title: Medical education for a healthier population: reflections on the Flexner Report from a public health perspective.
abstract: Abraham Flexner's 1910 report is credited with promoting critical reforms in medical education. Because Flexner advocated scientific rigor and standardization in medical education, his report has been perceived to place little emphasis on the importance of public health in clinical education and training. However, a review of the report reveals that Flexner presciently identified at least three public-health-oriented principles that contributed to his arguments for medical education reform: (1) The training, quality, and quantity of physicians should meet the health needs of the public, (2) physicians have societal obligations to prevent disease and promote health, and medical training should include the breadth of knowledge necessary to meet these obligations, and (3) collaborations between the academic medicine and public health communities result in benefits to both parties. In this article, commemorating the Flexner Centenary, the authors review the progress of U.S. and Canadian medical schools in addressing these principles in the context of contemporary societal health needs, provide an update on recent efforts to address what has long been perceived as a deficit in medical education (inadequate grounding of medical students in public health), and provide new recommendations on how to create important linkages between medical education and public health. Contemporary health challenges that require a public health approach in addition to one-on-one clinical skills include containing epidemics of preventable chronic diseases, reforming the health care system to provide equitable high-quality care to populations, and responding to potential disasters in an increasingly interconnected world. The quantitative skills and contextual knowledge that will prepare physicians to address these and other population health problems constitute the basics of public health and should be included throughout the continuum of medical education.
authors.affiliation: Association of American Medical Colleges, Washington, DC 20037, USA. rmaeshiro@aamc.org
authors.forename: Rika
authors.initials: R
authors.lastname: Maeshiro
authors.forename: Ian
authors.initials: I
authors.lastname: Johnson
authors.forename: Denise
authors.initials: D
authors.lastname: Koo
authors.forename: Jean
authors.initials: J
authors.lastname: Parboosingh
authors.forename: Jan K
authors.initials: JK
authors.lastname: Carney
authors.forename: Neil
authors.initials: N
authors.lastname: Gesundheit
authors.forename: Evelyn T
authors.initials: ET
authors.lastname: Ho
authors.forename: David
authors.initials: D
authors.lastname: Butler-Jones
authors.forename: Denise
authors.initials: D
authors.lastname: Donovan
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Finkelstein
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Bennett
authors.forename: Barbie
authors.initials: B
authors.lastname: Shore
authors.forename: Stephen A
authors.initials: SA
authors.lastname: McCurdy
authors.forename: Lloyd F
authors.initials: LF
authors.lastname: Novick
authors.forename: Lily Dow
authors.initials: LD
authors.lastname: Velarde
authors.forename: M Marie
authors.initials: MM
authors.lastname: Dent
authors.forename: Ann
authors.initials: A
authors.lastname: Banchoff
authors.forename: Laurence
authors.initials: L
authors.lastname: Cohen
mesh_terms: D002170:Canada; D002423:Cause of Death / Q000639:trends; D004501:Education, Medical / Q000639:trends*; D018166:Health Care Reform; D006801:Humans; D011634:Public Health / Q000193:education* / Q000639:trends; D014481:United States