(출처: http://history.library.ucsf.edu/theme_photo5.html)



Commentary: Understanding the Flexner Report

Flexner 입장

  • 의학적 실증주의(Medical positivism)
    • 플렉스너는 의학을 일반적 생물학 법칙을 따르는 실험학문이라 했다.
      • Flexner described medicine as an experimental discipline governed by the laws of general biology.
    • “It [the human body] is put together of tissues and organs, in their structure, origin and development not essentially unlike what the biologist is otherwise familiar with; it grows,  reproduces itself, decays, according to general laws.”1(p53)
  • 입학 요건 강화(Rigorous entrance requirements)
    • 플렉스너는 "이렇게 대충대충 교육받지도 못한 학생을 뽑아서는 실험실 교육과 임상실습 교육이 불가능하다"라고 했음.
      • A medical school, Flexner wrote, “cannot provide laboratory and bedside instruction on the one hand, and admit crude, untrained boys on the other.”1(p22)
  • 과학적 방법론(The scientific method)
    • 플렉스너가 말한 '과학적 방법'이란 어떤 아이디어를 정교한 실험으로 검증하여 정확한 사실(fact) 밝히는 것이다.
      • Flexner pointed out that the scientific method of thinking applied to medical practice. By scientific method, he meant the testing of ideas by well-planned experiments in which accurate facts were carefully obtained.
    • “The practicing physician and the ‘theoretical’ scientists are thus engaged in doing the same sort of thing, even while one is seeking to correct Mr. Smith’s digestive aberration and the other to localize the cerebral functions of the frog.”1(p92)
  • 행동에 의한 학습(Learning by doing)
    • "교육학적 측면에서, 근대 의학은 다른 모든 과학과목과 같이 '직접 해보는 '이어야 한다. 학생은 단순히 보고, 듣고, 암기하기만 해서는 된다"
      • “On the pedagogic side,” he wrote, “modern medicine, like all scientific teaching, is characterized by activity. The student no longer merely watches, listens, memorizes; he does.”1(p53) Flexner’s scorn for didactic instruction pervaded the report.
  • 연구(Original research)
    • Original research was a core activity at Flexner’s model medical school.
    • “Research, untrammeled by near reference to practical ends, will go on in every properly organized medical school; its critical method will dominate all teaching whatsoever.”1(p59)
    • To Flexner, the best teachers were usually “men of active, progressive temper” engaged in research; those uninterested in solving problems tended to be “perfunctory teachers.”1(p56)

 

Flexner report 대한 오해와 진실

Flexner 전에는 미국 의학교육에 아무 일도 변화도 없었다? No!

  • 이미 이전부터 변화는 시작되고 있었다.
    • Myths concerning Abraham Flexner abound. The most common myth is that little or nothing had happened in American medical education until Flexner arrived on the scene.

Flexner scientific medicine 강조했다? No!

  • Flexner "과학만으로 전문가적 진료의 기반을 다질 없다. 임상을 하는 사람은 통찰력(insight) 공감능력(sympathy) 있어야 한다." 했다.
    • The report itself has frequently been misunderstood. Because of its strong emphasis on scientific medicine, it has often been accused of ignoring the doctor–patient relationship and the humane aspects of medical care. Exactly the opposite was the case.
    • Science, Flexner wrote, was “inadequate” to provide the basis of professional practice The practitioner needs “insight and sympathy,” and here specific preparation is “much more difficult.”1(p26)
    • He wrote in 1925, “Scientific medicine in America—young, vigorous and positivistic—is today sadly deficient in cultural and philosophical background.”7(p18)

예방의학(Preventive medicine) 중요성을 무시했다? No!

  • "의사의 역할은 개인적/치료적 이라기보다는 사회적/예방적 이어야 한다."
    • Another common misperception is that the report denigrates the importance of preventive medicine “the physician’s function is fast becoming social and preventive, rather than individual  and curative.”1(p26)

빡빡하고 뻣뻣한 커리큘럼의 시초다? No!

  • "엄격한(iron-clad) 커리큘럼으로서 의학교육을 향상시키고자 하는 것은 전적으로 실수다."
    • Many have faulted the Flexner Report for fostering a crowded, inflexible curriculum Medical schools, he argued, must be trusted “with a certain amount of discretion.”1(p76) He believed that “the endeavor to improve medical education through iron-clad prescription of curriculum or  hours is a wholly mistaken effort.”1(p76)

의학교육 개혁의 Final document일까? No!

  • " 보고서의 해결책은 현재와 그리고 길어야 30 정도의 가까운 미래에 대한 것일 뿐이다"
  • Contrary to widespread popular opinion, the Flexner Report was not envisioned by its author as a final document. “This solution,” he wrote, “deals only with the present and the near future,—a generation, at most.


배울

He was uncompromising in his view that medicine is a public trust and that the profession and its educational system exist to serve.

These values, he argued, are timeless, regardless of the professional and social circumstances of the moment.

By and large, medical educators since his time have taken this message to heart. We certainly have done our best work in pursuit of this goal. An unswerving commitment to excellence and service—this was and continues to be Flexner’s gift to medical education and the medical profession.







 2010 Feb;85(2):193-6. doi: 10.1097/ACM.0b013e3181c8f1e7.

CommentaryUnderstanding the Flexner report.

Source

Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110, USA. kludmere@dom.wustl.edu

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