of the AMA, the NMA, had earlier already recognized the weakness of certain schools and had given its recommendations on how to improve conditions without public embarrassment, but only then after the Flexner report, the failing conditions became obviously and publicly embarrassing.
For the next decade, Howard and Meharry struggled to survive, along with 4 other schools. Flexner actually tried to help secure funding for Meharry and one other, but contemporary records show that his 1910 report directly led to the closure of three of the 5 he found unfit. Agencies and philanthropists did not get behind the struggling schools and to this day the blame game is bounced between Carnegie and Flexner for their inability to secure funding for the struggling four schools after 1912. To his credit where documented credit is due, Flexner found the CME to be judging the black schools too harshly and did try to find funding through his position at the General Education Board. Not enough public or private support was found for the other 4 schools and consequently they were unable to fund the conditions that would meet CME standards after Flexners severe suggestions targeted at the black schools.
Though Meharry and Howard did eventually find money and graduate up to 100 black students a year by 1950, they were still limited in their capabilities.
Given that the mindset (beginning with Flexner and his own words) continued to be the notion that schools for minorities should only produce physicians for their own kind, schools continued to refuse black students until 1966, further contributing to the reality that exists today. A reality, which unequivocally began with Flexners own words
Sorry for derailing the thread, but this topic goes hand in hand with modern day implicit bias during doctor-patient interactions like when physicians are incorrectly prescribing pain medications to minorities, physicians perceiving minorities' cardiac chest pains different than white cardiac pain, and the existence of minorities' suspicion of the healthcare system. Understanding the past is key to the present and future. The facts are that Flexners report came in the midst of educational reform, not at the forefront. He helped push an already rolling cart. That's what makes his contribution significant.
What's almost never mentioned whenever someone talks Flexner in passing are the shade of grey that goes with his report and the consequences.
Also. I despise arrogance.
http://thescholarship.ecu.edu/bitstream/handle/10342/3086/Abraham Flexner black medical schools.pdf
http://mobile.journals.lww.com/acad....aspx?year=2010&issue=02000&article=00021#ath
