Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0002
- Subject:
- History, American History: 20th Century
Typically regarded as a quiet time in American medical education, the interwar period was in fact highly dynamic. Medical research advanced and medical schools grew in size, wealth, and complexity. ...
More
Typically regarded as a quiet time in American medical education, the interwar period was in fact highly dynamic. Medical research advanced and medical schools grew in size, wealth, and complexity. The values associated with the Flexnerian revolution became generalized—particularly the commitment of medical schools to research. If American medical schools after World War II were to grow so large as to dwarf pre-World War II medical schools, that was because a solid institutional infrastructure was already in place that could effectively utilize the massive infusion of federal and private funds.Less
Typically regarded as a quiet time in American medical education, the interwar period was in fact highly dynamic. Medical research advanced and medical schools grew in size, wealth, and complexity. The values associated with the Flexnerian revolution became generalized—particularly the commitment of medical schools to research. If American medical schools after World War II were to grow so large as to dwarf pre-World War II medical schools, that was because a solid institutional infrastructure was already in place that could effectively utilize the massive infusion of federal and private funds.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0011
- Subject:
- History, American History: 20th Century
American medical schools of the 1960s were larger, more complex institutions than they had been a generation before. Indeed, they bore no more resemblance to pre-World War II medical schools than the ...
More
American medical schools of the 1960s were larger, more complex institutions than they had been a generation before. Indeed, they bore no more resemblance to pre-World War II medical schools than the multiversity did to the smaller and simpler American university of the 1930s. However, despite growing responsibilities, what made a medical school a medical school—in distinction from a research institute or group medical practice—was the presence of medical students. The period after World War II was significant for undergraduate medical education, as the curriculum continued to evolve, new experiments in medical education were undertaken, and many changes occurred in the lives and experiences of medical students. By the 1960s the teaching of medical students had evolved from the central mission of prewar medical schools to no more than a byproduct of what academic medical centers were now doing. Amid the pressures of research, graduate medical education, and the provision of increased patient care, the education of medical students had become merely a passing concern.Less
American medical schools of the 1960s were larger, more complex institutions than they had been a generation before. Indeed, they bore no more resemblance to pre-World War II medical schools than the multiversity did to the smaller and simpler American university of the 1930s. However, despite growing responsibilities, what made a medical school a medical school—in distinction from a research institute or group medical practice—was the presence of medical students. The period after World War II was significant for undergraduate medical education, as the curriculum continued to evolve, new experiments in medical education were undertaken, and many changes occurred in the lives and experiences of medical students. By the 1960s the teaching of medical students had evolved from the central mission of prewar medical schools to no more than a byproduct of what academic medical centers were now doing. Amid the pressures of research, graduate medical education, and the provision of increased patient care, the education of medical students had become merely a passing concern.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0015
- Subject:
- History, American History: 20th Century
Throughout its history, the American medical school, like the rest of the country's system of higher education, had been shaped by social, economic, and political developments in the larger society. ...
More
Throughout its history, the American medical school, like the rest of the country's system of higher education, had been shaped by social, economic, and political developments in the larger society. Thus, it was hardly a surprise that many of the pressures experienced by academic health centers in the 1970s and 1980s arose from outside events. Yet, academic health centers encountered additional dilemmas that could not so clearly be related to external pressures. A number of traditional challenges to medical education grew more intense: the problem of teaching bedside medicine as biomedical research became increasingly molecular, the perpetual difficulty of achieving a suitable institutional balance between teaching and research, and the ongoing dilemmas of residency and fellowship training. These frustrating problems arose mainly from the evolution of medical knowledge and the institutional development of academic health centers rather than from the challenges imposed by a hostile external environment.Less
Throughout its history, the American medical school, like the rest of the country's system of higher education, had been shaped by social, economic, and political developments in the larger society. Thus, it was hardly a surprise that many of the pressures experienced by academic health centers in the 1970s and 1980s arose from outside events. Yet, academic health centers encountered additional dilemmas that could not so clearly be related to external pressures. A number of traditional challenges to medical education grew more intense: the problem of teaching bedside medicine as biomedical research became increasingly molecular, the perpetual difficulty of achieving a suitable institutional balance between teaching and research, and the ongoing dilemmas of residency and fellowship training. These frustrating problems arose mainly from the evolution of medical knowledge and the institutional development of academic health centers rather than from the challenges imposed by a hostile external environment.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.001.0001
- Subject:
- History, American History: 20th Century
This book provides an account of American medical education in the 20th century, concluding with a call for the reformation of a system currently handicapped by managed care and by narrow, ...
More
This book provides an account of American medical education in the 20th century, concluding with a call for the reformation of a system currently handicapped by managed care and by narrow, self-centred professional interests. The book describes the evolution of American medical education from 1910, when a muck-raking report on medical diploma mills spurred the reform and expansion of medical schools, to the current era of managed care, when commercial interests once more have come to the fore, compromising the training of the nation's future doctors. The book portrays the experience of learning medicine from the perspective of students, house officers, faculty, administrators, and patients, and traces the immense impact on academic medical centres of outside factors such as World War II, the National Institutes of Health, private medical insurance, and Medicare and Medicaid. Most notably, the book explores the very real threats to medical education in the current environment of managed care, viewing these developments not as a catastrophe but as a challenge to make many long-overdue changes in medical education and medical practice.Less
This book provides an account of American medical education in the 20th century, concluding with a call for the reformation of a system currently handicapped by managed care and by narrow, self-centred professional interests. The book describes the evolution of American medical education from 1910, when a muck-raking report on medical diploma mills spurred the reform and expansion of medical schools, to the current era of managed care, when commercial interests once more have come to the fore, compromising the training of the nation's future doctors. The book portrays the experience of learning medicine from the perspective of students, house officers, faculty, administrators, and patients, and traces the immense impact on academic medical centres of outside factors such as World War II, the National Institutes of Health, private medical insurance, and Medicare and Medicaid. Most notably, the book explores the very real threats to medical education in the current environment of managed care, viewing these developments not as a catastrophe but as a challenge to make many long-overdue changes in medical education and medical practice.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0001
- Subject:
- History, American History: 20th Century
Scientific advance, technological achievement, and individual and collective professional ambition all played indispensable roles in the complex story of the creation of America's system of medical ...
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Scientific advance, technological achievement, and individual and collective professional ambition all played indispensable roles in the complex story of the creation of America's system of medical education. So did a host of important social factors, such as the rationalization of America's school system, the rise of the modern university, the country's economic growth, the development of a tradition of philanthropy, the reform impulse of the progressive era, and the new responsibilities that local, state, and federal government began to assume for the regulation of society's affairs. Nevertheless, at the heart of the transformation of American medical education was a revolution in ideas concerning how medicine should be taught. Traditional teaching devices—the lecture and textbook—diminished in importance. Instead, emphasis was placed on laboratory work in the scientific subjects and hospital work with real responsibility for patient care in the clinical years, in the hope that students would develop the power of critical reasoning, the capacity to generalize, and the ability to find out and evaluate information for themselves.Less
Scientific advance, technological achievement, and individual and collective professional ambition all played indispensable roles in the complex story of the creation of America's system of medical education. So did a host of important social factors, such as the rationalization of America's school system, the rise of the modern university, the country's economic growth, the development of a tradition of philanthropy, the reform impulse of the progressive era, and the new responsibilities that local, state, and federal government began to assume for the regulation of society's affairs. Nevertheless, at the heart of the transformation of American medical education was a revolution in ideas concerning how medicine should be taught. Traditional teaching devices—the lecture and textbook—diminished in importance. Instead, emphasis was placed on laboratory work in the scientific subjects and hospital work with real responsibility for patient care in the clinical years, in the hope that students would develop the power of critical reasoning, the capacity to generalize, and the ability to find out and evaluate information for themselves.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0003
- Subject:
- History, American History: 20th Century
If knowledgeable physicians agreed on one principle, it was that medical education was a lifelong process. The education of a physician began long before medical school, since a student's success at ...
More
If knowledgeable physicians agreed on one principle, it was that medical education was a lifelong process. The education of a physician began long before medical school, since a student's success at learning medicine depended heavily on the aptitude, characteristics, and educational background that person brought to medical school in the first place. The four years of medical school—“undergraduate medical education,” as it came to be called—were focused on principles and fundamentals. Traditionally, writers have examined undergraduate medical education mainly in terms of courses and curriculum. However, formal medical instruction represented only one of many important forces that shaped physicians. Another significant influence was the “hidden curriculum”—the implicit messages continually conveyed, the education that occurred by example rather than by word, and the imprinting of attitudes and values that regularly occurred. In addition, medical students themselves had much to say about how they learned medicine. Far from being passive flotsam in the educational ocean, they had an important impact on the environment of medical schools.Less
If knowledgeable physicians agreed on one principle, it was that medical education was a lifelong process. The education of a physician began long before medical school, since a student's success at learning medicine depended heavily on the aptitude, characteristics, and educational background that person brought to medical school in the first place. The four years of medical school—“undergraduate medical education,” as it came to be called—were focused on principles and fundamentals. Traditionally, writers have examined undergraduate medical education mainly in terms of courses and curriculum. However, formal medical instruction represented only one of many important forces that shaped physicians. Another significant influence was the “hidden curriculum”—the implicit messages continually conveyed, the education that occurred by example rather than by word, and the imprinting of attitudes and values that regularly occurred. In addition, medical students themselves had much to say about how they learned medicine. Far from being passive flotsam in the educational ocean, they had an important impact on the environment of medical schools.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0004
- Subject:
- History, American History: 20th Century
In the years following World War I, medical knowledge, techniques, and practices were growing and changing too rapidly. Even a superior experience in medical school could no longer prepare a person ...
More
In the years following World War I, medical knowledge, techniques, and practices were growing and changing too rapidly. Even a superior experience in medical school could no longer prepare a person for private practice. Accordingly, a period of hospital education following graduation—the “internship”—became standard for every physician. In addition, further training was necessary for those who wished to enter specialty practice or pursue academic careers. For these purposes the “residency”—a several-year hospital experience following internship—became the accepted vehicle. In the creation of a system of graduate medical education, the Johns Hopkins Medical School played a seminal role. Nevertheless, the university-based, academic model introduced by Johns Hopkins was never to succeed so completely in graduate medical education as it did in undergraduate medical education. Always, the tension between education and service, between university ideals and apprenticeship traditions, wracked even the best intern and residency programs. Moreover, unlike undergraduate medical education, which remained university-based and regulated, graduate medical education became hospital-based and professionally regulated.Less
In the years following World War I, medical knowledge, techniques, and practices were growing and changing too rapidly. Even a superior experience in medical school could no longer prepare a person for private practice. Accordingly, a period of hospital education following graduation—the “internship”—became standard for every physician. In addition, further training was necessary for those who wished to enter specialty practice or pursue academic careers. For these purposes the “residency”—a several-year hospital experience following internship—became the accepted vehicle. In the creation of a system of graduate medical education, the Johns Hopkins Medical School played a seminal role. Nevertheless, the university-based, academic model introduced by Johns Hopkins was never to succeed so completely in graduate medical education as it did in undergraduate medical education. Always, the tension between education and service, between university ideals and apprenticeship traditions, wracked even the best intern and residency programs. Moreover, unlike undergraduate medical education, which remained university-based and regulated, graduate medical education became hospital-based and professionally regulated.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0008
- Subject:
- History, American History: 20th Century
The ties formed between the federal government and academic medical centers during World War II irrevocably altered the scale of medical research in the United States. Over the next two decades, ...
More
The ties formed between the federal government and academic medical centers during World War II irrevocably altered the scale of medical research in the United States. Over the next two decades, staggering growth in the research enterprise occurred, the result of a massive infusion of federal dollars. Although some schools received much more money than others, ultimately all were transformed. To many observers, the 1950s and 1960s were lithe days for the “researcher”, as research grew to overshadow teaching and clinical practice at many academic medical centers. The ascendancy of American medical research occurred as part of the more generalized expansion of science and higher education in the United States produced after the the war by federal spending.Less
The ties formed between the federal government and academic medical centers during World War II irrevocably altered the scale of medical research in the United States. Over the next two decades, staggering growth in the research enterprise occurred, the result of a massive infusion of federal dollars. Although some schools received much more money than others, ultimately all were transformed. To many observers, the 1950s and 1960s were lithe days for the “researcher”, as research grew to overshadow teaching and clinical practice at many academic medical centers. The ascendancy of American medical research occurred as part of the more generalized expansion of science and higher education in the United States produced after the the war by federal spending.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0018
- Subject:
- History, American History: 20th Century
As the 20th century was ending, a second revolutionary period in American medical education had begun. Major characteristics of this period included the erosion of the clinical learning environment, ...
More
As the 20th century was ending, a second revolutionary period in American medical education had begun. Major characteristics of this period included the erosion of the clinical learning environment, the diminishing of faculty scholarship, and the reemergence of a proprietary system of medical schools in which the faculties' financial well-being was placed before education and research. Medical schools were beginning to leave the university for the health care delivery system, while hospitals once again had begun to dominate medical schools in establishing directions and policies for the joint institution.Less
As the 20th century was ending, a second revolutionary period in American medical education had begun. Major characteristics of this period included the erosion of the clinical learning environment, the diminishing of faculty scholarship, and the reemergence of a proprietary system of medical schools in which the faculties' financial well-being was placed before education and research. Medical schools were beginning to leave the university for the health care delivery system, while hospitals once again had begun to dominate medical schools in establishing directions and policies for the joint institution.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0013
- Subject:
- History, American History: 20th Century
In the 1960s and 1970s, America was rocked by social unrest, as the antiwar and civil rights movements tore at the fabric of American society. The passions, moral fervor, and discord swept through ...
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In the 1960s and 1970s, America was rocked by social unrest, as the antiwar and civil rights movements tore at the fabric of American society. The passions, moral fervor, and discord swept through the medical schools, undermining their confidence. Student rebellions, house-staff unionization, and the clamor of women and minorities, especially African Americans, to receive a place in medicine challenged the traditionally staid and self-confident medical faculties. It became clear that medical schools, as all institutions in society, were vulnerable to external social conditions that they could not control. Though medical schools emerged from the protest era little changed, the myth of autonomy had been exposed as false. These disparate events each revealed fundamental features of American medical education. Student activism, and faculty reaction to it, demonstrated the fundamentally conservative nature of medical schools and their student bodies.Less
In the 1960s and 1970s, America was rocked by social unrest, as the antiwar and civil rights movements tore at the fabric of American society. The passions, moral fervor, and discord swept through the medical schools, undermining their confidence. Student rebellions, house-staff unionization, and the clamor of women and minorities, especially African Americans, to receive a place in medicine challenged the traditionally staid and self-confident medical faculties. It became clear that medical schools, as all institutions in society, were vulnerable to external social conditions that they could not control. Though medical schools emerged from the protest era little changed, the myth of autonomy had been exposed as false. These disparate events each revealed fundamental features of American medical education. Student activism, and faculty reaction to it, demonstrated the fundamentally conservative nature of medical schools and their student bodies.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0016
- Subject:
- History, American History: 20th Century
In the 1970s and 1980s a distinct malaise pervaded many medical schools. As they increased their role in patient care, and as they grew ever larger in size, they struggled to maintain their ...
More
In the 1970s and 1980s a distinct malaise pervaded many medical schools. As they increased their role in patient care, and as they grew ever larger in size, they struggled to maintain their institutional cohesiveness and clear focus on academic work. In addition, medical schools, long a symbol of public service, began to appear self-serving and unconcerned with the public good. To many, the once-clear distinction between a university teaching hospital and a large community hospital began to blur, as did the formerly clear differences between a university medical school dedicated to serving the public and a scientific corporation seeking to maximize markets and profits.Less
In the 1970s and 1980s a distinct malaise pervaded many medical schools. As they increased their role in patient care, and as they grew ever larger in size, they struggled to maintain their institutional cohesiveness and clear focus on academic work. In addition, medical schools, long a symbol of public service, began to appear self-serving and unconcerned with the public good. To many, the once-clear distinction between a university teaching hospital and a large community hospital began to blur, as did the formerly clear differences between a university medical school dedicated to serving the public and a scientific corporation seeking to maximize markets and profits.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0014
- Subject:
- History, American History: 20th Century
Domestic tranquility returned quickly to the United States with the end of the Vietnam War. Nevertheless, in the 1970s and 1980s, academic health centers came under new external pressures. Other ...
More
Domestic tranquility returned quickly to the United States with the end of the Vietnam War. Nevertheless, in the 1970s and 1980s, academic health centers came under new external pressures. Other aspects of the outside environment began to turn sour, as social and demographic trends, new government policies, and changing public attitudes started to work to their disadvantage. Medical schools and teaching hospitals were increasingly perceived as stressed institutions, and a dispirited mood developed among them. Their confidence and sense of autonomy, so prominent before World War II and during the mythic “golden age” of the 1950s and 1960s, dwindled. Always dependent upon external funding, medical schools had never been as truly autonomous as it once seemed. Nevertheless, it now appeared that they were vulnerable to every jolt on an increasingly bumpy road.Less
Domestic tranquility returned quickly to the United States with the end of the Vietnam War. Nevertheless, in the 1970s and 1980s, academic health centers came under new external pressures. Other aspects of the outside environment began to turn sour, as social and demographic trends, new government policies, and changing public attitudes started to work to their disadvantage. Medical schools and teaching hospitals were increasingly perceived as stressed institutions, and a dispirited mood developed among them. Their confidence and sense of autonomy, so prominent before World War II and during the mythic “golden age” of the 1950s and 1960s, dwindled. Always dependent upon external funding, medical schools had never been as truly autonomous as it once seemed. Nevertheless, it now appeared that they were vulnerable to every jolt on an increasingly bumpy road.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0009
- Subject:
- History, American History: 20th Century
The expansion of clinical service in the two decades following World War II created strains within academic medical centers, largely because of the distractions that patient care inevitably placed on ...
More
The expansion of clinical service in the two decades following World War II created strains within academic medical centers, largely because of the distractions that patient care inevitably placed on teaching and research. Nevertheless, few academic medical centers lost sight—at least for long—of their unique role as educators of future physicians, and as producers of new medical knowledge and technologies. They worked hard to preserve the learning environment of the teaching hospital, even as that environment came under pressure from changing social, economic, and demographic circumstances. After the war, the strength of American medicine continued to reside in its academic medical centers—the collaborations of medical schools and teaching hospitals that generated knowledge, produced doctors, served as the ultimate arbiters in complicated clinical cases, and defined the standards of excellence in patient care.Less
The expansion of clinical service in the two decades following World War II created strains within academic medical centers, largely because of the distractions that patient care inevitably placed on teaching and research. Nevertheless, few academic medical centers lost sight—at least for long—of their unique role as educators of future physicians, and as producers of new medical knowledge and technologies. They worked hard to preserve the learning environment of the teaching hospital, even as that environment came under pressure from changing social, economic, and demographic circumstances. After the war, the strength of American medicine continued to reside in its academic medical centers—the collaborations of medical schools and teaching hospitals that generated knowledge, produced doctors, served as the ultimate arbiters in complicated clinical cases, and defined the standards of excellence in patient care.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0012
- Subject:
- History, American History: 20th Century
With the passage in 1965 of Medicare and Medicaid, a new era began—one in which the clinical activities of medical schools began to hypertrophy, swelling out of proportion to their other duties. This ...
More
With the passage in 1965 of Medicare and Medicaid, a new era began—one in which the clinical activities of medical schools began to hypertrophy, swelling out of proportion to their other duties. This effect was not expected at the time Medicare and Medicaid legislation was enacted, nor did it happen immediately. Nevertheless, in the years that followed, clinical service rapidly grew to become their most conspicuous activity and most important source of income. In the process, their link to the university weakened, their commitment to academic values decreased, their tradition of charity eroded, and they became enmeshed more firmly than ever in the health care delivery system. If research had once been the master, that role at most medical schools was increasingly assumed by patient care—to the increasing subordination of both research and teaching.Less
With the passage in 1965 of Medicare and Medicaid, a new era began—one in which the clinical activities of medical schools began to hypertrophy, swelling out of proportion to their other duties. This effect was not expected at the time Medicare and Medicaid legislation was enacted, nor did it happen immediately. Nevertheless, in the years that followed, clinical service rapidly grew to become their most conspicuous activity and most important source of income. In the process, their link to the university weakened, their commitment to academic values decreased, their tradition of charity eroded, and they became enmeshed more firmly than ever in the health care delivery system. If research had once been the master, that role at most medical schools was increasingly assumed by patient care—to the increasing subordination of both research and teaching.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0006
- Subject:
- History, American History: 20th Century
Though medical schools and teaching hospitals were separate entities, they operated extremely closely, and their individual successes depended very much on their collaboration. In the late 1920s, the ...
More
Though medical schools and teaching hospitals were separate entities, they operated extremely closely, and their individual successes depended very much on their collaboration. In the late 1920s, the term “medical center” came into use to describe arrangements in which a medical school and teaching hospital occupied adjoining physical sites. The term was first used in conjunction with the opening of the Columbia Presbyterian Medical Center in 1928 and the New York Hospital–Cornell Medical Center in 1932. After World War II these complexes came to be called “academic medical centers.” Though no two were exactly alike, the centers typically consisted of a medical school, a university-owned or controlled hospital, and affiliated specialty hospitals or institutes. Academic medical centers were at the center of efforts to improve the quality of medical care and the health of the people, thus rendering service to the nation at large. In short, academic medical centers, like their parent universities, accepted the duty of utility—that is, of providing service to the society that supported them, and allowed them to pursue their scientific interests.Less
Though medical schools and teaching hospitals were separate entities, they operated extremely closely, and their individual successes depended very much on their collaboration. In the late 1920s, the term “medical center” came into use to describe arrangements in which a medical school and teaching hospital occupied adjoining physical sites. The term was first used in conjunction with the opening of the Columbia Presbyterian Medical Center in 1928 and the New York Hospital–Cornell Medical Center in 1932. After World War II these complexes came to be called “academic medical centers.” Though no two were exactly alike, the centers typically consisted of a medical school, a university-owned or controlled hospital, and affiliated specialty hospitals or institutes. Academic medical centers were at the center of efforts to improve the quality of medical care and the health of the people, thus rendering service to the nation at large. In short, academic medical centers, like their parent universities, accepted the duty of utility—that is, of providing service to the society that supported them, and allowed them to pursue their scientific interests.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0010
- Subject:
- History, American History: 20th Century
The explosion of knowledge in all academic disciplines after World War II shattered traditional approaches toward scholarship. Fragmentation of disciplines and academic specialization occurred ...
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The explosion of knowledge in all academic disciplines after World War II shattered traditional approaches toward scholarship. Fragmentation of disciplines and academic specialization occurred throughout universities. In medicine, a similar fragmentation of knowledge and practice occurred. The movement toward specialization had been underway for many decades, but as biomedical research progressed, the growth of specialization and subspecialization rapidly accelerated. Though general practice did not disappear after World War II, its attractiveness as a career to physicians in training markedly decreased. Following internship, more and more medical graduates sought residencies to pursue a specialty, and after residency, many sought postdoctoral training in a clinical subspecialty as well. Teaching hospitals quickly met the increased demand for specialty training. Graduate medical education, once only a secondary interest of medical faculties, became one of their primary concerns. At many medical centers, the number of interns, residents, subspecialty residents, and clinical fellows grew to exceed the number of medical students. As the multiversity began to swell with graduate student training programs, the postwar academic medical center became home to a vastly expanded program of graduate medical education.Less
The explosion of knowledge in all academic disciplines after World War II shattered traditional approaches toward scholarship. Fragmentation of disciplines and academic specialization occurred throughout universities. In medicine, a similar fragmentation of knowledge and practice occurred. The movement toward specialization had been underway for many decades, but as biomedical research progressed, the growth of specialization and subspecialization rapidly accelerated. Though general practice did not disappear after World War II, its attractiveness as a career to physicians in training markedly decreased. Following internship, more and more medical graduates sought residencies to pursue a specialty, and after residency, many sought postdoctoral training in a clinical subspecialty as well. Teaching hospitals quickly met the increased demand for specialty training. Graduate medical education, once only a secondary interest of medical faculties, became one of their primary concerns. At many medical centers, the number of interns, residents, subspecialty residents, and clinical fellows grew to exceed the number of medical students. As the multiversity began to swell with graduate student training programs, the postwar academic medical center became home to a vastly expanded program of graduate medical education.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0017
- Subject:
- History, American History: 20th Century
In the mid-1980s a new paradigm became accepted, which emphasized that there were limits to what the country could spend on health care, given the reality of finite resources in the face of a ...
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In the mid-1980s a new paradigm became accepted, which emphasized that there were limits to what the country could spend on health care, given the reality of finite resources in the face of a seemingly inexhaustible demand for medical services. Concern about health care costs had been growing for many years, but in the 1980s cost-consciousness finally began to dominate the health-care debate. Accordingly, the pass-through era of reimbursement of medical care carne to an end. In its place, a competitive marketplace for medical care emerged—one that focused on prospective payment, lower prices, and the restricted use of hospitals and specialized services. If the 20th century had been the age of abundance for medicine, it appeared that the 21st would be the era of resource constraints. These new forces left academic health centers reeling. Both teaching hospitals and medical schools were threatened, even as they undertook major steps to reduce costs and operate more efficiently.Less
In the mid-1980s a new paradigm became accepted, which emphasized that there were limits to what the country could spend on health care, given the reality of finite resources in the face of a seemingly inexhaustible demand for medical services. Concern about health care costs had been growing for many years, but in the 1980s cost-consciousness finally began to dominate the health-care debate. Accordingly, the pass-through era of reimbursement of medical care carne to an end. In its place, a competitive marketplace for medical care emerged—one that focused on prospective payment, lower prices, and the restricted use of hospitals and specialized services. If the 20th century had been the age of abundance for medicine, it appeared that the 21st would be the era of resource constraints. These new forces left academic health centers reeling. Both teaching hospitals and medical schools were threatened, even as they undertook major steps to reduce costs and operate more efficiently.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0007
- Subject:
- History, American History: 20th Century
Medical schools had long been responsible for the quality of care rendered civilians, but during World War II they took direct responsibility for the military's medical care as well. The proportion ...
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Medical schools had long been responsible for the quality of care rendered civilians, but during World War II they took direct responsibility for the military's medical care as well. The proportion of faculty that enlisted in the armed services was much higher than that of the general profession. At the country's 52 general hospital units and 20 evacuation hospital units, the medical personnel, which numbered about 2,500, came almost entirely from academic medical centers. At home, schools were extremely short-staffed, but they nonetheless increased the production of doctors to meet both military and civilian needs. In addition, they conducted an extraordinary amount of war-related medical research, which enabled a dramatic reduction in death and suffering among troops in combat.Less
Medical schools had long been responsible for the quality of care rendered civilians, but during World War II they took direct responsibility for the military's medical care as well. The proportion of faculty that enlisted in the armed services was much higher than that of the general profession. At the country's 52 general hospital units and 20 evacuation hospital units, the medical personnel, which numbered about 2,500, came almost entirely from academic medical centers. At home, schools were extremely short-staffed, but they nonetheless increased the production of doctors to meet both military and civilian needs. In addition, they conducted an extraordinary amount of war-related medical research, which enabled a dramatic reduction in death and suffering among troops in combat.
Charles Webster
- Published in print:
- 1994
- Published Online:
- October 2011
- ISBN:
- 9780198229742
- eISBN:
- 9780191678912
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780198229742.003.0012
- Subject:
- History, British and Irish Modern History
This chapter examines teaching and research in medicine at Oxford during the period from 1914 to 1970. During the early part of the 20th century, medicine lost grounds to the humanities and the ...
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This chapter examines teaching and research in medicine at Oxford during the period from 1914 to 1970. During the early part of the 20th century, medicine lost grounds to the humanities and the general revival of the medical school occurred only in the 1960s. By the 1970s, the quota for medical students had been increased and a new syllabus was developed to serve as a bridge course designed to act as an introduction to the scientific basis of clinical medicine. In addition, a major building for the medical school was constructed using money from the Commonwealth Fund. Thus, the university had to come terms with its role as a complete medical school by 1970.Less
This chapter examines teaching and research in medicine at Oxford during the period from 1914 to 1970. During the early part of the 20th century, medicine lost grounds to the humanities and the general revival of the medical school occurred only in the 1960s. By the 1970s, the quota for medical students had been increased and a new syllabus was developed to serve as a bridge course designed to act as an introduction to the scientific basis of clinical medicine. In addition, a major building for the medical school was constructed using money from the Commonwealth Fund. Thus, the university had to come terms with its role as a complete medical school by 1970.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0005
- Subject:
- History, American History: 20th Century
After World War I, teaching hospitals championed the same academic ideals as their affiliated medical schools, and the two institutions acted in concert in education, research, and patient care. The ...
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After World War I, teaching hospitals championed the same academic ideals as their affiliated medical schools, and the two institutions acted in concert in education, research, and patient care. The relationship between medical schools and teaching hospitals was one of codependency. Medical schools, ever on the alert for clinical facilities, understood that access to the wards of hospitals was essential for teaching and research. Teaching hospitals, in turn, understood that their preeminence in 20th-century medical practice was a consequence of their participation in medical education. Though teaching hospitals of the period served as nearly ideal educational laboratories, this did not occur without costs or consequences. It quickly became apparent that teaching hospitals could not be as efficient as nonteaching hospitals, if at the same time they were providing a rich educational environment. In addition, the fact that indigent but not private patients were routinely used in teaching challenged the common belief that medical education resulted in better patient care.Less
After World War I, teaching hospitals championed the same academic ideals as their affiliated medical schools, and the two institutions acted in concert in education, research, and patient care. The relationship between medical schools and teaching hospitals was one of codependency. Medical schools, ever on the alert for clinical facilities, understood that access to the wards of hospitals was essential for teaching and research. Teaching hospitals, in turn, understood that their preeminence in 20th-century medical practice was a consequence of their participation in medical education. Though teaching hospitals of the period served as nearly ideal educational laboratories, this did not occur without costs or consequences. It quickly became apparent that teaching hospitals could not be as efficient as nonteaching hospitals, if at the same time they were providing a rich educational environment. In addition, the fact that indigent but not private patients were routinely used in teaching challenged the common belief that medical education resulted in better patient care.
