Left to right are NOSM dean Dr. Roger Strasser and Beyond Flexner investigators Dr. Hurshey Bell, Dr. Malika Fair and Dr. Donald Barr.
The Northern Ontario School of Medicine (NOSM) is one of six medical schools in North America under the microscope as part of a U.S.-based study examining new models of medical education for the 21st century.
“Beyond Flexner: the Social Mission of Medical Education in the 21st Century” is being carried out by the Department of Health Policy at George Washington University’s School of Public Health and Health Services in Washington, D.C. to address the “unintended consequences” of a model of medical education espoused in the original Flexner Report of 1910.
The Flexner model, which still serves as the dominant model of medical education in North America, “creates great physicians,” said Dr. Malika Fair, co-principal investigator of the study and an emergency medicine specialist attached to George Washington University. “The problem is that there’s a lack of physicians going into primary care, the number of minorities has not increased significantly and our physicians are primarily practising in urban areas. So the question is how can medical education respond to these concerns and do something about reducing health inequities?”
Investigators are studying six medical schools that have ventured beyond the Flexner model. NOSM was “an obvious choice,” said Fair, because of its social accountability mandate, its “remarkable” curriculum and its success in producing physicians opting to practise as primary care doctors in underserviced communities.
The other five schools are the Morehouse School of Medicine in Atlanta, Georgia, the University of Oklahoma at Tulsa, the School of Community Medicine at Southern Illinois University, the A.T. Still School of Osteopathic Medicine in Arizona and the University of New Mexico.
Today’s dominant template for medical education dates back to Abraham Flexner’s 1910 Carnegie Foundation report, which was highly critical of the state of medical education in the United States at the time and advocated the swift closure of the majority of schools then in existence.
Those that survived were largely university based and “firmly committed to medical science for the basis of medical education – tying medical education to what has now become the academic health centre,” according to a Beyond Flexner backgrounder.
By embedding medical education in the research university, “Flexner ordained that medical school applicants would have to have the academic and financial capabilities required by that institution.”
The model hasn’t proven particularly effective in addressing the problems of equity in health and “is so pervasively accepted that it is rarely examined or challenged,” claims the study team.
Furthermore, “the growth of the academic health centre as an incubator of and enthusiastic customer for technology has imprinted values in generations of students,” keeping them “close to the medical centre in specialty and in geographic choice after they graduate” and frustrating efforts to improve access to care.
Fair and several other members of the Beyond Flexner study team spent time in Sudbury, Thunder Bay and Kapuskasing during a three-day site visit to NOSM earlier this year.
“I was definitely impressed with the school,” she said. “It was evident that we weren’t the only ones interested in a social mission.”
Fair and her co-principal investigator, Dr. Fitzhugh Mullan, expect to publish a report in April 2012 and are planning to organize a conference for medical educators in June.